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. 2004;2004(1):CD004668.
doi: 10.1002/14651858.CD004668.

Complex behavioural and educational interventions for nocturnal enuresis in children

C M A Glazener  1 , J H C Evans, R E Peto
Affiliations

Complex behavioural and educational interventions for nocturnal enuresis in children

C M A Glazener et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults.

Objectives: To assess the effects of complex behavioural and educational interventions on nocturnal enuresis in children, and to compare them with other interventions.

Search strategy: We searched the Cochrane Incontinence Group trials register (December 2002) and the reference lists of relevant articles. Date of the most recent searches: December 2002.

Selection criteria: All randomised or quasi-randomised trials of complex behavioural or educational interventions for nocturnal enuresis in children were included, except those focused solely on daytime wetting. Comparison interventions included no treatment, simple and physical behavioural methods, alarms, desmopressin, tricyclics, and miscellaneous other interventions.

Data collection and analysis: Two reviewers independently assessed the quality of the eligible trials, and extracted data.

Main results: Sixteen trials involving 1081 children were identified which included a complex or educational intervention for nocturnal enuresis. The trials were mostly small and some had methodological problems including the use of a quasi-randomised method of concealment of allocation in three trials and baseline differences between the groups in another three.A complex intervention (such as dry bed training (DBT) or full spectrum home training (FSHT)) including an alarm was better than no-treatment control groups (eg RR for failure or relapse after stopping DBT 0.25; 95% CI 0.16 to 0.39) but there was not enough evidence about the effects of complex interventions alone if an alarm was not used. A complex intervention on its own was not as good as an alarm on its own or the intervention supplemented by an alarm (eg RR for failure or relapse after DBT alone versus DBT plus alarm 2.81; 95% CI 1.80 to 4.38). On the other hand, a complex intervention supplemented by a bed alarm might reduce the relapse rate compared with the alarm on its own (eg RR for failure or relapse after DBT plus alarm versus alarm alone 0.5; 95% CI 0.31 to 0.80).There was not enough evidence to judge whether providing educational information about enuresis was effective, irrespective of method of delivery. There was some evidence that direct contact between families and therapists enhanced the effect of a complex intervention, and that increased contact and support enhanced a package of simple behavioural interventions, but these were addressed only in single trials and the results would need to be confirmed by further randomised controlled trials, in particular the effect on use of resources.

Reviewer's conclusions: Although DBT and FSHT were better than no treatment when used in combination with an alarm, there was insufficient evidence to support their use without an alarm. An alarm on its own was also better than DBT on its own, but there was some evidence that combining an alarm with DBT was better than an alarm on its own, suggesting that DBT may augment the effect of an alarm. There was also some evidence that direct contact with a therapist might enhance the effects of an intervention.

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Conflict of interest statement

JHCE has received reimbursement for attending a conference, fees for lecturing and a consultancy fee which was paid into a research fund from Ferring Pharmaceuticals, manufacturers of desmopressin. He is also an author of one of the included trials (Redsell 2003).

Figures

1.1
1.1. Analysis
Comparison 1 Complex interventions versus no‐treatment controls, Outcome 1 Mean number of wet nights per week on treatment.
1.3
1.3. Analysis
Comparison 1 Complex interventions versus no‐treatment controls, Outcome 3 Number not achieving 14 consecutive dry nights.
1.4
1.4. Analysis
Comparison 1 Complex interventions versus no‐treatment controls, Outcome 4 Number failing or relapsing.
2.2
2.2. Analysis
Comparison 2 Complex interventions alone versus other behavioural interventions, Outcome 2 Number not achieving 14 consecutive dry nights.
2.3
2.3. Analysis
Comparison 2 Complex interventions alone versus other behavioural interventions, Outcome 3 Number failing or relapsing.
3.1
3.1. Analysis
Comparison 3 Supplemented complex interventions versus other behavioural interventions, Outcome 1 Mean number of wet nights per week on treatment.
3.3
3.3. Analysis
Comparison 3 Supplemented complex interventions versus other behavioural interventions, Outcome 3 Number not achieving 14 consecutive dry nights.
3.4
3.4. Analysis
Comparison 3 Supplemented complex interventions versus other behavioural interventions, Outcome 4 Mean number of wet nights per week at follow up.
3.5
3.5. Analysis
Comparison 3 Supplemented complex interventions versus other behavioural interventions, Outcome 5 Number failing or relapsing.
4.1
4.1. Analysis
Comparison 4 Sensitivity analysis: supplemented complex interventions versus other behavioural interventions, Outcome 1 Number not achieving 14 consecutive dry nights.
4.2
4.2. Analysis
Comparison 4 Sensitivity analysis: supplemented complex interventions versus other behavioural interventions, Outcome 2 Number failing or relapsing.
5.2
5.2. Analysis
Comparison 5 Complex interventions ‐ different training regimens, Outcome 2 Number not achieving 14 consecutive dry nights.
5.3
5.3. Analysis
Comparison 5 Complex interventions ‐ different training regimens, Outcome 3 Number failing or relapsing.
6.2
6.2. Analysis
Comparison 6 Comparing components of complex interventions, Outcome 2 Number not achieving 14 dry nights.
7.1
7.1. Analysis
Comparison 7 Complex interventions versus drugs, Outcome 1 Number not achieving 14 consecutive dry nights.
7.2
7.2. Analysis
Comparison 7 Complex interventions versus drugs, Outcome 2 Mean number of wet nights per week on treatment.
7.3
7.3. Analysis
Comparison 7 Complex interventions versus drugs, Outcome 3 Number failing or relapsing.
8.1
8.1. Analysis
Comparison 8 Educational interventions versus no‐treatment controls, Outcome 1 Number not achieving 14 consecutive dry nights.
8.2
8.2. Analysis
Comparison 8 Educational interventions versus no‐treatment controls, Outcome 2 Number failing or relapsing.
9.1
9.1. Analysis
Comparison 9 Different educational interventions compared, Outcome 1 Number not achieving 14 consecutive dry nights.
9.2
9.2. Analysis
Comparison 9 Different educational interventions compared, Outcome 2 Number failing or relapsing.
See this image and copyright information in PMC

References

References to studies included in this review

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References to other published versions of this review

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