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Yassin MM, Saad MN, Khalifa AM, Said AM. Advancing clinical understanding of surface electromyography biofeedback: bridging research, teaching, and commercial applications. Expert Rev Med Devices 2024:1-18. [PMID: 38967375 DOI: 10.1080/17434440.2024.2376699] [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: 02/10/2024] [Accepted: 07/02/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Expanding the use of surface electromyography-biofeedback (EMG-BF) devices in different therapeutic settings highlights the gradually evolving role of visualizing muscle activity in the rehabilitation process. This review evaluates their concepts, uses, and trends, combining evidence-based research. AREAS COVERED This review dissects the anatomy of EMG-BF systems, emphasizing their transformative integration with machine-learning (ML) and deep-learning (DL) paradigms. Advances such as the application of sophisticated DL architectures for high-density EMG data interpretation, optimization techniques for heightened DL model performance, and the fusion of EMG with electroencephalogram (EEG) signals have been spotlighted for enhancing biomechanical analyses in rehabilitation. The literature survey also categorizes EMG-BF devices based on functionality and clinical usage, supported by insights from commercial sectors. EXPERT OPINION The current landscape of EMG-BF is rapidly evolving, chiefly propelled by innovations in artificial intelligence (AI). The incorporation of ML and DL into EMG-BF systems augments their accuracy, reliability, and scope, marking a leap in patient care. Despite challenges in model interpretability and signal noise, ongoing research promises to address these complexities, refining biofeedback modalities. The integration of AI not only predicts patient-specific recovery timelines but also tailors therapeutic interventions, heralding a new era of personalized medicine in rehabilitation and emotional detection.
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Affiliation(s)
- Mazen M Yassin
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
- Biomedical Engineering Department, Faculty of Engineering, Minia University, Minia, Egypt
- Department of Biomedical Engineering, Helwan University, Cairo, Egypt
| | - Mohamed N Saad
- Biomedical Engineering Department, Faculty of Engineering, Minia University, Minia, Egypt
| | - Ayman M Khalifa
- Department of Biomedical Engineering, Helwan University, Cairo, Egypt
| | - Ashraf M Said
- Biomedical Engineering Program, Electrical Engineering Department, Benha Faculty of Engineering, Benha University, Al Qalyubiyah, Egypt
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Sheyn D, Chakraborty N, Chen YB, Mahajan ST, Hijaz A. Use of a Digital Conversational Agent for the Management of Overactive Bladder. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:536-544. [PMID: 37930265 DOI: 10.1097/spv.0000000000001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
IMPORTANCE Conservative therapy is effective for the treatment of overactive bladder (OAB) but may be limited by accessibility to care. OBJECTIVE The objective of this study was to evaluate the efficacy of a digital conversational agent (CeCe) for the treatment of OAB. STUDY DESIGN This was a prospective observational trial utilizing a digital conversational agent developed by Renalis University Hospitals (Cleveland, Ohio) for the treatment of OAB. Patients were given access to CeCe over an 8-week period and were instructed on how to perform bladder training and pelvic floor exercises and taught about bladder health. The primary outcome was a decrease in the International Consultation on Incontinence-Overactive Bladder Quality-of-Life Questionnaire (ICIQ-OAB-QoL) score from week 1 to week 8. Patients also completed the 36-item Short-Form Health Survey and Generalized Anxiety Disorder Questionnaire at the same intervals and voiding diaries at weeks 1, 4, and 8. A power analysis was performed and determined that a total of 30 patients would be needed to demonstrate a significant difference in symptom scores after use of CeCe with 80% power and an α error of 5%. RESULTS Twenty-nine patients completed all data collection. The ICIQ-OAB-QoL scores were significantly different between weeks 1 and 8 (62 [IQR], 49-75) vs 32 [IQR, 24-43]; P < 0.001). Patients also reported a decrease in frequency pretreatment and posttreatment (7 [IQR, 6-10] vs 5 [IQR, 4-7]; P = -0.04), nocturia (2 [IQR, 1-3] vs 1 [IQR, 1-2]; P = 0.03), and urge urinary incontinence (2 [IQR, 1-5] vs 0 [IQR, 0-3]; P = 0.04). Consumption of alcohol decreased from week 1 to week 8 (24 oz [IQR, 12-36 oz) to 14 oz (IQR, 9-22 oz]; P = 0.02). CONCLUSION The use of a digital conversational agent effectively reduced the severity of symptoms and improved quality of life in patients with OAB.
