News from Annals of Internal Medicine tip sheet, Sept. 16, 2014

Kegel exercises to strengthen pelvic floor muscles, bladder training, and weight loss and exercise are effective nonsurgical treatment options for women with urinary incontinence (UI), according to a new evidence-based clinical practice guideline from the American College of Physicians (ACP) being published Annals of Internal Medicine. UI affects about 25 percent of women ages 14 to 21, 44 to 57 percent of women ages 40 to 60, and 75 percent of women ages 75 and older. These estimates may be low as one study showed that at least half of incontinent women do not report the issue to their physician.

ACP recommends that medications be avoided, if possible. Instead, women with stress UI (the inability to retain urine when laughing, coughing, or sneezing), should practice Kegel exercises, a form of pelvic floor muscle training that comprise relaxing and tightening the muscles that control urine flow. For women with urgency UI (the loss of urine for no apparent reason after suddenly feeling the need or urge to urinate), ACP recommends bladder training, a form of behavioral therapy that involves urinating on a set schedule and gradually increasing the time between urination. If bladder training is unsuccessful, ACP recommends that physicians choose a medication based on adverse effects and tolerability, ease of use, and cost. For women with mixed UI, a combination of stress and urgency incontinence, ACP recommends Kegel exercises with bladder training. For obese women with UI, ACP recommends weight loss and exercise.

Note: The URL will be live at 5:00 p.m. on Monday, September 15 and can be included in news stories. For a PDF, please contact Megan Hanks. To interview a physician from ACP, please contact Steve Majewski at smajewski@acponline.org or 215-351-2653.

Patients on generic statins have better adherence to their medication and better clinical outcomes than those taking brand-name prescriptions, according to a study being published in Annals of Internal Medicine. Statins are the most frequently prescribed drugs in the United States. When taken as prescribed, statins effectively reduce LDL cholesterol levels and cardiovascular events. However, some patients do not adhere to their medication regimen. Researchers studied health records for a cohort of more than 90,000 Medicare beneficiaries to determine whether patients are more adherent to generic statins versus brand-name statins and whether greater adherence improves health outcomes. The research showed that, compared with those who initiated a brand-name statin, patients who initiated a generic statin had better adherence to their medication and an 8 percent lower rate of a composite endpoint that included cardiovascular events and death. The researchers conclude that lower out-of-pocket costs for patients improved adherence to therapy and improved clinical outcomes.

Note: The URL will be live at 5:00 p.m. on Monday, September 15 and can be included in news stories. The summary for patients is free at http://www.annals.org/article.aspx?doi=10.7326/P14-9033. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Jessica Maki at jmaki3@partners.org or 617-525-6373.

In the short term, patients who received chiropractic care coupled with home exercise and advice reported greater reductions in back-related leg pain (BRLP) than those who received home exercise advice alone, according to a study being published in Annals of Internal Medicine. BRLP, such as sciatica, is often disabling and causes more work loss, medication use, and health-related costs than uncomplicated low back pain. Managing BRLP is complicated because there is little evidence to guide treatment decisions. Most patients with BRLP are treated with medications and injections, which raises concerns about overuse and safety. In a controlled trial, researchers randomly assigned 192 adults with subacute or chronic BRLP to either 12 weeks of chiropractic therapy plus home exercise and advice or home exercise and advice alone. Patients in the chiropractic plus exercise group were allowed up to 20 chiropractic visits during the 12-week trial. Home exercise and advice included in-person instructions on how to perform positioning and stabilization exercises and how often to do them, as well as telephone and e-mail follow up from providers. At 12 weeks, patients in the chiropractic and home exercise and advice group reported greater improvements in pain and function than those in the exercise and advice alone group. At one year, differences between groups were no longer present, except in some secondary outcomes.

Note: The URL will be live at 5:00 p.m. on Monday, September 15 and can be included in news stories. The summary for patients is free at http://www.annals.org/article.aspx?doi=10.7326/P14-9031. For a PDF, please contact Megan Hanks. The lead author may be contacted through Mr. Kit Breshears at kit@umn.edu or 612-624-2141, or Mr. Matt DePoint at mdepoint@umn.edu or 612-625-4100.