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Geng E, Yin S, Yang Y, Ke C, Fang K, Liu J, Wang D. The effect of perioperative pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: a meta-analysis. Int Braz J Urol 2023; 49:441-451. [PMID: 37267610 PMCID: PMC10482454 DOI: 10.1590/s1677-5538.ibju.2023.0053] [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: 02/15/2023] [Accepted: 05/09/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). We performed this meta-analysis to investigate whether PFME during the entire perioperative period, including before and after RP, can significantly improve the recovery of postoperative UI. METHODS We systematically reviewed randomized controlled trials (RCT) from PubMed, Medline, web of science, Cochrane library, and clinicalitrials.com prior to October 2022. Efficacy data were pooled and analyzed using Review Manager Version 5.3. Pooled analyses of urinary incontinence rates 1, 3, 6, and 12 months postoperatively were conducted, using odds ratio (OR) and 95% confidence intervals (CIs). RESULTS We included a total of 15 RCT studies involving 2178 patients received RP. Postoperative UI could be improved after 1 month, 3 months and 6 months, and the OR were 0.26 (95%CI:0.15-0.46) 0.30 (95%CI: 0.11-0.80) 0.20 (95%CI: 0.07- 0.56) in postoperative PFME group compared to no PFME group. However, there was no significant difference between the two groups in 12 months after surgery, and the OR was 0.85(95%CI: 0.48,1.51). There were similar results in perioperative PFME group compared to no PFME group with the OR of 0.35 (95%CI: 0.12, 0.98) and 0.40 (95%CI: 0.21, 0.75) in 1 and 3 months after surgery. Our results indicated no significant difference between perioperative PFME group and postoperative PFME group. The OR was 0.58 (95%CI: 0.20-1.71) 0.58 (95%CI:0.20-0.71) and 0.66 (95%CI: 0.32-1.38) in 1, 3 and 6 months after surgery. CONCLUSION Application of PFME after RP significantly reduced the incidence of early postoperative UI, and additional preoperative PFME had no significant improvement on the recovery of UI.
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Affiliation(s)
- Erkang Geng
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Sifan Yin
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Yulin Yang
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Changxing Ke
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Kewei Fang
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Jianhe Liu
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Daoqi Wang
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
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Brosina de Leon E, Cardoso MN, de Brito E, dos Santos MM, Almeida FA. The development of a physical therapy service to treat urinary incontinence: Results of a RE-AIM evaluation. Front Glob Womens Health 2022; 3:1004140. [DOI: 10.3389/fgwh.2022.1004140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundA conservative physiotherapy service development addressed to treat urinary incontinence for older women was studied using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework.DesignWe conducted a pragmatic case study design based on RE-AIM.Settings/participantsIncluded women ≥ 60 years of age, with self-reported UI symptoms.ResultsA total of 34 older women were enrolled in the service with a mean age of 61.53 years. There was a significant improvement in the strength of the pelvic floor muscles, power, endurance, and fast contraction capacity after the intervention, however, it was observed a high dropout rate. Program implementation was supported by Physical Therapy teams who engaged in care coordination. The program has been maintained for over 4 years.ConclusionOur findings demonstrate that UI patients would benefit from physiotherapy treatment and that this intervention is feasible. This RE-AIM evaluation provides lessons learned and strategies for future adoption, implementation, and maintenance of a Physical Therapy pelvic service.
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Zhang D, Wang S, Gao L, Jia Y, Wang H, Sun X, Wang J. Analysis of Characteristics and Quality of Life of Elderly Women with Mild to Moderate Urinary Incontinence in Community Dwellings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5609. [PMID: 35565009 PMCID: PMC9105851 DOI: 10.3390/ijerph19095609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/24/2022] [Accepted: 05/03/2022] [Indexed: 02/01/2023]
Abstract
Introduction: The incidence of urinary incontinence (UI) increases with age. Mild and moderate UI have little impact on women and are easily ignored. This study reports the characteristics of non-severe UI and quality of life (QOL) in elderly women using data from a Development and Evaluation of a Senile UI Alert System study. Methods: 926 women aged ≥60 were enrolled from six subcenters across China, among whom 717 SUI patients and 209 UUI/MUI patients were grouped into Group A and Group B, respectively, according to leakage symptoms. Demographic and clinical data, pelvic organ prolapse quantification and pelvic floor muscle strength measurement (PFMS) were collected from participants, followed by evaluation of QOL and sexual life. Result: The major type of UI in community women was SUI (77.4%); MUI and UUI accounted for 20.63% and 1.94%, respectively. Weakened PFMS was detected in 78.2% of the participants. Group B was significantly higher in terms of median age, weight, BMI, waist circumference and menopausal years, and had the greater UI severity and impact on QOL, as well as less active sex live than group A (p < 0.05). Conclusion: SUI distributes dominantly in elderly community women, but UUI/MUI has greater impact on QOL and is related to a less active sex life, which requires more attention from medical staff.