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Affiliation(s)
- David Sheyn
- From the Department of Urology, University Hospitals Cleveland
| | | | | | - Sangeeta T Mahajan
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH
| | - Adonis Hijaz
- From the Department of Urology, University Hospitals Cleveland
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Leite AMC, de Araújo RC, Santos AVRD, Barbosa SAM, Amorim DA, da Sena Fraga CD, Pitangui ACR. Efficacy of educational instructions on pelvic floor muscle training in the treatment of urinary incontinence: Systematic review and meta-analysis. Neurourol Urodyn 2024; 43:219-235. [PMID: 37712496 DOI: 10.1002/nau.25287] [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: 06/04/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE The present study aimed to investigate the efficacy of educational interventions on pelvic floor (PF) muscle training in the treatment of urinary incontinence (UI). METHODS This is a systematic review of literature with meta-analysis, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). To do so, randomized clinical trials that performed educational interventions of PF, UI, and developed the training of PF muscles (TPFM) for incontinent women, performing group or individual comparisons, with control and experimental groups or with two or more experimental groups were selected. The search for papers was performed in the following databases: PubMed, Scopus, Embase, Web of Science, and SciELO, no specific publication date was chosen. The risk of bias was performed using the PEDro scale and the quality of the evidence was performed using GRADE. RESULTS The review included six studies with 1003 participants. Most studies presented 5-8 points regarding risk of bias. Most of the studies were performed in the last 5 years, with women of various ages, high educational level and prevalence of UI of effort. The present study showed that offering educational instructions and guiding women on TPFM was capable of reducing urinary symptoms. When compared to control, significant between-group differences were found in the studies, in which the control group did not receive any kind of instructions or treatment (p < 0.05). The use of technologies through mobile apps was efficient in the treatment of incontinent women (p < 0.05). Performing TPFM individually or in groups did not present differences in the results, with both improving urinary symptoms. The meta-analysis presented a mean effect and a clinically important difference in three studies. CONCLUSION The interventions involving instructions to TPFM associated to health education brought improvements to urinary symptoms.
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Affiliation(s)
- Alana Mirelle Coelho Leite
- Universidade de Pernambuco e Universidade Estadual da Paraíba, Programa Associado de Pós-Graduação em Enfermagem da Universidade de Pernambuco, Rua Arnóbio Marques, Recife, Pernambuco, Brasil
| | | | | | | | - Danielly Alves Amorim
- Universidade de Pernambuco, Departamento de Fisioterapia, Petrolina, Pernambuco, Brasil
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ÖZEN Ş, POLAT Ü. Bladder training and Kegel exercises on urinary symptoms in female patients with multiple sclerosis. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2023. [DOI: 10.1111/ijun.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Şükrü ÖZEN
- Bingöl University Faculty of Health Sciences Department of Nursing Bingöl Turkey
| | - Ülkü POLAT
- Gazi University Faculty of Health Sciences Department of Nursing Ankara Turkey
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Bai J, Tian Y, Wang Y, Zhang X, Wang P. Physical and Rehabilitation Therapy for Overactive Bladder in Women: A Systematic Review and Meta-Analysis. Int J Clin Pract 2023; 2023:6758454. [PMID: 36704247 PMCID: PMC9833926 DOI: 10.1155/2023/6758454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To compare the effects of different physical and rehabilitation therapies on women with overactive bladder (OAB). DESIGN Network meta-analysis. Data source: The Embase, Scopus, and PubMed databases were systematically searched from their inception to June 22, 2022. We included only RCTs, with no language restrictions. Articles in the reference lists and related studies were thoroughly reviewed. Review Methods. This network meta-analysis included related studies on different physical and rehabilitation therapies for OAB. Data were extracted independently from the included randomized controlled trials by two authors, and they used the Cochrane Collaboration's tool to evaluate the risk of bias. We used RevMan to assess the risk assessment of research bias. This network meta-analysis was performed using the Stata software. We completed the review in accordance with the PRISMA items for systematic reviews and meta-analyses statement. RESULTS Twelve randomized controlled trials involving 637 patients were included in this meta-analysis. All physical and rehabilitation therapies improved daytime micturition frequency and nocturia frequency in OAB patients. Percutaneous tibial nerve stimulation (PTNS), BT + ES, and BT + BF + ES are better interventions for OAB treatment. There were no significant differences in PTNS, BT + ES, and BT + BF + ES. CONCLUSION All physical and rehabilitation therapies can improve daytime micturition and nocturia frequency in OAB. PTNS, BT + ES, and BT + BF + ES were the priority therapies.
