A post-market, cluster randomised controlled trial of the effect of the TENA SmartCare Change Indicator on continence care efficiency and skin health in nursing homes

Abstract

Background Urinary Incontinence (UI) is highly prevalent in older residents of nursing homes. For many, management consists of using appropriate products (pads) maintained by a check and change regimen; this is often poorly managed. Digital health technology devices, like urine saturation sensors, may aid ensure timely change of pads. This study examined the efficacy and safety of the use of the TENA SmartCare Change Indicator (Change Indicator) device for nursing home residents with UI. Methods Cluster randomised controlled trial of device use in older nursing home residents with UI, compared to usual care. Co-primary outcomes were a compound care efficiency score and change in skin health. Secondary resident and caregiver outcomes were also compared. Results Fourteen sites were recruited, nine of which operated routine check and change regimens. Included units comprised 108 residents, 53 in the intervention group and 49 in the usual care group and 83 caregivers (31 usual care, 52 intervention). The median age of residents was 87 (range 59–101) years; 21.5% were male. Care efficiency was improved by 30 min/day in the intervention group and 16 min/day in the usual care group (P > .05). There was no change in skin health. There were statistically significant improvements in sleep quality and a total of 24 hour absorbency of pads used, favouring device use. One device related harm was reported. Discussion This comparative trial of a device designed to improve the delivery of continence care to older residents of nursing homes resulted in reductions in time spent in continence care by 30 min/day, or a 31% reduction. Given that the study failed to demonstrate its primary outcome, it is difficult to assess the clinical relevance of device use. The reduction in pad use and in number of sleep interruptions are valuable outcomes. A longer-term implementation and efficacy study is warranted.