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Chen L, Han Y, Wang L, Zhang H, Zheng Y, Zhang R, Meng G, Zhang YP, Ji D. Conservative Interventions for Urinary Incontinence on Postpartum Women: A Systematic Review and Meta-Analysis. J Midwifery Womens Health 2024. [PMID: 38807257 DOI: 10.1111/jmwh.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/14/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Urinary incontinence (UI) is common in postpartum women and can lead to a reduced quality of life and withdrawal from fitness and exercise activities. Conservative management interventions such as pelvic floor muscle training (PFMT), use of vaginal cones, and biofeedback have been recommended as first-line treatment. We aimed to explore the effects of conservative interventions on UI rate, severity, and incontinence-specific quality of life in postpartum women with UI. METHODS Nine databases were searched from inception to August 2022: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, Wanfang, China National Knowledge Infrastructure, China Biological Medicine, and VIP Journal Integration Platform. Randomized controlled trials examining the effects of conservative interventions on postpartum UI were included. RESULTS Initial searches produced 1839 results, of which 17 studies were eligible. All included studies had a low to moderate risk of bias. Supervised PFMT and use of a vaginal cone were more effective than individual PFMT in decreasing rates of UI (odds ratio, 0.29; 95% CI, 0.14-0.61). Individual PFMT combined with acupuncture (mean difference, -1.91; 95% CI, -2.46 to -1.37) or electroacupuncture and supervised PFMT combined with moxibustion were more effective than individual supervised PFMT alone in improving the severity of symptoms. Furthermore, electrical stimulation and biofeedback combined with acupoint stimulation or core training were more effective than electrical stimulation and biofeedback alone. For improving the incontinence-specific quality of life, supervised PFMT was more efficacious than individual PFMT; electrical stimulation and biofeedback plus core training were more beneficial than electrical stimulation and biofeedback alone. DISCUSSION Supervised PFMT and use of a vaginal cone were more beneficial in decreasing rates of UI compared with individual PFMT. Superior effects in decreasing UI severity may be achieved by combining PFMT or electrical simulation and biofeedback with other therapies. Electrical stimulation and biofeedback plus core training, as well as supervised PFMT, are most effective in improving incontinence-specific quality of life. Further research is required to provide more evidence on the efficacy of these therapies.
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Affiliation(s)
- Lixia Chen
- Medical Emergency Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- Faculty of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ying Han
- School of Nursing, Dalian University, Dalian, China
| | - Liang Wang
- Nursing Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Han Zhang
- Department of Nursing, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yanan Zheng
- Department of Nursing, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Rui Zhang
- School of Nursing, Dalian University, Dalian, China
| | - Ge Meng
- Faculty of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yin-Ping Zhang
- Faculty of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Daihong Ji
- Department of Nursing, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Hakim S, Santoso BI, Rahardjo HE, Setiati S, Kusumaningsih W, Erwinanto, Prihartono J, Ibrahim N, Indriatmi W. Analyze, design, develop, implement, and evaluate approach to develop a pelvic floor muscle training guidebook to treat stress urinary incontinence in women. Obstet Gynecol Sci 2024; 67:323-334. [PMID: 38479353 PMCID: PMC11099090 DOI: 10.5468/ogs.23212] [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: 08/21/2023] [Revised: 12/09/2023] [Accepted: 02/27/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE Stress urinary incontinence (SUI) is a common problem that affects the quality of life of women worldwide. Pelvic floor muscle training (PFMT) is an effective conservative first-line treatment for SUI. However, low compliance with PFMT is one of the main reasons for therapeutic failure. Indirect supervision using a guidebook may improve PFMT outcomes. To develop a PFMT guidebook using the analyze, design, development, implementation, and evaluation (ADDIE) method. METHODS A guidebook was developed from July 2020 to April 2021 using the ADDIE method. This prospective study used mixed methods, namely qualitative analysis, focus group discussions, and in-depth interviews, and involved various experts from urogynecology, urology, medical rehabilitation, and physiotherapy departments. A pilot study was conducted on patients with SUI to evaluate the effectiveness of the guidebook. RESULTS The ADDIE method was successfully implemented to develop the PFMT guidebook. The formative evaluation of the ADDIE steps mainly focused on the PFMT technique, content clarity, illustration, design, and color choice of the book. After the pilot study, the guidebook significantly improved Incontinence Impact Questionnaire, Short Form, 1-hour pad test, and perineometer scores. However, the pilot study showed no significant improvement in Urogenital Distress Inventory, Short Form scores. CONCLUSION The PFMT guidebook developed using the ADDIE method improved outcomes in patients with SUI.