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Affiliation(s)
- Jingwen Bai
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Yilan Tian
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
| | - Yiran Wang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
| | - Xiaofang Zhang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
| | - Ping Wang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
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Yıldız N, Özlü A. Factors predicting the treatment success of bladder training for urgency urinary incontinence. Neurourol Urodyn 2022; 41:1809-1816. [PMID: 35989536 DOI: 10.1002/nau.25028] [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: 04/18/2022] [Revised: 07/28/2022] [Accepted: 08/07/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the efficacy of bladder training (BT) for urgency urinary incontinence (UUI) and to determine women characteristics that are predictors for success. METHODS Clinical data of 110 women with UUI who had received BT over 8 weeks were analyzed retrospectively. Patients were evaluated in terms of incontinence severity (24-h pad test), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and the number of pads), symptom severity (OAB-V8), incontinence-related QoL (IIQ-7) and treatment success. Treatment success was evaluated at a ≥50% reduction in incontinence episodes at the end of the treatment. RESULTS A statistically significant improvement was found in all parameters (incontinence severity, frequency of voiding, nocturia, incontinence episodes and the number of pads, symptom severity, and incontinence-related QoL) at the end of the treatment compared to the baseline values in women with UUI who had received BT (p < 0.001). The treatment success rate was 35.5%. In the multivariate analysis (OR, 95% CI), the treatment was found to be more successful in women with higher education levels (p = 0.012, p = 0.029) and of younger ages (p = 0.004). CONCLUSION It can be concluded that the BT given to women with UUI is effective in reducing incontinence severity, frequency, nocturia, incontinence episodes, number of pads, symptom severity, and improving QoL. Young age and high education levels are the predictive factors in the treatment success of BT in women with UUI. For this reason, these predictive factors should be considered in determining the treatment strategy for women with UUI.
