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1.
Int Braz J Urol ; 45(6): 1196-1203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808408

RESUMO

AIMS: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. MATERIALS AND METHODS: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. RESULTS: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). CONCLUSION: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not signifi cantly improve urinary continence or erectile function at 3 months after RP.


Assuntos
Disfunção Erétil/reabilitação , Exercícios de Alongamento Muscular/métodos , Diafragma da Pelve/fisiopatologia , Assistência Perioperatória/métodos , Prostatectomia/reabilitação , Incontinência Urinária/reabilitação , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Gradação de Tumores , Estadiamento de Neoplasias , Neurorretroalimentação , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
2.
Actas urol. esp ; 43(10): 526-535, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185258

RESUMO

Contexto y objetivo: La incontinencia urinaria es el efecto secundario con mayor impacto en la calidad de vida después de la prostatectomía radical. El objetivo de nuestro artículo es revisar la evidencia científica actual sobre las variaciones quirúrgicas descritas para preservar la continencia urinaria después de la prostatectomía radical. Adquisición de la evidencia: Se realizó una revisión sistemática de la literatura en PubMed, Cochrane y ScienceDirect según los criterios PRISMA (Preferred reporting items for systematic reviews and meta-analyses), utilizando los términos: urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot assisted laparoscopic prostatectomy, robotic prostatectomy y los criterios de selección PICO. Se identificaron 1.603 referencias de las que se seleccionaron 27 publicaciones que cumplieron los criterios de inclusión, 6 fueron ensayos clínicos aleatorizados y 4 metaanálisis. Síntesis de la evidencia: Las técnicas más empleadas para alcanzar una continencia urinaria precoz son la preservación del cuello vesical, de las bandeletas neurovasculares y la reconstrucción del rabdoesfínter, siendo esta la técnica con mayor evidencia, ya que existen 3 ensayos clínicos aleatorizados. Pese que algunas variaciones técnicas han conseguido mejorías en los resultados funcionales, la ausencia de consenso en la definición de incontinencia urinaria y la manera de evaluarla no permiten elaborar recomendaciones técnicas basadas en evidencia científica de calidad. Conclusiones: La reconstrucción del rabdoesfínter es la única técnica que ha demostrado mejoría en la recuperación precoz de la continencia urinaria tras la prostatectomía radical. La evidencia científica actual es heterogénea y limitada, por lo que son necesarios estudios aleatorizados bien diseñados para evaluar las modificaciones técnicas


Background and objective: Urinary incontinence is the adverse effect with more impact on patients’ quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy. Evidence acquisition: We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1,603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis. Evidence synthesis: The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence. Conclusions: The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique


Assuntos
Humanos , Masculino , Prostatectomia/métodos , Prostatectomia/reabilitação , Incontinência Urinária/reabilitação , Qualidade de Vida , Medicina Baseada em Evidências , Incontinência Urinária/complicações , Robótica , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos
3.
Rehabilitación (Madr., Ed. impr.) ; 53(3): 146-154, jul.-sept. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185551

RESUMO

Objetivo: demostrar si un protocolo reducido de 6 sesiones de ejercicios tónicos y fásicos es capaz de mejorar la calidad de vida y la fuerza muscular en los pacientes con incontinencia urinaria (IU). Material y métodos: se realizó un estudio prospectivo tipo antes y después a 67 pacientes con IU remitidos al Departamento de Rehabilitación del Hospital Universitario de Santa Cristina, Madrid, España. El estudio se realizó de enero del 2016 a diciembre del 2018. En la evaluación inicial, se registraron los datos de filiación, los factores predisponentes y el tipo de IU. Los pacientes recibieron recomendaciones de estilo de vida y los cuestionarios/escalas ICIQ-SF/I-QOL que debían rellenarse al inicio/final del tratamiento. La evaluación manométrica fue registrada en la evaluación inicial/final por el equipo MYOMED(R) 932 ENRAF NONIUS (CE 0197). El protocolo consistió en una sesión de 30 min de ejercicios tónicos/fásicos (15 min cada uno) 2 veces a la semana durante un máximo de 6 sesiones, supervisadas por un fisioterapeuta. Resultados: la edad media fue de 52,1±12,7 años. Mujeres 94% (n=63). La fuerza máxima y media de la contracción del suelo pélvico fue de 26,4±15,6 y 5,3±3,9mmHg, respectivamente, y aumentó significativamente después del tratamiento a 35,5±19,6 y 7,6±4,4mmHg (p<0,0001). El ICIQ-SF fue de 10,1±5 y disminuyó significativamente a 6,6±4,6 (p<0,0001). La I-QOL aumentó significativamente de 66,1±21,9 a 77,9±18,1 puntos (p<0,0001). La subescala I-QOL limitación de actividad se elevó de 63,7±22,6 a 77,3±17,8 (p<0,0001); la subescala I-QOL efecto psicosocial aumentó de 73,8±23,9 a 82,5±18,7 (p=0,0004); y la subescala I-QOL vergüenza social se incrementó de 56,5±23,7 a 70,5±22,1 (p<0,0001). Conclusión: el biofeedback manométrico es capaz de disminuir la IU y mejorar la calidad de vida y los valores manométricos. Este protocolo reducido de 6 sesiones podría aplicarse a otras instituciones públicas y privadas y podría tener un impacto económico en el sistema de salud y en la economía de los pacientes