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Affiliation(s)
- Di Zhang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China; (D.Z.); (S.W.); (L.G.); (Y.J.); (J.W.)
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
- Research Center of Female Pelvic Floor Disorders, Peking University, Beijing 100871, China
| | - Shiyan Wang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China; (D.Z.); (S.W.); (L.G.); (Y.J.); (J.W.)
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
- Research Center of Female Pelvic Floor Disorders, Peking University, Beijing 100871, China
| | - Lei Gao
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China; (D.Z.); (S.W.); (L.G.); (Y.J.); (J.W.)
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
- Research Center of Female Pelvic Floor Disorders, Peking University, Beijing 100871, China
| | - Yuanyuan Jia
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China; (D.Z.); (S.W.); (L.G.); (Y.J.); (J.W.)
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
- Research Center of Female Pelvic Floor Disorders, Peking University, Beijing 100871, China
| | - Haibo Wang
- Clinical Research Institute, Peking University, Beijing 100871, China;
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China; (D.Z.); (S.W.); (L.G.); (Y.J.); (J.W.)
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
- Research Center of Female Pelvic Floor Disorders, Peking University, Beijing 100871, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China; (D.Z.); (S.W.); (L.G.); (Y.J.); (J.W.)
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
- Research Center of Female Pelvic Floor Disorders, Peking University, Beijing 100871, China
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Construction of Progress Prediction Model of Urinary Incontinence in Elderly Women: Protocol for a Multi-Center, Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020734. [PMID: 35055556 PMCID: PMC8775636 DOI: 10.3390/ijerph19020734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 01/27/2023]
Abstract
Background: Urinary incontinence (UI) is a common health problem and seriously affects quality of life. Many women lack understanding of UI or are too ashamed to seek medical advice early, leading to a low treatment rate. The aim of this study is to establish an effective UI progress prediction model for elderly women with UI for earlier detection and better treatment. Methods: This study is conducted as a prospective, multi-center, cohort study, and recruits 800 women aged ≥60 with mild or moderate UI in China. Participants are divided into three groups: stress urinary incontinence group (SUI), urgency urinary incontinence group (UUI), and mixed urinary incontinence group (MUI). This study will investigate the general conditions of patients, after complete relevant pelvic floor function assessment, as well as after follow up at 6 months, 12 months, and 18 months by telephone. The primary endpoint is UI disease progress. Single factor and multi-factor Cox regression model analyses are undertaken to evaluate the associated risk factors affecting the progress of UI to establish a progress prediction model for elderly women. Discussion: This study will provide more predictive information for elderly women with UI, and new clinical references for the intervention and the treatment of UI for medical staff.
