Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review.

This systematic review examined the use of incontinence-specific QOL measures in clinical trials of female incontinence treatments, and systematically evaluated their quality using a standard checklist. Of 61 trials included in the review, 58 (95.1%) used an incontinence-specific QOL measure. The most commonly used were IIQ (19 papers), I-QoL (12 papers) and UDI (9 papers). Eleven papers (18.0%) used measures which were not referenced or were developed specifically for the study. The eight QOL measures identified had good clinical face validity and measurement properties. We advise researchers to evaluate carefully the needs of their specific study, and select the QOL measure that is most appropriate in terms of validity, utility and relevance, and discourage the development of new measures. Until better evidence is available on the validity and comparability of measures, we recommend that researchers consider using IIQ or I-QOL with or without UDI in trials of incontinence treatments

Confirmatory factor analysis and examination of the psychometric properties of the eating beliefs questionnaire.

BACKGROUND: The Eating Beliefs Questionnaire (EBQ) is a 27-item self-report measure that assesses positive and negative beliefs about binge eating. It has been validated and its factor structure explored in a non-clinical sample. This study tested the psychometric properties of the EBQ in a clinical and a non-clinical sample. METHOD: A sample of 769 participants (573 participants recruited from the university and general community, 76 seeking treatment for an eating disorder and 120 participating in obesity research) completed a battery of questionnaires. A subset of clinical participants with a diagnosis of Bulimia Nervosa or Binge Eating Disorder completed the test-battery before and after receiving a psychological treatment (n = 27) or after allocation to a wait-list period (n = 28), and a subset of 35 community participants completed the test battery again after an interval of two-weeks. Confirmatory Factor Analysis (CFA) was performed. RESULTS: CFA found a two-factor structure that provided a good fit to the data, supporting the solution presented in the development paper. Items with poor psychometric properties were removed, resulting in a 16 item measure. EBQ scores were found to correlate with binge eating episode frequency, increases in body mass index (BMI), and measures of eating disorder behaviours and related psychopathology. The EBQ was found to have excellent internal consistency (α = .94), good test-retest reliability (r = .91) and sensitivity to treatment. CONCLUSION: These findings indicate that the EBQ is a psychometrically sound and clinically useful measure

Implementing pelvic floor muscle training in women's childbearing years: A critical interpretive synthesis of individual, professional, and service issues

Antenatal pelvic floor muscle training (PFMT) may be effective for the prevention and treatment of urinary and fecal incontinence both in pregnancy and postnatally, but it is not routinely implemented in practice despite guideline recommendations. This review synthesizes evidence that exposes challenges, opportunities, and concerns regarding the implementation of PFMT during the childbearing years, from the perspective of individuals, healthcare professionals (HCPs), and organizations.MethodsCritical interpretive synthesis of systematically identified primary quantitative or qualitative studies or research syntheses of women's and HCPs attitudes, beliefs, or experiences of implementing PFMT.ResultsFifty sources were included. These focused on experiences of postnatal urinary incontinence (UI) and perspectives of individual postnatal women, with limited evidence exploring the views of antenatal women and HCP or wider organizational and environmental issues. The concept of agency (people's ability to effect change through their interaction with other people, processes, and systems) provides an over?arching explanation of how PFMT can be implemented during childbearing years. This requires both individual and collective action of women, HCPs, maternity services and organizations, funders and policymakers.ConclusionNumerous factors constrain women's and HCPs capacity to implement PFMT. It is unrealistic to expect women and HCPs to implement PFMT without reforming policy and service delivery. The implementation of PFMT during pregnancy, as recommended by antenatal care and UI management guidelines, requires policymakers, organizations, HCPs, and women to value the prevention of incontinence throughout women's lives by using low?risk, low?cost, and proven strategies as part of women's reproductive health

Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence (APPEAL): protocol for a feasibility and pilot cluster randomised controlled trial

