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Yang X, Sayer L, Bassett S, Woodward S. Group-based pelvic floor muscle training for pregnant women: A randomized controlled feasibility study. J Adv Nurs 2024. [PMID: 39140698 DOI: 10.1111/jan.16365] [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: 04/12/2024] [Revised: 07/05/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024]
Abstract
AIM This study aims to test the feasibility and acceptability of a group-based pelvic floor muscle training for pregnant women in China and facilitate women's adherence to the pelvic floor muscle training programme. BACKGROUND Urinary incontinence is a prevalent health problem in women worldwide, especially in pregnant women. Supervised pelvic floor muscle training is recommended as the first-line conservative treatment for urinary incontinence. However, the implementation and effectiveness of pelvic floor muscle training are limited by insufficient human resources and low adherence. Group-based interventions may improve people's adherence to interventions by facilitating peer support. However, it has been investigated in a limited number of maternity studies. DESIGN Feasibility testing randomized controlled trial, accompanied by a mixed methods process evaluation. METHODS This study was guided by the Medical Research Council framework for complex interventions and the Behaviour Change Wheel guide to developing interventions. A three-phase, mixed-methods design was used in this study. This study reported the feasibility of the group-based pelvic floor muscle training programme. Semi-structured reviews were conducted following the intervention to explore the acceptability of the programme. RESULTS The study included 48 pregnant women with a recruitment rate of 52.17%. The adherence rate to the training programme was 66.67%. The intervention was positively valued, in particular the support promoting participants' adherence, but additional changes need to be made to the programme for a future trial. CONCLUSIONS Group-based pelvic floor muscle training programme provides a possible way of delivering pelvic floor muscle training with limited health professionals in China. The study showed promising results concerning the acceptability and feasibility of the intervention, which were well perceived by both pregnant women and the midwife. IMPLICATIONS FOR PATIENT CARE Group-based pelvic floor muscle training may have the potential of reducing the prevalence of urinary incontinence in pregnant women with insufficient healthcare professionals. IMPACT This study assessed the feasibility of delivering group-based pelvic floor muscle training in pregnant women in China. The group-based pelvic floor muscle training is acceptable to both pregnant women and the midwife, but integrating online and face-to-face sessions need to be considered. The findings of this study provided evidence for delivering group-based pelvic floor muscle training to pregnant women in China. REPORTING METHOD The study has adhered to CONSORT guidelines (Table S1) and TIDier checklist (Table S2). PATIENT AND PUBLIC CONTRIBUTION The patient and public have been invited as stakeholders during the development of the intervention. They worked with healthcare professionals to co-design the group-based pelvic floor muscle training programme. REGISTRATION The trial was registered on ClinicalTrials.gov (NCT05242809) under the title 'Development and Feasibility Testing of a Group-based PFMT Programme for Antenatal Women in Nanjing City in China'.
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Affiliation(s)
- Xiaowei Yang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Department of Clinical Teaching and Research, Nanjing Vocational Health College, Nanjing, China
| | - Lynn Sayer
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sam Bassett
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sue Woodward
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Zhu J, Pang H, Wang P, Chen Y, Li H, Liu Q, Wang L, Jin H, Gong L, Xie J, Lai T, Li A, Liu L, Yan M, Zhou L, Luan Y, Wang L, Li X, Luo X, Fu Y, Niu J, Zhao W, Liu Q, Zhao R, Lou W, Morse AN, Yin J, Dang L, Yang H, Li L, Lv J, Zhu L. Female urinary incontinence in China after 15 years' efforts: Results from large-scale nationwide surveys. Sci Bull (Beijing) 2024:S2095-9273(24)00559-0. [PMID: 39214741 DOI: 10.1016/j.scib.2024.04.074] [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: 01/11/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 09/04/2024]
Abstract
Urinary incontinence (UI) is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected. This study aims to systematically assess the prevalence and dynamics of female UI in China, and can inform further policies and have international implications. This study used three nationwide investigations: A national cross-sectional survey in 2021; another nationwide cross-sectional survey in 2006; and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019. The weighted prevalence of female UI and its subtypes, including stress UI (SUI), urgency UI (UUI), and mixed UI (MUI), were estimated as primary outcomes. Knowledge, attitude and care-seeking behaviors of UI were evaluated. It was found that the weighted prevalence of female UI was 16.0 % (95% CI, 13.3 %-19.1%) with SUI remaining the predominant subtype (7.0%) in 2021, followed by MUI (6.5%) and UUI (1.9%). The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021. 52.7% (95% CI, 45.9%-59.4 %) of women were aware that UI was a medical condition, and only 10.1% of women with UI sought health care. After 15 years of development, there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in China-they were found to be associated with UI prevalence. The UI prevalence in China was significantly lower in 2021 compared to that in 2006. Despite the achievement, UI remains a public health problem, especially given China's fast aging and three-child policy. More innovations, especially those that can facilitate care seeking, are needed to address this prevalent yet treatable condition.
