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Er-Rabiai Y, Torres-Lacomba M, Casaña J, Núñez-Cortés R, Calatayud J. Correlation of Self-Efficacy for Pelvic Floor Muscle Exercise with Symptoms of Stress Urinary Incontinence in Women. Int Urogynecol J 2024:10.1007/s00192-024-05818-z. [PMID: 38861006 DOI: 10.1007/s00192-024-05818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/24/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Self-efficacy for pelvic floor exercises, i.e. confidence in achieving pelvic floor contractions, may predict adherence to treatment. However, there is a paucity of literature investigating the clinical relevance of this outcome. The aim was to determine the relationship between self-efficacy for pelvic floor exercise and symptom severity, pelvic floor distress and impact on quality of life, as well as sociodemographic characteristics and pelvic floor muscle strength in women with stress urinary incontinence (SUI). METHODS A cross-sectional study was conducted in women with SUI. The Spanish version of the Broome Pelvic Muscle Self-Efficacy Scale was used to assess self-efficacy for pelvic floor exercise. The dependent variables were: urinary incontinence symptoms using the International Consultation on Incontinence Questionnaire, short form (ICIQ-SF), pelvic floor distress symptoms using the Urogenital Distress Inventory-6, impact on quality of life using the Incontinence Impact Questionnaire (IIQ-7), leakage using the 1-h pad test, number of SUI episodes per week and pelvic floor muscle strength. RESULTS A total of 56 women with a median age of 44.5 years were included. Self-efficacy for pelvic floor exercise correlated negatively and moderately with the ICIQ-SF (r = -0.529; p < 0.001), IIQ-7 (r = -0.442; p = 0.001), 1-h pad test (rs = -0.467; p < 0.001); and number of SUI episodes/week (rs = -0.489; p < 0.001). Correlation with the other outcomes was weak or non-existent. Linear regression with forward selection showed that the ICIQ-SF was the variable most related to self-efficacy (β: -3.01, 95% CI: -4.03 to -1.69). CONCLUSIONS These findings highlight the importance of assessing self-efficacy for pelvic floor exercise in the treatment of women with SUI. Future prospective studies are needed to confirm these findings.
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Affiliation(s)
- Yasmin Er-Rabiai
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - María Torres-Lacomba
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Ouchi M, Kitta T, Chiba H, Higuchi M, Abe-Takahashi Y, Togo M, Kusakabe N, Murai S, Kikuchi H, Matsumoto R, Osawa T, Abe T, Shinohara N. Physiotherapy for continence and muscle function in prostatectomy: a randomised controlled trial. BJU Int 2024. [PMID: 38658057 DOI: 10.1111/bju.16369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To assess the effectiveness of pre- and postoperative supervised pelvic floor muscle training (PFMT) on the recovery of continence and pelvic floor muscle (PFM) function after robot-assisted laparoscopic radical prostatectomy (RARP). PATIENTS AND METHODS We carried out a single-blind randomised controlled trial involving 54 male patients scheduled to undergo RARP. The intervention group started supervised PFMT 2 months before RARP and continued for 12 months after surgery with a physiotherapist. The control group was given verbal instructions, a brochure about PFMT, and lifestyle advice. The primary outcome was 24-h pad weight (g) at 3 months after RARP. The secondary outcomes were continence status (assessed by pad use), PFM function, and the Expanded Prostate Cancer Index Composite (EPIC) score. RESULTS Patients who participated in supervised PFMT showed significantly improved postoperative urinary incontinence (UI) compared with the control group (5.0 [0.0-908.0] g vs 21.0 [0.0-750.0] g; effect size: 0.34, P = 0.022) at 3 months after RARP based on 24-h pad weight. A significant improvement was seen in the intervention compared with the control group (65.2% continence [no pad use] vs 31.6% continence, respectively) at 12 months after surgery (effect size: 0.34, P = 0.030). Peak pressure during a maximum voluntary contraction was higher in the intervention group immediately after catheter removal and at 6 months, and a longer duration of sustained contraction was found in the intervention group compared with the control group. We were unable to demonstrate a difference between groups in EPIC scores. CONCLUSION Supervised PFMT can improve postoperative UI and PFM function after RARP. Further studies are needed to confirm whether intra-anal pressure reflects PFM function and affects continence status in UI in men who have undergone RARP.
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Affiliation(s)
- Mifuka Ouchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroki Chiba
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Madoka Higuchi
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yui Abe-Takahashi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mio Togo
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Naohisa Kusakabe
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Sachiyo Murai
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Kijmanawat A, Saraluck A, Manonai J, Wattanayingcharoenchai R, Aimjirakul K, Chinthakanan O. Mobile Application Based Pelvic Floor Muscle Training for Treatment of Stress Urinary Incontinence: An Assessor-Blind, Randomized, Controlled Trial. J Clin Med 2023; 12:7003. [PMID: 38002618 PMCID: PMC10672388 DOI: 10.3390/jcm12227003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to increase treatment adherence. This study compared a reduction in SUI, exercise adherence, and quality of life in PFMT with animation vs. standard instruction. A prospective, single-blind, randomized control trial was collected. SUI patients were randomized into the application or control groups confirmed using a one-hour pad test. In the intervention group, the PFMT application was applied via mobile phone (PFMT with animations, recording system, and reminder system). The standard exercise protocol was similar in both groups. Additional follow-up was conducted at 4, 8, and 12 weeks. A total of 51 participants were randomized to the application (n = 26) and control groups (n = 25), respectively. At the 12-week follow-up, there was no significant difference between the two groups in terms of SUI cure rate, SUI severity by pad test, and daily SUI episodes from the bladder diary (p-value of 0.695, 0.472, and 0.338, respectively). The mean PFME adherence in the application group was higher than the control group at 8 weeks (66.3 ± 13.6 vs. 52.7 ± 16.6, p = 0.002) and 12 weeks (59.1 ± 13.9 vs. 37.8 ± 11.0, p = 0.001). The application group reported no difference from the conventional PFMT group in terms of improvements in SUI cure rate, symptom severity, and quality of life effects at 12-week follow-up. However, the improvement evaluated by the mean difference in SUI episodes and quality of life effects (ICIQ-UI SF) reported a better outcome in the mobile app group. The PFMT application has been proven to be an effective tool that improves PFMT adherence.
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Affiliation(s)
| | | | | | | | | | - Orawee Chinthakanan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (A.K.); (A.S.); (J.M.); (R.W.); (K.A.)
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Takacs P, Pákozdy K, Koroknai E, Erdődi B, Krasznai Z, Kozma B. A randomized controlled pilot trial to assess the effectiveness of a specially formulated food supplement and pelvic floor muscle training in women with stress-predominant urinary incontinence. BMC Womens Health 2023; 23:321. [PMID: 37340306 DOI: 10.1186/s12905-023-02476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/10/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is the first-line treatment approach for stress urinary incontinence. Creatine and leucine have been shown to improve muscle function. Our aim was to assess the effectiveness of a food supplement and PFMT in women with stress-predominant urinary incontinence. METHODS Women with stress-predominant urinary incontinence were randomized in 1:1 ratio to receive daily oral supplementation for six weeks with either a food supplement (treatment group) or placebo (control group). Both groups were instructed to perform standardized daily PFMT. The primary outcome was the Urogenital Distress Inventory Short Form (UDI-6) score. Secondary outcomes were the Incontinence Impact Questionnaire (IIQ-7) score, Patient's Global Impression of Severity (PGI-S), and Biomechanical Integrity score (BI-score) measured by Vaginal Tactile Imager. To have a power of 80% and a significance level of 5% to detect a decrease of 16 points in the UDI-6 score, a sample size of 32 was needed, with 16 patients in each arm of our trial. RESULTS Sixteen women in the control group and sixteen in the treatment group completed the trial. Between-group analysis revealed no significant differences between the control and treatment group except for mean change (delta) in vaginal squeeze pressure [(cmH2O, mean ± SD), 5 ± 12 vs. 15 ± 15, P = 0.04] and mean change (delta) in PGI-S score [(mean ± SD), -0.2 ± 0.9 vs. -0.8 ± 0.8, P = 0.04]. Within-group analysis showed that UDI-6 and IIQ-7 scores improved significantly from baseline to six weeks in the treatment group but not in the control group [UDI-6 score (mean ± SD) 45 ± 21 vs. 29 ± 21, P = 0.02; 43 ± 18 vs. 33 ± 26, P = 0.22] [IIQ-7 score (mean ± SD) 50 ± 30 vs. 30 ± 21, P = 0.01; 48 ± 23 vs.40 ± 28, P = 0.36]. PGI-S scores only improved in the treatment group from baseline to six weeks after treatment [PGI-S score (mean ± SD) 3.1 ± 0.8 vs. 2.3 ± 0.8, P = 0.0001]. BI-score, on average, improved significantly in the treatment and control group as well [SD unit, mean, from - 1.06 to -0.58, P = 0.001; from - 0.66 to -0.42, P = 0.04]. CONCLUSIONS Women with stress-predominant urinary incontinence receiving a specially formulated supplement in addition to daily PFMT for six weeks had significantly improved urinary symptoms (decrease in UDI-6 score and IIQ-7) and BI-score compared to their baseline. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05358769. 27/04/2022.
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Affiliation(s)
- Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 526, Norfolk, VG, 23507-2007, USA
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Krisztina Pákozdy
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Erzsébet Koroknai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Balázs Erdődi
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Zoárd Krasznai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Bence Kozma
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary.
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Cross D, Waheed N, Krake M, Gahreman D. Effectiveness of supervised Kegel exercises using bio-feedback versus unsupervised Kegel exercises on stress urinary incontinence: a quasi-experimental study. Int Urogynecol J 2023; 34:913-920. [PMID: 35802177 PMCID: PMC9266083 DOI: 10.1007/s00192-022-05281-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate and compare the efficacy of supervised Kegel exercises with bio-feedback on stress urinary incontinence (SUI) and pelvic floor muscle strength (PFMS) compared with unsupervised Kegel exercises. METHOD Matched-group quasi-experimental study of 29 female participants divided into two groups (supervised and non-supervised) was conducted over 12 weeks. Baseline measurements of PFMS were undertaken by a women's health physiotherapist and a Kegel exercise regime bespoke designed for each participant. The supervised group visited the physiotherapist monthly for bio-feedback training (BT); the unsupervised group continued at home with their individualised Kegel exercises. Data were collected via a perineometer (Peritron™) and self-reporting responses to questionnaires. All participants received a final PFMS measurement on completion of the study. RESULTS Overall Incontinence Severity index (ISI) score was significantly lower in the supervised group post-intervention. Wilcoxon signed-rank tests indicated that supervised Kegel exercises significantly reduced frequency (p= 0.002) and severity (p= 0.020) of overall ISI. Analysis of PFMS were not significantly different, despite an increase in maximum voluntary contraction or pelvic floor muscle strength (PFMS) (p= 0.032) in the supervised group. Of the questionnaires, results of Wilcoxon signed-rank tests indicated that "total bother" was significantly reduced (p= 0.005) in the supervised group. The correlation analysis between PFMS and ISI did not reveal any significant results. CONCLUSIONS The study confirmed that supervised BT is more effective in reducing SUI than unsupervised Kegel exercises, and that this reduction in ISI score did not correlate with the improvement in PFMS.