Objective: to determine whether a short 6-session protocol of tonic/ phasic exercises can enhance quality of life and muscular strength in patients with urinary incontinence (UI). Material and methods: a prospective before-after study was performed in 67 patients with UI referred to the Rehabilitation Department of the Santa Cristina University Hospital in Madrid, Spain. In the initial assessment, the patient's personal details, predisposing factors and type of UI were registered. Patients received lifestyle recommendations. The ICIQ-SF/I-QOL questionnaires/scales were completed at the beginning and end of treatment. The manometric evaluation was registered in the first and last assessment by the MYOMED(R) 932 equipment. The protocol consisted of a 30-minute session of tonic/phasic exercises (15minutes each) twice weekly for a maximum of 6 sessions, supervised by a physiotherapist. Results: the mean age was 52.1±12.7 years and 94% of the patients (n=63) were women. The maximum and mean strength of the pelvic floor contraction was 26.4±15.6 and 5.3±3.9mmHg, respectively, which significantly increased after treatment to 35.5±19.6 and 7.6±4.4mmHg (P<.0001). The ICIQ-SF score was 10.1±5 and significantly decreased to 6.6±4.6 (P<0.0001). The I-QOL score significantly increased from 66.1±21.9 to 77.9±18.1 points (P<.0001). The I-QOL ALB subscale (avoidance and limiting behaviour) increased from 63.7±22.6 to 77.3±17.8 (P<.0001); the I-QoL PSI subscale (psychosocial impact) increased from 73.8±23.9 to 82.5±18.7 (P=.0004); and the I-QOL SE subscale (social embarrassment) increased from 56.5±23.7 to 70.5±22.1 (P<.0001). Conclusion: manometric feedback reduces UI and improves both quality of life and manometric values. This short 6-session protocol could be applied in other public and private centres and could provide economic benefits to the health system and to patients


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Manometria/métodos , Terapia por Exercício/métodos , Incontinência Urinária/reabilitação , Força Muscular/fisiologia , Estudos Prospectivos , Resultado do Tratamento , Estudos Controlados Antes e Depois/métodos , Retroalimentação Fisiológica
4.
Fisioterapia (Madr., Ed. impr.) ; 41(4): 227-236, jul.-ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183100

RESUMO

Antecedentes: La incontinencia urinaria femenina es un problema de salud de elevada prevalencia, costes sociales y económicos. El entrenamiento muscular del suelo pélvico es el tratamiento conservador más utilizado en mujeres con cualquier tipo de incontinencia urinaria, pero requiere de la adhesión a dichos programas de entrenamiento. Sin embargo, los estudios publicados hasta la fecha alertan de la falta de adherencia a estos programas, identificándose como una barrera para el proceso de recuperación. Objetivo: El objetivo de este trabajo es describir la adherencia al entrenamiento muscular del suelo pélvico en las mujeres con incontinencia urinaria. Estrategia de búsqueda y selección de estudios: Se realizó una revisión bibliográfica en las bases de datos PubMed, Medes, LILACS, CINAHL, CUIDENPlus, PsycINFO, ENFISPO, La biblioteca Cochrane Plus, Trip, ProQuest, PROSPERO, Epistemonikos, The Cochrane Library, SPORTDiscus, PEDro, IBECS, Web of Science y Scopus, completándose con una estrategia de búsqueda manual. Los artículos incluidos fueron ensayos controlados aleatorizados o análisis secundarios de los mismos, publicados entre 2007 y 2018. La evaluación de la calidad metodológica se realizó con la escala PEDro, realizándose la implementación de las normas PRISMA. Resultados: Siete artículos se incluyeron en esta revisión. Las tasas de adherencia variaron entre el 92 y el 53,55% en el corto plazo y entre el 80 y el 38,1% en el seguimiento. Los sistemas de medición se basaron en diarios, cuestionarios y datos recogidos por los fisioterapeutas. La falta de homogeneidad en los estudios supone una limitación para un metaanálisis válido. Conclusiones: Las tasas de adherencia del entrenamiento muscular del suelo pélvico en incontinencia urinaria femenina son bajas, siendo necesarias acciones que puedan homogeneizar los sistemas de medición y las estrategias de mejora de la adherencia terapéutica


Introduction: Female urinary incontinence is a health problem of high prevalence, social and economic costs. Training of the pelvic floor muscles is the most used conservative treatment in women with any type of urinary incontinence, but requires adherence to these programs. However, studies published to date warn of the lack of adherence to these programs, identifying this as a barrier to the recovery process. Objective: The objective of this work is to describe the adherence to pelvic floor muscle training in women with urinary incontinence. Search strategy and study selection: A bibliographic review was made in the databases PubMed, Medes, LILACS, CINAHL, CUIDENPlus, PsycINFO, ENFISPO, The Cochrane Plus library, Trip, ProQuest, PROSPERO, Epistemonikos, The Cochrane Library, SPORTDiscus, PEDro, IBECS, Web of Science and Scopus, completing with a manual search strategy. The articles included were randomised controlled trials, or secondary analyses of these, published between 2007 and 2018. The evaluation of the methodological quality was carried out using the PEDro scale, with the implementation of the PRISMA standards. Results: Seven articles were included in this review. Adherence rates varied between 92% and 53.55% in the short term, and between 80% and 38.1% in the follow-up. The measurement systems were based on diaries, questionnaires, and data collected by the physiotherapists. The lack of homogeneity in the studies is a limitation for a valid meta-analysis. Conclusions: The adherence rates of pelvic floor muscle training in female patients with urinary incontinence are low, and actions are needed to standardise measurement systems, as well as strategies to improve therapeutic adherence


