Article

Comparison of pelvic floor muscle training, electromyography biofeedback, and neuromuscular electrical stimulation for bladder dysfunction in people with multiple sclerosis: A Randomised Pilot Study

Faculty of Life and Health Sciences, Ulster University, Aontroim, Northern Ireland, United Kingdom
Neurourology and Urodynamics (Impact Factor: 2.87). 01/2006; 25(4):337-48. DOI: 10.1002/nau.20209
Source: PubMed

ABSTRACT

Bladder dysfunction affects up to 90% of the multiple sclerosis (MS) population. Interventions such as Pelvic Floor Training and Advice (PFTA), Electromyography (EMG) Biofeedback, and Neuromuscular Electrical Stimulation (NMES) have received limited research attention within this population. This study aimed to determine the effectiveness of a combined programme of PFTA, EMG Biofeedback, and NMES for bladder dysfunction in MS.
Females (n = 30) who fulfilled strict inclusion/exclusion criteria were recruited. Outcome measures (weeks 0, 9, 16, and 24) included: 3-day Voiding Diary; 24 hr Pad-Test; Uroflowmetry; Pelvic Floor Muscle Assessment; Incontinence Impact Questionnaire (IIQ); Urogenital Distress Inventory (UDI); King's Health Questionnaire (KHQ), and the Multiple Sclerosis Quality of Life-54 Instrument (MSQoL-54). Following baseline (week 0) assessment, participants were randomly allocated, under double blind conditions, to one of the three groups: Group 1 (PFTA); Group 2 (PFTA and EMG Biofeedback); and Group 3 (PFTA, EMG Biofeedback, and NMES). Treatment was for 9 weeks.
Baseline severity (measured by number of leaks and pad weight) showed some variation between groups, although not statistically significant (P > 0.05); with the caveat that this baseline imbalance makes interpretation difficult, a picture emerges that at week 9, Group 3 demonstrated superior benefit as measured by the number of leaks and pad test than Group 2, with Group 1 showing less improvement when compared to week 0; this was statistically significant between Groups 1 and 3 for number of leaks (P = 0.014) and pad tests (P = 0.001), and Groups 1 and 2 for pad tests (P = 0.001). A similar pattern was evident for all other outcome measures.
Results suggest that these treatments, used in combination, may reduce urinary symptoms in MS. Further research will establish the effectiveness of these interventions.

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    • "La limitation d'activité et la restriction de participation 19—22 ainsi que la qualité de vie 20—22 des patients se voient également significativement améliorées. Quant aux paramètres liés à la vidange vésicale tel que le résidu post-mictionnel, ils ne sont que rarement significativement améliorés [19] [21]. L'amélioration concerne plus les hommes que les femmes [18]. "
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    ABSTRACT: To assess the effectiveness of conservative therapeutic approaches in a multiple sclerosis population. Review was performed in PubMed, PEDro, Scopus and Cochrane Library using combinations of the following keywords: multiple sclerosis; bladder dysfunction; overactive bladder; detrusor hyperreflexia; urge incontinence; urgency; stress incontinence; pelvic floor muscle; biofeedback; PTNS; tibial nerve; bladder training; physical therapy; physiotherapy; conservative treatment and behavioral therapy. Six randomized articles including 289 patients were selected. Four papers exhibited strong scores for the methodological quality assessment. The parameters always significantly improved concerned: number of incontinence episodes (decreased from 64% to 86% after treatment versus before treatment), quality of life (P≤0.001), severity of irritative symptoms (decreased by more than 50% after treatment versus before treatment), and nocturia (P=0.035 to P<0.001). Activities and participation, maximum flow rate, mean voided volume and daytime frequency were not significantly improved in all trials. The physical therapy techniques could be effective for the treatment of urinary disorders in multiple sclerosis populations with mild disability. However, the analyses are based on six studies within only four showed good methodological quality. No strong conclusions regarding treatment approaches can be drawn from this review.
    Full-text · Article · Mar 2014 · Progrès en Urologie
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    • "La limitation d'activité et la restriction de participation 19—22 ainsi que la qualité de vie 20—22 des patients se voient également significativement améliorées. Quant aux paramètres liés à la vidange vésicale tel que le résidu post-mictionnel, ils ne sont que rarement significativement améliorés [19] [21]. L'amélioration concerne plus les hommes que les femmes [18]. "
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    ABSTRACT: Aim To assess the effectiveness of conservative therapeutic approaches in a multiple sclerosis population. Material Review was performed in PubMed, PEDro, Scopus and Cochrane Library using combinations of the following keywords: multiple sclerosis; bladder dysfunction; overactive bladder; detrusor hyperreflexia; urge incontinence; urgency; stress incontinence; pelvic floor muscle; biofeedback; PTNS; tibial nerve; bladder training; physical therapy; physiotherapy; conservative treatment and behavioral therapy. Results Six randomized articles including 289 patients were selected. Four papers exhibited strong scores for the methodological quality assessment. The parameters always significantly improved concerned: number of incontinence episodes (decreased from 64% to 86% after treatment versus before treatment), quality of life (P ≤ 0.001), severity of irritative symptoms (decreased by more than 50% after treatment versus before treatment), and nocturia (P = 0.035 to P < 0.001). Activities and participation, maximum flow rate, mean voided volume and daytime frequency were not significantly improved in all trials. Conclusions The physical therapy techniques could be effective for the treatment of urinary disorders in multiple sclerosis populations with mild disability. However, the analyses are based on six studies within only four showed good methodological quality. No strong conclusions regarding treatment approaches can be drawn from this review.
    Full-text · Article · Jan 2013
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    • "Two studies used McDonald criteria [38] to confirm diagnosis [25, 27], three reported diagnosis confirmation by a neurologist but did not discuss criteria [26, 31, 32], two studies reported confirmed diagnoses but did not report by who or how [30, 33], and three studies did not report whether MS diagnosis was confirmed or not [28, 29, 34]. Five studies measured participants' baseline Expanded Disability Status Scale (EDSS) scores [25, 27, 30–32]; three of these studies provided mean EDSS scores for intervention and comparator groups. The EDSS is a measure of neurological impairment from 0 (normal neurological exam) to 10.0 (dead). "
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    ABSTRACT: Background. Mind-body therapies are used to manage physical and psychological symptoms in many chronic health conditions. Objective. To assess the published evidence for using mind-body techniques for symptom management of multiple sclerosis. Methods. MEDLINE, PsycINFO, and Cochrane Clinical Trials Register were searched from inception to March 24, 2012. Eleven mind-body studies were reviewed (meditation, yoga, biofeedback, hypnosis, relaxation, and imagery). Results. Four high quality trials (yoga, mindfulness, relaxation, and biofeedback) were found helpful for a variety of MS symptoms. Conclusions. The evidence for mind-body medicine in MS is limited, yet mind-body therapies are relatively safe and may provide a nonpharmacological benefit for MS symptoms.
    Full-text · Article · Nov 2012
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