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Affiliation(s)
- Donelle Cross
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, 0909, Australia.
- College of Nursing and Health Sciences, Flinders University, Bedford Park, 5042, Australia.
| | - Nasreena Waheed
- College of Nursing and Health Sciences, Flinders University, Bedford Park, 5042, Australia
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, 0909, Australia
| | | | - Daniel Gahreman
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, 0909, Australia
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Papanikolaou DT, Lampropoulou S, Giannitsas K, Skoura A, Fousekis K, Billis E. Pelvic floor muscle training: Novel versus traditional remote rehabilitation methods. A systematic review and meta-analysis on their effectiveness for women with urinary incontinence. Neurourol Urodyn 2023; 42:856-874. [PMID: 36808744 DOI: 10.1002/nau.25150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To investigate the effectiveness of supervised remote rehabilitation programs comprising novel methods of pelvic floor muscle (PFM) training for women with urinary incontinence (UI). DESIGN A systematic review and meta-analysis including randomized controlled trials (RCTs), involving novel supervised PFM rehabilitation programs as intervention groups (e.g., mobile applications programs, web-based programs, vaginal devices) versus more traditional PFM exercise groups (acting as control); both sets of groups being offered remotely. METHODS Data have been searched and retrieved from the electronic databases of Medline, PUBMED, and PEDro using relevant key words and MeSH terms. All included study data were handled as reported in the Cochrane Handbook for Systematic Reviews of Interventions and the evaluation of their quality was undertaken utilizing the Cochrane risk-of-bias tool 2 (RoB2) for RCTs. The included RCTs, involved adult women with stress UI (SUI) or mixed urinary incontinence, where SUI were the most predominant symptoms. Exclusion criteria involved pregnant women or up to 6-month postpartum, systemic diseases and malignancies, major gynecological surgeries or gynecological problems, neurological dysfunction or mental impairments. The searched outcomes included subjective and objective improvements of SUI and exercise adherence in PFM exercises. Meta-analysis was conducted and included studies pulled by the same outcome measure. RESULTS The systematic review included 8 RCTs with 977 participants. Novel rehabilitation programs included mobile applications (1 study), web-based programs (1 study) and vaginal devices (6 studies) versus more traditional remote PFM training, involving home-based PFM exercise programs (8 studies). Estimated quality with Cochrane's RoB2, presented the 80% of the included studies as "some concerns" and the 20% as "high risk." Meta-analysis included 3 studies with no heterogeneity (I2 = 0) across them. Weak-evidenced results presented home PFM training equally effective with novel PFM training methods (mean difference: 0.13, 95% confidence interval: -0.47, 0.73), with small total effect size (0.43). CONCLUSIONS Novel PFM rehabilitation programs presented as effective (but not superior) to traditional ones in women with SUI, both offered remotely. However, individual parameters of novel remote rehabilitation including supervision by the health professional, remains in question and larger RCTs are required. Connection between devices and applications in combination with real-time synchronous communication between patient and clinician during treatment is challenged for further research across novel rehabilitation programs.
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Affiliation(s)
- Dimitra Tania Papanikolaou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Sofia Lampropoulou
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | | | - Anastasia Skoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Konstantinos Fousekis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Evdokia Billis
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
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Kumar V, Malhotra V, Sinha V. Evaluation of Individual Quality of Life (QOL) Among Patients with Tracheostomy Using WHO-QOL BREF Questionnaire. Indian J Otolaryngol Head Neck Surg 2022; 74:5207-5216. [PMID: 36742676 PMCID: PMC9895232 DOI: 10.1007/s12070-020-02052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Tracheostomy is one of the most frequently performed surgical procedures worldwide. The placement of tracheostomy in a patient is associated with significant morbidities as apart from the physical impact of the procedure, a profound and persistent effect on psychosocial, financial, environmental and other aspects of global health of the patient becomes inevitable. However, there is a surprising paucity of literature assessing the Quality of Life (QOL) in patients with tracheostomy tube placement. This study was undertaken with the objective to assess the effect of tracheostomy on Quality of Life (QOL) of patients in an urban tertiary health care setup in India. Patients who underwent tracheostomy tube placement irrespective of the indication were included in the study and followed up for a period of up to 3 months to determine the effect of tracheostomy tube placement on the Quality of Life. A questionnaire based on World Health Organisation (WHO) QOL BREF scheme was utilized to evaluate QOL in the immediate post operative period and again appraised after a period of 3 months. The results were statistically analyzed, tabulated and compared using paired t test to evaluate the 'p' value in every domain i.e., physical, social, psychological and environmental, of the WHO QOL-BREF evaluation tool. 63 patients were enrolled in the study after excluding the patients not fulfilling the selection criteria. The majority of patients were male over the age of 50 years (mean age 57 years). There was a noteworthy depreciation in QOL score in patients as WHO-QOL-BREF scores in all the 4 domains were significantly lower after 3 months. The most affected were the Environmental domain (p value 5E-15) whereas the domain of Psychological showed least depreciation of mean QOL score (p value 7.7E-5). Insertion of a tracheostomy tube has a significant impact on the quality of life of the patient and the amount of burden increases with worsening quality of life. A holistic and scientific approach to assess and manage tracheostomy induced morbidity on the patient is necessary. The patients' views of the aspects of life should be used by health policy makers, clinicians, and caregivers as a reliable guide to the most important priorities for treatment and medical interventions. Large prospective multicenter studies may be undertaken for the developement of a standardized and internationally accepted tracheostomy specific quality of life evaluation tool.
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Affiliation(s)
- Vivek Kumar
- Department of ENT, PMCH, Ashok Rajpath, Patna, 800004 India
| | | | - Vineet Sinha
- Department of ENT, PMCH, Ashok Rajpath, Patna, 800004 India
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Brosina de Leon E, Cardoso MN, de Brito E, dos Santos MM, Almeida FA. The development of a physical therapy service to treat urinary incontinence: Results of a RE-AIM evaluation. Front Glob Womens Health 2022; 3:1004140. [DOI: 10.3389/fgwh.2022.1004140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundA conservative physiotherapy service development addressed to treat urinary incontinence for older women was studied using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework.DesignWe conducted a pragmatic case study design based on RE-AIM.Settings/participantsIncluded women ≥ 60 years of age, with self-reported UI symptoms.ResultsA total of 34 older women were enrolled in the service with a mean age of 61.53 years. There was a significant improvement in the strength of the pelvic floor muscles, power, endurance, and fast contraction capacity after the intervention, however, it was observed a high dropout rate. Program implementation was supported by Physical Therapy teams who engaged in care coordination. The program has been maintained for over 4 years.ConclusionOur findings demonstrate that UI patients would benefit from physiotherapy treatment and that this intervention is feasible. This RE-AIM evaluation provides lessons learned and strategies for future adoption, implementation, and maintenance of a Physical Therapy pelvic service.
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Tunuguntla HSGR, Tunuguntla R, Kathuria H, Sidana A, Chaudhari N, Verma S, Shivanand I. App-based Yoga of Immortals: A Novel, Easy-to-use Intervention in the Management of Urinary Incontinence. Urology 2022; 167:73-81. [PMID: 35788018 DOI: 10.1016/j.urology.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the effectiveness Yoga of Immortals (YOI) intervention in participants with urinary incontinence (UI) of all types. YOI uniquely combines specific yogic postures, breathing exercises, sound therapy & meditation and is practiced by many for general well-being. MATERIALS AND METHODS In this App-based cohort study, a survey was sent to the YOI app subscribers. Those who identified with UI and consented were sent the ICIQ-UI- SF (for mean symptom score & severity of UI), and the ICIQ-LUTS-QOL (for impact of UI on QOL) Questionnaires at baseline, 4, and 8 weeks. Global impression of improvement was assessed by PGI-I scale. RESULTS 258/422 participants (18-74 years) were included and showed significant decrease in mean scores on the ICIQ-UI-SF (4.06 ± 0.24 at baseline; 2.90 ± 0.22 at 4-weeks [p ≤ 0.001] and 3.44 ± 0.23 at 8 weeks [p ≤ 0.001]) and ICIQ-LUTS-QOL (28.36± 0.74 at baseline; 24.46± 0.70 at 4-weeks [p ≤ 0.001] and 25.78± 0.70 at 8 weeks [p≤ 0.001]). Additionally, the 55-60 year subgroup also had significant decrease in mean scores on ICIQ-LUTS-QOL (25.06 ±1.20 at base line; 21.69 ± 1.07 at 4 weeks [p ≤ 0.01] and 22.28 ± 0.96 at 8 weeks [p ≤ 0.01]). CONCLUSION YOI intervention resulted in significant improvement in mean scores on ICIQ-LUTS-QOL; ICIQ-UI-SF; frequency and severity of urinary leak; and daily life activity. Majority of the participants felt 'very much better' on PGI-scale. Being app- based, it has the added advantage of the ability to be used anytime and anywhere.
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Affiliation(s)
- Hari Siva Gurunadha Rao Tunuguntla
- Department of Surgery, Division of Urology, Director, Section of Female Pelvic Medicine and Reconstructive Surgery, Voiding Dysfunction, Functional Urology, Neuro-Urology, Male Lower Genitourinary Reconstruction, Genitourinary Prosthetics, and Urodynamics, Robert Wood Johnson Medical School & Robert Wood Johnson University Hospital, 1, RWJ Place, New Brunswick, NJ 08901, USA.
| | - Renuka Tunuguntla
- Hunterdon Medical Center, Center for Healthy Aging, 121 Route 31, Suite 1000, Fleminton, NJ 08822, USA.
| | - Himanshu Kathuria
- Department of Pharmacy, National University of Singapore, Singapore 117543, Republic of Singapore.
| | - Abhinav Sidana
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267.
| | | | - Sadhna Verma
- The Cincinnati Veterans Administration Hospital & University of Cincinnati College of Medicine, 234 Goodman Street, Cincinnati, OH 45267-0761.