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Affiliation(s)
- Necmettin Yıldız
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Aysun Özlü
- Department of Physical Medicine and Rehabilitation, Kutahya Health Sciences University Faculty of Medicine, Kütahya, Turkey
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Leonardo K, Seno DH, Mirza H, Afriansyah A. Biofeedback-assisted pelvic floor muscle training and pelvic electrical stimulation in women with overactive bladder: A systematic review and meta-analysis of randomized controlled trials. Neurourol Urodyn 2022; 41:1258-1269. [PMID: 35686543 DOI: 10.1002/nau.24984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/16/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This meta-analysis aims to compare biofeedback-assisted pelvic muscle floor training (PFMT) and pelvic electrical stimulation (ES) as an intervention group, with PFMT or bladder training (BT) as the control group, in women with an overactive bladder (OAB). METHOD PubMed, Cochrane, CINAHL, EMBASE, and Scopus were systematically searched for randomized controlled trials (RCTs) published up to November 2021. The RCTs were screened for our eligibility criteria and quality was evaluated using the Cochrane Risk Index of Bias tools. The outcomes were changes in quality of life (QoL), episodes of incontinence, and the number of participants cured/improved. RESULTS Eight studies involving 562 patients (comprising 204 patients with biofeedback-assisted PFMT, 108 patients with pelvic ES, and 250 patients who received PFMT alone or BT and lifestyle recommendations only, as the control group) were included. The ES group showed significant differences in terms of changes to QoL (mean difference [MD]: 7.41, 95% confidence interval [CI]: 7.90-12.92, p = 0.008), episodes of incontinence (MD: -1.33, 95% CI: -2.50 to -0.17, p = 0.02), and the number of participants cured or improved (risk ratio [RR]: 1.46, 95% CI: 1.14-1.87, p = 0.003), while the biofeedback group resulted in nonsignificant changes in QoL (MD: 0.13, 95% CI: 7.87-8.12, p = 0.98), episodes of incontinence (MD: 0.01, 95% CI: -0.89 to 0.90, p = 0.99), and the number of participants cured or improved (RR: 1.15, 95% CI: 0.99-1.33, p = 0.08), both compared to the control group respectively. CONCLUSION This meta-analysis shows that low-frequency pelvic ES appears to be sufficient and effective as an additional intervention for women with OAB in clinical practice according to improvements in the subjects' QoL and reduction of symptoms. Meanwhile, biofeedback-assisted PFMT does not appear to be a significant adjuvant for conservative OAB therapy.
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Affiliation(s)
- Kevin Leonardo
- Department of Surgery, Division of Urology, Persahabatan General Hospital, Jakarta, Indonesia
| | - Doddy Hami Seno
- Department of Surgery, Division of Urology, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hendy Mirza
- Department of Surgery, Division of Urology, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Andika Afriansyah
- Department of Surgery, Division of Urology, Persahabatan General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Alkis O, Ozlu A, Kartal IG, Sevim M, Baser A, Aras B. How effectively do we apply first-line treatment in overactive bladder? Int Urogynecol J 2022; 33:2299-2306. [PMID: 35779110 DOI: 10.1007/s00192-022-05279-2] [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: 03/17/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to reveal the effectiveness of the combination of behavioral therapy (BT), drug therapy, and pelvic floor muscle training (PFMT) in patients with the diagnosis of overactive bladder (OAB) who did not respond to drug therapy. METHODS Seventy female patients aged between 18 and 65 years diagnosed with wet-type OAB, who did not respond to drug therapy, were included in our study, which was planned as a prospective randomized controlled trial. The patients were randomly assigned to one of two groups. BT and a combination of anticholinergic + beta3-agonist was implemented in the control group for 12 weeks. BT and PFMT were applied with a combination of anticholinergic + beta3-agonist in the active therapy group for 12 weeks. Post-treatment changes in OAB, ICIQ-SF scores, and frequency and nocturia were compared. RESULTS The age and BMI averages of the groups were similar (p>0.01). After the treatment, no significant decrease was observed in OAB scores in the control group (p = 0.06), but a significant decrease was observed in the active therapy group (p<0.01). The mean ICIQ-SF scores and the number of nocturia were found to decrease in both groups after 12 weeks of treatment (p<0.01). There was no significant decrease in frequency in the control group (p = 0.054). It regressed significantly in the active therapy group (p<0.01). After the treatment, 3 of 30 the patients in control group (10%) and 11 of the 32 patients in the active therapy group (34.3%) said that their complaints had regressed and that they were pleased with their current situation. Although after the treatment, 4 patients in the control group were dry (13.3%), 10 patients in the active therapy group were dry (31.25%). CONCLUSIONS We demonstrated that drug therapy, BT, and PFMT, which are recommended in the first-line treatment of OAB reduce the need for invasive treatments when they are well explained to the patients and combined.