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Affiliation(s)
- Jiming Zhu
- Vanke School of Public Health, Institute for Healthy China, Tsinghua University, Beijing 100084, China
| | - Haiyu Pang
- Institute of Clinical Medicine, National Infrastructures for Translational Medicine, State Key Laboratory of Common Mechanism Research for Major Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Peicheng Wang
- Vanke School of Public Health, Institute for Healthy China, Tsinghua University, Beijing 100084, China
| | - Yanhua Chen
- Vanke School of Public Health, Institute for Healthy China, Tsinghua University, Beijing 100084, China
| | - Huihui Li
- School of Economics and Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen 361005, China
| | - Qing Liu
- Department of Gynecology, Gansu Provincial Maternity and Child-Care Hospital, Gansu Provincial Central Hospital, Lanzhou 730050, China
| | - Luwen Wang
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hangmei Jin
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Liyan Gong
- Department of Pelvic Floor Rehabilitation, Hubei Maternity and Childcare Hospital, Hubei Province Women and Children Hospital, Wuhan 430070, China
| | - Jingyan Xie
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Ting Lai
- Department of Gynecology, Guiyang Maternal and Child Health Care Hospital, Guiyang 550003, China
| | - Aiyang Li
- Beijing Miyun District Hospital, Beijing 101500, China
| | - Lubin Liu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Mengsha Yan
- Vanke School of Public Health, Institute for Healthy China, Tsinghua University, Beijing 100084, China
| | - Lifei Zhou
- Department of Gynecology, Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang 050051, China
| | - Yanqiu Luan
- Maternal and Child Health Hospital of Beijing Dongcheng District, Beijing 100007, China
| | - Lin Wang
- Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
| | - Xiaoli Li
- Department of Gynecology, Shanxi Maternal and Child Health Hospital, Taiyuan 030009, China
| | - Xiping Luo
- Department of Gynecology, Guangdong Province Women and Children Hospital, Guangzhou 511442, China
| | - Yingjie Fu
- Ministry of Women's Health, Harbin Maternal and Child Health Care and Family Planning Service Center, Harbin 150010, China
| | - Jumin Niu
- Department of Gynecology, Shenyang Women's and Children's Hospital, Shenyang 110011, China
| | - Wen Zhao
- Haidian District Maternal and Child Health Care Hospital, Beijing 100080, China
| | - Qiming Liu
- Department of Gynecology and Obstetrics, Maternal and Child Health Hospital of Yanqing District, Beijing 102100, China
| | - Renfeng Zhao
- Department of Gynecology and Obstetrics, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Wenjia Lou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Abraham N Morse
- Department of OBGYN, Tufts University School of Medicine, Boston 02111, USA
| | - Jiahui Yin
- Department of Public Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Le Dang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Hua Yang
- Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Liming Li
- School of Public Health, Peking University Health Science Center, Peking University Center for Public Health and Epidemic Preparedness & Response, Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China.
| | - Jun Lv
- School of Public Health, Peking University Health Science Center, Peking University Center for Public Health and Epidemic Preparedness & Response, Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing 100191, China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Common Mechanism Research for Major Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Yount-Tavener SM, Fay RA. Maintaining A Long-Term Practice of Daily Pelvic Floor Muscle Exercises: What Do Childbearing Women Think? J Midwifery Womens Health 2024; 69:567-576. [PMID: 38520694 DOI: 10.1111/jmwh.13626] [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] [Revised: 01/02/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION To be effective, pelvic floor muscle therapy (PFMT) exercises should be intense, be practiced consistently, and include clinical support. Many women do not adhere to a consistent PFMT program, compromising the resolution or prevention of urinary incontinence (UI). This study aimed to answer 2 key questions: What prevents women from performing PFMT long term, and what can health care providers do to support women to perform them? METHODS Postpartum women from 4 sites in the United States completed a questionnaire about experiences with PFMT or Kegel exercises during and after pregnancy. This study focused on one of the 7 open-ended questions: What would prevent you from performing Kegels lifelong? Thematic analysis was implemented via an inductive approach using Braun and Clarke's 6-phase process. RESULTS Three salient themes emerged that help explain factors that prevent women from adhering to a daily PFMT routine: (1) life gets in the way, (2) inadequate PFMT education and instruction, and (3) disconnect exists about long-term consequences. The sample included 368 participants. DISCUSSION The themes were congruent with the limited body of qualitative literature on experience with PFMT exercises. This study was able to identify areas of need in the US maternal health care system to help childbearing people adopt daily PFMT, such as (1) inadequate parental leave and childcare support, (2) no formalized education related to UI and PFMT and a lack of pelvic health promotion, (3) lacking prioritization of long-term PFMT, and (4) the need to dispel the acceptance that UI postbirth is normal. Health care providers should prioritize interactive education, emphasizing how to correctly perform PFMT and the importance and effectiveness of integrating clinical support. To adequately encompass pelvic floor health care and education up to one year postbirth, changes are needed to the US perinatal health care system, providing sufficient insurance reimbursement and parental social support programs.