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Jochum F, Garbin O, Godet J, Ragueneau M, Meyer C, Billecocq S, Lecointre L, Akladios C, Host A. Prospective evaluation of the connected biofeedback EMY Kegel trainer in the management of stress urinary incontinence. J Gynecol Obstet Hum Reprod 2021; 51:102280. [PMID: 34861424 DOI: 10.1016/j.jogoh.2021.102280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/15/2021] [Accepted: 11/28/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate changes in the quality of life with the connected biofeedback EMY Kegel trainer in patients suffering from stress urinary incontinence. Materiel and methods: This was a prospective, single-center, non-comparative study, which took place between September 2019 and October 2020, in the University Hospitals of Strasbourg. Eligible patients were instructed to use the EMY probe for a minimum of 10 min per day for five days per week. To assess quality of life and urinary symptoms, the Contilife and ICIQ-SF scores were completed each month until the final visit (M3). The PGI-I was also completed at 3 months to assess the benefit of the EMY Kegel Trainer. RESULTS A total of 55 patients were included. At the inclusion visit (M0), the mean Contilife and ICIQ-SF scores were respectively at 6.6 ± 1.5 and 10.5 ± 3.0 points. At the final visit (M3), the mean Contilife score increased to 9.2 ± 1.0, indicating an improvement in quality of life. The mean ICIQ-SF score decreased to 4.2 ± 4.0, indicating an improvement in urinary symptoms. The PGI-I questionnaire identified a positive assessement of the EMY Kegel trainer. On the 55 patients included, 35 (64%) reported completing at least 36 sessions during the study, i.e. an average of 3 sessions per week. CONCLUSIONS This study suggests that perineal rehabilitation by biofeedback using the EMY Kegel trainer might be beneficial.
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Affiliation(s)
- Floriane Jochum
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France.
| | - Olivier Garbin
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Julien Godet
- Groupe Méthodes en Recherche Clinique, Strasbourg University Hospital, Strasbourg, France
| | - Mathilde Ragueneau
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Chantal Meyer
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Sylvie Billecocq
- Maternité Notre Dame Du Bon Secours, Hôpital Saint-Joseph, Paris, France
| | - Lise Lecointre
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France; I-Cube UMR 7357 - Laboratoire des Sciences de l'ingénieur, de l'informatique et de l'imagerie. Université de Strasbourg, Strasbourg, France; Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
| | - Chérif Akladios
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Aline Host
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
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Hagen S, Bugge C, Dean SG, Elders A, Hay-Smith J, Kilonzo M, McClurg D, Abdel-Fattah M, Agur W, Andreis F, Booth J, Dimitrova M, Gillespie N, Glazener C, Grant A, Guerrero KL, Henderson L, Kovandzic M, McDonald A, Norrie J, Sergenson N, Stratton S, Taylor A, Williams LR. Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: the OPAL RCT. Health Technol Assess 2021; 24:1-144. [PMID: 33289476 DOI: 10.3310/hta24700] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Urinary incontinence affects one in three women worldwide. Pelvic floor muscle training is an effective treatment. Electromyography biofeedback (providing visual or auditory feedback of internal muscle movement) is an adjunct that may improve outcomes. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of biofeedback-mediated intensive pelvic floor muscle training (biofeedback pelvic floor muscle training) compared with basic pelvic floor muscle training for treating female stress urinary incontinence or mixed urinary incontinence. DESIGN A multicentre, parallel-group randomised controlled trial of the clinical effectiveness and cost-effectiveness of biofeedback pelvic floor muscle training compared with basic pelvic floor muscle training, with a mixed-methods process evaluation and a longitudinal qualitative case study. Group allocation was by web-based application, with minimisation by urinary incontinence type, centre, age and baseline urinary incontinence severity. Participants, therapy providers and researchers were not blinded to group allocation. Six-month pelvic floor muscle assessments were conducted by a blinded assessor. SETTING This trial was set in UK community and outpatient care settings. PARTICIPANTS Women aged ≥ 18 years, with new stress urinary incontinence or mixed urinary incontinence. The following women were excluded: those with urgency urinary incontinence alone, those who had received formal instruction in pelvic floor muscle training in the previous year, those unable to contract their pelvic floor muscles, those pregnant or < 6 months postnatal, those with prolapse greater than stage II, those currently having treatment for pelvic cancer, those with cognitive impairment affecting capacity to give informed consent, those with neurological disease, those with a known nickel allergy or sensitivity and those currently participating in other research relating to their urinary incontinence. INTERVENTIONS Both groups were offered six appointments over 16 weeks to receive biofeedback pelvic floor muscle training or basic pelvic floor muscle training. Home biofeedback units were provided to the biofeedback pelvic floor muscle training group. Behaviour change techniques were built in to both interventions. MAIN OUTCOME MEASURES The primary outcome was urinary incontinence severity at 24 months (measured using the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form score, range 0-21, with a higher score indicating greater severity). The secondary outcomes were urinary incontinence cure/improvement, other urinary and pelvic floor symptoms, urinary incontinence-specific quality of life, self-efficacy for pelvic floor muscle training, global impression of improvement in urinary incontinence, adherence to the exercise, uptake of other urinary incontinence treatment and pelvic floor muscle function. The primary health economic outcome was incremental cost per quality-adjusted-life-year gained at 24 months. RESULTS A total of 300 participants were randomised per group. The primary analysis included 225 and 235 participants (biofeedback and basic pelvic floor muscle training, respectively). The mean 24-month International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form score was 8.2 (standard deviation 5.1) for biofeedback pelvic floor muscle training and 8.5 (standard deviation 4.9) for basic pelvic floor muscle training (adjusted mean difference -0.09, 95% confidence interval -0.92 to 0.75; p = 0.84). A total of 48 participants had a non-serious adverse event (34 in the biofeedback pelvic floor muscle training group and 14 in the basic pelvic floor muscle training group), of whom 23 (21 in the biofeedback pelvic floor muscle training group and 2 in the basic pelvic floor muscle training group) had an event related/possibly related to the interventions. In addition, there were eight serious adverse events (six in the biofeedback pelvic floor muscle training group and two in the basic pelvic floor muscle training group), all unrelated to the interventions. At 24 months, biofeedback pelvic floor muscle training was not significantly more expensive than basic pelvic floor muscle training, but neither was it associated with significantly more quality-adjusted life-years. The probability that biofeedback pelvic floor muscle training would be cost-effective was 48% at a £20,000 willingness to pay for a quality-adjusted life-year threshold. The process evaluation confirmed that the biofeedback pelvic floor muscle training group received an intensified intervention and both groups received basic pelvic floor muscle training core components. Women were positive about both interventions, adherence to both interventions was similar and both interventions were facilitated by desire to improve their urinary incontinence and hindered by lack of time. LIMITATIONS Women unable to contract their muscles were excluded, as biofeedback is recommended for these women. CONCLUSIONS There was no evidence of a difference between biofeedback pelvic floor muscle training and basic pelvic floor muscle training. FUTURE WORK Research should investigate other ways to intensify pelvic floor muscle training to improve continence outcomes. TRIAL REGISTRATION Current Controlled Trial ISRCTN57746448. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 70. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Dunedin, New Zealand
| | - Mary Kilonzo
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Wael Agur
- NHS Ayrshire and Arran, Kilmarnock, UK
| | - Federico Andreis
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Joanne Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maria Dimitrova
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nicola Gillespie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Cathryn Glazener
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Aileen Grant
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Karen L Guerrero
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lorna Henderson
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Marija Kovandzic
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Nicole Sergenson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Susan Stratton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anne Taylor
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Louise R Williams
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Effects of Biofeedback-Guided Pelvic Floor Muscle Training With and Without Extracorporeal Magnetic Innervation Therapy on Stress Incontinence: A Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2021; 48:153-161. [PMID: 33690249 DOI: 10.1097/won.0000000000000740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We evaluated the effects of biofeedback-guided pelvic floor muscle training (EMG-BF), with and without extracorporeal magnetic innervation (EMG-BF+ExMI) therapy on lower urinary tract symptoms based on frequency of stress urinary incontinence (SUI) and grams of urine loss, health-related quality of life, and sexual function in women with SUI. DESIGN This was a randomized controlled trial. SUBJECTS AND SETTING The sample comprised 51 adult women with SUI. Their mean age was 50.92 years (SD 8.88). Twenty-six were randomly allocated to EMG-BF alone and 25 were allocated to undergo EMG-BF+ExMI. METHODS This study's main outcome was lower urinary tract symptoms measured via the 1-hour pad test (grams of urine loss) and a 3-day bladder diary (frequency of stress incontinence episodes). Additional outcome measures were health-related quality of life measured with the Incontinence Quality of Life (I-QOL) questionnaire, sexual function evaluated via the Female Sexual Function Index (FSFI), and pelvic floor muscle contraction force measured via a perineometer and Modified Oxford Scale (MOS). All participants underwent biofeedback-enhanced pelvic floor muscle training using EMG during 20-minute sessions twice weekly for a period of 8 weeks. In addition to the EMG-BF+ExMI group, ExMI was applied during 20-minute sessions twice weekly for a period of 8 weeks. Participants from both groups were asked to perform pelvic floor muscle exercises at home (60 pelvic floor muscle contractions daily, divided into 3 sessions of 20 contractions each). Outcome measures were made at baseline and repeated at the end of treatment. RESULTS Fifteen (57.7%) in the EMG-BF group and 13 (52.0%) in the EMG-BF+ExMI group achieved dryness. Four participants (15.4%) in the EMG-BF group and 5 (20%) in the EMG-BF+ExMI group experienced improvement. Seven patients (26.9%) in the EMG-BF group and 7 (28%) in the EMG-BF+ExMI group did not benefit from the treatments. There was no statistically significant difference between the groups in terms of cure and improvement (P = .895). CONCLUSIONS Findings indicate that use of magnetic innervation does not improve lower urinary tract symptoms, health-related quality of life, sexual function, and pelvic floor muscle strength when compared to pelvic floor muscle training alone.
