Abstract 47: ICONS: Identifying Continence OptioNs after Stroke: Findings From a Randomised Trial

Introduction: Urinary incontinence following acute stroke is common, affecting between 40%-60% of people in hospital after a stroke. Despite the availability of clinical guidelines for urinary incontinence and urinary incontinence after stroke, national audit data suggest incontinence is often poorly managed. Conservative interventions (e.g. bladder training, pelvic floor muscle training and prompted voiding) have been shown to have some effect with participants in Cochrane systematic reviews, but have not had their effectiveness demonstrated with stroke patients. Methods: A cluster randomised controlled pilot trial designed to assess the feasibility of a full-scale cluster randomised trial and to provide preliminary evidence of the effectiveness and cost-effectiveness of a systematic voiding programme for the management of continence after stroke. Stroke services were randomised to receive the systematic voiding programme, the systematic voiding programme plus supported implementation (using facilitation as a means of enabling and supporting staff to change their practice), or usual care. The trial aimed to recruit 500 participants in 12 stroke services (4 services per arm). The primary outcome was presence/absence of urinary incontinence. Secondary outcomes included frequency and severity of urinary incontinence, quality of life and cost-utility. Outcomes were measured at six weeks, twelve weeks and twelve months after stroke. Process data included rates of recruitment and retention and fidelity of intervention delivery. An integrated qualitative evaluation was conducted in order to describe implementation and assist in explaining potential mediators and modifiers of the process. Results: Recruitment ended on July 31 st 2012. In total 413 participants were recruited; 164 received the systematic voiding programme, 125 the systematic voiding programme plus supported implementation and 124 usual care. Findings from the six and twelve week primary and secondary effectiveness outcomes will be presented. Conclusion: Not yet available.