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Hagen S, Bugge C, Dean SG, Elders A, Hay-Smith J, Kilonzo M, McClurg D, Abdel-Fattah M, Agur W, Andreis F, Booth J, Dimitrova M, Gillespie N, Glazener C, Grant A, Guerrero KL, Henderson L, Kovandzic M, McDonald A, Norrie J, Sergenson N, Stratton S, Taylor A, Williams LR. Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: the OPAL RCT. Health Technol Assess 2021; 24:1-144. [PMID: 33289476 DOI: 10.3310/hta24700] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Urinary incontinence affects one in three women worldwide. Pelvic floor muscle training is an effective treatment. Electromyography biofeedback (providing visual or auditory feedback of internal muscle movement) is an adjunct that may improve outcomes. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of biofeedback-mediated intensive pelvic floor muscle training (biofeedback pelvic floor muscle training) compared with basic pelvic floor muscle training for treating female stress urinary incontinence or mixed urinary incontinence. DESIGN A multicentre, parallel-group randomised controlled trial of the clinical effectiveness and cost-effectiveness of biofeedback pelvic floor muscle training compared with basic pelvic floor muscle training, with a mixed-methods process evaluation and a longitudinal qualitative case study. Group allocation was by web-based application, with minimisation by urinary incontinence type, centre, age and baseline urinary incontinence severity. Participants, therapy providers and researchers were not blinded to group allocation. Six-month pelvic floor muscle assessments were conducted by a blinded assessor. SETTING This trial was set in UK community and outpatient care settings. PARTICIPANTS Women aged ≥ 18 years, with new stress urinary incontinence or mixed urinary incontinence. The following women were excluded: those with urgency urinary incontinence alone, those who had received formal instruction in pelvic floor muscle training in the previous year, those unable to contract their pelvic floor muscles, those pregnant or < 6 months postnatal, those with prolapse greater than stage II, those currently having treatment for pelvic cancer, those with cognitive impairment affecting capacity to give informed consent, those with neurological disease, those with a known nickel allergy or sensitivity and those currently participating in other research relating to their urinary incontinence. INTERVENTIONS Both groups were offered six appointments over 16 weeks to receive biofeedback pelvic floor muscle training or basic pelvic floor muscle training. Home biofeedback units were provided to the biofeedback pelvic floor muscle training group. Behaviour change techniques were built in to both interventions. MAIN OUTCOME MEASURES The primary outcome was urinary incontinence severity at 24 months (measured using the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form score, range 0-21, with a higher score indicating greater severity). The secondary outcomes were urinary incontinence cure/improvement, other urinary and pelvic floor symptoms, urinary incontinence-specific quality of life, self-efficacy for pelvic floor muscle training, global impression of improvement in urinary incontinence, adherence to the exercise, uptake of other urinary incontinence treatment and pelvic floor muscle function. The primary health economic outcome was incremental cost per quality-adjusted-life-year gained at 24 months. RESULTS A total of 300 participants were randomised per group. The primary analysis included 225 and 235 participants (biofeedback and basic pelvic floor muscle training, respectively). The mean 24-month International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form score was 8.2 (standard deviation 5.1) for biofeedback pelvic floor muscle training and 8.5 (standard deviation 4.9) for basic pelvic floor muscle training (adjusted mean difference -0.09, 95% confidence interval -0.92 to 0.75; p = 0.84). A total of 48 participants had a non-serious adverse event (34 in the biofeedback pelvic floor muscle training group and 14 in the basic pelvic floor muscle training group), of whom 23 (21 in the biofeedback pelvic floor muscle training group and 2 in the basic pelvic floor muscle training group) had an event related/possibly related to the interventions. In addition, there were eight serious adverse events (six in the biofeedback pelvic floor muscle training group and two in the basic pelvic floor muscle training group), all unrelated to the interventions. At 24 months, biofeedback pelvic floor muscle training was not significantly more expensive than basic pelvic floor muscle training, but neither was it associated with significantly more quality-adjusted life-years. The probability that biofeedback pelvic floor muscle training would be cost-effective was 48% at a £20,000 willingness to pay for a quality-adjusted life-year threshold. The process evaluation confirmed that the biofeedback pelvic floor muscle training group received an intensified intervention and both groups received basic pelvic floor muscle training core components. Women were positive about both interventions, adherence to both interventions was similar and both interventions were facilitated by desire to improve their urinary incontinence and hindered by lack of time. LIMITATIONS Women unable to contract their muscles were excluded, as biofeedback is recommended for these women. CONCLUSIONS There was no evidence of a difference between biofeedback pelvic floor muscle training and basic pelvic floor muscle training. FUTURE WORK Research should investigate other ways to intensify pelvic floor muscle training to improve continence outcomes. TRIAL REGISTRATION Current Controlled Trial ISRCTN57746448. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 70. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Dunedin, New Zealand