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Takahashi S, Takei M, Asakura H, Gotoh M, Ishizuka O, Kato K, Koyama M, Takeyama M, Tomoe H, Yamanishi T, Yokoyama O, Yoshida M, Yoshimura Y, Yoshizawa T. Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition). Int J Urol 2021; 28:474-492. [PMID: 33650242 DOI: 10.1111/iju.14492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100 mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100 mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masami Takeyama
- Urogynecology Center, First Towakai Hospital, Takatsuki, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasukuni Yoshimura
- Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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Fuentes-Aparicio L, Balasch-Bernat M, López-Bueno L. Add-On Effect of Postural Instructions to Abdominopelvic Exercise on Urinary Symptoms and Quality of Life in Climacteric Women with Stress Urinary Incontinence. A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:928. [PMID: 33494479 PMCID: PMC7908128 DOI: 10.3390/ijerph18030928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/24/2022]
Abstract
The aim of this study was to investigate the add-on effect of postural instructions to an abdominopelvic exercise program on incontinence urinary symptoms (UI symptoms) and quality of life (QoL) in climacteric women with stress urinary incontinence (SUI). A randomized controlled trial was performed with a total of 40 climacteric women with SUI aged between 46 and 75 years old. Participants were randomly assigned to two groups: a group performing an abdominopelvic exercise program (AEP) (n = 20) and a group performing abdominopelvic exercise with the addition of postural instructions (AEPPI) (n = 20). Primary outcome measures were UI symptoms, UI impact and QoL related to UI (UI-QoL), measured by 48 h Pad Test and International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF), which were assessed at baseline, post-intervention and 3 months follow-up. Secondary outcome was patient's satisfaction measured by the 100-point Visual Analogic Scale (VAS) only after the intervention. Between-groups differences were observed in terms of UI-QoL immediately after intervention. Within-groups differences were observed between baseline to 3 months follow-up and between post-intervention to 3 months follow-up in AEPPI group (p < 0.05) for UI-QoL and UI impact. UI symptoms were improved in both groups between baseline to 3-months follow-up (p < 0.05). Patient's satisfaction was higher in the AEPPI group (p < 0.05). The addition of postural instructions to an abdominopelvic exercise program improves UI impact to QoL and patients' satisfaction in women with SUI.
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Affiliation(s)
- Laura Fuentes-Aparicio
- Department of Physiotherapy, University of Valencia, Gascó Oliag, 5, 46010 Valencia, Spain; (L.F.-A.); (L.L.-B.)
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Gascó Oliag, 5, 46010 Valencia, Spain
| | - Mercè Balasch-Bernat
- Department of Physiotherapy, University of Valencia, Gascó Oliag, 5, 46010 Valencia, Spain; (L.F.-A.); (L.L.-B.)
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Gascó Oliag, 5, 46010 Valencia, Spain
| | - Laura López-Bueno
- Department of Physiotherapy, University of Valencia, Gascó Oliag, 5, 46010 Valencia, Spain; (L.F.-A.); (L.L.-B.)
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15
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Bou Kheir G, Grande P, Roumeguère T. [Home-based devices for the treatment of female urinary incontinence: A literature review]. Prog Urol 2020; 31:186-194. [PMID: 33358466 DOI: 10.1016/j.purol.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 11/02/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Literature review on the home-based options for the conservative management of stress urinary incontinence including biofeedback and weighted vaginal cones.. METHODS Research was conducted in the Cochrane Library and Pubmed to find articles, published until March 2020, dealing with the conservative management of incontinence. RESULTS A total of 9 randomized controlled trials were included, 4 concerning biofeedback and 5 concerning vaginal cones. Most of them highlighted the superiority of these three methods compared to the absence of treatment but were not superior compared to the pelvic floor muscles training in the clinic setting. CONCLUSION Home-based devices for female stress urinary incontinence is a safe and effective treatment for female urinary incontinence. It has not shown superiority to physiotherapist-guided pelvic floor muscle reinforcement and needs more evidence to gain its place as a first line therapeutic option.
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Affiliation(s)
- G Bou Kheir
- Urology department, university clinics of Brussels, hôpital Erasme, université libre de Bruxelles, Route de Lennik 808, Brussels, Belgique.
| | - P Grande
- Urology department, hospital Centre Sud-Essonne, Étampes, France
| | - T Roumeguère
- Urology department, university clinics of Brussels, hôpital Erasme, université libre de Bruxelles, Route de Lennik 808, Brussels, Belgique
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Bertuit J, Barrau M, Huet S, Rejano-Campo M. Intérêt des applications mobiles et internet dans la prise en charge de l’incontinence urinaire d’effort chez la femme. Prog Urol 2020; 30:1022-1037. [DOI: 10.1016/j.purol.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/04/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
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Hagen S, Elders A, Stratton S, Sergenson N, Bugge C, Dean S, Hay-Smith J, Kilonzo M, Dimitrova M, Abdel-Fattah M, Agur W, Booth J, Glazener C, Guerrero K, McDonald A, Norrie J, Williams LR, McClurg D. Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial. BMJ 2020; 371:m3719. [PMID: 33055247 PMCID: PMC7555069 DOI: 10.1136/bmj.m3719] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women. DESIGN Parallel group randomised controlled trial. SETTING 23 community and secondary care centres providing continence care in Scotland and England. PARTICIPANTS 600 women aged 18 and older, newly presenting with stress or mixed urinary incontinence between February 2014 and July 2016: 300 were randomised to PFMT plus electromyographic biofeedback and 300 to PFMT alone. INTERVENTIONS Participants in both groups were offered six appointments with a continence therapist over 16 weeks. Participants in the biofeedback PFMT group received supervised PFMT and a home PFMT programme, incorporating electromyographic biofeedback during clinic appointments and at home. The PFMT group received supervised PFMT and a home PFMT programme. PFMT programmes were progressed over the appointments. MAIN OUTCOME MEASURES The primary outcome was self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form (ICIQ-UI SF), range 0 to 21, higher scores indicating greater severity) at 24 months. Secondary outcomes were cure or improvement, other pelvic floor symptoms, condition specific quality of life, women's perception of improvement, pelvic floor muscle function, uptake of other urinary incontinence treatment, PFMT self-efficacy, adherence, intervention costs, and quality adjusted life years. RESULTS Mean ICIQ-UI SF scores at 24 months were 8.2 (SD 5.1, n=225) in the biofeedback PFMT group and 8.5 (SD 4.9, n=235) in the PFMT group (mean difference -0.09, 95% confidence interval -0.92 to 0.75, P=0.84). Biofeedback PFMT had similar costs (mean difference £121 ($154; €133), -£409 to £651, P=0.64) and quality adjusted life years (-0.04, -0.12 to 0.04, P=0.28) to PFMT. 48 participants reported an adverse event: for 23 this was related or possibly related to the interventions. CONCLUSIONS At 24 months no evidence was found of any important difference in severity of urinary incontinence between PFMT plus electromyographic biofeedback and PFMT alone groups. Routine use of electromyographic biofeedback with PFMT should not be recommended. Other ways of maximising the effects of PFMT should be investigated. TRIAL REGISTRATION ISRCTN57756448.
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Affiliation(s)
- Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Susan Stratton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Nicole Sergenson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Sarah Dean
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Maria Dimitrova
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Mohamed Abdel-Fattah
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Wael Agur
- Crosshouse Hospital, NHS Ayrshire and Arran, Crosshouse, Kilmarnock, UK
| | - Jo Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Cathryn Glazener
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Karen Guerrero
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Louise R Williams
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
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Al Belushi ZI, Al Kiyumi MH, Al-Mazrui AA, Jaju S, Alrawahi AH, Al Mahrezi AM. Effects of home-based pelvic floor muscle training on decreasing symptoms of stress urinary incontinence and improving the quality of life of urban adult Omani women: A randomized controlled single-blind study. Neurourol Urodyn 2020; 39:1557-1566. [PMID: 32483851 DOI: 10.1002/nau.24404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/15/2023]
Abstract
AIM This study aims to determine the effectiveness of home-based pelvic floor muscle training (PFMT) on decreasing the severity of symptoms and improving the quality of life (QOL) among Omani women with stress urinary incontinence (SUI). METHODS A randomized controlled single-blind trial was conducted in three primary health care centers in Muscat. Eligible women who were diagnosed with SUI (from a concurrent phase-I study which was a cross-sectional study to determine the prevalence of urinary incontinence in Oman) were invited to take part. The consenting subjects were randomly allocated to either an intervention group (unsupervised PFMT) or a control group (lecture with no PFMT). Baseline and 12-week assessment of both groups was carried out for the primary outcome using the validated Arabic version of the International Consultation on Incontinence Questionnaire (ICIQ)-short form and the secondary outcome by blinded measures of pelvic floor muscle (PFM) strength using the modified Oxford grading system (MOGS), endurance, and perineometer. RESULTS A total of 73 subjects were included in the study. They were randomly divided into two groups. Both groups were similar at the baseline in terms of sociodemographic characteristics, ICIQ score, and PFM strength. At the 12-weeks assessment, there was a significant difference in the ICIQ score (P < .001) between the intervention group and the control one. There was no statistical difference between the two groups in MOGS, endurance, or perineometer values. CONCLUSIONS The home-based PFMT is an effective treatment in reducing the severity of symptoms and improving the QOL in women with SUI.
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Affiliation(s)
- Zalikha I Al Belushi
- Department of Primary Care, North Batinah Governorate, Ministry of Health, Suhar, Oman
| | - Maisa H Al Kiyumi
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ahlaam A Al-Mazrui
- Physiotherapy Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sanjay Jaju
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Abdul H Alrawahi
- Department of Research and Studies, Oman Medical Specialty Board, Muscat, Oman
| | - Abdulaziz M Al Mahrezi
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman
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Ouchi M, Kitta T, Takahashi Y, Chiba H, Higuchi M, Togo M, Shinohara N. Reliability of manometry for assessing pelvic floor muscle function in healthy men. Neurourol Urodyn 2020; 39:1464-1471. [PMID: 32339324 PMCID: PMC7384036 DOI: 10.1002/nau.24374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/23/2020] [Accepted: 04/14/2020] [Indexed: 11/08/2022]
Abstract
Objectives To the best of our knowledge, no study has examined the reliability of assessment methods for male pelvic floor muscle (PFM) function. Therefore, this study aimed to clarify the reliability of manometry with an anal sensor (Peritron cat 9300A) to assess PFM function in healthy men. Methods Healthy male subjects (n = 21) without urinary leakage underwent testing to assess PFM function, and intra‐ and interrater reliability tests among examiners were performed. The PFM function included maximal anorectal squeeze pressure, endurance, mean anorectal squeeze pressure, gradient, and area under the curve during PFM voluntary contraction. Results Participants had a median age of 38 years (range 26‐51), and a mean BMI of 23.2 ± 2.0 kg/m2. Satisfactory intra‐ and interrater reliability scores were found for resting pressure, anorectal squeeze pressure, and endurance. The intra‐rater reliability of resting pressure, anorectal squeeze pressure, and endurance were 0.71, 0.89, and 0.75 for examiner 1 and 0.72, 0.89, and 0.87 for examiner 2. The interrater reliability for resting pressure, anorectal squeeze pressure, and endurance were 0.58, 0.93, and 0.61, respectively. Conclusions This is the first prospective study showing the favorable intra‐ and interrater reliability of manometry for PFM function in healthy men. Our findings demonstrated that manometry can provide both reliable and reproducible data regarding PFM function in continent men, suggesting Peritron cat 9300A can be used to evaluate the PFM function in men.
