Behavioral therapy for urinary symptoms in Parkinson's disease: A randomized clinical trial.

Aim Determine the efficacy of behavioral therapy for urinary symptoms in Parkinson's disease. Methods Randomized trial of behavioral therapy compared with control condition among adults (aged 54-85 years, 74% male, 10% Black/ 83% White) with Parkinson's and greater than or equal to 4 incontinence episodes weekly. Behavioral therapy included pelvic floor muscle exercises, bladder training, fluid and constipation management. Both groups completed bladder diary self-monitoring. Outcomes included diary-derived incontinence and ICIQ-overactive bladder (OAB) score (range, 0-16) with bother and quality of life questionnaires (higher scores = worse outcomes). Results Fifty-three participants randomized and 47 reported 8-week outcomes including 26 behavioral therapy and 21 control. Behavioral vs control participants were similar with respect to age (71.0 +/- 6.1 vs 69.7 +/- 8.2 years), sex (70% vs 78% male), motor score, cognition, mean weekly incontinence episodes (13.9 +/- 9.6 vs 15.1 +/- 11.1) and OAB symptoms (8.9 +/- 2.4 vs 8.3 +/- 2.2). Weekly incontinence reduction was similar between behavioral (-6.2 +/- 8.7) and control participants (-6.5 +/- 13.8) (P = 0.89). After multiple imputation analysis, behavioral therapy participants reported statistically similar reduction in OAB symptoms compared to control (-3.1 +/- 2.8 vs -1.9 +/- 2.2, P = 0.19); however quality of life (-22.6 +/- 19.1 vs -7.0 +/- 18.4, P = 0.048) and bother (-12.6 +/- 17.2 vs - 6.7 +/- 8.8, P = 0.037) improved significantly more with behavioral therapy. Conclusion Self-monitoring resulted in fewer urinary symptoms; however, only multicomponent behavioral therapy was associated with reduced bother and improved quality of life. Providers should consider behavioral therapy as initial treatment for urinary symptoms in Parkinson's disease.