Assuntos
Humanos , Feminino , Cooperação e Adesão ao Tratamento , Incontinência Urinária/terapia , Diafragma da Pelve/fisiologia , Modalidades de Fisioterapia/instrumentação , Incontinência Urinária/reabilitação , Inquéritos e Questionários , Diafragma da Pelve/fisiopatologia
5.
Maturitas ; 125: 57-62, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31133219

RESUMO

OBJECTIVES: Treatments for genitourinary syndrome of menopause (GSM) may not be suitable for all women, may not be completely effective, and may cause adverse effects. Therefore, there is a need to explore new treatment approaches. The objectives were to evaluate the feasibility of using a pelvic floor muscle training (PFMT) program in postmenopausal women with GSM, and to investigate its effect on symptoms, signs, activities of daily living (ADL), quality of life (QoL) and sexual function. STUDY DESIGN: Postmenopausal women with GSM participated in a single-arm feasibility study embedded in a randomized controlled trial (RCT) on PFMT for urinary incontinence. This substudy was composed of two pre-intervention evaluations, a 12-week PFMT program and a post-intervention evaluation. MAIN OUTCOME MEASURES: Feasibility was defined as study completion and participation in physiotherapy sessions and in-home exercises. The effects of the PFMT program were assessed by measuring GSM symptoms ('Most Bothersome Symptom' approach, ICIQ-UI SF), GSM signs (Vaginal Health assessment scale), GSM's impact on ADL (Atrophy Symptom questionnaire), QoL and sexual function (ICIQ-VS, ICIQ-FLUTSsex) and leakage episodes. RESULTS: Thirty-two women participated. The study completion rate was high (91%), as was participation in treatment sessions (96%) and in-home exercises (95%). Post-intervention, there were significant reductions in GSM symptoms and signs (p < 0.01) as well as in its impacts on ADL, QoL and sexual function (p < 0.05). CONCLUSIONS: A study including a PFMT program is feasible, and the outcomes indicate PFMT to be an effective treatment approach for postmenopausal women with GSM and urinary incontinence. This intervention should be assessed through a RCT.


Assuntos
Atrofia/fisiopatologia , Terapia por Exercício/métodos , Menopausa , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/reabilitação , Vagina/fisiopatologia , Atividades Cotidianas , Idoso , Atrofia/patologia , Terapia por Estimulação Elétrica , Estudos de Viabilidade , Feminino , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Femininos/reabilitação , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Sexualidade , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/psicologia , Vagina/patologia
7.
Eur J Phys Rehabil Med ; 55(3): 342-352, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30947493

RESUMO

BACKGROUND: Rehabilitation interventions are diverse - making decisions about pooling data in meta-analyses challenging. Intervention reporting templates such as the Consensus on Exercise Reporting Template (CERT) may help reviewers document intervention variability. AIM: To assess inter-rater agreement and utility of CERT used to assess completeness of reporting of one rehabilitation exercise intervention: pelvic floor muscle training (PFMT). DESIGN: A non-experimental agreement study. SETTING: Update of the Cochrane systematic review comparing different approaches to PFMT for urinary incontinence in women. POPULATION: Two PFMT arms from 21 newly identified trials. METHODS: Five raters independently used CERT to assess sufficiency of reporting of each arm (experimental PFMT and control PFMT) of each trial. One rater, PFMT non-expert, rated all trials. Four raters, all PFMT experts, assessed a mutually exclusive subgroup of the trials. In addition to rating sufficiency - "Yes" compared to No" or "Uncertain" - raters also reported on CERT utility. Expert ratings were used to determine the proportion of CERT items rated as sufficiently reported. Rater agreement was estimated using coefficient kappa and McNemar's test. RESULTS: The range of CERT items rated as sufficiently reported was 0 to 15 of 19 items, and the mean for both trial arms was 5.5. For agreement, 11 of 19 items had sufficient data to estimate coefficient kappa and only 3 of 11 had a kappa >0.4 (moderate agreement). From the 12 of 19 items for which McNemar's test could be performed, five had evidence that PFMT experts more often rated the reporting as sufficient than the non-expert. Raters reported the CERT template was comprehensive but not complete and needed contextualizing for PFMT. CONCLUSIONS: Completeness of reporting was poor for this example of a rehabilitation exercise intervention, and equally poor in both trial arms. Inter-rater agreement of completeness of reporting was also poor. Using a data extraction tool with poor rater-agreement may add unnecessary burden in a review. However, using a data extraction tool that enables assessment of intervention homogeneity has benefits in making decisions about which data to pool or not. CLINICAL REHABILITATION IMPACT: Researchers reporting clinical trials must pay more attention to completeness of rehabilitation exercise reporting.