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Affiliation(s)
- Mifuka Ouchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Japan.,Department of Physical Therapy, School of Rehabilitation Sciences, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Japan
| | - Yui Takahashi
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Japan
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Japan
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Japan
| | - Mio Togo
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Japan
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Urinary Incontinence in Women: Modern Methods of Physiotherapy as a Support for Surgical Treatment or Independent Therapy. J Clin Med 2020; 9:jcm9041211. [PMID: 32340194 PMCID: PMC7230757 DOI: 10.3390/jcm9041211] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
Urinary incontinence (UI) is a common health problem affecting quality of life of nearly 420 million people, both women and men. Pelvic floor muscle (PFM) training and other physiotherapy techniques play an important role in non-surgical UI treatment, but their therapeutic effectiveness is limited to slight or moderate severity of UI. Higher UI severity requires surgical procedures with pre- and post-operative physiotherapy. Given that nearly 30%–40% of women without dysfunction and about 70% with pelvic floor dysfunction are unable to perform a correct PFM contraction, therefore, it is particularly important to implement physiotherapeutic techniques aimed at early activation of PFM. Presently, UI physiotherapy focuses primarily on PFM therapy and its proper cooperation with synergistic muscles, the respiratory diaphragm, and correction of improper everyday habits for better pelvic organ support and continence. The purpose of this work is a systematic review showing the possibilities of using physiotherapeutic techniques in the treatment of UI in women with attention to the techniques of PFM activation. Evidence of the effectiveness of well-known (e.g., PFM training, biofeedback, and electrostimulation) and less-known (e.g., magnetostimulation, vibration training) techniques will be presented here regarding the treatment of symptoms of urinary incontinence in women.
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Leme Nagib AB, Riccetto C, Martinho NM, Camargos Pennisi PR, Blumenberg C, Paranhos LR, Botelho S. Use of mobile apps for controlling of the urinary incontinence: A systematic review. Neurourol Urodyn 2020; 39:1036-1048. [DOI: 10.1002/nau.24335] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/25/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Anita Bellotto Leme Nagib
- Physiotherapy DepartmentUniversity Center of Associated Colleges (UNIFAE)São João da Boa Vista São Paulo Brazil
- Department of Surgery, Faculty of Medical Sciences, Postgraduate Program in Surgery SciencesState University of Campinas (UNICAMP)Campinas São Paulo Brazil
| | - Cássio Riccetto
- Department of Surgery, Faculty of Medical Sciences, Postgraduate Program in Surgery SciencesState University of Campinas (UNICAMP)Campinas São Paulo Brazil
| | - Natalia Miguel Martinho
- Department of Surgery, Faculty of Medical Sciences, Postgraduate Program in Surgery SciencesState University of Campinas (UNICAMP)Campinas São Paulo Brazil
- Physiotherapy DepartmentRegional University Center of the Espírito Santo do PinhalEspírito Santo do Pinhal São Paulo Brazil
| | - Pedro Rogério Camargos Pennisi
- Department of Preventive and Community Dentistry, School of DentistryFederal University of UberlândiaUberlândia Minas Gerais Brazil
| | - Cauane Blumenberg
- Social Medicine Department, Post‐graduate Program in EpidemiologyFederal University of PelotasPelotas Rio Grande do Sul Brazil
| | - Luiz Renato Paranhos
- Department of Preventive and Community Dentistry, School of DentistryFederal University of UberlândiaUberlândia Minas Gerais Brazil
| | - Simone Botelho
- Department of Surgery, Faculty of Medical Sciences, Postgraduate Program in Surgery SciencesState University of Campinas (UNICAMP)Campinas São Paulo Brazil
- Motor Science Institute, Post‐graduate Program in Rehabilitation SciencesFederal University of Alfenas (UNIFAL‐MG)Alfenas Minas Gerais Brazil
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García-Sánchez E, Ávila-Gandía V, López-Román J, Martínez-Rodríguez A, Rubio-Arias JÁ. What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4358. [PMID: 31717291 PMCID: PMC6887794 DOI: 10.3390/ijerph16224358] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022]
Abstract
Pelvic floor muscle training is commonly used for urine loss. However, research studies have not determined which training load is the most effective for women with stress urinary incontinence (SUI). Moreover, none of the previous reviews or studies have described the total effectiveness of pelvic floor muscle training (PFMT) with an objective test such as the pad test. The objectives were to analyze the effectiveness of pelvic floor muscle training in women with SUI and to determine which training load produces the greatest adaptations for decreasing urine loss. The search was conducted in three databases (PubMed, Web of Science and Cochrane), for randomized controlled trials (RCTs) that evaluated the effects of PFMT. Studies were included if they met the following criteria: participants were women; were older than 18; had SUI; were treated with PFMT; and the assessments of the effects were measured with a pad test. Finally, 10 articles (293 women) analyzed the pad test in women with SUI who performed PFMT. The meta-analysis showed that PFMT, independent of the protocol used in the study, resulted in decreased urine loss in women suffering from SUI. However, for large effects, the program should last 6-12 weeks, with >3 sessions/week and a length of session <45 min.
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Affiliation(s)
- Esther García-Sánchez
- Department of Exercise Physiology, Universidad Católica de Murcia, 30107 Murcia, Spain; (E.G.-S.); (V.Á.-G.); (J.L.-R.)
- Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, 30003 Murcia, Spain
- Health Sciences PhD program, Universidad Católica de Murcia, 30107 Murcia, Spain
| | - Vicente Ávila-Gandía
- Department of Exercise Physiology, Universidad Católica de Murcia, 30107 Murcia, Spain; (E.G.-S.); (V.Á.-G.); (J.L.-R.)
| | - Javier López-Román
- Department of Exercise Physiology, Universidad Católica de Murcia, 30107 Murcia, Spain; (E.G.-S.); (V.Á.-G.); (J.L.-R.)
- Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, 30003 Murcia, Spain
| | - Alejandro Martínez-Rodríguez
- Department of Analytical Chemistry, Nutrition and Food Science, Faculty of Science, Alicante University, 03690 Alicante, Spain;
| | - Jacobo Á. Rubio-Arias
- Faculty of Sports, UCAM, Universidad Católica de Murcia, 30107 Murcia, Spain
- Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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Bokne K, Sjöström M, Samuelsson E. Self-management of stress urinary incontinence: effectiveness of two treatment programmes focused on pelvic floor muscle training, one booklet and one Internet-based. Scand J Prim Health Care 2019; 37:380-387. [PMID: 31317808 PMCID: PMC6713123 DOI: 10.1080/02813432.2019.1640921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objectives: In a previous study, self-management of stress urinary incontinence (SUI), via an Internet-based programme or a booklet improved symptoms and quality of life. We wanted to evaluate the effectiveness of these programmes when implemented for free use, as well as to characterize the users. Design: Pragmatic prospective cohort study. Setting and subjects: Information about the Internet programme and the booklet was provided at www.tät.nu and by nurse midwives. Both programmes included a three-month pelvic floor muscle training (PFMT) programme. Questionnaires were used at the start and after three months. Main outcome measures: Characteristics of the participants regarding age and education. Reductions in symptom severity was measured using the validated ICIQ-UI SF. Results: 109 women using the booklet, and 166 women using the Internet-based programme responded to the pre-treatment questionnaire. Of these, 53 (48.6%) in the booklet group and 27 (16.3%) in the Internet group responded to the follow-up. The mean age of booklet users was higher, 59.4 years vs. 54.5 years (p = .005). The proportion of women with post-secondary education was high, 59% in the booklet group and 67% in the Internet group. The mean reduction in the symptom score was 2.6 points (SD 3.4) in the booklet group, and 3.4 (SD 2.9) in the Internet group. These reductions were significant within both groups, with no difference between the groups, and in the same order of magnitude as in the previous randomised controlled study. Conclusion: Two self-management programmes for SUI, one provided as a booklet and one as an Internet-based programme, also rendered clinically relevant improvements when made freely available. KEY POINTS Female stress urinary incontinence can be treated using self-management programmes focused on pelvic floor muscle training. This study evaluates the effect of two different programmes, one provided as a booklet and one Internet-based, when made freely available to the public. •Both programmes rendered clinically relevant improvements, in the same order of magnitude as in the previous randomised controlled study. •Self-management of stress urinary incontinence should be recommended to women that request treatment.
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Affiliation(s)
- Kajsa Bokne
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden;
| | - Malin Sjöström
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development – Östersund, Umeå University, Umeå, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden;
- CONTACT Eva Samuelsson Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87 Umeå, Sweden
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Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review. J Gen Intern Med 2019; 34:1615-1625. [PMID: 31062225 PMCID: PMC6667523 DOI: 10.1007/s11606-019-05028-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/06/2019] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urinary incontinence (UI) is a common malady in women. Numerous nonsurgical treatments are available, each associated with risk of adverse events (AEs). METHODS We systematically reviewed nonsurgical interventions for urgency, stress, or mixed UI in women, focusing on AEs. We searched MEDLINE®, Cochrane Central Trials Registry, Cochrane Database of Systematic Reviews, and Embase® through December 4, 2017. We included comparative studies and single-group studies with at least 50 women. Abstracts were screened independently in duplicate. One researcher extracted study characteristics and results with verification by another independent researcher. When at least four studies of a given intervention reported the same AE, we conducted random effects model meta-analyses of proportions. We also assessed the strength of evidence. RESULTS There is low strength of evidence that AEs are rare with behavioral therapies and neuromodulation, and that periurethral bulking agents may result in erosion and increase the risk of voiding dysfunction. High strength of evidence finds that anticholinergics and alpha agonists are associated with high rates of dry mouth and constitutional effects such as fatigue and gastrointestinal complaints. Onabotulinum toxin A (BTX) is also associated with increased risk of urinary tract infections (UTIs) and voiding dysfunction (moderate strength of evidence). DISCUSSION Behavioral therapies and neuromodulation have low risk of AEs. Anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. BTX is associated with UTIs and voiding dysfunction. Periurethral bulking agents are associated with erosion and voiding dysfunction. These AEs should be considered when selecting appropriate UI treatment options. AE reporting is inconsistent and AE rates across studies tended to vary widely. Trials should report AEs more consistently.
