Minimal intervention and video-mediated consultation methods in the behavioural treatment of childhood nocturnal enuresis

Abstract

Childhood nocturnal enuresis (bedwetting) is a prevalent, clinically demanding condition affecting approximately 500,000 children in the United Kingdom. At the age of 5 years, around 15-20% of all children wet the bed at least twice weekly, this figure falling to 5% at age 10 years. The disorder can have far-reaching social and emotional consequences for both the child and their family if left untreated. The most successful treatments for childhood functional (non-organic) nocturnal enuresis are of behavioural origin, namely urine alarm training and dry-bed training. The former is widely adopted in the treatment of bedwetting; however, it has a high relapse rate. In contrast, the latter tends to have a better long-term remission rate. However, due to the intricate nature of dry-bed training and costs relating to its implementation, it is rarely utilised by healthcare practitioners. Two studies reported in this thesis (the first a pilot investigation, and the second a main investigation) examined the relative efficacy of urine alarm training and a modified version of drybed training in the treatment of childhood functional nocturnal enuresis when both were delivered by identical minimal intervention methods (i.e., biblio-cumvideo therapy combined with telephone and intermittent clinic supervision) at the primary care level of service delivery. The findings demonstrated that modified drybed training was significantly superior to urine alarm training in terms of its long term remission rate. Moreover, families of bedwetting children found the modified dry-bed training programme simple to understand and implement. As a result of these findings, and as an extension into the evaluation of minimal intervention service delivery, a study was conducted to investigate the relative efficacy of modified dry-bed training delivered via video-mediated consultation and face-to-face consultation in the treatment of childhood functional nocturnal enuresis. A further objective was to evaluate patient, parent, and therapist satisfaction with video mediated consultation as compared to face-to-face consultation. The findings revealed that modified dry-bed training was equally efficacious across both consultation modes in terms of its long-term remission rate. Patients and their parents were generally satisfied with both modes of consultation, with few significant differences between the 2 consultation groups on any variable as assessed by a post-treatment patient and parent satisfaction scale. However, the therapist was more satisfied with face-to-face consultation than video-mediated consultation. Results are discussed in terms of their relevance to future research and clinical practice.