Assuntos
Terapia por Exercício , Distúrbios do Assoalho Pélvico/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Revisão Sistemática como Assunto , Incontinência Urinária/reabilitação , Consenso , Medicina Baseada em Evidências , Humanos , Reprodutibilidade dos Testes , Inquéritos e Questionários
8.
Rehabilitación (Madr., Ed. impr.) ; 53(1): 8-12, ene.-mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185406

RESUMO

Objetivo: Identificar las situaciones que puedan hacer variar en algún sentido los resultados de las herramientas Pad test 1 y 24horas e ICIQ-SF. Participantes: Cinco fisioterapeutas que realizaron las entrevistas y tratamiento a 81 pacientes intervenidos de prostatectomía radical. Método: Se realizó un estudio cualitativo fenomenológico descriptivo, mediante técnica de grupo focal de 5 personas (4 mujeres y un hombre) responsables del tratamiento y valoración de pacientes con incontinencia urinaria tras prostatectomía. Se transcribieron las grabaciones realizadas y se utilizó el programa Atlas.ti7 para codificar las variables. Resultados: Se identificaron importantes factores a tener en cuenta en el uso de los instrumentos de medida para el diagnóstico y valoración de la incontinencia urinaria en todas las herramientas utilizadas. Conclusiones: Existen situaciones que pueden modificar la objetividad de las distintas pruebas para la valoración de la incontinencia urinaria. Así se ha detectado, entre otras, una menor ingesta de líquidos, una menor actividad, utilización de pinza manual o de orinales para evitar las pérdidas, así como la interferencia con el uso de determinados fármacos


Objective: To identify situations that may alter the results of the 1-hour and 24-hour Pad test and the short-form International Consultation in Incontinence Questionnaire (SF-ICIQ). Participants: Five physiotherapists, who conducted the interviews and treatment of 81 patients undergoing radical prostatectomy. Method: A qualitative descriptive phenomenological study was carried out, using a focus group technique with five people (4 women and 1 man) responsible for the treatment and assessment of patients with urinary incontinence after prostatectomy. Recordings were transcribed and the Atlas.ti7 programme was used to carry out the coding of the variables. Results: Important factors were identified in the use of measuring instruments for the diagnosis and assessment of urinary incontinence in all the tools used. Conclusions: Some situations can modify the objectivity of the various tests for the assessment of urinary incontinence. Some of the factors identified were lower fluid intake, less activity, use of manual clamp or urinals to avoid leakage, as well as the interference of certain drugs


Assuntos
Humanos , Masculino , Incontinência Urinária/diagnóstico , Prostatectomia/reabilitação , Psicometria/instrumentação , Neoplasias da Próstata/reabilitação , Urodinâmica/fisiologia , Incontinência Urinária/reabilitação , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Pesquisa Qualitativa , Grupos Focais
9.
BMJ Open ; 9(2): e024152, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782894

RESUMO

INTRODUCTION: Female urinary incontinence (UI) is common affecting up to 45% of women. Pelvic floor muscle training (PFMT) is the first-line treatment but there is uncertainty whether intensive PFMT is better than basic PFMT for long-term symptomatic improvement. It is also unclear which factors influence women's ability to perform PFMT long term and whether this has impacts on long-term outcomes. OPAL (optimising PFMT to achieve long-term benefits) trial examines the effectiveness and cost-effectiveness of basic PFMT versus biofeedback-mediated PFMT and this evaluation explores women's experiences of treatment and the factors which influence effectiveness. This will provide data aiding interpretation of the trial findings; make recommendations for optimising the treatment protocol; support implementation in practice; and address gaps in the literature around long-term adherence to PFMT for women with stress or mixed UI. METHODS AND ANALYSIS: This evaluation comprises a longitudinal qualitative case study and process evaluation (PE). The case study aims to explore women's experiences of treatment and adherence and the PE will explore factors influencing intervention effectiveness. The case study has a two-tailed design and will recruit 40 women, 20 from each trial group; they will be interviewed four times over 2 years. Process data will be collected from women through questionnaires at four time-points, from health professionals through checklists and interviews and by sampling 100 audio recordings of appointments. Qualitative analysis will use case study methodology (qualitative study) and the framework technique (PE) and will interrogate for similarities and differences between the trial groups regarding barriers and facilitators to adherence. Process data analyses will examine fidelity, engagement and mediating factors using descriptive and interpretative statistics. ETHICS AND DISSEMINATION: Approval from West of Scotland Research Ethics Committee 4 (16/LO/0990). Findings will be published in journals, disseminated at conferences and through the final report. TRIAL REGISTRATION NUMBER: ISRCTN57746448.


Assuntos
Neurorretroalimentação/métodos , Diafragma da Pelve , Modalidades de Fisioterapia , Incontinência Urinária por Estresse/reabilitação , Biorretroalimentação Psicológica/métodos , Eletromiografia , Feminino , Humanos , Estudos Longitudinais , Pesquisa Qualitativa , Autoeficácia , Incontinência Urinária/reabilitação
10.
BMJ Open ; 9(2): e024153, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782895

RESUMO

INTRODUCTION: Accidental urine leakage is a distressing problem that affects around one in three women. The main types of urinary incontinence (UI) are stress, urgency and mixed, with stress being most common. Current UK guidelines recommend that women with UI are offered at least 3 months of pelvic floor muscle training (PFMT). There is evidence that PFMT is effective in treating UI, however it is not clear how intensively women have to exercise to give the maximum sustained improvement in symptoms, and how we enable women to achieve this. Biofeedback is an adjunct to PFMT that may help women exercise more intensively for longer, and thus may improve continence outcomes when compared with PFMT alone. A Cochrane review was inconclusive about the benefit of biofeedback, indicating the need for further evidence. METHODS AND ANALYSIS: This multicentre randomised controlled trial will compare the effectiveness and cost-effectiveness of PFMT versus biofeedback-mediated PFMT for women with stress UI or mixed UI. The primary outcome is UI severity at 24 months after randomisation. The primary economic outcome measure is incremental cost per quality-adjusted life-year at 24 months. Six hundred women from UK community, outpatient and primary care settings will be randomised and followed up via questionnaires, diaries and pelvic floor assessment. All participants are offered six PFMT appointments over 16 weeks. The use of clinic and home biofeedback is added to PFMT for participants in the biofeedback group. Group allocation could not be masked from participants and healthcare staff. An intention-to-treat analysis of the primary outcome will estimate the mean difference between the trial groups at 24 months using a general linear mixed model adjusting for minimisation covariates and other important prognostic covariates, including the baseline score. ETHICS AND DISSEMINATION: Approval granted by the West of Scotland Research Ethics Committee 4 (16/LO/0990). Written informed consent will be obtained from participants by the local research team. Serious adverse events will be reported to the data monitoring and ethics committee, the ethics committee and trial centres as required. A Standard Protocol Items: Recommendations for Interventional Trials checklist and figure are available for this protocol. The results will be published in international journals and included in the relevant Cochrane review. TRIAL REGISTRATION NUMBER: ISRCTN57746448; Pre-results.