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Affiliation(s)
- Surahman Hakim
- Urogynecology Division, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
- Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Budi Iman Santoso
- Urogynecology Division, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
| | | | - Siti Setiati
- Geriatrics Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
| | | | - Erwinanto
- Urogynecology Division, Department of Obstetrics and Gynecology, Dr. Kariadi Hospital, Semarang,
Indonesia
| | - Joedo Prihartono
- Department of Community Medicine, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
| | - Nurhadi Ibrahim
- Department of Physiology and Biophysics, Faculty of Medicine University of Indonesia, Jakarta,
Indonesia
| | - Wresti Indriatmi
- Dermatology and Venereology, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
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Dos Santos Sousa AJ, Cordeiro Rodrigues J, Falcão Padilha J, Garcia Godoy A, Menezes Degani A, Danna-Santos A, Driusso P. Effects of health education on women with urinary incontinence: systematic review and meta-analysis. Int Urogynecol J 2024; 35:273-289. [PMID: 38099941 DOI: 10.1007/s00192-023-05693-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 11/06/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the effects of health education (HE) on urinary symptoms and quality of life in women with urinary incontinence (UI). METHODS A systematic review and meta-analysis of trials evaluating HE for women with UI. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. RESULTS The search identified 5,118 articles. Eighteen papers were considered eligible. The interventions investigated included health education (HE), combined intervention, self-management (SM), and structured training (ST). Outcomes included quality of life (QoL), UI frequency, UI severity, impression of improvement, incontinence symptoms, urine leakage, fear of leakage, urgency, and incontinence impact. Compared with the control group there was a significant improvement in the frequency, severity, and impact on the QoL for women with UI (assessed by the total score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ SF); RR = -1.47, 95% CI [-2.07, -0.88]; two trials; low certainty of the evidence). CONCLUSIONS This review shows that HE seems to be beneficial in the treatment of women with UI when compared with control women (no treatment or general health care), improving the frequency, severity, and impact on QoL assessed by the ICIQ SF total score. However, the certainty of this evidence is low.
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Affiliation(s)
- Ana Jéssica Dos Santos Sousa
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Jéssica Cordeiro Rodrigues
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Juliana Falcão Padilha
- Urogynecological Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Amapá, Macapá, AP, Brazil
| | - Amanda Garcia Godoy
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Adriana Menezes Degani
- Laboratory for Advancements in Rehabilitation Sciences, Department of Physical Therapy, Western Michigan University, Kalamazoo, MI, USA
| | - Alessander Danna-Santos
- Laboratory for Advancements in Rehabilitation Sciences, Department of Physical Therapy, Western Michigan University, Kalamazoo, MI, USA
| | - Patricia Driusso
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil.
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Kharaji G, ShahAli S, Ebrahimi-Takamjani I, Sarrafzadeh J, Sanaei F, Shanbehzadeh S. Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence - a systematic review and meta-analysis. Int Urogynecol J 2023; 34:1339-1349. [PMID: 36811635 PMCID: PMC9944784 DOI: 10.1007/s00192-023-05489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study synthesized the effects of supervised and unsupervised pelvic floor muscle training (PFMT) programs on outcomes relevant to women's urinary incontinence (UI). METHODS Five databases were searched from inception to December 2021, and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity of UI, and patient satisfaction outcomes were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference. RESULTS Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias", and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFM function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised and unsupervised PFMT with thorough education and regular reassessment showed better results than those for unsupervised PFMT without educating patients about correct PFM contractions. CONCLUSIONS Supervised and unsupervised PFMT programs can both be effective in treating women's UI if training sessions and regular reassessments are provided.
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Affiliation(s)
- Ghazal Kharaji
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Ismail Ebrahimi-Takamjani
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Sarrafzadeh
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fateme Sanaei
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Shanbehzadeh
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Curillo-Aguirre CA, Gea-Izquierdo E. Effectiveness of Pelvic Floor Muscle Training on Quality of Life in Women with Urinary Incontinence: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1004. [PMID: 37374208 PMCID: PMC10301414 DOI: 10.3390/medicina59061004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Urinary incontinence (UI) is a condition that is more common in women than men and has an increasing prevalence with age. It provides a range of psychological and physical burdens that negatively affect the patient's quality of life (QoL). However, the economic burden for the healthcare system is being augmented due to the increasing life expectancy of the population. This article aims to identify the effectiveness of pelvic floor muscle training (PFMT) on the QoL in women with UI. Materials and Methods: A systematic review and meta-analysis were conducted in the PubMed, EMBASE, ProQuest medicine, Cochrane Library, and Google Scholar databases. The terms selected according to components of PICOS were women with urinary incontinence, pelvic floor muscle training, watchful or other types of therapies, quality of life, randomized controlled trials, and interventional or observational studies. The articles included were those published between November 2018 and November 2022. Ten articles were found for the systematic review and eight for the meta-analysis. Results: The QoL moderately increased when PFMT was used on women with UI, the results indicating an overall small effect on the QoL across the controlled studies and a moderate effect on the QoL across the one-group pre-post-studies. Conclusions: Specific QoL domains, such as social activities and general health, also demonstrated benefits from PFMT interventions. This study confirmed the effectiveness of PFMT on the QoL in women with UI, mainly for patients with stress urinary incontinence.
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Affiliation(s)
| | - Enrique Gea-Izquierdo
- Faculty of Medicine, Pontifical Catholic University of Ecuador, Quito 170143, Ecuador
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