| | - Mary Kilonzo
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Wael Agur
- NHS Ayrshire and Arran, Kilmarnock, UK
| | - Federico Andreis
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Joanne Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maria Dimitrova
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nicola Gillespie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Cathryn Glazener
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Aileen Grant
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Karen L Guerrero
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lorna Henderson
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Marija Kovandzic
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Nicole Sergenson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Susan Stratton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anne Taylor
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Louise R Williams
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Nagib ABL, Silva VR, Martinho NM, Marques A, Riccetto C, Botelho S. Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:535-544. [PMID: 34461664 PMCID: PMC10301951 DOI: 10.1055/s-0041-1733979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of pelvic floor muscle training (PFMT) through gametherapy for relieving urinary symptoms of climacteric women with stress or mixed urinary incontinence (UI). METHODS Randomized clinical trial, divided into two groups: Gametherapy (G_Game) and Control (G_Control). Both groups received recommendations about unsupervised PFMT, and G_Game also received supervised PFMT through gametherapy. After 5 consecutive weeks, the feasibility was investigated considering participant adherence, urinary symptoms (evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF] questionnaire), and pelvic floor function (PERFECT Scheme: power, endurance, repetition and fast). The Fisher exact, Kruskal-Wallis, Wilcoxon sign paired, and Mann-Whitney U tests were used by intention-to-treat analysis, using STATA 15.1 (StataCorp, College Station, TX, USA) software. RESULTS The present study included 20 women per group and observed a higher adherence in G_Game. In the intragroup analysis, a decrease in the ICIQ-UI-SF score was observed in both groups (14.0 to 10.0; 13.5 to 0), associated with increased endurance (2.5 to 3.5; 2.5 to 4.0) in G_Control and G_Game, respectively. Moreover, there was a concomitant increase in pelvic floor muscles (PFMs) power (2.0 to 3.0), repetition (3.0 to 5.0), and fast (10.0 to 10.0) in G_Game. In the intergroup analysis, a reduction of UI was observed (p < 0.001; r = 0.8), as well an increase in PFM power (p = 0.027, r = 0.2) and endurance (p = 0.033; r = 0.3) in G_Game. CONCLUSION The feasibility of supervised PFMT through gametherapy was identified by observing participant adherence, relief of urinary symptoms, and improvement in PFM function.
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Affiliation(s)
- Anita Bellotto Leme Nagib
- Faculty of Medical Sciences, Statel University of Campinas, UNICAMP, Campinas, SP, Brazil.,University Center of Associated Colleges, São João da Boa Vista, SP, Brazil
| | - Valeria Regina Silva
- Faculty of Medical Sciences, Statel University of Campinas, UNICAMP, Campinas, SP, Brazil.,University José do Rosário Vellano, UNIFENAS, Alfenas, MG, Brazil
| | - Natalia Miguel Martinho
- Faculty of Medical Sciences, Statel University of Campinas, UNICAMP, Campinas, SP, Brazil.,University Center of Associated Colleges, São João da Boa Vista, SP, Brazil.,Regional University Center of Espírito Santo do Pinhal, UNIPINHAL, Espírito Santo do Pinhal, SP, Brazil
| | - Andrea Marques
- Physical Therapy Service, Center for Integral Attention to Women's Health - Women's Hospital Prof. Dr. José Aristodemo Pinotti, CAISM, State University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Cassio Riccetto
- Faculty of Medical Sciences, Statel University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Simone Botelho
- Faculty of Medical Sciences, Statel University of Campinas, UNICAMP, Campinas, SP, Brazil.,Postgraduate Program in Rehabilitation Sciences - Motor Science Institute - Federal University of Alfenas, UNIFAL-MG, Alfenas, MG, Brazil
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Bou Kheir G, Grande P, Roumeguère T. [Home-based devices for the treatment of female urinary incontinence: A literature review]. Prog Urol 2020; 31:186-194. [PMID: 33358466 DOI: 10.1016/j.purol.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 11/02/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Literature review on the home-based options for the conservative management of stress urinary incontinence including biofeedback and weighted vaginal cones.. METHODS Research was conducted in the Cochrane Library and Pubmed to find articles, published until March 2020, dealing with the conservative management of incontinence. RESULTS A total of 9 randomized controlled trials were included, 4 concerning biofeedback and 5 concerning vaginal cones. Most of them highlighted the superiority of these three methods compared to the absence of treatment but were not superior compared to the pelvic floor muscles training in the clinic setting. CONCLUSION Home-based devices for female stress urinary incontinence is a safe and effective treatment for female urinary incontinence. It has not shown superiority to physiotherapist-guided pelvic floor muscle reinforcement and needs more evidence to gain its place as a first line therapeutic option.