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Efficacy of biofeedback-assisted pelvic floor muscle training in females with pelvic floor dysfunction. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2014.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Nunes EFC, Sampaio LMM, Biasotto-Gonzalez DA, Nagano RCDR, Lucareli PRG, Politti F. Biofeedback for pelvic floor muscle training in women with stress urinary incontinence: a systematic review with meta-analysis. Physiotherapy 2019; 105:10-23. [DOI: 10.1016/j.physio.2018.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/19/2018] [Indexed: 01/22/2023]
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The Effect of Pelvic Floor Muscles Exercise on Quality of Life in Women with Stress Urinary Incontinence and Its Relationship with Vaginal Deliveries: A Randomized Trial. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5321864. [PMID: 30723739 PMCID: PMC6339740 DOI: 10.1155/2019/5321864] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 11/17/2022]
Abstract
Introduction Urinary incontinence (UI) is a health problem affecting the quality of women's lives (QOL) at various life stages. Stress urinary incontinence (SUI) can be caused by previous vaginal deliveries and is especially likely to occur in the perimenopausal period. The most commonly recommended first-choice treatment methods involve exercises for the pelvic floor muscles (PFM). The aim of this study was to assess the impact of isolated PFM exercises and combined training of the PFM and the m.transversus abdominis (TrA) muscle on the QoL of patients with SUI with regard to the number of vaginal deliveries. Material and Methods 137 women with SUI were qualified for analysis (mean age 53,1 ± 5,5). To assess the effectiveness of PFM training QOL questionnaire was used (ICIQ-LUTS qol). PFM training for groups A (PFM+TrA) and B (PFM) was intended for 12 weeks. Statistica v. 12.0 PL, StatSoft, USA, was used for statistical calculations. Results The analysis demonstrated that conservative treatment based on the A training program (PFM + TrA) yielded statistically significantly better results than the B program (PFM), with the improvement observed in such QoL domains as the performance of household duties, physical activity and travelling, social limitations, emotions, sleep problems and fatigue, the frequency of changing panty liners, fluid intake control, and embarrassment. Conclusion Both the combined training of the PFM and the synergistic (TrA) muscle and the isolated PFM exercises improve the QoL of women with SUI. Nonetheless, the combined PFM and TrA muscle physiotherapy is more effective. The exercises for the PFM and the synergistic muscle give better results in women who have given birth fewer than three times than isolated PFM exercises.
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Ouchi M, Kitta T, Kanno Y, Moriya K, Suzuki S, Shinohara N, Kato K. Medium-term follow-up after supervised pelvic floor muscle training for patients with anterior vaginal wall prolapse. Eur J Obstet Gynecol Reprod Biol 2018; 225:95-100. [PMID: 29702450 DOI: 10.1016/j.ejogrb.2018.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 04/01/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to determine changes in quality of life, urogenital symptoms, and adherence to pelvic floor muscle training (PFMT) for pelvic organ prolapse (POP) in the medium term. STUDY DESIGN The present study conducted a pretest-posttest quasi-experimental study design. Of 29 participants in 4-month supervised PFMT, 27 completed all assessments in a follow-up study. Twenty subjects were included in final analysis except 7 participants who underwent surgery during follow-up. To evaluate urogenital symptoms, they completed a prolapse-quality of life (P-QOL) questionnaire and POP-specific QOL. A urologist evaluated the prolapse status of all participants with POP-Q. In addition, the participants were asked about their adherence to PFMT, PFMT obstacles, and where PFMT was performed. All outcome measures were assessed at the following three time points: before PFMT, immediately after PFMT with one-on-one session, and at follow-up via a phone call. Values of p < 0.05 were considered significant. RESULTS Of the 29 participants in the 4-month supervised PFMT, 27 completed all assessments in a follow-up study (response rate: 93.1%). The percentages of patients who continued PFMT at least 4 times declined substantially in non-operated at follow-up compared with supervised PFMT period. POP-specific QOL such as general health, prolapse impact, and role limitation were significantly worse at follow-up compared with immediately after PFMT despite initial improvement in the short term (p < 0.05). CONCLUSION POP-specific QOL gradually worsened compared with patients immediately after supervised PFMT in mild to moderate POP women who were followed up without surgery at a 2-year follow-up. Adherence to home-based PFMT might decline without further supervision. It might indicate that to PFMT would be required to maintain symptoms and QOL in medium term. Further study will be needed to clarify if PFMT is effective to improve urogenital symptoms and QOL in long term among the patients with POP.
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Affiliation(s)
- Mifuka Ouchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan; School of Rehabilitation Sciences, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeyuki Suzuki
- Department of Physical and Occupational Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
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Orhan C, Akbayrak T, Özgül S, Baran E, Üzelpasaci E, Nakip G, Özgül N, Beksaç MS. Effects of vaginal tampon training added to pelvic floor muscle training in women with stress urinary incontinence: randomized controlled trial. Int Urogynecol J 2018. [PMID: 29536140 DOI: 10.1007/s00192-018-3585-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We evaluated whether vaginal tampon training (VTT) combined with pelvic floor muscle training (PFMT) results in better outcomes than PFMT alone for treating stress urinary incontinence (SUI). METHODS This was a randomized, controlled study. Patients were allocated to either the combined program, consisting of PFMT and VTT over 12 weeks [PFMT and VTT group (n = 24)] or to PFMT alone [PFMT group (n = 24)]. The primary outcome measure was self-reported improvement, while secondary outcome measures were severity of incontinence, quality of life (QoL), urinary parameters, and pelvic floor muscle strength (PFMS) and endurance (PFME). Values were analyzed with Friedman, Mann-Whitney U, Wilcoxon, and chi-square tests. RESULTS Between-group analysis showed no statistically significant differences in self-reported improvement, severity of incontinence, symptom distress score, PFMS, PFME, urinary parameters, and all domains of QoL scores, except social limitations, at weeks 4, 8, and 12 (p > 0.05). However, the increase in PFMS and PFME between baseline and week 12 and earlier improvement was significantly greater in the PFMT and VTT than in the PFMT group (both p < 0.05) CONCLUSION: Short-term results demonstrated that PFMT with and without VT exercises had similar effectiveness on the symptoms of SUI and QoL.
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Affiliation(s)
- Ceren Orhan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, 06100, Samanpazari, Ankara, Turkey.
| | - Türkan Akbayrak
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, 06100, Samanpazari, Ankara, Turkey
| | - Serap Özgül
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, 06100, Samanpazari, Ankara, Turkey
| | - Emine Baran
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, 06100, Samanpazari, Ankara, Turkey
| | - Esra Üzelpasaci
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, 06100, Samanpazari, Ankara, Turkey
| | - Gülbala Nakip
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, 06100, Samanpazari, Ankara, Turkey
| | - Nejat Özgül
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksaç
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Pogonchenkova IV, Khan MA, Korchazhkina NB, Novikova EV, Bokova IA, Lyan NA. [The application of the physical factors for the medical rehabilitation of the children presenting with neurogenic dysfunction of the bladder]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2017; 94:53-58. [PMID: 29388934 DOI: 10.17116/kurort201794653-58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/31/2017] [Accepted: 09/27/2017] [Indexed: 11/18/2022]
Abstract
This article describes the modern technologies for the medical rehabilitation of the children presenting with neurogenic dysfunction of the bladder aimed at improving the act of urination at all levels of innervation. The most frequent variant of neurogenic dysfunction of the bladder in the children is the hyper-reflexive one; it is this variant in which the most pronounced disorders of urodynamics due to intravesical hypertension and detrusor hypoxia are observed. The urodynamic disorders are known to contribute to the formation of the characteristic clinical picture associated with the hyper-reflexive urinary bladder dysfunction in the children characterized by the mandatory urination syndrome, pollakiuria, imperative urges, and mandatory urinary incontinence in the combination with enuresis. The treatment of urinary bladder dysfunction includes both behavioural and medication therapeutic modalities. The "golden standard" for the pharmacotherapy of neurogenic bladder dysfunction of the hyper-reflexive type in the childhood is the use of M-cholinoblockers, such as oxybutynin. The popularity of the physiotherapeutic methods is attributable to their influence on the main links of pathogenesis, the absence of side effects, and the possibility of application in the children of the early age. The combined treatment of neurogenic bladder dysfunction includes the use of a wide range of physiotherapeutic methods the action of which is aimed at regulating the act of urination at all levels of innervation of the bladder, normalizing the tone of the muscles of the bladder, eliminating sphincter insufficiency, improving circulation and accelerating the maturation of the neuromuscular apparatus of the pelvic organs. At present, the natural and preformed methods of physiotherapy are finding the wide application for the management of neurogenic dysfunction of the bladder in the children in the conjunction with therapeutic physical exercises, massage, and the biological feedback (BFB) technique.
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Affiliation(s)
- I V Pogonchenkova
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine
| | - M A Khan
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine.,I.M. Sechenov First Moscow State Medical University
| | | | - E V Novikova
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine.,I.M. Sechenov First Moscow State Medical University
| | - I A Bokova
- I.M. Sechenov First Moscow State Medical University
| | - N A Lyan
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine.,I.M. Sechenov First Moscow State Medical University
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Lee KS, Yoo TK, Liao L, Wang J, Chuang YC, Liu SP, Chu R, Sumarsono B. Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study. BMC Urol 2017; 17:108. [PMID: 29162085 PMCID: PMC5698954 DOI: 10.1186/s12894-017-0294-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022] Open
Abstract
Background Lower urinary tract symptoms (LUTS) and overactive bladder (OAB) symptoms have a substantial effect on quality of life (QoL). We report QoL and mental health results from a LUTS prevalence study in three Asian countries. Methods A cross-sectional, population-representative, internet-based study among individuals aged ≥40 years in China, Taiwan and South Korea. Instruments included: Overactive Bladder Symptom Score (OABSS); International Prostate Symptom Score (IPSS); other International Continence Society (ICS) symptom questions; health-related QoL 12-item short-form (HRQoL-SF12v2); Work Limitations Questionnaire (WLQ); Hospital Anxiety and Depression Scale (HADS). Presence of LUTS was determined according to ICS criteria, with three symptom groups (storage, voiding and post-micturition). Post-stratification weighting matched the age and sex population distribution per country. Initial data analyses were based on descriptive statistics. Significance testing undertaken post hoc included: independent-samples t-test (differences in HRQoL between sexes and between individuals with/without LUTS; relationship between HRQoL score and OABSS; differences in HADS anxiety and depression scores between individuals with/without LUTS; association between HADS anxiety/depression scores and OABSS), chi-square test (association between LUTS prevalence and workplace productivity) and analysis of variance (differences in HRQoL score and in HADS anxiety/depression scores between individuals with different symptom groups, association between HADS anxiety/depression scores and IPSS). Results In total, 8284 participants were included. HRQoL scores were significantly worse (p < 0.001) among individuals with versus without LUTS (ICS criteria): mean physical health domain scores were 61.1 (standard deviation [SD], 20.1) and 76.7 (17.0), respectively; corresponding mental health domain scores were 34.8 (12.7) and 43.7 (10.7). Workplace productivity was best among individuals without LUTS (difficulties reported by 2–3% of individuals), and worst in those with all three ICS symptom groups (difficulties reported by 29–38% of individuals; p = 0.001). Mean HADS scores showed significantly worse (p < 0.001) levels of anxiety and depression among individuals with versus without LUTS: anxiety, 6.5 (SD, 3.7) and 4.0 (3.3); corresponding mean depression scores were 6.8 (4.3) and 4.2 (3.6). Increasing OAB severity was also associated with decreasing HRQoL physical and mental health scores. Conclusion LUTS and increasing OAB severity are both associated with impaired QoL, reduced workplace productivity, and increased tendency towards anxiety and depression. These results highlight the need to ensure that individuals with LUTS receive appropriate, effective treatment. Trial registration ClinicalTrials.gov identifier: NCT02618421, registered 26 November 2015 (retrospectively registered).
