Reducing Disparities in Urinary Control Symptoms for Minority Women

NCT06798311 | Recruiting

• 2 other identifiers: IRB24-11315R01DK129849-04
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 2

Brief Summary

The study is designed to address the disparity in available conservative/behavioral treatments for UI/LUTS. The program was developed by experts from urogynecology, psychology, and physical therapy then modified based on focus group feedback from racially minoritized women. The study team created a patient-centered, culturally adapted, self-directed, 8-week, home-based module for women with LUTS/UI. The SUPPORT program combines multiple evidence-based conservative treatments for LUTS/UI including cognitive behavioral therapy, behavioral modifications, and home physical therapy exercise. Progression through the home-based program is supported by research staff. This prospective interventional study aims to evaluate the feasibility and acceptability of the SUPPORT program and its impact on patient-centered treatment outcomes, while enabling comparisons across race and ethnicity. This approach will provide a comprehensive understanding of how to effectively deliver self-management strategies for pelvic floor disorders. At the start of the 8 week SUPPORT course participants will also be given access to a custom programmed GPT trained on the SUPPORT workbook and given instructions on empathetic communication techniques and assisting patients in performing the SUPPORT exercises as outlined in the program. At the end of 8 weeks patients will fill out a survey assessing the frequency of use and interactions with the LLM.

Conditions

Urinary Incontinence (UI); Lower Urinary Tract Symptoms (LUTS); Pelvic Floor Disorder

Keywords

cognitive behavioral therapy; self-directed; physical therapy; behavioral modifications; pelvic floor; home-based; health disparities

Outcome Measures

Primary Outcomes (1)

• Urinary Symptom Changes (UDI Subscale)

  To compare changes in urinary symptoms using the validated Urinary Distress Inventory (UDI) subscale of the Pelvic Floor Distress Inventory (PFDI) between baseline and 8-weeks (program completion) in patients undergoing the SUPPORT program. The Urinary Distress Inventory (UDI-6) is a validated 6-item questionnaire that assesses lower urinary tract symptoms, including incontinence, in women. The UDI-6 score is calculated by averaging the responses to each question (possible value 0 to 4), then multiplying that average by 25 to scale the score from 0 to 100. A higher score indicates greater distress.

  From enrollment to the end of treatment at 8 weeks

Secondary Outcomes (9)

• Urinary symptoms - UDI-6 (16 Weeks)

  From enrollment to 16 weeks after SUPPORT program initiation

• Urinary symptoms - LURN SI-10 (16 Weeks)

  From enrollment to 16 weeks after SUPPORT program initiation

• Patient Global Impression of Improvement (PGI-I)

  From enrollment to 16 weeks after SUPPORT program initiation

• Pelvic Organ prolapse Distress Inventory and Colorectal-Anal distress Inventory subscales

  From enrollment to 16 weeks after SUPPORT program initiation

• Adherence

  From enrollment to 16 weeks after SUPPORT program initiation

Study Arms (1)

SUPPORT workbook

EXPERIMENTAL

All enrolled patients will be given access to the SUPPORT workbook (hard copy and PDF). The SUPPORT workbook contains a template for how pelvic floor physical therapy is delivered in the typical in-person setting with a combination of education, bladder re-training exercises, pelvic floor stretching and core strengthening. Patients also will be given access to a custom programmed GPT trained on the SUPPORT workbook and given instructions on empathetic communication techniques and assisting patients in performing the SUPPORT exercises as outlined in the program.

Behavioral: SUPPORT workbook

Interventions

SUPPORT workbook BEHAVIORAL

The SUPPORT workbook contains a template for how pelvic floor physical therapy is delivered in the typical in-person setting with a combination of education, bladder re-training exercises, pelvic floor stretching and core strengthening. To aid in the demonstration of physical therapy exercises, the workbook includes QR-coded links to videos of a physical therapist performing the exercises in an ideal form. The videos include audio instruction to ensure that patients can learn the concepts in either visual, auditory or written form. The cognitive behavioral therapy (CBT) portion of the workbook is adapted from the standardized CBT protocol and includes short introductions and exercises pertaining to cognitive flexibility, behavioral activation and social support. The total time commitment for the program is 2-hours per week. Patients also will be given access to a custom programmed GPT trained on the SUPPORT workbook and given instructions on empathetic communication techniques.

Also known as: cognitive behavior therapy

SUPPORT workbook

Eligibility Criteria

• Age: 18 Years+
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 years or older
• Able to converse in English
• A response of at least "somewhat bothered" by urinary incontinence, urinary frequency or urgency on the UDI
• Willing to engage in conservative treatment of their UI/LUTS for 16 weeks

You may not qualify if:

• Anterior or posterior pelvic organ prolapse beyond the hymen or apical prolapse to the hymen
• Currently taking medications for their UI/LUTS or history of surgical intervention for UI
• Patients with abnormal PVR and positive urine culture at time of study entry
• History of recurrent UTIs
• History of mobility or neurologic disorders that would prevent ability to complete at home physical therapy
• Planning to start PT within the next 16 weeks

Sponsors & Collaborators

• University of Chicago: lead
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): collaborator
• Northwestern University: collaborator

Study Sites (2)

Northwestern University

Chicago, Illinois, 60611, United States

NOT YET RECRUITING

The University of Chicago

Chicago, Illinois, 60637, United States

RECRUITING

Related Publications (25)

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• Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, Markland AD. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014 Jan;123(1):141-148. doi: 10.1097/AOG.0000000000000057.