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Affiliation(s)
- G Bou Kheir
- Urology department, university clinics of Brussels, hôpital Erasme, université libre de Bruxelles, Route de Lennik 808, Brussels, Belgique.
| | - P Grande
- Urology department, hospital Centre Sud-Essonne, Étampes, France
| | - T Roumeguère
- Urology department, university clinics of Brussels, hôpital Erasme, université libre de Bruxelles, Route de Lennik 808, Brussels, Belgique
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Grant A, Bugge C, Wells M. Designing process evaluations using case study to explore the context of complex interventions evaluated in trials. Trials 2020; 21:982. [PMID: 33246496 PMCID: PMC7694311 DOI: 10.1186/s13063-020-04880-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
Background Process evaluations are an important component of an effectiveness evaluation as they focus on understanding the relationship between interventions and context to explain how and why interventions work or fail, and whether they can be transferred to other settings and populations. However, historically, context has not been sufficiently explored and reported resulting in the poor uptake of trial results. Therefore, suitable methodologies are needed to guide the investigation of context. Case study is one appropriate methodology, but there is little guidance about what case study design can offer the study of context in trials. We address this gap in the literature by presenting a number of important considerations for process evaluation using a case study design. Main text In this paper, we define context, the relationship between complex interventions and context, and describe case study design methodology. A well-designed process evaluation using case study should consider the following core components: the purpose; definition of the intervention; the trial design, the case, the theories or logic models underpinning the intervention, the sampling approach and the conceptual or theoretical framework. We describe each of these in detail and highlight with examples from recently published process evaluations. Conclusions There are a number of approaches to process evaluation design in the literature; however, there is a paucity of research on what case study design can offer process evaluations. We argue that case study is one of the best research designs to underpin process evaluations, to capture the dynamic and complex relationship between intervention and context during implementation. We provide a comprehensive overview of the issues for process evaluation design to consider when using a case study design. Trial registration DQIP - ClinicalTrials.gov number, NCT01425502 - OPAL - ISRCTN57746448
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Affiliation(s)
- Aileen Grant
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7QB, UK.
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Pathfoot Building, Stirling, FK9 4LA, UK
| | - Mary Wells
- Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, London, W6 8RP, UK
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Hagen S, Elders A, Stratton S, Sergenson N, Bugge C, Dean S, Hay-Smith J, Kilonzo M, Dimitrova M, Abdel-Fattah M, Agur W, Booth J, Glazener C, Guerrero K, McDonald A, Norrie J, Williams LR, McClurg D. Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial. BMJ 2020; 371:m3719. [PMID: 33055247 PMCID: PMC7555069 DOI: 10.1136/bmj.m3719] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women. DESIGN Parallel group randomised controlled trial. SETTING 23 community and secondary care centres providing continence care in Scotland and England. PARTICIPANTS 600 women aged 18 and older, newly presenting with stress or mixed urinary incontinence between February 2014 and July 2016: 300 were randomised to PFMT plus electromyographic biofeedback and 300 to PFMT alone. INTERVENTIONS Participants in both groups were offered six appointments with a continence therapist over 16 weeks. Participants in the biofeedback PFMT group received supervised PFMT and a home PFMT programme, incorporating electromyographic biofeedback during clinic appointments and at home. The PFMT group received supervised PFMT and a home PFMT programme. PFMT programmes were progressed over the appointments. MAIN OUTCOME MEASURES The primary outcome was self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form (ICIQ-UI SF), range 0 to 21, higher scores indicating greater severity) at 24 months. Secondary outcomes were cure or improvement, other pelvic floor symptoms, condition specific quality of life, women's perception of improvement, pelvic floor muscle function, uptake of other urinary incontinence treatment, PFMT self-efficacy, adherence, intervention costs, and quality adjusted life years. RESULTS Mean ICIQ-UI SF scores at 24 months were 8.2 (SD 5.1, n=225) in the biofeedback PFMT group and 8.5 (SD 4.9, n=235) in the PFMT group (mean difference -0.09, 95% confidence interval -0.92 to 0.75, P=0.84). Biofeedback PFMT had similar costs (mean difference £121 ($154; €133), -£409 to £651, P=0.64) and quality adjusted life years (-0.04, -0.12 to 0.04, P=0.28) to PFMT. 48 participants reported an adverse event: for 23 this was related or possibly related to the interventions. CONCLUSIONS At 24 months no evidence was found of any important difference in severity of urinary incontinence between PFMT plus electromyographic biofeedback and PFMT alone groups. Routine use of electromyographic biofeedback with PFMT should not be recommended. Other ways of maximising the effects of PFMT should be investigated. TRIAL REGISTRATION ISRCTN57756448.