Assuntos
Neurorretroalimentação/métodos , Modalidades de Fisioterapia , Incontinência Urinária por Estresse/reabilitação , Análise Custo-Benefício , Eletromiografia , Feminino , Humanos , Diafragma da Pelve , Resultado do Tratamento , Reino Unido , Incontinência Urinária/reabilitação
11.
Braz J Phys Ther ; 23(2): 116-124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30704906

RESUMO

BACKGROUND: Although the efficacy of pelvic floor muscle training (PFMT) and bladder training are well established, there is a paucity of patient centered models using these interventions to treat women with UI at primary level of health assistance in Brazil. OBJECTIVE: To investigate the effectiveness of a physical therapy intervention to treat women with UI in primary health centers. METHODS: Pragmatic non-randomized controlled trial in which women with UI from the community participated in a supervised physical therapy program consisting of bladder training plus 12 weeks of PFMT, performed either at home or in the health center. Outcome measures were amount and frequency of urine loss measured by the 24-h pad-test and the 24-h voiding diary; secondary outcome was the impact of UI on quality of life measured by the ICIQ-SF. Outcomes were measured at baseline, at the 6th and 12th weeks of the intervention and 1 month after discharge. RESULTS: Interventions reduced the amount (pad-test, p=0.004; d=0.13, 95% CI=-0.23 to 0.49) and frequency of urine loss (voiding diary, p=0.003; d=0.51, 95%CI=0.14 to 0.87), and the impact of UI on quality of life (ICIQ-SF, p<0.001; d=1.26, 95%CI=0.87 to 1.66) over time, with positive effects from the 6th week up to 1 month for both intervention setting (home and health center), and no differences between them. CONCLUSION: Interventions were effective, can be implemented in primary health centers favoring the treatment of a greater number of women who do not have access to specialized physical therapy. TRIAL REGISTRATION: RBR-8tww4y.


Assuntos
Diafragma da Pelve , Bexiga Urinária/fisiopatologia , Incontinência Urinária/fisiopatologia , Brasil , Terapia por Exercício , Feminino , Humanos , Modalidades de Fisioterapia , Atenção Primária à Saúde , Incontinência Urinária/reabilitação
12.
Braz J Phys Ther ; 23(2): 93-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30704907

RESUMO

BACKGROUND: Pelvic floor muscle training is the most commonly used physical therapy treatment for women with urinary incontinence. OBJECTIVES: To assess the effects of Pelvic floor muscle training for women with urinary incontinence in comparison to a control treatment and to summarize relevant economic findings. METHODS: Cochrane Incontinence Group Specialized Register (February 12, 2018). SELECTION CRITERIA: Randomized or quasi-randomized trials in women with stress, urgency or mixed urinary incontinence (symptoms, signs, or urodynamic). DATA COLLECTION AND ANALYSIS: Trials were independently assessed by at least two reviewers authors and subgrouped by urinary incontinence type. Quality of evidence was assessed by adopting the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: The review included thirty-one trials involving 1817 women from 14 countries. Overall, trials were small to moderate size, and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration. Based on data available, we can be confident that Pelvic floor muscle training can cure or improve symptoms of stress and all other types of urinary incontinence. It may reduce the number of leakage episodes and the quantity of leakage, while improving reported symptoms and quality of life. Women were more satisfied with Pelvic floor muscle training, while those in control groups were more likely to seek further treatment. Long-term effectiveness and cost-effectiveness of Pelvic floor muscle training needs to be further researched. CONCLUSIONS: The addition of ten new trials did not change the essential findings of the earlier review, suggesting that Pelvic floor muscle training could be included in first-line conservative management of women with urinary incontinence.


Assuntos
Contração Muscular/fisiologia , Diafragma da Pelve , Incontinência Urinária/reabilitação , Terapia por Exercício , Feminino , Humanos , Modalidades de Fisioterapia
13.
Am J Obstet Gynecol ; 220(1): 87.e1-87.e13, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30595143

RESUMO

BACKGROUND: Because of the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking. OBJECTIVE: To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence, and to examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months. MATERIALS AND METHODS: Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were willing to temporarily forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice-weekly group classes and once-weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group), or a nonspecific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months. RESULTS: Of the 56 women randomized (28 to yoga, 28 to control), the mean age was 65.4 (±8.1) years (range, 55-83 years), the mean baseline incontinence frequency was 3.5 (±2.0) episodes/d, and 37 women (66%) had urgency-predominant incontinence. A total of 50 women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P = .19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P = .07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P = .045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. A total of 48 nonserious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice. CONCLUSION: Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program, and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practice. When taught with attention to women's clinical needs, yoga may offer a potential community-based behavioral self-management strategy for incontinence to enhance clinical treatment, although future research should assess whether yoga offers unique benefits for incontinence above and beyond other physical activity-based interventions.


