ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes: protocol for the ELECTRIC randomised trial

• Published in: Current controlled trials in cardiovascular medicine Vol. 20; no. 1; p. 723
• Main Authors: Booth, J, Aucott, L, Cotton, S, Goodman, C, Hagen, S, Harari, D, Lawrence, M, Lowndes, A, Macaulay, L, MacLennan, G, Mason, H, McClurg, D, Norrie, J, Norton, C, O'Dolan, C, Skelton, D A, Surr, C, Treweek, S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16-12-2019; BioMed Central; BMC
• Subjects: Adults; Bladder; Care and treatment; Care homes; Clinical trials; Cognitive ability; Cost-Benefit Analysis; Costs; Dementia; Elderly; Feasibility studies; Fecal incontinence; Frailty; Health Care Costs; Homes for the Aged - economics; Humans; Incontinence; Intervention; Multicenter Studies as Topic; Nursing; Nursing home; Nursing homes; Nursing Homes - economics; Older adults; Older people; Pragmatic Clinical Trials as Topic; Quality of life; Recovery of Function; Social isolation; Study Protocol; Tibial Nerve; Tibial nerve stimulation; Time Factors; Transcutaneous Electric Nerve Stimulation - adverse effects; Transcutaneous Electric Nerve Stimulation - economics; Treatment Outcome; United Kingdom; Urinary incontinence; Urinary Incontinence - diagnosis; Urinary Incontinence - economics; Urinary Incontinence - physiopathology; Urinary Incontinence - therapy; Urinary tract infections; Urine; Urodynamics; United Kingdom; United Kingdom > UK; England; Scotland; Urinary incontinence; Tibial nerve stimulation; Nursing home; Older adults; Care homes
• ISSN: 1745-6215; 1745-6215
• DOI: 10.1186/s13063-019-3723-7

Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CHs) and profoundly impacts on residents' dignity and quality of life. CHs predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe and low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in CHs is not known. The ELECTRIC trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in CH residents and investigate the associated costs and consequences.
This is a pragmatic, multicentre, placebo-controlled, randomised parallel-group trial comparing the effectiveness of TPTNS (target n = 250) with sham stimulation (target n = 250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff-reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-h Pad Weight Tests, post void residual urine (bladder scans), Patient Perception of Bladder Condition, Minnesota Toileting Skills Questionnaire and Dementia Quality of Life. Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors, and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers.
TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication.
ClinicalTrials.gov, NCT03248362. Registered on 14 August 2017. ISRCTN, ISRCTN98415244. Registered on 25 April 2018. https://www.isrctn.com/.