Systematic review of cure rates in incontinence – role of clinical experts




Poster session 2 Thursday: Evidence synthesis - methods / improving conduct and reporting


Thursday 14 September 2017 - 12:30 to 14:00


All authors in correct order:

Riemsma R1, Deshpande S1, Misso K1, Hutt E2, Huige N3, Kleijnen J1
1 Kleijnen Systematic Reviews Ltd., York, United Kingdom
2 Medica Market Access Ltd., Tonbridge, United Kingdom
3 SCA, Gothenburg, Sweden
Presenting author and contact person

Presenting author:

Sohan Deshpande

Contact person:

Abstract text
Background: We performed a systematic review of cure and success rates of treating incontinence in people with urinary or faecal incontinence.

Objectives: We were interested in cure and success rates of interventions and subsequent dependence on containment products, not in the relative effectiveness of interventions. Therefore, we used cure and success rates from individual study arms. We planned to calculate average cure and success rates.

Methods and Results: For comparability of cure rates across studies it was important that populations, outcomes and follow-up durations were similar. Therefore we reported cure rates by subgroup (people with stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI); faecal incontinence (FI); people with disabilities or neurological diseases; and, elderly or cognitively impaired). We focused on ‘cure’ (no leakage), as this was the most unambiguous outcome. However, for faecal incontinence ‘cure’ is often not reported; therefore, success rates were collected together with a full description of the outcome reported. Only when outcome definitions were similar enough was combining results contemplated. Finally, outcomes were reported with follow-up ranging from 12 weeks to 10 years. Therefore, results were grouped by follow-up period (>12 weeks to <4.5 months, ≥4.5 months to <9 months, ≥9 to <15 months, ≥15 months to <21 months, ≥21 months to <2.5 years, ≥2.5 years to <4 years, and ≥4 years).
The project was performed in close collaboration with a group of 9 clinical specialists. They played a vital role in defining population subgroups, outcomes and in identifying relevant interventions. The group also advised about whether or not combining results was feasible. The results table for people with urgency urinary incontinence was as follows (Table 1). Similar tables were constructed for the other subgroups.

Conclusions: In the end we decided to present results by population subgroup, outcome, intervention and follow-up period, without combining any of the results, as the studies were too heterogeneous. When judging heterogeneity, input from clinical experts was essential.