Assuntos
Qualidade de Vida , Incontinência Urinária/diagnóstico , Incontinência Urinária/reabilitação , Ioga , Centros Médicos Acadêmicos , Fatores Etários , Idoso , Terapia por Exercício/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Seleção de Pacientes , Diafragma da Pelve , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Resultado do Tratamento , Incontinência Urinária/psicologia , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/reabilitação
14.
Neurourol Urodyn ; 38(3): 1005-1008, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30697814

RESUMO

AIMS: Energy-based devices using radiofrequency and laser technologies have gained popularity as therapies for vaginal atrophy, urinary incontinence, and vaginal prolapse. They have been promoted by cosmetic and aesthetic industries for vaginal "laxity" and vaginal "rejuvenation," both of which are undefined conditions and terms. This article aims to review the current available literature and its quality on this emerging technology. METHODS: An international panel of gynaecologists, urogynaecologists, and urologists undertook a review of the available published literature, identifying articles, guidance, and society statements on the use vaginal energy-based devices. RESULTS: There is currently no formal guidance for the use of vaginal energy based therapies. No randomized controlled trials have been published. No comparative studies to existing treatment has been carried out. Studies suggest that vaginal laser can be used in the treatment of vaginal prolapse or "vaginal laxity" and stress urinary incontinence with no quality evidence supporting the use of the therapy for vaginal atrophy or lichen sclerosis. CONCLUSIONS: This international group propose that whilst there remains a paucity of good quality data describing the safety, benefits, and appropriate use of vaginal radiofrequency or laser treatments in gynaecology and urogynaecology, a consensus best practice document by an established scientific community needs to be developed.


Assuntos
Cosméticos , Terapia a Laser/instrumentação , Ondas de Rádio , Rejuvenescimento , Incontinência Urinária/terapia , Doenças Vaginais/terapia , Feminino , Humanos , Incontinência Urinária/reabilitação , Vagina , Doenças Vaginais/reabilitação , Vulva
15.
Telemed J E Health ; 25(2): 160-164, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29792574

RESUMO

BACKGROUND: Pelvic floor exercises are effective in improving muscle strength and urinary incontinence symptoms. Increasingly popular mobile applications can be effective in teaching patients these exercises. INTRODUCTION: A mobile application, Bwom©, aims to educate women about pelvic floor exercises with individually tailored plans relevant to the user's risk factors. The objective of this study is to assess the understandability and actionability of Bwom. MATERIALS AND METHODS: This is a cross-sectional survey of patients and providers at an academic medical center. The survey utilized the Patient Education Material Assessment Tool (PEMAT) validated by the U.S. Department of Health Services, which provides scores on understandability and actionability. Participants completed an initial demographic survey, used Bwom for 2 weeks, and then completed the PEMAT tool. RESULTS: Twenty five patients and 22 providers participated in the study, for a total of 47 participants. Providers included gynecology residents and faculty (91%), pelvic floor physical therapists (5%), and other healthcare professionals (5%). The majority of patients were age 31-40 (70%) and Caucasian (55%). Thirty nine percent had not yet tried pelvic floor exercises on their own before the study. The mean understandability score was 93.8% (±11.7) and the mean actionability score was 91.7% (±16.3). DISCUSSION: This study paves the way for future investigations into the effectiveness of this app in decreasing symptoms of pelvic floor weakness and incontinence. CONCLUSIONS: This study demonstrates that Bwom shows promise as a mobile application to educate women about pelvic floor exercises by providing user-friendly actions in an understandable way.


Assuntos
Terapia por Exercício/métodos , Aplicativos Móveis , Diafragma da Pelve/fisiologia , Incontinência Urinária/reabilitação , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Fatores Socioeconômicos
16.
Physiotherapy ; 105(1): 114-119, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30340838

RESUMO

OBJECTIVES: To determine in women with clinically stable chronic lung disease (CLD) and healthy women; (1) prevalence of urinary incontinence; (2) risk factors for urinary incontinence; (3) effects of a standard course of specialised physiotherapy treatment (PT) in women with CLD. DESIGN: Prospective prevalence study; PT study in CLD subgroup. SETTING: Tertiary metropolitan public hospital. PARTICIPANTS: Women with cystic fibrosis (CF, n=38), chronic obstructive pulmonary disease (COPD, n=27) and 69 healthy women without CLD. PT study - 10 women with CLD. INTERVENTIONS: Five continence PT sessions over 3 months. MAIN OUTCOME MEASURES: Prevalence and impact of incontinence (questionnaire), number of leakage episodes (7-day accident diary), pelvic floor muscle function (ultrasound imaging) and quality of life (King's Health Questionnaire). RESULTS: The majority of women in all three groups reported episodes of incontinence (CF 71%; COPD 70%; healthy women 55%). Compared to age-matched healthy controls, women with CF reported more episodes of incontinence (P=0.006) and more commonly reported stress incontinence (P=0.001). A logistic regression model revealed that women with CLD were twice as likely to develop incontinence than healthy women (P=0.05). Women with COPD reported significantly more 'bother' with incontinence than age-matched women with incontinence. There was a significant reduction in incontinence episodes following treatment, which was maintained after three months. CONCLUSIONS: The presence of CLD is an independent predictor of incontinence in women. In older women this is associated with more distress than in age-matched peers without CLD. Larger treatment studies are indicated for women with CLD and incontinence.