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• Yazdany T, Jakus-Waldman S, Jeppson PC, Schimpf MO, Yurteri-Kaplan LA, Ferzandi TR, Weber-LeBrun E, Knoepp L, Mamik M, Viswanathan M, Ward RM; American Urogynecologic Society. American Urogynecologic Society Systematic Review: The Impact of Weight Loss Intervention on Lower Urinary Tract Symptoms and Urinary Incontinence in Overweight and Obese Women. Female Pelvic Med Reconstr Surg. 2020 Jan/Feb;26(1):16-29. doi: 10.1097/SPV.0000000000000802.

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• Siddiqui NY, Ammarell N, Wu JM, Sandoval JS, Bosworth HB. Urinary Incontinence and Health-Seeking Behavior Among White, Black, and Latina Women. Female Pelvic Med Reconstr Surg. 2016 Sep-Oct;22(5):340-5. doi: 10.1097/SPV.0000000000000286.

  PMID: 27171320 BACKGROUND

• Segal JL, Vassallo B, Kleeman S, Silva WA, Karram MM. Prevalence of persistent and de novo overactive bladder symptoms after the tension-free vaginal tape. Obstet Gynecol. 2004 Dec;104(6):1263-9. doi: 10.1097/01.AOG.0000147596.44421.72.

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• Rhodes RE, Fiala B. Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: the evidence. Physiother Theory Pract. 2009 Jul;25(5-6):424-41. doi: 10.1080/09593980902835344.

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• Markland AD, Richter HE, Fwu CW, Eggers P, Kusek JW. Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008. J Urol. 2011 Aug;186(2):589-93. doi: 10.1016/j.juro.2011.03.114.

  PMID: 21684555 BACKGROUND

• Mandimika CL, Murk W, Mcpencow AM, Lake AG, Miller D, Connell KA, Guess MK. Racial Disparities in Knowledge of Pelvic Floor Disorders Among Community-Dwelling Women. Female Pelvic Med Reconstr Surg. 2015 Sep-Oct;21(5):287-92. doi: 10.1097/SPV.0000000000000182.

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• Kotarinos RK. Pelvic floor physical therapy in urogynecologic disorders. Curr Womens Health Rep. 2003 Aug;3(4):334-9.

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• Kiyosaki K, Ackerman AL, Histed S, Sevilla C, Eilber K, Maliski S, Rogers RG, Anger J. Patients' understanding of pelvic floor disorders: what women want to know. Female Pelvic Med Reconstr Surg. 2012 May-Jun;18(3):137-42. doi: 10.1097/SPV.0b013e318254f09c.

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• Harlow BL, Bavendam TG, Palmer MH, Brubaker L, Burgio KL, Lukacz ES, Miller JM, Mueller ER, Newman DK, Rickey LM, Sutcliffe S, Simons-Morton D. The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium: A Transdisciplinary Approach Toward Promoting Bladder Health and Preventing Lower Urinary Tract Symptoms in Women Across the Life Course. J Womens Health (Larchmt). 2018 Mar;27(3):283-289. doi: 10.1089/jwh.2017.6566. Epub 2017 Sep 15.

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• FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor. Int Urogynecol J Pelvic Floor Dysfunct. 2003 Oct;14(4):269-75; discussion 275. doi: 10.1007/s00192-003-1050-7. Epub 2003 Aug 7.

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• Dumoulin C, Hay-Smith EJ, Mac Habee-Seguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014 May 14;(5):CD005654. doi: 10.1002/14651858.CD005654.pub3.

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• Berger AA, Tan-Kim J, Menefee SA. Long-term Risk of Reoperation After Synthetic Mesh Midurethral Sling Surgery for Stress Urinary Incontinence. Obstet Gynecol. 2019 Nov;134(5):1047-1055. doi: 10.1097/AOG.0000000000003526.

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• Alewijnse D, Mesters I, Metsemakers J, van den Borne B. Predictors of long-term adherence to pelvic floor muscle exercise therapy among women with urinary incontinence. Health Educ Res. 2003 Oct;18(5):511-24. doi: 10.1093/her/cyf043.

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• Barber MD, Spino C, Janz NK, Brubaker L, Nygaard I, Nager CW, Wheeler TL; Pelvic Floor Disorders Network. The minimum important differences for the urinary scales of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. Am J Obstet Gynecol. 2009 May;200(5):580.e1-7. doi: 10.1016/j.ajog.2009.02.007.

  PMID: 19375574 BACKGROUND

• Alas AN, Dunivan GC, Wieslander CK, Sevilla C, Barrera B, Rashid R, Maliski S, Eilber K, Rogers RG, Anger JT. Health Care Disparities Among English-Speaking and Spanish-Speaking Women With Pelvic Organ Prolapse at Public and Private Hospitals: What Are the Barriers? Female Pelvic Med Reconstr Surg. 2016 Nov/Dec;22(6):460-466. doi: 10.1097/SPV.0000000000000315.

  PMID: 27636216 BACKGROUND

MeSH Terms

Conditions

Urinary Incontinence; Lower Urinary Tract Symptoms; Pelvic Floor Disorders

Interventions

Cognitive Behavioral Therapy

Condition Hierarchy (Ancestors)

Urination Disorders; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Urological Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Pregnancy Complications

Intervention Hierarchy (Ancestors)

Behavior Therapy; Psychotherapy; Behavioral Disciplines and Activities

Study Officials

• Kimberly Kenton, MD

  University of Chicago

  PRINCIPAL INVESTIGATOR

• James Griffith, PhD

  University of Chicago

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Jinxuan (Rowena) Shi, MA

CONTACT

773-795-2731; jinxuan.shi@bsd.uchicago.edu

Tara Samsel, BS

CONTACT

773-795-2729; tara.samsel@bsd.uchicago.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 22, 2025
• First Posted: January 29, 2025
• Study Start: October 28, 2024
• Primary Completion: May 1, 2026
• Study Completion: May 1, 2026
• Last Updated: March 18, 2025

Record last verified: 2025-03

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)