Biofeedback Reduces Psychological Burden in Older Women With Urge UI

Laurie Barclay, MD
In older women with urge urinary incontinence (UI), biofeedback (BFB) therapy significantly improved psychological burden, especially in those with a history of depression, according to the results of a study reported in the December issue of the Journal of the American Geriatrics Society.
"The goal of the current study was to assess the effect of BFB on psychological burden in older women with urge UI and the potential effect of depression on the response," write Stasa D. Tadic, MD, from the University of Pittsburgh in Pennsylvania, and colleagues. "Because depression is associated with 'learned helplessness,'" which incontinence might augment, it was further hypothesized that the psychological burden of urge UI is greater in older women with a history of depression and that subjects with a history of depression might respond better to BFB, because it improves their perception of helplessness by teaching them how to control the urgency and, in the process, substantially reduces incontinence as well."
In this secondary analysis of an ongoing trial at an academic medical center, 42 community-dwelling women at least 60 years of age with urge UI received BFB and behavioral training in urge suppression during an 8-week intervention. Study endpoints were frequency of urge UI on a 3-day bladder diary, psychological burden evaluated with the Urge Impact Scale (URIS-24) total and subscale scores, history of depression, and depressive symptoms on the Mental Component Subscale (MCS) of the Medical Outcomes Study 36-Item Short Form Survey (SF-36). Age and chronic conditions were considered as covariates.
BFB was associated with improvements in UI (by 45%; P = .001) and psychological burden (P = .001 for a total URIS-24 score and for all 3 subscales; P = .01 for the MCS of the SF-36). The magnitude of UI improvement was similar for those with and without a history of depression, but improvement in psychological outcomes was twice as great in those with a history of depression, especially on the perception of control subscale. Improvement was not related to depressive symptoms at baseline.
"In older women with urge UI, BFB significantly improves psychological burden, especially in those with a history of depression, in whom psychological burden is linked to change in perception of control," the study authors write. "Psychological factors are relevant outcome measures for UI, and these data suggest that focusing on UI frequency alone may have underestimated BFB's efficacy and additional therapeutic benefits."
Limitations of the study include sample limited to community-dwelling women; analysis of the effect of depression not an original trial objective, resulting in less than optimal evaluation of depressive symptoms; lack of specificity of the SF-36; inability to exclude the effect of the therapeutic role played by the BFB technician rather than the BFB itself; and interim analysis of an ongoing study with small sample size.
"These findings suggest that it may be worth screening patients with urge UI for a history of depression, as suggested by others, especially if therapy for depression is found to further enhance the response to BFB," the study authors conclude. "Further studies will be necessary to address these possible implications."
The National Institutes of Health and the John A. Hartford Foundation University of Pittsburgh Center of Excellence funded this study. Two of the study authors have disclosed various financial relationships with Laborie Medical Technologies, Aventis, and Merck. The remaining study authors have disclosed no relevant financial relationships.
J Am Geriatr Soc. 2007;55:2010-2015.