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ICONS: Identifying Continence Options after Stroke

ICONS is a four year research programme to design, implement and conduct a preliminary evaluation of the effectiveness and cost-effectiveness of a systematic voiding programme for the management of urinary incontinence after stroke.

Urinary incontinence following acute stroke is common, affecting between 40%-60% of people in hospital after a stroke. Despite the availability of clinical guidelines for urinary incontinence and urinary incontinence after stroke, national audit data suggest incontinence is often poorly managed. Conservative interventions (e.g. bladder training, pelvic floor muscle training and prompted voiding) have been shown to have some effect with participants in Cochrane systematic reviews, but have not had their effectiveness demonstrated with stroke patients.

Study aims

The trial aims to assess the feasibility of a full-scale cluster-randomised trial: to test the interventions for preliminary evidence of clinical effect and to provide information to enable estimates of the number of sites and patients that would need to be recruited for a full-scale cluster-randomised trial to evaluate effectiveness.

Findings so far

The ICONS research programme has introduced evidence-based systematic voiding programmes tailored to the physical and cognitive capabilities of each patient in 12 stroke services (14 stroke units) in England and Wales. The programme comprises simple, conservative approaches as a first-line strategy in line with the recommendations of the Intercollegiate Stroke Working Party National clinical guidelines for stroke. While over 230 patients have so far consented to take part in the trial, all patients in each participating stroke unit who met the inclusion criteria were managed according to the systematic voiding programme.

The research programme encompasses four components of the NHS Outcomes Framework 2011/2: preventing people from dying prematurely; enhancing quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury and ensuring that people have a positive experience of care. Continence was identified as a key concern in the last National Sentinel Audit of stroke care. This research programme has raised the profile of continence management and demonstrated an improvement in the assessment and management of continence within stroke units. Findings on patient outcome and cost-effectiveness will be available in December 2012.

Patient, public and carer involvement has been integral to the whole research programme; this has included diversity in the involvement of stroke survivors with aphasia. We have demonstrated the impact of this through an on-going evaluation. The PPI component has received recognition at National level, evidenced through an invitation from INVOLVE to contribute to their Guide on diversity and inclusion for active involvement in research.

The research programme has contributed to the level of knowledge about continence among health professionals through a tailored, on-line training resource.

Further information

For more information about this project, please contact Dr. Lois Thomas