Assuntos
Fibrose Cística/epidemiologia , Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Incontinência Urinária/epidemiologia , Incontinência Urinária/reabilitação , Adulto , Fatores Etários , Idoso , Fibrose Cística/psicologia , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Prevalência , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida , Incontinência Urinária/psicologia
17.
J Health Psychol ; 24(2): 254-263, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-27302604

RESUMO

This article analyzed how sexual satisfaction, suffering, severity and impact of urinary incontinence, and psychological morbidity affected women's quality of life and whether suffering mediated the relationship between psychological morbidity and quality of life. The study included 80 women diagnosed with urinary incontinence receiving rehabilitation treatment. Regression analysis showed that sexual satisfaction, suffering, and urinary incontinence severity and impact predicted quality of life and that suffering mediated the relationship between psychological morbidity and quality of life. The findings suggest that interventions should be tailored according to the suffering reported by women and the impact of the urinary incontinence on the couple's sexual relationship.


Assuntos
Qualidade de Vida/psicologia , Incontinência Urinária/psicologia , Incontinência Urinária/reabilitação , Adulto , Idoso , Feminino , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Orgasmo , Portugal , Análise de Regressão , Comportamento Sexual/psicologia , Estresse Psicológico , Inquéritos e Questionários
18.
Top Stroke Rehabil ; 26(2): 128-135, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30526438

RESUMO

OBJECTIVE: The purpose of this study is to investigate the effects of pelvic floor muscle exercises (PFMEs) done by stroke patients at home in line with the health belief model (HBM) on patient care outcomes and caregivers' burdens. METHOD: In the study, a quasi-experimental design with a pre- and post-test control group was used. The study was conducted with 20 patients in the experimental group and 18 patients in the control group. The patients and caregivers were evaluated at baseline and after the 12-week PFME intervention performed at home. The data were analyzed with the chi-square, Mann-Whitney U, Wilcoxon signed rank test and multiple regression analysis. RESULTS: A statistically significant difference was found between the two groups in terms of the mean scores they obtained from the ICIQ-SF and I-QOL, the number of urinary incontinence episodes, pad test after interventions and quality of life scores (p < 0.05), while no statistically significant difference was found between the groups in terms of the mean scores for the Burden Interview (p > 0.05). An increase was determined in the self-efficacy of the patients in the experimental group after the PFMEs (p < 0.05). CONCLUSIONS: Given the results of the present study, it is recommended that in the management of post-stroke urinary incontinence, post-stroke patients should be encouraged to do PFME at home in line with the HBM, and they should be monitored periodically.


Assuntos
Cuidadores/psicologia , Terapia por Exercício/métodos , Diafragma da Pelve , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Incontinência Urinária/etiologia , Incontinência Urinária/reabilitação , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores Socioeconômicos , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
19.
Actas urol. esp ; 42(9): 557-566, nov. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174856

RESUMO

Antecedentes: La gimnasia abdominal hipopresiva se propone como un nuevo paradigma en la rehabilitación del suelo pélvico. Sus postulados contradicen la recomendación del entrenamiento muscular del suelo pélvico en el posparto. Objetivo: Conocer si la gimnasia abdominal hipopresiva es más eficaz que el entrenamiento muscular del suelo pélvico u otros tratamientos conservadores alternativos para la rehabilitación del suelo pélvico. Métodos: Las bases de datos consultadas fueron Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), PEDro, PubMed, Scopus, Trip Database y Web of Science. Se seleccionaron revisiones sistemáticas, ensayos clínicos o estudios analíticos que evaluasen la eficacia de la gimnasia abdominal hipopresiva en mujeres. Los resultados medidos fueron: el fortalecimiento de la musculatura del suelo pélvico, la incidencia de incontinencia de orina o prolapso o la remisión de los síntomas. Se incluyeron 4 ensayos clínicos; su calidad se midió con la escala PEDro. Resultados: La gimnasia hipopresiva es menos eficaz que el entrenamiento muscular del suelo pélvico para activar los músculos del suelo pélvico, lograr el cierre de hiato del elevador del ano e incrementar el grosor muscular, la fuerza y la resistencia del suelo pélvico. Implicación práctica: La evidencia revisada no apoya la recomendación de la gimnasia abdominal hipopresiva para el fortalecimiento del suelo pélvico ni en el posparto ni fuera de él. El entrenamiento muscular del suelo pélvico se mantiene como primera línea de tratamiento en las disfunciones del suelo pélvico. Conclusión: Faltan ensayos clínicos de calidad que evalúen la eficacia de la gimnasia abdominal hipopresiva


Background: Hypopressive abdominal gymnastics has been proposed as a new paradigm in rehabilitating the pelvic floor. Its claims contraindicate the recommendation for pelvic floor muscle training during the postpartum period. Objective: To determine whether hypopressive abdominal gymnastics is more effective than pelvic floor muscle training or other alternative conservative treatments for rehabilitating the pelvic floor. Methods: We consulted the databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Trip Database and Web of Science. We selected systematic reviews, clinical trials and analytical studies that assessed the efficacy of hypopressive abdominal gymnastics in women. The measured outcomes were the strengthening of the pelvic floor muscles, the incidence of urine incontinence or prolapse and symptom remission. We included 4 clinical trials, whose quality was measured with the PEDro scale. Results: Hypopressive gymnastics is less effective than pelvic floor muscle training for activating pelvic floor muscles, achieving closure of the levator hiatus of the anus and increasing pelvic floor muscle thickness, strength and resistance. Practical implication: The evidence reviewed does not support the recommendation for hypopressive abdominal gymnastics for strengthening the pelvic floor either during the postpartum period or outside that period. Pelvic floor muscle training remains the first-line treatment for pelvic floor dysfunction. Conclusion: There is a lack of quality clinical trials that have evaluated the efficacy of hypopressive abdominal gymnastics


