A multicomponent intervention is effective in improving health-related quality of life (HRQOL) among women with moderate to severe overactive bladder (OAB), according to a recent study published in JAMA Network Open.
Takeaways
- Multicomponent interventions, including cognitive behavior therapy, show promise in enhancing the health-related quality of life (HRQOL) for women with moderate to severe overactive bladder (OAB), as demonstrated in a recent study published in JAMA Network Open.
- OAB, affecting approximately 10% to 20% of women, presents symptoms such as urgency, frequency, and nocturia, significantly impacting patients' HRQOL, with an estimated cost of $82.6 billion in 2020.
- Lifestyle modifications, bladder training, and pelvic floor muscle training are often utilized for OAB treatment, with behavioral therapy proving more effective than anticholinergic medications in certain cases.
- The randomized controlled trial evaluated a multicomponent intervention program, comprising four sessions over six weeks, focusing on techniques such as self-monitoring, educational sessions, lifestyle modifications, and pelvic floor muscle training.
- Findings revealed substantial improvements in HRQOL scores among participants receiving the intervention, indicating the potential efficacy of such approaches in enhancing the lives of women grappling with OAB, while adverse events remained minimal and unrelated to the intervention.
OAB, presenting in approximately 10% to 20% of women, appears as urination urgency and often includes frequency and nocturia. These symptoms may significantly impact a patient’s HRQOL, and the estimated cost of OAB was $82.6 billion in 2020.
OAB is often treated through lifestyle modifications, bladder training, and pelvic floor muscle training. This method of behavioral therapy has been found as more effective than anticholinergic medications, but often only plays a secondary role after drug therapy.
To evaluate the efficacy of a cognitive behavior therapy (CBT) program for OAB treatment, investigators conducted a randomized, controlled, open-label, multicenter, parallel-group superiority trial. Recruitment was performed from January 16, 2020, to December 31, 2022.
Participants included women aged 20 to 80 years with an OAB diagnosis, an Eastern Cooperative Oncology Group Performance Status of 0, and able to provide informed consent. OAB was determined by an OAB symptom score (OABSS) above 6.
Patients with bladder abnormalities, urinary tract infection, previous urinary incontinence surgery, pregnancy, unable to understand Japanese, depression, dementia, and unsuitable for participation were excluded from the analysis. Participants were randomized 1:1 to either a multicomponent intervention group or waiting list group.
In the intervention group, patients underwent 4 sessions lasting 30 minutes. During these sessions, patients learned 6 techniques, including self-monitoring of urinary habits, educational sessions about the normal urinary tract system and OAB, lifestyle modifications, pelvic floor muscle training, exposure-based bladder training, and relapse prevention.
Sessions were divided into 3 parts, including review of homework, introduction of new techniques, and review of the day’s session. Techniques were implemented over a 6-week period.
Self-questionnaires evaluating outcomes were completed at weeks 0, 5, 9, and 13. Change in HRQOL scores was the primary outcome of the analysis, evaluated using the Overactive Bladder Questionnaire (OAB-q).
The OAB-q includes 6 subscales measured from 0 to 100 points, with greater improvement reported in patients with higher scores. Secondary outcomes included other OAB-q subscales, OABSS, King’s Health Questionnaire, Hospital Anxiety and Depression Scale, and EuroQol 5-dimensional and 5-level questionnaire.
Participants were aged a mean 63.5 years in both groups. Moderate OAB was reported in 92.3% of the intervention group and 87.5% of the control group.
In the intervention group, the HRQOL score changed by 23.9 points between baseline and week 13, from 18.4 to 29.5. In the control group, the score changed by 11.3 points, from 6.2 to 16.4. At week 5, the total OAB-q was 12.8 points higher in the intervention group vs the control group. At weeks 9 and 13, these differences were 11.9 and 12.6, respectively.
A minimally important improvement at follow-up was reported in 76.4% of the intervention group and 55.3% of the control group. The standardized mean difference was 0.82.
KHQ severity measures, KHQ personal relations, total OABSS, EuroQol 5-dimensional and 5-level questionnaire, and urge incontinence frequency did not differ between groups. However, all other secondary outcomes were improved in the intervention group vs the control group.
Only 1 serious adverse event was identified in the intervention group and was deemed unrelated to the intervention. Other adverse events reported included 3 cases of acute cystitis in the intervention group and 2 in the control group, 1 case of herpes in the intervention group, and 1 case of headache in the control group.
These results indicated improved HRQOL among women with OAB after the intervention. Investigators concluded a multicomponent intervention may be effective treatment for women with OAB.
Reference
Funada S, Luo Y, Uozumi R, et al. Multicomponent intervention for overactive bladder in women: A randomized clinical trial. JAMA Netw Open. 2024;7(3):e241784. doi:10.1001/jamanetworkopen.2024.1784