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Affiliation(s)
- Susan M Yount-Tavener
- Department of Midwifery and Women's Health, Frontier Nursing University, Lexington, Kentucky
| | - Rebecca A Fay
- Department of Midwifery and Women's Health, Frontier Nursing University, Lexington, Kentucky
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Zhang D, Bo K, Montejo R, Sánchez-Polán M, Silva-José C, Palacio M, Barakat R. Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third- or fourth-degree perineal tear: Systematic review and meta-analysis of randomized clinical trials. Acta Obstet Gynecol Scand 2024; 103:1015-1027. [PMID: 38140841 PMCID: PMC11103147 DOI: 10.1111/aogs.14744] [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: 08/12/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The complex process of pregnancy and childbirth significantly influences the well-being of both mother and child. Today all pregnant women without medical contraindications are recommended to start or continue regular aerobic and strength training for at least 150 min per week to prevent pregnancy-related diseases and conditions. Urinary incontinence in pregnancy, episiotomy and third- or fourth-degree perineal tear during labor can greatly impact womens' health, quality of life and ability to be physically active. The aim of this study was to examine the efficacy of pelvic floor muscle training (PFMT) during pregnancy in the prevention of urinary incontinence, episiotomy, and third- or fourth-degree perineal tear. MATERIAL AND METHODS A systematic review and meta-analysis (CRD42022370600) was performed. Only randomized clinical trials published between 2010 and 2023 were included. The following databases were examined: EBSCO (including Academic Search Premier, Education Resources Information Center, MEDLINE, SPORTDiscus and OpenDissertations databases), Clinicaltrials.gov, Web of Science, Scopus, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database (PEDro). Three meta-analyses to investigate the effect of PFMT exclusively or implemented as a section within a physical activity program during pregnancy on urinary incontinence, episiotomy, and third- or fourth-degree perineal tear were conducted. RESULTS Thirty studies were analyzed (N = 6691). An effective preventive action of PFMT was found for urinary incontinence (z = 3.46; p < 0.0005; relative risk [RR] = 0.72, 95% confidence interval [CI]: 0.59, 0.87, I2 = 59%) and third- or fourth-degree perineal tear (z = 2.89; p = 0.004; RR = 0.50, 95% CI: 0.31, 0.80, I2 = 48%) but not for episiotomy (z = 0.80; p = 0.42; RR = 0.95, 95% CI: 0.85, 1.07, I2 = 75%). CONCLUSIONS PFMT during pregnancy proves to be an effective preventive intervention for reducing the risk of urinary incontinence and the occurrence of third- or fourth-degree perineal tears. These findings highlight the importance of incorporating PFMT into antenatal care and training programs to improve maternal well-being and overall childbirth outcomes.
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Affiliation(s)
- Dingfeng Zhang
- AFIPE Research Group, Universidad Politécnica de Madrid, Madrid, Spain
| | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Norway
| | - Rocío Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Montse Palacio
- BCNatal, Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Barcelona, Spain
- Hospital Universitario Clinic, Barcelona, Spain
| | - Rubén Barakat
- AFIPE Research Group, Universidad Politécnica de Madrid, Madrid, Spain
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Yang C, Wang SZ, Chen S, Du S, Wang GQ, Guo W, Xie XL, Peng BH, Du SH, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence. JOURNAL OF INTEGRATIVE MEDICINE 2024; 22:258-269. [PMID: 38677968 DOI: 10.1016/j.joim.2024.04.002] [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: 02/06/2024] [Accepted: 03/18/2024] [Indexed: 04/29/2024]
Abstract
Urinary incontinence (UI) is a common problem worldwide. It has a major impact on physical and social activities and interpersonal relationships. UI is common in women, but is under-reported and under-treated. It affects the quality of life of female patients severely. Acupuncture and moxibustion have been proposed as potentially effective interventions for female UI. Hence, for the benefit of acupuncture practitioners around the world, the World Federation of Acupuncture-moxibustion Societies initiated a project to develop a clinical practice guideline (CPG) for the use of acupuncture and moxibustion to treat female UI. This CPG was developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role. The clinical questions, recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method. This CPG contains ten recommendations about the use of acupuncture and moxibustion interventions for ten clinical questions, which include nine conditional recommendations for the intervention and one conditional recommendation for either the intervention or the comparison. This CPG also provides one protocol for conventional filiform needle therapy, two therapy protocols for deep needling stimulation on lumbosacral acupoints, and four moxibustion therapy protocols, based on the protocols presented in randomized controlled trials reviewed by the GDG. Please cite this article as: Yang C, Wang SZ, Chen S, Du S, Wang GQ, Guo W, Xie XL, Peng BH, Du SH, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence. J Integr Med. 2024; 22(3): 258-269.
