Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial

Area of Science:

• Stroke Rehabilitation
• Urology
• Geriatric Medicine

Background:

• Urinary incontinence (UI) is prevalent in post-stroke patients, often inadequately managed.
• Previous reviews show conservative interventions like bladder training benefit UI, but evidence in stroke survivors is limited.

Purpose of the Study:

• To assess the feasibility of a cluster randomized controlled trial for a systematic voiding programme (SVP) in managing post-stroke UI.
• To evaluate the effectiveness of SVP and SVP with supported implementation (SVP+) compared to usual care (UC) on UI and related outcomes.

Main Methods:

• A cluster randomized controlled feasibility trial involving 4 stroke services in each of three arms: SVP, SVP+, and UC.
• Feasibility outcomes included participant recruitment and retention rates.
• Effectiveness outcomes measured UI presence/absence at 6 and 12 weeks, UI type, continence at discharge, UI severity, function, quality of life, and mortality.

Main Results:

• Recruitment of 413 patients was successful, with acceptable retention rates (85% at 6 weeks, 88% at 12 weeks).
• No significant difference in the primary outcome of UI was observed between SVP/SVP+ and UC at 6 or 12 weeks.
• A potential reduction in urge incontinence was noted at 12 weeks in the intervention arms compared to usual care.

Conclusions:

• The systematic voiding programme (SVP) trial met its feasibility objectives for recruitment and retention.
• While not powered to confirm effectiveness, preliminary findings suggest a possible benefit for urge incontinence, warranting further investigation.
• A full-scale trial to definitively assess the effectiveness of SVP for post-stroke UI is recommended.