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Affiliation(s)
- Okan Alkis
- Faculty of Medicine, Department of Urology, Kütahya Health Science University, Kutahya, Turkey.
| | - Aysun Ozlu
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kütahya Health Science University, Kutahya, Turkey
| | - Ibrahim Guven Kartal
- Faculty of Medicine, Department of Urology, Kütahya Health Science University, Kutahya, Turkey
| | - Mehmet Sevim
- Faculty of Medicine, Department of Urology, Kütahya Health Science University, Kutahya, Turkey
| | - Aykut Baser
- Faculty of Medicine, Department of Urology, Bandırma Ondokuzeylül University, Bandırma, Turkey
| | - Bekir Aras
- Faculty of Medicine, Department of Urology, Kütahya Health Science University, Kutahya, Turkey
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Kajbafvala M, Ashnagar Z, Lucio A, Firoozeh F, Salehi R, Pashazadeh F, Dadgoo M, Jafari H. Pelvic floor muscle training in multiple sclerosis patients with lower urinary tract dysfunction: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 59:103559. [DOI: 10.1016/j.msard.2022.103559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 01/10/2023]
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Shi C, Zhou D, Yu W, Jiao W, Shi G, Wang Y. Efficacy of Yun-Type Optimized Pelvic Floor Training Therapy for Middle-Aged Women With Severe Overactive Bladder: A Randomized Clinical Trial. Front Surg 2021; 8:670123. [PMID: 34336915 PMCID: PMC8316598 DOI: 10.3389/fsurg.2021.670123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022] Open
Abstract
Background: This study aimed to evaluate the clinical efficacy of Yun-type optimized pelvic floor training therapy for middle-aged women with severe overactive bladder (OAB). Methods: This randomized, observer-blinded, parallel-group controlled clinical trial included 108 middle-age women with severe OAB and assigned them to the intervention group (treated with combination of Yun-type optimized pelvic floor training with solifenacin for 12 weeks) and control group (treated with solifenacin for 6 weeks and, after 2 weeks of elution, received the combination of Yun-type optimized pelvic floor training and solifenacin for 6 weeks). The outcomes associated with OAB, pelvic floor muscle (PFM) function, and sexual function were compared after 6 and 12/14 weeks of treatment. Results: The primary variables were OAB-associated outcomes, including overactive bladder symptom score (OABSS), urgent urination, urine, nocturia, urge urinary incontinence, patient's perception of bladder condition, urogenital distress inventory-6, incontinence impact questionnaire-7, voiding volume, average flow rate, and maximum flow rate. The secondary variables were indicators related to PFM function and sexual function. These indicators were significantly improved in both groups after interventions. Notably, the improvements in most of these indicators were superior in the intervention group than in the control group after 6 weeks and 12/14 weeks of treatment. Conclusions: The use of Yun-type optimized pelvic floor training adds to the benefits of solifenacin regarding severe OAB-associated outcomes, PMF function, and sexual function in middle-aged women with severe OAB. Combining Yun-type optimized pelvic floor training with traditional drug therapies may improve clinical outcomes in patients with severe OAB. Trial Registration: ChiCTR-INR-17012189.