Background: Antenatal pelvic floor muscle exercises (PFME) in women without prior urinary incontinence (UI) are effective in reducing postnatal UI; however, UK midwives often do not provide advice and information to women on undertaking PFME, with evidence that among women who do receive advice, many do not perform PFME. Methods: The primary aim of this feasibility and pilot cluster randomised controlled trial is to provide a potential assessment of the feasibility of undertaking a future definitive trial of a midwifery-led antenatal intervention to support women to perform PFME in pregnancy and reduce UI postnatally. Community midwifery teams in participating NHS sites comprise trial clusters (n = 17). Midwives in teams randomised to the intervention will be trained on how to teach PFME to women and how to support them in undertaking PFME in pregnancy. Women whose community midwifery teams are allocated to control will receive standard antenatal care only. All pregnant women who give birth over a pre-selected sample month who receive antenatal care from participating community midwifery teams (clusters) will be sent a questionnaire at 10–12 weeks postpartum (around 1400–1500 women). Process evaluation data will include interviews with midwives to assess if the intervention could be implemented as planned. Interviews with women in both trial arms will explore their experiences of support from midwives to perform PFME during pregnancy. Data will be stored securely at the Universities of Birmingham and Exeter. Results will be disseminated through publications aimed at maternity service users, clinicians, and academics and inform a potential definitive trial of effectiveness. The West Midlands–Edgbaston Research Ethics Committee approved the study protocol. Discussion: Trial outcomes will determine if criteria to progress to a definitive cluster trial are met. These include women’s questionnaire return rates, prevalence of UI, and other health outcomes as reported by women at 10–12 weeks postpartum. Progress to a definitive trial however is likely to be prevented in the UK context by new perinatal pelvic health service, although this may be possible elsewhere. Trial registration: https://doi.org/10.1186/ISRCTN10833250. Registered 09/03/202

Opportunities, challenges and concerns for the implementation and uptake of pelvic floor muscle assessment and exercises during the childbearing years: protocol for a critical interpretive synthesis

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: Pregnancy and childbirth are important risk factors for urinary incontinence (UI) in women. Pelvic floor muscle exercises (PFME) are effective for prevention of UI. Guidelines for the management of UI recommend offering pelvic floor muscle training (PFMT) to women during their first pregnancy as a preventive strategy. The objective of this review is to understand the relationships between individual, professional, inter-professional and organisational opportunities, challenges and concerns that could be essential to maximise the impact of PFMT during childbearing years and to effect the required behaviour change. METHODS: Following systematic searches to identify sources for inclusion, we shall use a critical interpretive synthesis (CIS) approach to produce a conceptual model, mapping the relationships between individual, professional, inter-professional and organisational factors and the implementation, acceptability and uptake of PFME education, assessment and training during the childbearing years. Purposive sampling will be used to identify potentially relevant material relating to topics or areas of interest which emerge as the review progresses. A wide range of empirical and non-empirical sources will be eligible for inclusion to encompass the breadth of relevant individual, professional, inter-professional and organisational issues relating to PFME during childbearing years. Data analysis and synthesis will identify key themes, concepts, connections and relationships between these themes. Findings will be interpreted in relation to existing frameworks of implementation, attitudes and beliefs of individuals and behaviour change. We will collate examples to illustrate relationships expressed in the conceptual model and identify potential links between the model and drivers for change. DISCUSSION: The CIS review findings and resulting conceptual model will illustrate relationships between factors that might affect the implementation, acceptability and uptake of PFME education, assessment and training during the childbearing years. The model will inform the development and evaluation of a training package to support midwives with implementation and delivery of effective PFME during the antenatal period. The review forms part of the first phase of the United Kingdom National Institute for Health Research funded 'Antenatal Preventative Pelvic floor Exercises And Localisation (APPEAL)' programme (grant number: RP-PG-0514-20002) to prevent poor health linked to pregnancy and childbirth-related UI. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42016042792.The APPEAL project is funded by a National Institute for Health Research (NIHR) programme grant for applied research (RP-PG-0514-20002). MP and SD were supported in their contribution to the development of the research proposal by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula. CM is part-funded by the CLAHRC West Midlands, and DB is part-funded by the CLAHRC South London

Strength in diversity: enhancing learning in vocationally-orientated, master's level courses

Postgraduate education in geography, especially at the Master’s level, is undergoing significant changes in the developed world. There is an expansion of vocationally-oriented degree programmes, increasing recruitment of international students, integration of work place skills, and the engagement of non-traditional postgraduate students as departments respond to policies for a more ‘inclusive’ higher education. This paper sets the context by outlining some programmatic changes in selected countries (Australia, the UK, and the USA). We briefly reflect on how postgraduate ‘bars’ or ‘levels’ are defined and explore in detail what ‘diversity’ or ‘heterogeneity’ means in these new postgraduate settings. The paper then explores some examples of practice drawn from our own experiences, whilst recognising that relevance will vary in other contexts. Finally we consider how diversity can be harnessed as a strength that has potential to enhance taught elements of contemporary postgraduate education in and beyond the discipline

