Uncertainty in making decisions about health care
Identifying important areas of uncertainty in the treatment or management of urinary incontinence
The MS Trust has been part of a panel of charities, health professionals and academics working with the James Lind Alliance to identify 'clinical uncertainties' in the management of bladder problems.
Every day patients, carers and clinicians have to make choices between different treatments or different methods of management for health problems. The choice made can have an important impact on the life of the person involved. Therefore it is best if information based on up to date research is available which patients, carers and clinicians can discuss together to help them make the right choice.
But sometimes not enough up to date information exists and as a result patients, carers and clinicians are faced with uncertainty regarding the best choice to make. The James Lind Alliance calls these situations 'clinical uncertainties' - questions and choices in the treatment or management of bladder control problems which cannot currently be informed by up to date information based on research evidence.
The list of prioritised uncertainties will be used to ensure that future research addresses these issues. This will be a great help for similar people facing the same decisions in the future.
Final list of prioritised uncertainties
The list of prioritised uncertainties was made available in September 2009 prior to its publication in the journal Neurology and Urodynamics.
- What are the optimal pelvic floor muscle training protocols (frequency and duration of therapy) for the treatment of different patterns of urinary incontinence?
- Development of system for classifying 'intensity' of pelvic floor muscle training programmes
- Systematic review to assess the effectiveness of programmes of increasing intensity
- Modelling with economic evaluation of cost-effectiveness of programmes of increasing intensity
- [Subsequent primary studies may be needed]
- Can guidance or training for general practitioners on appropriate pathways of care improve the management of patients with urinary incontinence?
- Systematic review of GP-based interventions (such as guidelines, and continuing professional development) aimed at increasing the quality of care of patients with urinary incontinence
- [Subsequent primary data collection studies likely to be needed]
- What is best practice for the treatment of combined stress urinary incontinence and detrusor over activity?
- Systematic review of interventions for incontinence where the patient group have a combination of stress and urgency incontinence
- [Subsequent primary data collection studies likely to be needed]
- What catheter regimens are most effective in preventing urinary tract infections in patients using intermittent self-catheterisation for the management of a neurogenic bladder?
What is the effectiveness and safety of prophylactic versus symptomatic antibiotic therapy in patients with neurogenic bladder dysfunction using intermittent self-catheterisation? - [Updated systematic reviews]
- Randomised trials in patient with neurogenic bladder dysfunction using intermittent self-catheterisation to evaluate: alternative catheter regimens; and antibiotic prophylaxis vs no antibiotic prophylaxis
- Which treatment is most effective for the reduction of urinary frequency and urgency?
- New systematic review
- Is urodynamic testing prior to surgery for urinary incontinence associated with better continence rates and quality of life, than surgery indicated without such testing?
- Pre-trial economic modelling
- Pragmatic randomised controlled trial
- What is best practice for the management of stress urinary incontinence following failed tension free vaginal tape surgery?
- New systematic review
- [Subsequent primary data collection studies likely to be needed]
- What are the most effective treatments of daytime urinary incontinence in children?
- Updated systematic review
- [Subsequent primary data collection studies likely to be needed]
- Are disposable catheters more or less acceptable than reusable catheters, in terms of effective bladder management, patient experience and urinary tract infections?
- [Updated systematic review]
- Pragmatic randomised controlled trial comparing disposable (single use) catheters with reusable catheters
- In women with prolapse (symptomatic or asymptomatic) and stress urinary incontinence, should suburethral tapes be inserted at the same time as repairing the prolapse?
- Pragmatic randomised controlled trial
- Read a report by the MS Trust's representative on the project - February 2009
The James Lind Alliance is supported by the Medical Research Council and the Department of Health.