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Affiliation(s)
- Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 68, Hangeulbiseok-ro, Nowon-gu, Seoul, Korea.
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, Beijing, China
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Romeo Chu
- Astellas Pharma Singapore Pte. Ltd., Singapore, Singapore.,, Present address: 5 Pemimpin Drive, #19-03 Seasons View, Singapore, Singapore
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Mori A, Kakiuchi M, Matsumoto E, Nozaki S. Ingenuity for enabling the habituation of pelvic floor muscle training. J Phys Ther Sci 2017; 29:1287-1291. [PMID: 28878449 PMCID: PMC5574347 DOI: 10.1589/jpts.29.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/09/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To clarify factors contributing to habituation of pelvic floor muscle training
(PFMT) for urinary incontinence. [Subjects and Methods] We included 13 healthy females and
examined diurnal and nocturnal urination frequency at initial program participation and at
3 months. The survey used the International Consultation on Incontinence
Questionnaire-Short Form (ICIQ-SF), a 10-level self-assessment of anxiety associated with
urinary incontinence, and a 10-level self-evaluation of PFMT understanding and skill
acquisition. We evaluated PFMT practice at home and postures that facilitated PFMT. The
practice of PFMT at home was surveyed during a 3-month period. [Results] Compared to
baseline, the level of skill acquisition assessed by the ICIQ-SF and PFMT according to the
10-level self-evaluation improved significantly at 3 months. The rate of PFMT sessions
performed at home per week was high. The number of times PFMT was performed per day was
positively correlated with level of understanding and acquisition of skills pertaining to
PFMT, according to the 10-level self-assessment. [Conclusion] By incorporating behavior
modification techniques appropriate for urinary incontinence and by increasing the level
of understanding regarding incontinence and PFMT, as well as the level of skill
acquisition, self-efficacy increased. This may have motivated habituation of PFMT.
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Affiliation(s)
- Akiko Mori
- Department of Physical Therapy School of Rehabilitation, Hyogo University of Health Sciences, Japan
| | | | - Emi Matsumoto
- Department of Rehabilitation Medicine, Kansai Electric Power Hospital, Japan
| | - Sonoko Nozaki
- Department of Neurology, Kansai Rosai Hospital, Japan
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Ouchi M, Kato K, Gotoh M, Suzuki S. Physical activity and pelvic floor muscle training in patients with pelvic organ prolapse: a pilot study. Int Urogynecol J 2017. [DOI: 10.1007/s00192-017-3356-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ahadi T, Taghvadoost N, Aminimoghaddam S, Forogh B, Bazazbehbahani R, Raissi GR. Efficacy of biofeedback on quality of life in stages I and II pelvic organ prolapse: A Pilot study. Eur J Obstet Gynecol Reprod Biol 2017; 215:241-246. [PMID: 28686982 DOI: 10.1016/j.ejogrb.2017.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 05/06/2017] [Accepted: 06/14/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Pelvic organ prolapse (POP) is a prevalent disorder which seriously affects the sufferer's quality of life. The main goal of this study was to evaluate biofeedback impact on quality of life in women with mild to moderate POP. STUDY DESIGN 40 females in stages I and II POP were allocated into 2 groups. One group received pelvic floor muscle exercise and lifestyle advice in addition to biofeedback twice a week for 4 weeks, while the other received a lifestyle advice sheet and pelvic floor muscle exercise without biofeedback. A valid Persian version of P-QOL questionnaire was applied to assess the patients̕ quality of life at baseline, 4 weeks and 12 weeks follow up. Pressure biofeedback and Physical examination were also performed in order to determine pelvic floor muscle strength and staging of the prolapse, respectively. Collected data were analyzed by mixed ANOVA test using SPSS 22. RESULTS Biofeedback improved the quality of life in seven of nine P-QOL domains. However, it had no significant impact either on pelvic floor muscle strength or on the stage of the prolapse. CONCLUSION Biofeedback could be considered as a non-invasive treatment leading to quality of life promotion in women with stages I and II POP.
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Affiliation(s)
- Tannaz Ahadi
- Physical Medicine & Rehabilitation, Iran University of Medical Sciences, Firoozgar Hospital, Neuromuscular Research Center, Tehran, Iran
| | - Neda Taghvadoost
- Physical Medicine & Rehabilitation, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Iran
| | - Soheila Aminimoghaddam
- Gynecology-Oncology, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Iran
| | - Bijan Forogh
- Physical Medicine & Rehabilitation, Iran University of Medical Sciences, Firoozgar Hospital, Neuromuscular Research Center, Tehran, Iran
| | | | - Gholam Reza Raissi
- Physical Medicine & Rehabilitation, Iran University of Medical Sciences, Firoozgar Hospital, Neuromuscular Research Center, Tehran, Iran.
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Ptak M, Brodowska A, Ciećwież S, Rotter I. Quality of Life in Women with Stage 1 Stress Urinary Incontinence after Application of Conservative Treatment-A Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E577. [PMID: 28556806 PMCID: PMC5486263 DOI: 10.3390/ijerph14060577] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 01/08/2023]
Abstract
Stress urinary incontinence (SUI) influences quality of life in female patients. In this study, we used ICIQ LUTS QoL (The International Consultation Incontinence Questionnaire Lower Urinary Tract Symptoms quality of life) to determine the quality of life (QoL) in various domains in patients with stage 1 SUI. The study included 140 perimenopausal women subjected to urodynamic tests at the Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Police (Poland) in 2013-2015. The study subjects were divided into two groups, A and B. Each patient completed two questionnaires, an original survey developed by the authors and the validated ICIQ LUTS QoL. Two exercise programs, each lasting for 3 months and consisting of 4 weekly sessions, were recommended to the study subjects. The program for Group A included exercises for pelvic floor muscles (PFM) with simultaneous tension of the transverse abdominal muscle (TrA), and the program for Group B, PFM exercises without TrA tension. After completing the exercise programs, patients with stage 1 SUI, both from Group A and from Group B, showed a significant improvement in most QoL domains measured with ICIQ LUTS QoL. However, more beneficial effects of the training were observed in the group subjected to PFM exercises with TrA tension.
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Affiliation(s)
- Magdalena Ptak
- Department of Medical Rehabilitation, Pomeranian Medical University, Szczecin, 71-210, Poland.
| | - Agnieszka Brodowska
- Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Police, 72-010, Poland.
| | - Sylwester Ciećwież
- Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Police, 72-010, Poland.
| | - Iwona Rotter
- Department of Medical Rehabilitation, Pomeranian Medical University, Szczecin, 71-210, Poland.
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Innovative treatment modalities for urinary incontinence: a European survey identifying experience and attitude of healthcare providers. Int Urogynecol J 2017; 28:1725-1731. [PMID: 28432409 PMCID: PMC5655557 DOI: 10.1007/s00192-017-3339-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/04/2017] [Indexed: 12/04/2022]
Abstract
Introduction and hypothesis Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25% to 51%. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI). A European research consortium is investigating an innovative system based on information and communication technology for the conservative treatment of women with SUI. When introducing a new intervention, implementation barriers arise and need to be identified. Therefore, we investigated healthcare providers’ experience with and attitude towards innovative care options. Methods We performed an online survey to assess (1) the characteristics and practice of healthcare providers, (2) current protocols for SUI, (3) current use of biofeedback, and (4) knowledge about serious gaming. The survey was sent to members of professional societies in Europe (EUGA), UK (BSUG) and The Netherlands (DPFS). Results Of 341 questionnaires analyzed (response rate between 18% and 30%), 64% of the respondents had access to a protocol for the treatment of SUI, and 31% used biofeedback when treating patients with SUI. However, 92% considered that biofeedback has a clear or probable added value, and 97% of those who did not use biofeedback would change their practice if research evidence supported its use. Finally, 89% of respondents indicated that they had no experience of serious gaming, but 92% considered that it could be useful. Conclusions Although inexperienced, European urogynecologists and physical therapists welcome innovative treatment options for the conservative treatment of SUI such as portable wireless biofeedback and serious gaming. Scientific evidence is considered a prerequisite to incorporate such innovations into clinical practice.
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STRES ÜRİNER İNKONTİNANSLI KADINLARDA PELVİK TABAN KAS EĞİTİMİNE EK OLARAK UYGULANAN ELEKTROMYOGRAFİK BİOFEEDBACK EĞİTİMİNİN ETKİNLİĞİNİN İNCELENMESİ. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2017. [DOI: 10.21673/anadoluklin.301479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Asklund I, Nyström E, Sjöström M, Umefjord G, Stenlund H, Samuelsson E. Mobile app for treatment of stress urinary incontinence: A randomized controlled trial. Neurourol Urodyn 2016; 36:1369-1376. [PMID: 27611958 DOI: 10.1002/nau.23116] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/15/2016] [Indexed: 11/05/2022]
Abstract
AIMS To evaluate the effect of a mobile app treatment for stress urinary incontinence (SUI) in women. METHODS Randomized controlled trial, conducted 2013-2014 in Sweden. Community-dwelling adult women with ≥1 SUI episode/week recruited through our website and randomized to app treatment (n = 62) or control group (postponed treatment, n = 61). One participant from each group was lost to follow-up. Intervention was the mobile app Tät® with a treatment program focused on pelvic floor muscle training (PFMT), and information about SUI and lifestyle factors. Primary outcomes, 3 months after randomization: symptom severity (International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form [ICIQ-UI SF]); and condition-specific quality of life (ICIQ Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]). RESULTS One hundred and twenty-three women were included (mean age 44.7), with moderate/severe SUI (97.5%, 120/123), mean ICIQ-UI SF score 11.1 (SD 2.8) and mean ICIQ-LUTSqol score 34.4 (SD 6.1) at baseline. At follow-up, the app group reported improvements in symptom severity (mean ICIQ-UI SF score reduction: 3.9, 95% confidence interval 3.0-4.7) and condition-specific quality of life (mean ICIQ-LUTSqol score reduction: 4.8, 3.4-6.2) and the groups were significantly different (mean ICIQ-UI SF score difference: -3.2, -4.3to -2.1; mean ICIQ-LUTSqol score difference: -4.6, -7.8 to -1.4). In the app group, 98.4% (60/61) performed PFMT at follow-up, and 41.0% (25/61) performed it daily. CONCLUSIONS The mobile app treatment was effective for women with SUI and yielded clinically relevant improvements. This app may increase access to first-line treatment and adherence to PFMT.
