A synopsis of four Cochrane systematic reviews on bladder training and voiding programmes using metastudy techniques for qualitative research

Article type
Authors
Roe B, Ostaszkiewicz J, Milne J, Wallace S
Abstract
Background: Bladder training, prompted voiding, habit retraining and timed voiding are behavioural interventions developed for the management of urinary incontinence in adults. Cochrane systematic reviews on their effectiveness have been published. Metastudy techniques are methods developed for the systematic review of qualitative studies and provide a useful template for a synopsis of systematic reviews to inform health care and future research. Objectives: To compare and contrast four Cochrane systematic reviews on behavioural interventions, including bladder training and toileting programmes for the management of urinary incontinence. To provide a synopsis of findings related to theory, methods, data analysis and outcomes. Methods: Metastudy techniques used for the synthesis of qualitative studies comprise five stages: selection and appraisal of primary research, meta-theory, meta-method, meta-data analysis and meta-synthesis. These allow discursive comparison and contrast across studies and, in this case, the systematic reviews to provide a narrative synopsis. Findings relate to historical and theoretical constructs, methods, outcomes, clinical effectiveness, adherence, feasibility and sustainability. Results: All are conservative therapies with a focus on a programme of voiding. They differ in their overall aim, pattern of toileting or voiding involved, and degree of participation by client or caregiver. There was operational overlap in terminology used in the trials and a lack of mutual exclusivity. The number of trials providing evidence on effectiveness of voiding programmes is limited. There is suggestive evidence that bladder training is effective, and there is limited evidence for prompted voiding, and long-term follow up is required. The most common outcome is frequency of urinary incontinence. Bladder training has been combined with pelvic floor muscle exercises, drug therapies, cognitive and lifestyle modification. Conclusions: The terminology, theory and definitions underpinning voiding programmes needs to be re-conceptualised and standardised and could impact existing and future systematic reviews. Toileting programmes warrant further study for particular groups of clients. Investigation of the role of cognitive behavioural therapy and combined complex interventions for the management of urinary incontinence in adults is warranted. Metastudy techniques provide a useful framework to compare and contrast systematic reviews, develop synopsis, and identify future directions of research.