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Affiliation(s)
- Chaoliang Shi
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Dan Zhou
- School of Health and Social Care, Shanghai Urban Construction Vocational College, Shanghai, China
| | - Wandong Yu
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wei Jiao
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Guowei Shi
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yangyun Wang
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
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Karaaslan Y, Toprak Celenay S, Kucukdurmaz F. Comparison of Pelvic Floor Muscle Training With Connective Tissue Massage to Pelvic Floor Muscle Training Alone in Women With Overactive Bladder: A Randomized Controlled Study. J Manipulative Physiol Ther 2021; 44:295-306. [PMID: 34090550 DOI: 10.1016/j.jmpt.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/17/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of a 6-week program of pelvic floor muscle training (PFMT) plus connective tissue massage (CTM) to PFMT alone in women with overactive bladder (OAB) symptoms on those symptoms, pelvic floor muscle strength, and quality of life. METHODS Thirty-four participants were randomly divided into PFMT+CTM (n = 17) and PFMT (n = 17) groups. PFMT was applied every day and CTM was applied 3 days a week for 6 weeks. Before treatment, at week 3, and after treatment (week 6), we assessed pelvic floor muscle strength (with a perineometer), bladder symptoms (with a urine diary), OAB symptom severity (with the 8-item Overactive Bladder Questionnaire [OAB-V8]), urgency (with the Patient Perception of Intensity of Urgency Scale [PPIUS]), and quality of life (with King's Health Questionnaire [KHQ]). The Mann-Whitney U test, χ2 test, Friedman test, and Dunn multiple comparison test were used for analysis. RESULTS In both groups, pelvic floor muscle strength increased, whereas OAB symptoms and PPIUS and KHQ scores decreased after treatment (P < .05). Although the OAB-V8, PPIUS, and KHQ scores decreased at week 3, frequency, OAB-V8, and PPIUS scores, in addition to some parameters of the KHQ, decreased after treatment in the PFMT+CTM group compared to the PFMT group (P < .05). CONCLUSION Compared to PFMT alone, PFMT+CTM achieved superior outcomes in reducing OAB symptoms in the early and late periods.
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Affiliation(s)
- Yasemin Karaaslan
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Beykent University, Istanbul, Turkey
| | - Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Health Science Faculty, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | - Faruk Kucukdurmaz
- Department of Urology, Faculty of Medicine, Sanko University, Gaziantep, Turkey
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Celenay ST, Karaaslan Y, Coban O, Oskay K. A comparison of Kinesio taping and external electrical stimulation in addition to pelvic floor muscle exercise and sole pelvic floor muscle exercise in women with overactive bladder: a randomized controlled study. Disabil Rehabil 2021; 44:5124-5132. [PMID: 34098818 DOI: 10.1080/09638288.2021.1925751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the effects of Kinesio taping® (KT) and external electrical stimulation (ES) in addition to pelvic floor muscle exercise (PFME) and sole PFME in women with overactive bladder (OAB). MATERIAL AND METHODS Patients with OAB were randomly allocated into PFME, PFME + KT, PFME + ES groups. All treatments were carried out for 6 weeks. OAB symptoms with voiding diary and Overactive Bladder-Version8 (OAB-V8), pelvic floor muscle strength (PFMS) with perineometer, quality of life with King's Health Questionnaire (KHQ) were assessed before (BT) and after treatment (AT). AT, the perception of improvement was inquired. RESULTS AT, OAB symptoms and KHQ scores decreased and PFMS improved in all groups (p < 0.05). The intergroup comparisons revealed a further decrease in voids/day, voids/night, OAB-V8, and some KHQ scores, and a further increase in the perception of improvement in the PFME + KT and PFME + ES groups compared to the PFME group (p < 0.05). In the PFME + ES group, there was a further decrease in numbers of incontinence compared to the PFME group, and in severity measures scores compared to the other groups (p < 0.05). CONCLUSION KT and external ES in addition to PFME were more effective than PFME alone in the treatment of OAB.IMPLICATIONS FOR REHABILITATIONPelvic floor muscle exercise was found to be effective in reducing overactive bladder symptoms and increasing quality of life.Kinesio taping or external electrical stimulation in addition to pelvic floor muscle exercise is more effective in improving overactive bladder symptoms, quality of life, and perception of improvement than pelvic floor muscle exercise alone.Kinesio taping and external electrical stimulation can be used as a complementary application in the treatment of overactive bladder.Pelvic floor muscle exercise, pelvic floor muscle exercise + Kinesio taping, and pelvic floor muscle exercise + electrical stimulation applications should be included in conservative treatment options in patients with overactive bladder to reduce symptoms and cost, and improve quality of life.
