Does patient activity level affect 24-hr pad test results in stress-incontinent women?

Standardization of the 24-hr pad test procedure would increase its validity as an objective measure of urinary incontinence. Our aim was to establish whether patient activity levels affect pad test results in stress-incontinent women, and if so, to develop a standard activity level during the testing period.

In this prospective observational study, 25 women with pure stress urinary incontinence (SUI) completed two 24-hr pad tests and documented their daily activities during a "normally active" and "minimally active" day. Activity level was compared with pad weight gain and the number of leakage episodes due to activity according to a patient activity diary (diarized activity leakage episodes) using non-parametric tests.

There was a significant difference between the "normally active" and "minimally active" days for median pad weight gain (9.9 g vs. 5.2 g, P < 0.05) and diarized activity leakage episodes (2 vs. 1, P < 0.05). When the days were re-categorized, there was a significant difference between "mild activity" and "moderate activity" days for median pad weight gain (4.85 g vs. 7.1 g, P < 0.05) and diarized activity leakage episodes (0 vs. 2, P < 0.05).

Increased patient activity levels increase the degree of leakage as measured by 24-hr pad weight gain therefore patients with SUI should perform the 24-hr pad test with standardized activity instructions. In scientific research, we recommend that women perform minimal physical activity, as this decreases the variation of activity. This approach will enhance the function of the 24-hr pad test as a severity measure between patients with SUI.