Identifying Continence Options after Stroke Project (ICONS)

Clinical Practice Research Unit (CPRU)

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.