The Construction And Application Of Behavioural Training Programme For Patients With Post-stroke Urinary Incontinence

Background:Post-stroke urinary incontinence(PSUI),one of the most common complication after stroke,is an important predictor of patients’ mortality and poor prognosis,and is associated with quality of life,functional status and discharge destination of stroke patients.Behavioural therapy can help patients establish behavioural habits of urination,improve symptoms of urinary incontinence,and eliminate the additional costs and potential risks of drug treatment and surgical treatment.However,there is a lack of structured behavioural therapy rehabilitation programme for patients with PSUI.The most common treatment strategy in clinical practice is indwelling ureters,ignoring the importance of bladder management in stroke patients’ behaviour change.The Health belief model(HBM)provides a theoretical framework of this study,constructing a behavioural therapy rehabilitation training programme by enhancing patient’s perception of illness,and in turn promotes healthy behaviours.In this study,a behavioural therapy rehabilitation training programme based on HBM is constructed and applied,using evidence-based theory,expert meeting method and quasi-experimental research design,in order to provide a theoretical and practical reference for promoting healthy beliefs,establishing healthy bladder management behaviours,and accelerating bladder recovery of PSUI patients.Objectives:1.Construct a behavioural therapy rehabilitation training programme for PSUI patients based on HBM conceptual framework,and with the method of literature review,evidence-based nursing and expert meeting.2.Implement a quasi-experimental study to evaluate the effectiveness of the behavioural therapy rehabilitation training programme,and to provide clinical evidence for behavioural therapy of PSUI patients.Methods:1.Intergrate high level evidences of clinical guidelines,systematic review,expert consensus and original studies related to behavioural therapy by literature review and evidence-based nursing.The first draft of the behavioural therapy rehabilitation training programme was being constructed by combining high level evidences and HBM conceptual framework.Then an expert meeting was held by inviting medical and nursing experts from rehabilitation,neurology,urology and psychology department to evaluate the structure and contents of the programme.The final draft of the behavioural therapy rehabilitation training programme for PSUI patients was then being determined by intergrating and revising the opinions of experts.2.A quasi-experimental study was conducted to evaluate the effectiveness of the behavioural therapy rehabilitation training programme in PSUI patients.68 subjects from Zhongda Hospital Southeast University and Jiangbei Campus were randomly divided into the experimental group(n=35)and the control group(n=33)from April to October in 2019.The control group implemented usual care and drinking program,the experimental group implemented the behavioural therapy rehabilitation training programme.The duration of intervention is 4 weeks.Patients were assessed at baseline,at the completion and 4 weeks after the intervention by using the Sociodemographic Characteristics Questionnaire,International Consultation on Incontinence Questionnaire-Short Form(ICI-Q-SF),Patient Perception of Bladder Condition(PPBC),Incontinence Quality of Life Questionnaire(I-QOL),Function Independent Measure(FIM),Coping Efficacy Scale and Health Education Knowledge Questionnaire.Results:1.A total of 21 studies were included for evidence synthesis,including 8 clinical guidelines,3 systematic reviews,5 randomized controlled trials and 5 quasi-experimental studies.A total of 34 items were selected,including 21 items of grade A and 13 items of grade B.These evidences were extracted to 4 intervention themes: health education,bladder retraining,pelvic floor muscle training and lifestyle interventions.The first draft of the behavioural therapy rehabilitation training programme was then being constructed by combining high level evidences and HBM conceptual framework.2.11 medical and nursing experts from rehabilitation,neurology,urology,and psychology department were selected for the expert meeting,in order to discuss and revise the feasibility and scientificity of the programme.The judging coefficient of experts on the programme was0.863,the degree of familiarity was 0.818 and the coefficient of expert authority was 0.841,which demonstrated that experts have a high degree of authority and are familiar with the contents of the programme.The final draft of behavioural therapy rehabilitation programme based on HBM for PSUI patients includes 5 training modules:(1)Standardized health education;(2)Timed voiding and prompted voiding;(3)Pelvic floor muscle training;(4)Delayed voiding and urgency suppression strategies;(5)Lifestyle intervention.Each training module was refined in terms of training content,possible difficulties/obstacles,coping strategies and training objectives.3.The study was conducted with 68 subjects,35 subjects in the experimental group and 33 subjects in the control group.The baseline results showed that the mean scores of ICI-Q-SF,I-QOL,I-QOL-avoidance behaviours,I-QOL-psychosocial impact,I-QOL-social embarrassment,FIM,motor-FIM,cognitive-FIM and coping efficacy were(14.13±3.80),(48.50±9.72),(24.03±3.76),(26.37±4.08),(14.28±2.91),(61.85±17.16),(41.54±14.45),(20.24±7.09)and(11.03±3.71)respectively,the median and quartile range of PPBC scores is4.00(3.00,5.00).The intervention results showed that:(1)The I-QOL and sub-dimensional scores,and coping efficacy score in the experimental group were significantly higher than those of the control group(P<0.05 or P<0.01)at the completion and 4 weeks after the intervention,and ICI-Q-SF score and PPBC score were significantly lower than those of the control group(P<0.01).The level of health education knowledge was significantly higher than that of the control group(P<0.01)after intervention.The FIM and cognitive-FIM score were significantly higher than those of the control group(P<0.01)at 4 weeks after the intervention,but there was no significant difference in motor-FIM score(P>0.05).(2)The I-QOL and sub-dimensional scores were significantly higher compared with the baseline(P<0.01)at the completion and 4 weeks after the intervention,ICI-Q-SF score and PPBC score were significantly lower compared with the baseline(P<0.01).The FIM and sub-dimensional,and coping efficiency score at 4 weeks after intervention were significantly higher compared with the baseline(P<0.01).Conclusion:This study constructed a behavioural therapy rehabilitation training programme based on HBM for PSUI patients in China,using the research method of literature review,evidence-based theory and expert meeting.The programme was then initially applied through a quasi-experimental study to validate the its effectiveness on PSUI patients’ urinary outcomes,quality of life,functional independence,self-efficacy,patient perception of bladder condition and level of health education knowledge.The results of this study can provide a clinical reference for bladder training and self-management of PSUI patients.This training programme can be added to the clinical rehabilitation as a nursing process,and also provide a training reference for future intervention studies on bladder management of PSUI patients.