Discussion
’ dependency, a reduced sensation of urinary urgency, incontinence, TTNS
PAD, AIDS, INCONTINENCE, INCONTINENCE
The economic analysis indicated that for the care homes involved in the study there was no meaningful change in resource use associated with continence care over time (pads, toileting assistance, health care use). Although costs were slightly lower for residents receiving TTNS than for the sham group differences were not significant. Changes to usual care pathways for continence care during the trial were the delivery of TTNS/sham intervention and the 24-hour pad collection. The latter being a trial specific activity which would not need to be continued in normal working practice. In line with the main findings of the ELECTRIC trial which reported that TTNS was not found to be clinically effective in this population [It was notable from the resource data that participants’ dependency on staff to take them to the toilet and the use of transfer and mobility aids were a daily and ongoing requirement. This was reflected in the observed lack of changes in continence care practices and therefore costs of the existing continence care pathways in care homes. If TTNS is effective then residents would be expected to experience a reduced sensation of urinary urgency and increased warning time for the need to void. However, if no additional toilet visits were provided to enable residents to void in a toilet, as opposed to using the absorbent pads to void, any effects produced by TTNS would be unlikely to be recognised. Incontinence in care homes is usually managed using absorbent pads. These can be costly to the care home and health service providers. Usage of continence products to manage UI did not change between timepoints and although costs were slightly lower for residents receiving TTNS than sham, differences were not significant. Only a small number of individuals reported use of primary care health professionals for incontinence related issues. Similarly, a small number of participants were reported as receiving medications prescribed for UI. The absence of anticholinergic medications and the very low reported use of the NHS continence service during the trial period confirmed that the usual continence care approach was to seek to contain UI rather than instigate active treatment for UI, in line with other studies [A cost consequence analysis approach was useful to indicate which costs and outcomes will be most relevant to future continence trials in care homes. Qualitative evidence indicated that a positive impact on laundry (a reduction in items requiring laundering due to UI) had been noted by one care home manager [