Sub-acute aged care hospital admission provides an opportunity to screen for urinary and faecal incontinence, to investigate and diagnose underlying causes and to begin intervention.  Although incontinence lengthens hospital stay and threatens independence it is rarely addressed during admission. We have previously noted that the highest agreement with patient- report of incontinence is with the Functional Autonomy measurement system (SMAF), a measure administer by Occupational therapists (OT) during routine in-patient assessment. The aim of this study was to identify where public health occupational therapists placed themselves on the knowledge-practice continuum of incontinence care, in order to target education that would prioritize completion rate of the SMAF measure and facilitate implementation of optimal continence care during hospitalisation.

A literature search was undertaken in google Scholar, Cochrane library, Medline, CINAHL and PsyInfo using the keywords: knowledge, beliefs, attitudes, practice enablers, barriers to practice, urinary incontinence, lower urinary tract symptoms, night, nocturia, urgency, continence, nurse, medical, staff, clinician, physician, hospital and ward. Existing measures of knowledge, attitudes, beliefs and practices related to incontinence were identified and scrutinised for relevant items. A preliminary item bank of 45 items was reduced to a 33-item urinary incontinence survey comprising information clinically relevant to occupational therapists working in public health. This measure was uploaded to a secure hospital database and online completion championed by an in-house occupational therapist. Data was analysed descriptively.

25 of 68 eligible OTs completed the urinary incontinence survey. 

Beliefs are summarized in Table 1. Overall, 96% of OTs agreed that UI is burdensome to the patient and important to address regardless of whether it is discussed. Subsequently, 84% of OTs believed that managing UI was an important part of their role and there are effective clinical treatments. However, 64% of OTs are not comfortable providing intervention to patients with bladder symptoms and 96% feel their understanding of management strategies could be significantly improved. 

Knowledge – 80% of OTs accurately demonstrated a general understanding of urinary incontinence, however, there was a gap in knowledge in relation to the different types of UI. Specifically, 80% correctly identified the definition of urgency, 48% were aware of stress incontinence and 40% of OTs accurately identified functional incontinence. 

Practices – All OTs reported identifying pre-admission UI and 96% communicated this to other staff members. Only 16% of OTs consistently referred a patient to a continence nurse specialist as an inpatient and 20% to an outpatient continence service. Use of continence pads to manage incontinence was considered appropriate by 80% of responding OTs. Functional training focused on improving skills involved with toileting, was initiated by half the responders, however, only 36% of OTs frequently provided intervention specific to urinary incontinence. This highlights the gap in knowledge in relation to managing a patient’s UI despite its perceived importance.

OTs demonstrate high awareness of UI being problematic for patients and believe that it is important to address. A cure for incontinence is not expected. Confidence in addressing UI beyond physical toileting skills was identified as a gap. Specific knowledge around assessment and intervention of incontinence in routine clinical OT care cannot be assumed.

Public health occupational therapists would support knowledge-practice education about incontinence care, in order to align practice with beliefs about patient burden of incontinence. Targeted upskilling would highlight optimal continence care during hospitalisation; as a side effect, completion rate of the SMAF measure may be increased.