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Affiliation(s)
- Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Susan Stratton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Nicole Sergenson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Sarah Dean
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Maria Dimitrova
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Mohamed Abdel-Fattah
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Wael Agur
- Crosshouse Hospital, NHS Ayrshire and Arran, Crosshouse, Kilmarnock, UK
| | - Jo Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Cathryn Glazener
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Karen Guerrero
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Louise R Williams
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
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ANDAÇ T, CAN GÜRKAN Ö, DEMİRCİ N. Üriner İnkontinansta Kanıt Temelli Tamamlayıcı ve Alternatif Tedaviler. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.605439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chang CP, Chang WH, Lee HL, Chen SF, Horng HC, Wang PH. Is the anchor matter? A short-term follow-up of the effect of mini-invasive mid urethra sling without anchor for urinary incontinence women. Taiwan J Obstet Gynecol 2020; 58:764-768. [PMID: 31759524 DOI: 10.1016/j.tjog.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Stress urinary incontinence (SUI) is a common disease in aged women, and some of them need surgical correction. Recently, the mid-urethral sling is an accepted surgical approach for SUI. However, complication may occur in this surgery, and some of them are needle-related. Therefore, the needleless system may diminish this-type complication. MATERIALS AND METHODS We conducted a retrospective study to evaluate the feasibility of women with SUI undergoing needleless sling surgery in 2017. Assessments were performed by two independent special urogynecologists before, during and post operation periods. We used a category-time-site-pain code following the International Continence Society and International Urogynecological Association (ICS/IUGA) Complication Classification Code (CCC) guidelines. RESULTS Thirty-eight women were analyzed. The characteristics of the patients were 66.3 ± 12.8 years old (mean ± standard deviation) of age, 2.8 ± 1.2 of parity, and 25.6 ± 4.2 kg/m2 of body mass index. All had history of vaginal delivery for term. The objective cure rate at 2- and 4-week follow-up was 97.4% (n = 37) and 94.7% (n = 36), respectively. The subjective cure rate at 2- and 4-week follow-up was both 89.5% (n = 34). Both objective and subjective cure rates remained constant and similar to the end of 4 weeks. There were 6 patients (15.8%) who had complications according to ICS/IUGA CCC guidelines. CONCLUSION This needleless mid-urethral sling procedure seemed to be feasible in the management of women with SUI in this small series and short-term follow-up study, suggesting that a further prospective, randomized, comparative study with other tension-free procedures and mini-sling systems can be conducted.
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Affiliation(s)
- Chia-Pei Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Ling Lee
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Fen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huann-Cheng Horng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Grant A, Dean S, Hay-Smith J, Hagen S, McClurg D, Taylor A, Kovandzic M, Bugge C. Effectiveness and cost-effectiveness randomised controlled trial of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: protocol for the OPAL (optimising pelvic floor exercises to achieve long-term benefits) trial mixed methods longitudinal qualitative case study and process evaluation. BMJ Open 2019; 9:e024152. [PMID: 30782894 PMCID: PMC6411251 DOI: 10.1136/bmjopen-2018-024152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Aileen Grant
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Sarah Dean
- South West Peninsula Collaboration for Leadership in Applied Research in Health Care (PenCLAHRC), University of Exeter, Exeter, UK
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Suzanne Hagen
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Doreen McClurg
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anne Taylor
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Marija Kovandzic
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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