Traumatic brain injury rehabilitation: an overview of systematic reviews of intervention effectiveness. A pre-published protocol

INTRODUCTION. Many authors are in favour of using systematic reviews as a method for evidence synthesis in rehabilitation and the last decade has introduced several guidelines to help with their implementation in rehabilitation contexts. At present, however, there is little clear information about the quantity and quality of systematic reviews on TBI rehabilitation interventions. AIM. We aim to conduct an overview of systematic reviews published on TBI rehabilitation interventions in order to summarise the current state of evidence in this area of clinical practice. In addition to providing information on strength of evidence for intervention effectiveness, our goal is to research and summarise two additional domains: reviews’ characteristics and evidence gaps. METHODS. We will carry out a comprehensive search of the Cochrane Library database (including Database of Abstracts and Reviews of Effectiveness) MEDLINE, CINAHL, EMBASE, Epistemonikos, PDQ-evidence, and PubMed to find relevant systematic reviews. We also will make efforts to identify ongoing reviews by searching for protocols in the Cochrane Library database and in PROSPERO. We are not going to search grey literature. We will use Covidence (https://www.covidence.org/home) to manage review selection. Two review team members will independently select the reviews to be included to the overview. A third researcher will be consulted for resolving disagreements. We will use Knack software (https://www.knack.com/), to extract data on review characteristics and review findings. We will include the systematic reviews on the adult TBI population (regardless of severity, stage of recovery, or other aspects of clinical presentation), any kind of rehabilitation interventions (regardless of setting, uni- or multidisciplinarity etc) to describe review characteristics. From those systematic reviews the ones with comparisons with no treatment, placebo or sham treatment, and usual care; and with outcomes such as quality of life, activity and participation – as per International Classification of Functioning, Disability & Health –residential status, family burden, and adverse effects will provide basis for intervention effectiveness analysis. We will assess the quality of reporting with updated PRISMA (Transparent Reporting of Systematic Reviews and Meta-Analysis) by making a judgement of “yes/no/unclear” without further descriptions. We will assess the methodological quality of included reviews with AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) instrument. SYNTHESIS. We will provide a report on the characteristics of all included reviews using simple statistical analyses and narrative accounts and the main summary of results based on intervention effectiveness. Also, we aim to present conclusions specific to each intervention in terms of the current evidence base: statistical and/or narrative descriptions of effects and the evidence quality, relevant contextual factors, population, rehabilitation setting, and comparisons researched. We will not perform meta-analysis. In order to example gaps in the current evidence of TBI rehabilitation, we will separately summarise the information on ICF categorizations covered with low or very-low quality evidence or no evidence at all from existing systematic reviews. CONCLUSIONS. To support knowledge translation, we will organise the overview of reviews’ findings as comprehensive evidence maps

Community inclusion of wheelchair users during the long-term recovery phase following the 2010/2011 Canterbury earthquakes

Research exploring how people living with disability experience community inclusion during the medium to long-term recovery following natural disasters is scant. Yet such information is vital to ensure that recovering communities are inclusive of all members within the population. This study explored the perspectives of people with specific functional needs, wheelchair users, regarding their experience of community inclusion in the four years following the 2010/2011 earthquakes in Christchurch, New Zealand. Thirteen adult wheelchair users were interviewed one-to-one and then invited to attend a group interview. The group interview presented a summary of the interview data for discussion to help clarify and prioritise elements of community inclusion. All data were subjected to thematic analysis. Four interrelated themes described the key elements of the participants’ experience of community post-earthquakes: 1) earthquakes magnified barriers, 2) community inclusion requires energy, 3) social connections are important, and 4) an unprecedented opportunity for change. Findings emphasized the need for recovery energies at a local and national level to move from conceptualizing disability in terms of individual vulnerability, to instead, focusing on reducing environmental barriers that inhibit community inclusion. Of critical importance is creating pathways for people who experience disability to be co-creators of this change