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Affiliation(s)
- Ina Asklund
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development-Östersund, Umeå University, Sweden
| | - Emma Nyström
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development-Östersund, Umeå University, Sweden
| | - Malin Sjöström
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development-Östersund, Umeå University, Sweden
| | - Göran Umefjord
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Hans Stenlund
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
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Xu H, Liu B, Wu J, Du R, Liu X, Yu J, Liu Z. A Pilot Randomized Placebo Controlled Trial of Electroacupuncture for Women with Pure Stress Urinary Incontinence. PLoS One 2016; 11:e0150821. [PMID: 26960195 PMCID: PMC4784883 DOI: 10.1371/journal.pone.0150821] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/19/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acupuncture is a potential conservative therapy for women with stress urinary incontinence (SUI). There is limited evidence to support its effectiveness due to the poor quality of existing studies. METHODS We performed a pilot randomized, controlled trial to preliminarily assess the efficacy of electroacupuncture (EA) in women with pure SUI. A total of 80 women with pure SUI were randomly assigned to receive EA with deep needling at BL33 and BL35 (n = 40) or sham EA with non-penetrating needling at sham acupoints (n = 40) three sessions per week for 6 weeks. The women were followed for 24 weeks. The primary outcome was the change from baseline in the amount of urine leakage measured by a 1-hour pad test after 6 weeks. The secondary outcomes included the 72-hour incontinence episode frequency (IEF), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, and patient self-evaluation of therapeutic effect. Adverse events (AEs) were monitored throughout the trial. RESULTS The median decrease from baseline of urine leakage measured by the 1-hour pad test was 2.5 g [interquartile range (IQR): 1.80-14.6 in the EA group, which was greater than the median decrease of 0.05 g (IQR: -2.80-+0.50) in the sham EA group after 6 weeks (p<0.01). The differences between groups in the decrease from baseline of 72-hour IEF became statistically significant at week 30 with a median decrease of 3.25 g (IQR: 1.25-5.69) in the EA group, and a median decrease of 1.00 g (IQR: -0.69-+2.88) in the sham EA group (p = 0.01). The participants in the EA group showed greater decreases in ICIQ-SF score and higher ratings in the help they received from the treatment than those in the sham EA group at weeks 6,18 and 30 (all p<0.05). No obvious AEs were observed in either group. CONCLUSION EA may effectively and safely relieve urinary incontinence symptoms and improve quality of life in women with pure SUI. EA demonstrated more than a placebo effect. Since this is a pilot study, results should be interpreted with caution. TRIAL REGISTRATION ClinicalTrials.gov NCT02445573.
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Affiliation(s)
- Huanfang Xu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baoyan Liu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiani Wu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruosang Du
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoxu Liu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jinna Yu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- * E-mail:
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Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training. BJU Int 2015; 116:955-64. [PMID: 25683075 PMCID: PMC4690161 DOI: 10.1111/bju.13091] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives To evaluate the long-term effects of two non-face-to-face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT). Subjects and Methods The present study was a randomized controlled trial with online recruitment of 250 community-dwelling women aged 18–70 years with SUI ≥ one time/week. Diagnosis was based on validated self-assessed questionnaires, 2-day bladder diary and telephone interview with a urotherapist. Consecutive computer-generated block randomization was carried out with allocation by an independent administrator to 3 months of treatment with either an internet-based treatment programme (n = 124) or a programme sent by post (n = 126). Both interventions focused mainly on PFMT. The internet group received continuous e-mail support from a urotherapist, whereas the postal group trained on their own. Follow-up was performed after 1 and 2 years via self-assessed postal questionnaires. The primary outcomes were symptom severity (International Consultation on Incontinence Questionnaire Short Form [ICIQ-UI SF]) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]). Secondary outcomes were the Patient Global Impression of Improvement, health-specific quality of life (EQ-visual analogue scale [EQ-VAS]), use of incontinence aids, and satisfaction with treatment. There was no face-to-face contact with the participants at any time. Analysis was based on intention-to-treat. Results We lost 32.4% (81/250) of participants to follow-up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (P < 0.001) improvements with large effect sizes (>0.8) for symptoms and condition-specific quality of life (QoL) after 1 and 2 years, respectively. No significant differences were found between the groups. The mean (sd) changes in symptom score were 3.7 (3.3) for the internet group and 3.2 (3.4) for the postal group (P = 0.47) after 1 year, and 3.6 (3.5) for the internet group and 3.4 (3.3) for the postal group (P = 0.79) after 2 years. The mean changes (sd) in condition-specific QoL were 5.5 (6.5) for the internet group and 4.7 the for postal group (6.5) (P = 0.55) after 1 year, and 6.4 (6.0) for the internet group and 4.8 (7.6) for the postal group (P = 0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (internet, 31.9% [28/88]; postal, 33.8% [27/80], P = 0.82), but after 2 years significantly more participants in the internet group reported this degree of improvement (39.2% [29/74] vs 23.8% [19/80], P = 0.03). Health-specific QoL improved significantly in the internet group after 2 years (mean change in EQ-VAS, 3.8 [11.4], P = 0.005). We found no other significant improvements in this measure. At 1 year after treatment, 69.8% (60/86) of participants in the internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the treatment result. After 2 years, the proportions were 64.9% (48/74) and 58.2% (46/79), respectively. Conclusion Non-face-to-face treatment of SUI with PFMT provides significant and clinically relevant improvements in symptoms and condition-specific QoL at 1 and 2 years after treatment.
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Affiliation(s)
- Malin Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Göran Umefjord
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hans Stenlund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Jácomo RH, Fitz FF, Alves AT, Fernandes IS, Teixeira FA, Sousa JBD. The effect of pelvic floor muscle training in urinary incontinent elderly women: a sistematic review. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.004.ar02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The International Continence Society (ICS) determines that the pelvic floor muscles training (PFMT) is the first-choice treatment of urinary symptoms in women. Objective The aim of this study was to systematize randomized controlled clinical trials that address the effects of PFMT in the treatment of urinary symptoms in older women using objective outcome measures. Method Systematic review search was performed eletronic the following databases: Medline, Pubmed, Lilacs, PEDro and manual research conducted in the references of the studies. Were considered eligible women aged over 60 years who performed PFMT in isolation, without the involvement of another technique. The PFMT performed in clinic or at home, with or without the supervision of a therapist and with or without the use of biofeedback as an adjunct. Considered as outcome measures urodynamic studies, voiding diary that assesses daytime urinary frequency, nocturnal urinary frequency, urinary incontinence and exchange absorbent, and, finally, the absorbent test that quantifies loss urinary grams. The assessment of methodological quality of the studies was conducted by PEDro scale. Results Three studies were reviewed in full. Only one trial was rated high methodological quality. There was significant improvement in urinary symptoms after treatment proposed in the three selected studies. Conclusion Considering the studies available so far are weak the evidence for the use of PFMT in the treatment of urinary symptoms in elderly women.
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Celiker Tosun O, Kaya Mutlu E, Ergenoglu AM, Yeniel AO, Tosun G, Malkoc M, Askar N, Itil IM. Does pelvic floor muscle training abolish symptoms of urinary incontinence? A randomized controlled trial. Clin Rehabil 2014; 29:525-37. [PMID: 25142280 DOI: 10.1177/0269215514546768] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 07/20/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether symptoms of urinary incontinence is reduced by pelvic floor muscle training, to determine whether urinary incontinence can be totally eliminated by strengthening the pelvic floor muscle to grade 5 on the Oxford scale. DESIGN Prospective randomized controlled clinical trial. SETTING Outpatient urogynecology department. SUBJECTS One hundred thirty cases with stress and mixed urinary incontinence. INTERVENTION All participants were randomly allocated to the pelvic floor muscle training group or control group. A 12-week home based exercise program, prescribed individually, was performed by the pelvic floor muscle training group. MAIN MEASURES Urinary incontinence symptoms (Incontinence Impact Questionnaire-7, Urogenital Distress Inventory-6, bladder diary, stop test and pad test) were assessed, and the pelvic floor muscle strength was measured for (PERFECT testing, perineometric and ultrasound) all participants before and after 12 weeks of treatment. RESULTS The pelvic floor muscle training group had significant improvement in their symptoms of urinary incontinence (P=0.001) and an increase in pelvic floor muscle strength (P=0.001, by the dependent t test) compared with the control group. All the symptoms of urinary incontinence were significantly decreased in the patients that had reached pelvic floor muscle strength of grade 5 and continued the pelvic floor muscle training (P<0.05). CONCLUSION The study demonstrated that pelvic floor muscle training is effective in reducing the symptoms of stress and mixed urinary incontinence and in increasing pelvic floor muscle strength.
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Affiliation(s)
- O Celiker Tosun
- Dokuz Eylül University, School of Physiotherapy and Rehabilitation, Turkey
| | - E Kaya Mutlu
- Istanbul University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Turkey
| | - A M Ergenoglu
- Ege University, Department of Obstetric and Gynecology, Turkey
| | - A O Yeniel
- Ege University, Department of Obstetric and Gynecology, Turkey
| | - G Tosun
- Tepecık Educaution and Research Hospital, Department of Obstetric and Gynecology, Turkey
| | - M Malkoc
- Dokuz Eylül University, School of Physiotherapy and Rehabilitation, Turkey
| | - N Askar
- Ege University, Department of Obstetric and Gynecology, Turkey
| | - I M Itil
- Ege University, Department of Obstetric and Gynecology, Turkey
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Is urinary incontinence the hidden secret complications after total hip arthroplasty? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24:1455-60. [DOI: 10.1007/s00590-014-1413-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/03/2014] [Indexed: 02/02/2023]
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Diagnosis and conservative management of female stress urinary incontinence. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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