Patient-Oriented Evidence That Matters
Guideline, with No Evidence, Suggests Annual Screening for Urinary Incontinence in Women
Am Fam Physician. 2019 Apr 1;99(7):459.
Should women be screened for symptoms of urinary incontinence?
The goal of screening is to identify a disorder before it becomes symptomatic if early treatment has the potential for greater benefit than waiting until symptoms are reported. Despite the failure to meet this definition, this guideline suggests annual screening of women for urinary incontinence and the effect, if any, on their lives. This guideline development group has too much investment in the recommendations to be credible, especially given the lack of evidence. (Level of Evidence = 5)
This guideline comes from the Women's Preventive Services Initiative, a collaboration between the U.S. government and the American College of Obstetricians and Gynecologists, with input from several other professional societies whose members care for women. Seeming to step on the sensible shoes of the U.S. Preventive Services Task Force, the stated goal of this group is to assure that women receive a comprehensive set of preventive services that are paid for by the government (https://www.womenspreventive-health.org/about/). This is already an inherent conflict of interest, so let us dig a little deeper. The authors performed a systematic review, finding no studies that evaluated the effectiveness of screening on improving symptoms, quality of life, or function. The strength of the evidence that supports the accuracy of screening methods is low. There is no research into the adverse effects of screening. The strength of the evidence that supports treatments for incontinence is low to moderate, and there is no evidence that suggests early detection results in better outcomes. Yet, the group has decided that clinicians should use a validated assessment instrument annually for all women to determine whether they have incontinence and whether it affects their health, function, or quality of life.
Study design: Practice guideline
Funding source: Government
Setting: Outpatient (any)
Editor's Note: Dr. Ebell is Deputy Editor for Evidence-Based Medicine for AFP and cofounder and Editor-in-Chief of Essential Evidence Plus, published by Wiley-Blackwell. Dr. Shaughnessy is an Assistant Medical Editor for AFP.
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