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Affiliation(s)
- Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Ankara Yildirim Beyazit University Ankara, Ankara, Turkey
| | - Yasemin Karaaslan
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Beykent University, Istanbul, Turkey
| | - Ozge Coban
- Faculty of Gulhane Physiotherapy and Rehabilitation, Health Science University, Ankara, Turkey
| | - Kemal Oskay
- Department of Urology, Ankara Gazi Mustafa Kemal Hospital, Ankara, Turkey
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Takahashi S, Takei M, Asakura H, Gotoh M, Ishizuka O, Kato K, Koyama M, Takeyama M, Tomoe H, Yamanishi T, Yokoyama O, Yoshida M, Yoshimura Y, Yoshizawa T. Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition). Int J Urol 2021; 28:474-492. [PMID: 33650242 DOI: 10.1111/iju.14492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100 mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100 mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masami Takeyama
- Urogynecology Center, First Towakai Hospital, Takatsuki, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasukuni Yoshimura
- Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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Cognitive components of behavioral therapy for overactive bladder: a systematic review. Int Urogynecol J 2021; 32:2619-2629. [PMID: 33609161 DOI: 10.1007/s00192-021-04720-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Behavioral therapy is the first-line treatment for overactive bladder (OAB); however, the cognitive components of behavioral therapy for OAB have not been evaluated. The purposes of this systematic review were to describe the cognitive components of behavioral therapy for OAB and evaluate their effectiveness as well as to describe their rationale and origins. METHODS Searches were conducted on the PubMed, CINAHL, Web of Science, Cochrane and PEDro databases. Inclusion criteria were single-arm or randomized controlled trials on OAB treatment that utilized behavioral therapy, with a description of a cognitive component of the behavioral therapy. Study participants were neurologically intact adults (n = 1169). Study methodological quality was assessed with the PEDro and Newcastle-Ottawa scales. RESULTS Five studies were included, published between 2009 and 2020. Methodological quality was variable. All studies reported a reduction of symptoms in participants receiving behavioral therapy. Cognitive components of behavioral therapy were not extensively described. Distraction was the most common cognitive strategy for managing urgency. The relative impact of the cognitive aspect of behavioral therapy could not be evaluated, and the cognitive aspects of behavioral therapy appear to be accepted wisdom, traceable to several key authors, that has not been subjected to scientific investigation. CONCLUSIONS Behavioral therapy for OAB appears useful, but its cognitive components are not well described, their relative importance has not been evaluated or ascertained, nor have they been rigorously studied.
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Gamé X, Phé V. [First-line treatment for non-neurogenic overactive bladder]. Prog Urol 2020; 30:904-919. [PMID: 33220819 DOI: 10.1016/j.purol.2020.08.055] [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: 07/20/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim was to synthesize current knowledge on overactive bladder (OAB) first-line treatments. METHOD A systematic literature review based on PubMed, Embase and Google Scholar was conducted in June 2020. RESULTS Behavioral treatments are based on bladder training and timed voiding using a bladder diary. Lifestyle modifications should be suggested. They include reduction of fluid intake, consumption of caffeine, sodas, weight loss, avoidance of acidic fruit juices and of spicy and acidic salty diet, alkalization of urine by diet and possibly, vitamin D supplementation. Pelvic floor muscle training is mainly based on manual techniques, electrostimulation and/or biofeedback. It has been shown to be effective in treating OAB. In menopausal women, local hormone therapy improves all OAB symptoms. Oral drugs include anticholinergics and beta-3-agonists. Their efficacy is quite similar and superior to placebo. In case of failure of monotherapy, they may be combined. CONCLUSION Apart from some lifestyle modifications, the efficacy of first-line treatments for OAB has been demonstrated by prospective controlled studies. They may be prescribed individually or in combination.