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Affiliation(s)
- Chao Yang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shan-Ze Wang
- Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Sheng Chen
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shuo Du
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Guan-Qun Wang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Wei Guo
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xiao-Long Xie
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Bi-Hui Peng
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shi-Hao Du
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Ji-Ping Zhao
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China.
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Liang S, Huang S, Andarini E, Wang Y, Li Y, Cai W. Development and internal validation of a risk prediction model for stress urinary incontinence throughout pregnancy: A multicenter retrospective longitudinal study in Indonesia. Neurourol Urodyn 2024; 43:354-363. [PMID: 38116937 DOI: 10.1002/nau.25364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND This study aimed to develop a risk prediction model for stress urinary incontinence (SUI) throughout pregnancy in Indonesian women. METHODS We conducted a multicenter retrospective longitudinal study involving pregnant women in Indonesia, who sought care at obstetrics clinics from January 2023 to March 2023, encompassing all stages of pregnancy. We collected data on their predictive factors and SUI outcome. SUI was diagnosed based on responses to the "leaks when you are physically active/exercising" criterion in the ICIQ-UI-SF questionnaire during our investigation of the participants. The models underwent internal validation using a bootstrapping method with 1000 resampling iterations to assess discrimination and calibration. RESULTS A total of 660 eligible pregnant women were recruited from the two study centers, with an overall SUI prevalence of 39% (258/660). The final model incorporated three predictive factors: BMI during pregnancy, constipation, and previous delivery mode. The area under the curve (AUROC) was 0.787 (95% CI: 0.751-0.823). According to the max Youden index, the optimal cut-off point was 44.6%, with a sensitivity of 79.9% and specificity of 65.9%. A discrimination slope of 0.213 was found. CONCLUSION The developed risk prediction model for SUI in pregnant women offers a valuable tool for early identification and intervention among high-risk SUI populations in Indonesian pregnant women throughout their pregnancies. These findings challenge the assumption that a high BMI and multiple previous deliveries are predictors of SUI in Indonesian women. Further research is recommended to validate the model in diverse populations and settings.
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Affiliation(s)
- Surui Liang
- Administrative Building, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
| | - Shijie Huang
- Administrative Building, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Esti Andarini
- Administrative Building, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Ying Wang
- Administrative Building, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wenzhi Cai
- Administrative Building, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
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Wenming C, Xiaoman D, Ling G, Yun L, Xiyan G. Acupuncture combined with pelvic floor rehabilitation training for postpartum stress urinary incontinence: protocol for a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1296751. [PMID: 38126072 PMCID: PMC10730657 DOI: 10.3389/fmed.2023.1296751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction The purpose of this study is to systematically evaluate the efficacy and safety of acupuncture combined with pelvic floor rehabilitation training in the treatment of postpartum stress urinary incontinence, and to promote the further promotion and application of acupuncture in the field of rehabilitation. Methods and analysis Randomized controlled trials (RCTs) of acupuncture combined with pelvic floor rehabilitation in the treatment of postpartum stress urinary incontinence will be searched in PubMed, Web of Science (WOS), Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang (WF), and VIP databases. The clinical trial Registry (ClinicalTrials.gov and Chinese clinical trial Registry) will also be searched. The search period is limited to July 1, 2023, and the language limit of this systematic review is Chinese and English. The primary outcome is clinical effective rate. International Consultation on Incontinence Questionnaire-Short Form (ICI-Q-SF), 1-h pad test, pelvic floor muscle potential value, incidence of adverse events are secondary outcomes. A meta-analysis will be performed using RevMan 5.4 statistical software. If feasible, subgroup analysis and sensitivity analysis will be performed to address potential causes of inconsistency and heterogeneity. The risk of bias will be assessed using the approach recommended by Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence will be assessed using GRADE. This Protocol has been developed in accordance with the guideline of Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015. Discussion Acupuncture combined with pelvic floor rehabilitation training can effectively promote the rehabilitation of postpartum stress urinary incontinence patients, and provide a reference for the clinical application of integrated Chinese and Western medicine treatment in the field of rehabilitation. Systematic review registration PROSPERO CRD42023455801.
