Evidence Based Practice
“The critical appraisal of the research evidence associated with an area of my professional practice”
I am going to critically appraise of research evidence on treatment of urinary stress incontinence in women with obesity. I chose this topic because currently I am working in urology department in hospital X; I am always having the chance to deal with women experiencing stress incontinence. In current practice we will teach them behavioral intervention program (pelvic floor exercise and bladder training) to lower the severity of urine leakage. That is why I want to explore more on this issue and see whether the use of vaginal cones also effective in treatment with behavioral intervention program.
Obesity is a common problem in developed countries, with an incidence of 33% (Roreyt 1998), this problem may directly leading to stress urinary incontinence (Ouslander 1996) which may hinder the normal daily life of an adult.
In Hong Kong Hospital Authority (HA) policy, there are no guideline in related to treatment regarding stress incontinence, it is always depends on surgeon’s preferences. Therefore I want to search for research evidence in associated with treatment of urinary stress incontinence which may beneficial in my working place.
The two answerable questions formulated using PICO tools are:
Quantitative Question – In women with obesity, how does behavioral intervention program compared to vaginal cones influence the occurrence of stress urinary incontinence?
Qualitative Question – How do obesity women perceive the method of behavioral intervention program in comparison to vaginal cones in regards to stress urinary incontinence?
P – Women with obesity
I – Behavioral Intervention Program
C – Vaginal Cones
O – Stress Urinary incontinence
In developing these two questions, first of all I have to set the patient population (P) which is “Women with Obesity”; then what I am looking in, the Outcome (O), is “Urinary Stress Incontinence”; for the intervention (I), the usual practice in my ward is “Behavioral Intervention Programme”; and the comparison (C) is the alternative method that I would like to look for which is using “Vaginal Cones”.
For the literature search strategies, “CINAHL” and “MEDLINE” were chosen for the search database because these two were related to nursing discipline. For the search terms, “Stress Incontinence” and “Pelvic Floor Exercise” were used and there were 132 paper searched. “Vaginal Cones” was not put in the search terms because there were only 8 paper retrieved, due to the limited number of results and too narrow information can be drawn, “vaginal cones” was not used in search terms in order to get a more boarder information. By adding more limitations such as Search Modes: Boolean/ Phrase; Duration: 2004 – present; Language: English; Category: Human, 53 papers retrieved. Then I have chosen 1 quantitative paper and 1 qualitative paper according to the abstract and the one closest to my area of interest. The papers I have chosen were:
* Quantitative paper: Behavioral Intervention Program versus Vaginal Cones on Stress Urinary Incontinence and Related Quality of Life: A Randomized Clinical Trial.
* Qualitative paper: Adherence to Behavioral Interventions for Stress Incontinence: Rates, Barriers, and Predictors.
The critical appraisal tools “Critical Appraisal Skills Programme (CASP)” was used in critical appraise the 2 articles. CASP was chosen because it is free to use and it contains 10 questions in each checklist which is relatively common and easy to use.
A. Quantitative paper: Behavioral Intervention Program versus Vaginal Cones on Stress Urinary Incontinence and Related Quality of Life: A Randomized Clinical Trial.
The aims and objectives in these articles are clear; it is to measure the severity of ur