Neurourology and Urodynamics Impact of Urinary Incontinence on Medical Rehabilitation Inpatients Trudy Mallinson, 1,2 * Colleen M. Fitzgerald, 2 Cynthia E. Neville, 3,4 Orit Almagor, 5 Larry Manheim, 5 Anne Deutsch, 6,7 and Allen Heinemann 6,7 1 Office for Clinical Practice Innovation, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia 2 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois 3 SmartBody Physical Therapy, Jacksonville, Florida 4 Department of Physical Therapy, University of North Florida, Jacksonville, Florida 5 Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 6 Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 7 Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, Illinois Aims: To determine the prevalence of urinary incontinence (UI) and its association with rehabilitation outcomes in patients receiving inpatient medical rehabilitation in the United States. Methods: A retrospective, cohort study of 425,547 Medicare patients discharged from inpatient rehabilitation facilities (IRFs) in 2005. We examined prevalence of UI at admission and discharge for 5 impairment groups. We examined the impact of demographics, health, and functional status on the primary outcome, change in continence status, and secondary outcomes of discharge location and 6-month mortality. Results: Approximately one-quarter (26.6%) of men were incontinent at admission compared to 22.2% of women. In all diagnostic groups, continence status remains largely unchanged from admission to discharge. Patients who are older, have cognitive difficulties, less functional improvement, and longer lengths of stay (LOS), are more likely to remain incontinent, compared to those who improved, after controlling for patient factors and clinical variables. UI was significantly associated with discharge to another post-acute setting (PAC). For orthopedic patients, UI was associated with a 71% increase in the likelihood of discharge to an institutional setting after controlling for patient factors and clinical variables. UI was not associated with death at 6 months post-discharge. Conclusions: UI is highly prevalent in IRF patients and is associated with increased likelihood of discharge to institutional care, particularly for orthopedic patients. Greater attention to identifying and treating UI in IRF patients may reduce medical expenditures and improve other outcomes. Neurourol. Urodynam. # 2015 Wiley Periodicals, Inc. Key words: prevalence; rehabilitation centers; treatment outcome; urinary incontinence INTRODUCTION Urinary incontinence (UI) is a major public health concern that limits a person’s daily activity, community participation and overall quality of life. 1 UI affects nearly 40% of women, 2 and 17% of men, 3 with high rates over the age of 65, 4 although significant underreporting is likely. 5 By 2050, it is projected that UI will affect 28 million Americans. 6 The costs associated with UI were estimated at around 19.5 billion dollars in the U.S. annually in 2004, 7 UI is associated with poor health care outcomes, nursing home admission, and greater health care resource utilization. 8 Although there is considerable information on the preva- lence of UI in community-living elders and nursing home residents, there are few data about the prevalence of UI in patients in inpatient medical rehabilitation facilities (IRFs). IRFs include hospitals and units that provide comprehensive interdisciplinary rehabilitation for at least 15 hr per week and provide 24-hr nursing care. The primary goals of rehabili- tation are recovery of function and discharge to community. There are no United States studies reporting the prevalence of UI among rehabilitation patients across rehabilitation diagno- ses. The largest non-US study examined the prevalence of UI among rehabilitation patients in Australia and New Zealand, reporting UI in 48% of orthopedic patients, 65% of stroke patients, 61% of brain dysfunction patients, and 81% among spinal cord dysfunction patients. 9 A recent study from Austria found UI in 60% of patients with fracture. 10 A few dated studies report UI in 21–41% of US stroke patients at rehabilitation admission. 11,12 The wide variation in estimates in likely due, in part, to the lack of a clear definition of incontinence. The goal of this study was to establish a baseline description of the prevalence of UI in IRFs in the U.S. and its association with rehabilitation outcomes. We hypothesized that less Dr. Hashim Hashim led the peer-review process as the Associate Editor responsible for the paper. Potential conflicts of interest: Nothing to disclose. Portions of the material included in this manuscript were presented at the American Congress of Rehabilitation Medicine and American Society of Neurorehabilitation Joint Conference: Rehabilitation Research: Interdisciplinary, International, interactive. Toronto, Ontario, Canada, October 17, 2008 and at the International Continence Society Meeting, San Francisco, California, October 1, 2009. Grant sponsor: National Institute on Disability and Rehabilitation Research, Health Services Research DRRP on Medical Rehabilitation; Grant number: H133A030807  Correspondence to: Trudy Mallinson, Ph.D., OTR/L, NZROT, School of Medicine and Health Sciences, The George Washington University, 2100 Pennsylvania Avenue, Room 318, Washington, DC 20037. E-mail: trudy@gwu.edu Received 16 June 2015; Accepted 28 September 2015 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/nau.22908 # 2015 Wiley Periodicals, Inc.