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Affiliation(s)
- Chu Wenming
- College of Acupuncture and Tuina, Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Deng Xiaoman
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Gao Ling
- College of Acupuncture and Tuina, Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Li Yun
- College of Acupuncture and Tuina, Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Gao Xiyan
- College of Acupuncture and Tuina, Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
- Department of Acupuncture, The Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
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Dong SM, Hickman LC. Current opinion: postpartum urinary disorders. Curr Opin Obstet Gynecol 2023; 35:510-516. [PMID: 37807921 DOI: 10.1097/gco.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to describe the common postpartum urinary sequelae including urinary retention and incontinence, and to summarize the management of these conditions. RECENT FINDINGS Despite the high frequency of urinary disorders in obstetrics, screening and management protocols are rarely utilized by providers. Large variation exists in the literature regarding assessment of postpartum urinary retention, values of postvoid residuals and management of indwelling catheters in the immediate postpartum population. Recent expert guidance outlines a strategy for managing this condition.Research also highlights that screening for peripartum urinary incontinence is not a routine practice. The diagnosis is made more challenging by the fact that patients commonly understate and over-normalize their symptoms. Emerging studies have found that pelvic floor muscle training is cost-effective, preventive, and may improve symptoms in the postpartum setting. SUMMARY Increased awareness of urinary disorders in pregnancy and postpartum is imperative for appropriate diagnosis and management. Instituting standardized voiding protocols postpartum will allow providers to avoid undiagnosed postpartum urinary retention and its repercussions. Improved screening and education regarding urinary incontinence in the peripartum is important for early management, such as pelvic floor muscle training, and improved quality of life.
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Affiliation(s)
- Shirley M Dong
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Yang X, Zhang A, Zhu R, Sayer L, Bassett S, Woodward S. Group-based PFMT programme for preventing and/or treating UI in pregnant women: protocol of a randomized controlled feasibility study. Pilot Feasibility Stud 2023; 9:180. [PMID: 37907990 PMCID: PMC10617193 DOI: 10.1186/s40814-023-01410-2] [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] [Received: 08/04/2022] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a prevalent health problem in women worldwide. Many women experience UI during pregnancy. The National Institute for Health and Care Excellence (NICE) recommended pelvic floor muscle training (PFMT) as the first-line conservative treatment for UI. However, it is not widely implemented due to the limited number of healthcare trainers. Group-based PFMT has been used with older women and a limited number of maternity studies. But the effectiveness of the group-based PFMT needs to be investigated because the overall quality of the studies is low. Therefore, this study aims to assess the feasibility of delivering a group-based PFMT programme for pregnant women in Nanjing city. METHODS This feasibility study will be conducted in Nanjing Maternity and Child Health Care Hospital in China, using a mixed methods design to investigate the feasibility and acceptability of delivering group-based PFMT to pregnant women. Pregnant women with or without the symptoms of UI will be included. This study aims to recruit 48 pregnant women with 24 in each arm. Participants will receive either the group-based PFMT delivered by a midwife or usual antenatal care which includes only verbal instruction on PFMT. The study will assess the completion rates, acceptability of outcome measures, recruitment and retention rate and calculate an appropriate sample size for a future study. DISCUSSION The results of this study will inform the design and implementation of a definitive randomized clinical trial to explore the effectiveness of the intervention. TRIAL REGISTRATION ClinicalTrials.gov, NCT05242809.
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Affiliation(s)
- Xiaowei Yang
- Department of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
- Department of Clinical Teaching and Research, Nanjing Vocational Health College, Nanjing, China.
| | - Aixia Zhang
- Nursing Department, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Rong Zhu
- Nursing Department, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Lynn Sayer
- Department of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sam Bassett
- Department of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sue Woodward
- Department of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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10
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Li J, Li T, Huang S, Chen L, Cai W. Motivations, psychosocial burdens, and decision-making modes of post-partum women with stress urinary incontinence engaging in pelvic floor physical therapy: a qualitative research. Int Urogynecol J 2023; 34:1803-1813. [PMID: 36745133 DOI: 10.1007/s00192-023-05466-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This qualitative research explores the motivations, psychosocial burdens, and decision-making modes of post-partum women with stress urinary incontinence (SUI) engaging in pelvic floor physical therapy (PFPT). METHODS This study was conducted face-to-face in a treatment room using qualitative semi-structured interviews with post-partum women who received PFPT for SUI between May and October 2022. Participant interviews were transcribed verbatim and thematically analyzed using NVivo software, which is most commonly used for qualitative data analysis. RESULTS Themes that impacted participants' decisions to receive PFPT included avoiding deterioration of SUI symptoms, believing that the sooner it is treated the better, being unable to adhere to home exercise programs, and dissatisfaction with quality of life. Some participants experienced psychosocial burdens when receiving PFPT, including impact on daily activities, worries about the baby, financial burdens, and uncertainty about the effect. There were two modes of decision making, which brought different experiences. Some participants preferred participant-provider shared decision making and reported effective doctor-patient communication, and striving for autonomous decisions. Other participants preferred their clinicians to decide on PFPT protocols in view of their trust in their midwives, institutional reputation, and lacking knowledge of PFPT. CONCLUSIONS We discovered that participants had both motivations and psychosocial burdens when receiving therapy. Some participants preferred participant-provider shared decision making, whereas others preferred their midwives to make decisions. Further more standardized studies with more robust samples are needed.
