Continence promotion for older hospital patients following surgery for fractured neck of femur: Pilot of a randomized controlled trial

Abstract

Evidence suggests that bladder control problems develop or worsen as a result of fractured neck of femur (#NOF) and its subsequent management.

The primary aim of this study was to reduce the prevalence and severity of post surgery continence problems among patients, aged from 60-years, undergoing surgery for #NOF, using a best practice “case-management model” multifactorial intervention.

Eligible consenting patients admitted with #NOF were randomized to intervention or control group. Self-report questionnaires compared pre-surgery, post surgery, and follow-up continence status between groups.

This pilot randomized controlled trial, which included 45 eligible patients aged 60 to 93-years, found no evidence that the intervention was effective in reducing prevalence of post-surgery incontinence in this acute setting. Staff surveys highlighted the need for open communication between the research team and hospital staff. Unclear results were attributed to the small sample size.

A central outcome was evidence that intervention to improve continence management for older people post-surgery is imperative. Focused assessment and treatment for those most at risk of incontinence after #NOF would be more acceptable to staff and a more efficient use of resources. A simple screening tool would ensure that those most at risk are detected, and targeted for care.

Keywords:

• urinary incontinence
• prevention
• management
• fractured neck of femur
• hip surgery
• randomized controlled trial
• elderly

Acknowledgements

• Thanks to Marie Hiscox (Research Nurse), Jan McLeod (Research Interviewer), Ian Robinson (Statistical assistant), Dr Lynette Mackenzie (Occupational Therapist), and staff and patients of John Hunter Hospital and the (former) Royal Newcastle Hospital.

• This project was funded by the National Continence Management Strategy, an Australian Government Initiative.

• Researchers in the Faculty of Health at The University of Newcastle are members of Hunter Medical Research Institute (HMRI).