Heidi D. Nelson, MD, MPH; Amy Cantor, MD, MPH; Miranda Pappas, MA; Liev Miller, BA
Disclaimer: Advisory Panel or Multidisciplinary Steering Committee participation in the Women's Preventive Services Initiative or authorship of this document does not constitute organizational or individual endorsement of the recommendations or conclusions. The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Health Resources and Services Administration. No statement in this report should be construed as an official position of the U.S. Department of Health and Human Services.
Grant Support: By cooperative agreement UH0MC29440 from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0225.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: See Supplement. Statistical code: Not applicable. Data set: See Appendix Tables and Figure; additional information is available from the investigators (e-mail, nelsonh@ohsu.edu).
Corresponding Author: Heidi D. Nelson, MD, MPH, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mailcode BICC, Portland, OR 97239; e-mail, nelsonh@ohsu.edu.
Current Author Addresses: Drs. Nelson and Cantor, Ms. Pappas, and Liev Miller: Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mailcode BICC, Portland, OR 97239.
Author Contributions: Conception and design: H.D. Nelson, A. Cantor.
Analysis and interpretation of the data: H.D. Nelson, A. Cantor, M. Pappas.
Drafting of the article: H.D. Nelson, A. Cantor, M. Pappas, L. Miller.
Critical revision of the article for important intellectual content: H.D. Nelson, A. Cantor, M. Pappas.
Final approval of the article: H.D. Nelson, A. Cantor, M. Pappas, L. Miller.
Provision of study materials or patients: H.D. Nelson.
Statistical expertise: H.D. Nelson.
Obtaining of funding: H.D. Nelson, A. Cantor.
Administrative, technical, or logistic support: H.D. Nelson, A. Cantor, M. Pappas, L. Miller.
Collection and assembly of data: H.D. Nelson, A. Cantor, M. Pappas, L. Miller.
Urinary incontinence is infrequently addressed during routine health care despite its high prevalence and adverse effects on health.
To evaluate whether screening for urinary incontinence in women not previously diagnosed improves outcomes (symptoms, quality of life, and function) and to evaluate the accuracy of screening methods and potential harms of screening.
English-language searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (1 January 1996 to 30 March 2018); ClinicalTrials.gov (April 2018); and reference lists of studies and reviews.
Randomized trials, cohort studies, systematic reviews of studies that enrolled nonpregnant women without previously diagnosed urinary incontinence and compared clinical outcomes and adverse effects between women who were and were not screened, and diagnostic accuracy studies that reported performance measures of screening tests.
Dual extraction and quality assessment of individual studies.
No studies evaluated the overall effectiveness or harms of screening. Seventeen studies evaluated the diagnostic accuracy of 18 screening questionnaires against a clinical diagnosis or results of diagnostic tests. Of these, 14 poor-quality studies were based in referral clinics, enrolled only symptomatic women, or had other limitations. One good-quality and 2 fair-quality studies (evaluating 4 methods) enrolled women not recruited on the basis of symptoms. Areas under the receiver-operating characteristic curve for stress, urge, and any type of incontinence in these studies were 0.79, 0.88, and 0.88 for the Michigan Incontinence Symptom Index; 0.85, 0.83, and 0.87 for the Bladder Control Self-Assessment Questionnaire; and 0.68, 0.82, and 0.75 for the Overactive Bladder Awareness Tool. The Incontinence Screening Questionnaire had a sensitivity of 66% and specificity of 80% for any type of incontinence.
Studies enrolled few participants, often from symptomatic referral populations; used various reference standards; and infrequently reported CIs.
Evidence is insufficient on the overall effectiveness and harms of screening for urinary incontinence in women. Limited evidence in general populations suggests fairly high accuracy for some screening methods.
Health Resources and Services Administration.
Nelson HD, Cantor A, Pappas M, et al. Screening for Urinary Incontinence in Women: A Systematic Review for the Women's Preventive Services Initiative. Ann Intern Med. 2018;169:311–319. [Epub ahead of print 14 August 2018]. doi: 10.7326/M18-0225
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© 2019
Published: Ann Intern Med. 2018;169(5):311-319.
DOI: 10.7326/M18-0225
Published at www.annals.org on 14 August 2018
Nephrology, Urological Disorders.
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