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Affiliation(s)
- Jie Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
| | - Shurong Huang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoan District, Shenzhen, 518101, Guangdong, China.
- School of Nursing, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Samsonova IA, Gaifulin RF, Toktar LR, Orazov MR, Kamarova ZN, Li KI, Pak VE. Pelvic floor muscle training as a method of prevention and treatment of pelvic floor dysfunction and genital prolapse. RUDN JOURNAL OF MEDICINE 2023. [DOI: 10.22363/2313-0245-2023-27-1-39-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Relevance. Pelvic floor dysfunction and pelvic organ prolapse are a significant problem today - even the initial manifestations of pelvic floor dysfunction can lead to reduced quality of sexual life, decreased activity, and then to social isolation and decreased self-esteem of women. Due to the growth of general life expectancy, the incidence rate is also increasing. One of the most popular conservative treatments for pelvic floor dysfunction is pelvic floor muscle training. The aim of this literature review is to consolidate the scattered information about the effectiveness of pelvic floor muscle training as a prevention and treatment of pelvic floor dysfunction. Materials and Methods. In writing the review, publications from the PubMed and Google Scholar databases from January 2019 were analyzed and systematized. Results and Discussion. Pelvic floor muscle training is one of the most prospective methods of non-invasive treatment for pelvic organ prolapse. It can take many forms and is represented by a range of different techniques: from the simple short-term muscle contraction and Kegel exercises to more complex and high-tech methods using electromyostimulation and biofeedback. However, timing of introduction and method for pelvic floor muscle training must be carefully considered in order to gain the maximum result. Conclusion. Based on the study, it can be concluded that the introduction of pelvic floor muscle training as part of prenatal care and in the antenatal period is the most appropriate way to prevent pelvic floor failure and genital prolapse. Further research is required to confirm the hypothesis.
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12
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Lee YS, Khan AA. Financial Toxicity for Female Patients with Urinary Incontinence. Curr Urol Rep 2023; 24:33-39. [PMID: 36527587 DOI: 10.1007/s11934-022-01130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Urinary incontinence (UI) is a common global condition that has been noted to disproportionately affect women. In this review, the authors present discussion of factors contributing to cost of care and various modalities of cost-effective care for UI for female patients. RECENT FINDINGS We found insurance and out-of-pocket (OOP) costs strongly impact of costs for patients. Further, in evaluation of UI, diagnosis can be a costly multi-step process for effective treatment. Treatment can be multimodal, including non-surgical (e.g., pessary, vaginal insert, pelvic floor muscle training, or PFMT), of which PFMT is a cost-effective, effective, and accessible treatment. Pharmacologic management is generally second-line for overactive bladder, but anti-muscarinic drugs and beta-3 agonists are cost-effective depending on willingness-to-pay and the health system in which they are acquired, respectively. Surgical management is considered the most cost-effective treatment as willingness-to-pay increased, with minimally invasive slings being the mainstay. Other relatively novel treatments are also discussed (e.g., EMSELLA) but require further research. Additionally, we discuss systematic barriers in decisions to seek care for urinary incontinence. Urologists are key agents in treating UI for their female patients, and seeking cost-effective options for treatment remains pivotal for quality care.
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Affiliation(s)
- Yeonsoo S Lee
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Aqsa A Khan
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA.
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13
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Reed P, Osborne LA, Whittall CM, Emery S, Truzoli R. Patient and economic benefits of psychological support for noncompliant patients. Front Psychol 2022; 13:829880. [PMID: 36186372 PMCID: PMC9521354 DOI: 10.3389/fpsyg.2022.829880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
The current paper provides an overview of treatment noncompliance at various points in the treatment pathway, especially with respect to treatment for Pelvic-floor Dysfunction (PFD). The effects of noncompliance on healthcare are considered, and examples of supporting patients psychologically to increase compliance are discussed. An outline of a method to identify costs of non-compliance, and where such costs most intensely impact the healthcare system, is provided. It is suggested that psychological support is effective in terms of increased compliance and improved healthcare economics. The model is presented for PFD, but the principles developed can be generalised to many aspects of healthcare.