Assuntos
Humanos , Feminino , Distúrbios do Assoalho Pélvico/reabilitação , Terapia por Exercício/métodos , Músculos Abdominais , Incontinência Urinária/reabilitação , Diafragma da Pelve , Postura , Incontinência Urinária/epidemiologia , Prolapso
20.
Cochrane Database Syst Rev ; 10: CD005654, 2018 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-30288727

RESUMO

BACKGROUND: Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI).This is an update of a Cochrane Review first published in 2001 and last updated in 2014. OBJECTIVES: To assess the effects of PFMT for women with urinary incontinence (UI) in comparison to no treatment, placebo or sham treatments, or other inactive control treatments; and summarise the findings of relevant economic evaluations. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register (searched 12 February 2018), which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings, and the reference lists of relevant articles. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials in women with SUI, UUI or MUI (based on symptoms, signs or urodynamics). One arm of the trial included PFMT. Another arm was a no treatment, placebo, sham or other inactive control treatment arm. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed trials for eligibility and risk of bias. We extracted and cross-checked data. A third review author resolved disagreements. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. We subgrouped trials by diagnosis of UI. We undertook formal meta-analysis when appropriate. MAIN RESULTS: The review included 31 trials (10 of which were new for this update) involving 1817 women from 14 countries. Overall, trials were of small-to-moderate size, with follow-ups generally less than 12 months and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration, study populations and outcome measures. There was only one study of women with MUI and only one study with UUI alone, with no data on cure, cure or improvement, or number of episodes of UI for these subgroups.Symptomatic cure of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were eight times more likely to report cure (56% versus 6%; risk ratio (RR) 8.38, 95% confidence interval (CI) 3.68 to 19.07; 4 trials, 165 women; high-quality evidence). For women with any type of UI, PFMT groups were five times more likely to report cure (35% versus 6%; RR 5.34, 95% CI 2.78 to 10.26; 3 trials, 290 women; moderate-quality evidence).Symptomatic cure or improvement of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were six times more likely to report cure or improvement (74% versus 11%; RR 6.33, 95% CI 3.88 to 10.33; 3 trials, 242 women; moderate-quality evidence). For women with any type of UI, PFMT groups were two times more likely to report cure or improvement than women in the control groups (67% versus 29%; RR 2.39, 95% CI 1.64 to 3.47; 2 trials, 166 women; moderate-quality evidence).UI-specific symptoms and quality of life (QoL) at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT group were more likely to report significant improvement in UI symptoms (7 trials, 376 women; moderate-quality evidence), and to report significant improvement in UI QoL (6 trials, 348 women; low-quality evidence). For any type of UI, women in the PFMT group were more likely to report significant improvement in UI symptoms (1 trial, 121 women; moderate-quality evidence) and to report significant improvement in UI QoL (4 trials, 258 women; moderate-quality evidence). Finally, for women with mixed UI treated with PFMT, there was one small trial (12 women) reporting better QoL.Leakage episodes in 24 hours at the end of treatment: PFMT reduced leakage episodes by one in women with SUI (mean difference (MD) 1.23 lower, 95% CI 1.78 lower to 0.68 lower; 7 trials, 432 women; moderate-quality evidence) and in women with all types of UI (MD 1.00 lower, 95% CI 1.37 lower to 0.64 lower; 4 trials, 349 women; moderate-quality evidence).Leakage on short clinic-based pad tests at the end of treatment: women with SUI in the PFMT groups lost significantly less urine in short (up to one hour) pad tests. The comparison showed considerable heterogeneity but the findings still favoured PFMT when using a random-effects model (MD 9.71 g lower, 95% CI 18.92 lower to 0.50 lower; 4 trials, 185 women; moderate-quality evidence). For women with all types of UI, PFMT groups also reported less urine loss on short pad tests than controls (MD 3.72 g lower, 95% CI 5.46 lower to 1.98 lower; 2 trials, 146 women; moderate-quality evidence).Women in the PFMT group were also more satisfied with treatment and their sexual outcomes were better. Adverse events were rare and, in the two trials that did report any, they were minor. The findings of the review were largely supported by the 'Summary of findings' tables, but most of the evidence was downgraded to moderate on methodological grounds. The exception was 'participant-perceived cure' in women with SUI, which was rated as high quality. AUTHORS' CONCLUSIONS: Based on the data available, we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI. It may reduce the number of leakage episodes, the quantity of leakage on the short pad tests in the clinic and symptoms on UI-specific symptom questionnaires. The authors of the one economic evaluation identified for the Brief Economic Commentary reported that the cost-effectiveness of PFMT looks promising. The findings of the review suggest that PFMT could be included in first-line conservative management programmes for women with UI. The long-term effectiveness and cost-effectiveness of PFMT needs to be further researched.


Assuntos
Terapia por Exercício/métodos , Contração Muscular/fisiologia , Diafragma da Pelve , Incontinência Urinária/reabilitação , Biorretroalimentação Psicológica , Feminino , Humanos , Períneo , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Incontinência Urinária por Estresse/reabilitação
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