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Affiliation(s)
- Phil Reed
- Department of Psychology, Swansea University, Swansea, United Kingdom
| | - Lisa A. Osborne
- School of Psychology and Counselling, The Open University, Milton Keynes, United Kingdom
- Swansea Bay University Health Board, Swansea, United Kingdom
| | | | - Simon Emery
- Swansea Bay University Health Board, Swansea, United Kingdom
| | - Roberto Truzoli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- *Correspondence: Roberto Truzoli,
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Does the Contractile Capability of Pelvic Floor Muscles Improve with Knowledge Acquisition and Verbal Instructions in Healthy Women? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159308. [PMID: 35954665 PMCID: PMC9368630 DOI: 10.3390/ijerph19159308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/10/2022]
Abstract
Seventy percent of women with pelvic floor dysfunctions (PFDs) are estimated to present deficient consciousness of their pelvic floor muscles (PFMs) and poor ability to contract them. Improving the proprioception of PFMs, defined as the capacity to know the status and position of each body part, and adequately contracting them could be a protective factor to prevent the appearance of PFDs in the general female population. This study aimed to identify the effectiveness of educational interventions and verbal instructions on how to contract and exercise the PFMs to improve the proprioception of the PFMs in women. A systematic search of studies published in the last 20 years until March 2022 was conducted in the PubMed, Cochrane Library, Web of Science, Scopus, PEDro, Lilacs, and Dialnet databases. A meta-analysis could not be performed due to the heterogeneity in the types of studies and included populations. This review followed the PRISMA guidelines for the design, search, and reporting of studies. The methodological quality was analysed via the PEDro and the Newcastle–Ottawa scales in the case of randomised clinical trials and non-randomised studies, respectively, while the quality of evidence was determined using the SIGN grading system for evidence-based guidelines. Descriptive and experimental studies published in English, Spanish, or Portuguese that evaluated the contractile capability of the PFMs in healthy women or women without a previous diagnosis of PFD were included. Seven articles that included a total of 2507 women were found, three of which were clinical trials with PEDro scores between 5 and 9 points out of 10 and four of which were non-randomised studies with NOS scores between 6 and 8 points out of 10. The outcomes were measured through vaginal palpation, visual observation, questionnaires for PFD symptoms, and self-perception reports. This review discriminated between two types of intervention, educational programmes and verbal instructions, and evaluated the changes observed in PFM strength and knowledgeability and the symptoms of PFDs. The findings showed that educational interventions and verbal instructions improve the proprioception of PFMs in women of all ages that are healthy or without a previous diagnosis of PFDs as well as their knowledge about the pelvic floor, healthy lifestyle habits, and symptoms that are potentially indicative of PFDs. Further high-quality randomised clinical trials are warranted to draw definitive conclusions about the effectiveness of educational interventions to improve the proprioception of the PFMs in women considered healthy or with mild symptoms that may be indicative of PFDs.
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Pelvic floor exercises and female stress urinary incontinence. Br J Gen Pract 2022; 72:185-187. [PMID: 35361602 PMCID: PMC8966921 DOI: 10.3399/bjgp22x719033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Alouini S, Memic S, Couillandre A. Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback or Electrostimulation in Women: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052789. [PMID: 35270480 PMCID: PMC8910078 DOI: 10.3390/ijerph19052789] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/18/2022]
Abstract
To determine the effectiveness of pelvic floor muscle training (PFMT) with or without biofeedback or electrostimulation in reducing urinary incontinence and pelvic floor muscle con-traction in non-pregnant women with urinary incontinence. Methods: The following electronic databases were searched: PubMed, Cochrane Central, ClinicalTrials.gov, EU Clinical Trials Register, and sources from NICE, FDA, EMA, and SMC (articles only in English, 2000–2021). Search terms were: urinary incontinence, pelvic floor muscle training or exercises, biofeedback, electrostimulation. We used the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for this systematic review. Relevant articles were selected, data were extracted, and quality was assessed. Data were extracted in predesigned form, followed by narrative synthesis. Results: Following the search, 15 RCTs were retrieved using the strict inclusion and exclusion criteria, assessing 2441 non-pregnant women with urinary incontinence. Of the 15 studies, 7 were low risk, 5 were medium risk, and 3 were high-risk studies. Of the 2441 patients, 970 were in PFMT, 69 were in extracorporeal magnetic innervation (ExMi) or with PFMT + BF, 30 were in electrostimulation (ES), 21 were in whole body vibration training (WBVT), 23 were in pelvic floor muscle + abdominal muscle therapy (PFM + AMT), 326 were in PFMT + biofeedback, 93 were in vaginal cones (VC), 362 were in PFMT + education, 318 were in education, and 229 were in control groups. The most often measures employed were pad tests, bladder diary, and questionnaire on the quality of life. Stress, urge and mixed urinary incontinence were studied. In all RCT, PFMT significantly reduced urinary incontinence, essentially SIU and MUI, when compared with the control group before and after treatment. Overall, out of 997 PFMT or PFMT + education patients, 504 patients (50.5%) showed improvement in urinary incontinence, and 218 became continent (21.8%) (negative pad test). In total, 62% of patients significantly reduced their urinary incontinence or cured it and improved their pelvic floor muscle contraction. All other physiotherapist techniques also significantly reduced urinary leakages, e.g., vaginal cones, biofeedback, ExMI, and WBVT when compared with the control group. There were no significant differences between these methods in reducing the severity of urinary incontinence. Conclusion: PFMT alone or with bio-feedback or electrostimulation was effective in reducing urinary incontinence and improving pelvic floor muscle contraction. PFMT when compared with other interventions such as bio-feedback, VC, and WBVT did not show significant differences but was superior to the control group. RCT studies with similar parameters used for measuring the outcomes need to be included.
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Affiliation(s)
- Souhail Alouini
- Center Hospitalier Regional d’Orléans, Departement of Gynecologic Surgery, 14 Avenue de L’hôpital, 45100 Orleans, France
- EUKCVL, Université d’Orléans, 45100 Orleans, France; (S.M.); (A.C.)
- Correspondence:
| | - Sejla Memic
- EUKCVL, Université d’Orléans, 45100 Orleans, France; (S.M.); (A.C.)
| | - Annabelle Couillandre
- EUKCVL, Université d’Orléans, 45100 Orleans, France; (S.M.); (A.C.)
- Laboratoire CIAMS, Université Paris—Sud, EA 4532, 91400 Orsay, France
- Laboratoire en Neurosciences, Physiologie et Psychologie, LINP2, Université Paris Nanterre, 92001 Nanterre, France
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Yang X, Zhang A, Sayer L, Bassett S, Woodward S. The effectiveness of group-based pelvic floor muscle training in preventing and treating urinary incontinence for antenatal and postnatal women: a systematic review. Int Urogynecol J 2021; 33:1407-1420. [PMID: 34453550 PMCID: PMC9206632 DOI: 10.1007/s00192-021-04960-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
Introduction and hypothesis Urinary incontinence (UI) is prevalent in antenatal and postnatal women. Pelvic floor muscle training (PFMT) is the first-line treatment for UI. Group-based PFMT provides a way for professionals to deliver this intervention to more women who need to prevent and/or treat UI. This review aims to (1) assess the effectiveness of group-based PFMT in preventing and treating UI in antenatal and postnatal women and (2) explore the characteristics of group-based intervention and factors which had an impact on the success of group-based PFMT. Methods Randomized controlled trials (RCTs) were included in this review. A comprehensive search was conducted in PubMed, Embase, Medline, PsycINFO, Maternity and Infant Care Database, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database and Wanfang Database. The overall quality was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RCTs which included pregnant and/or postnatal women with or without UI investigating the effectiveness of group-based PFMT were included. Results Five RCTs were included in this review. The overall quality of the results of the included studies was low. Delivering group-based PFMT during pregnancy significantly reduced the prevalence of UI in both the pregnant period [risk ratio (RR) = 0.67, 95% confidence interval (CI) 0.57 to 0.80, P < 0.00001] and the postnatal period [RR = 0.66, 95% CI 0.52 to 0.84, P = 0.0008]. Only one RCT delivered group-based PFMT during the postnatal period. Conclusion Evidence of weak quality supports the effectiveness of undertaking group-based PFMT in pregnancy to prevent UI during pregnancy and the postnatal period. No evidence showed the effectiveness of undertaking group-based PFMT in the postnatal period. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-04960-2.
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Affiliation(s)
- Xiaowei Yang
- King's College London, Department of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK. .,Nanjing Vocational Health College, Department of Clinical Teaching and Research Group, Nanjing, China.
| | - Aixia Zhang
- Nanjing Maternity and Child Health Care Hospital, Nursing Department, Nanjing, China
| | - Lynn Sayer
- King's College London, Department of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Sam Bassett
- King's College London, Department of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Sue Woodward
- King's College London, Department of Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
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