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Affiliation(s)
- X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, université Paul-Sabatier, TSA50032, 31059 Toulouse, France.
| | - V Phé
- Service d'urologie, AP-HP, hôpital Pitié-Salpêtrière, Sorbonne université, Paris, France
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Xu L, Fu C, Zhang Q, Xiong F, Peng L, Liang Z, Chen L, He C, Wei Q. Efficacy of biofeedback, repetitive transcranial magnetic stimulation and pelvic floor muscle training for female neurogenic bladder dysfunction after spinal cord injury: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e034582. [PMID: 32759239 PMCID: PMC7409967 DOI: 10.1136/bmjopen-2019-034582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/14/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Neurogenic bladder dysfunction is prevalent in female patients with spinal cord injury (SCI), and previous guidelines have recommended pelvic floor muscle training (PFMT) for first-line conservative treatment. However, the actual regimen of PFMT varies widely and the single treatment does not satisfy the need of some patients. Therefore, this study aims to provide a detailed rationale and methodology for comparing the effectiveness of PFMT, biofeedback and repetitive transcranial magnetic stimulation (rTMS) as adjunct treatments for neurogenic bladder dysfunction. METHODS AND ANALYSIS This trial is a single-centre randomised controlled trial for female patients with urinary incontinence (UI) in phase of chronic SCI. Eligible participants will be randomised to one of four arms: (1) PFMT, (2) PFMT with biofeedback, (3) PFMT and rTMS and (4) PFMT with biofeedback and rTMS. There will be 44 participants in each arm and all the subjects will undergo 20 treatment sessions, five times a week for 4 weeks. The outcomes will be evaluated at 4 weeks, 3 months and 6 months after randomisation. The primary outcome is the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, and the secondary outcomes include bladder diary, pelvic floor muscle function and the International Spinal Cord Injury Quality of Life Basic Data Set. ETHICS AND DISSEMINATION The Clinical Research and Biomedical Ethics Committee of the West China Hospital, Sichuan University has approved this trial and the approval number is 2019-885. All participants will be provided written informed consent after verification of the eligibility criteria. The results of this study will be accessible in peer-reviewed publications and be presented at academic conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1900026126).
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Affiliation(s)
- Lin Xu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chenying Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Qing Zhang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Feng Xiong
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Lihong Peng
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Zejun Liang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Li Chen
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chengqi He
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
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Toprak Celenay S, Korkut Z, Oskay K, Aydin A. The effects of pelvic floor muscle training combined with Kinesio taping on bladder symptoms, pelvic floor muscle strength, and quality of life in women with overactive bladder syndrome: A randomized sham-controlled trial. Physiother Theory Pract 2020; 38:266-275. [DOI: 10.1080/09593985.2020.1750079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Zehra Korkut
- Department of Therapy and Rehabilitation, KTO Karatay University, Konya, Turkey
| | - Kemal Oskay
- Department of Urology, Gazi Mustafa Kemal Hospital, Ankara, Turkey
| | - Arif Aydin
- Department of Urology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
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Is pelvic floor muscle training effective for symptoms of overactive bladder in women? A systematic review. Physiotherapy 2019; 106:65-76. [PMID: 32026847 DOI: 10.1016/j.physio.2019.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Overactive bladder (OAB) syndrome can be very bothersome and is associated with impaired quality of life and work productivity. OBJECTIVE To evaluate the effect of pelvic floor muscle training (PFMT) on OAB symptoms in women. Furthermore, to assess the influence of PFMT on pelvic floor muscle (PFM) function, satisfaction with treatment, side effects, adherence and the quality of exercise reporting. DATA SOURCES Systematic review of randomized controlled trials (RCTs). Electronic search was conducted on MEDLINE/PubMed, Embase, CINAHL, SciELO, SCOPUS, Web of Science and Physiotherapy Evidence Database (PEDro). The risk of bias was assessed using the PEDro scale. The Consensus on Exercise Reporting Template (CERT) was used to assess the quality of exercise reporting. STUDY SELECTION Full text RCTs including non-pregnant female participants, investigating PFMT vs inactive control or usual care, other life style modifications or other interventions. SYNTHESIS METHODS Descriptive analysis. RESULTS Eleven RCTs were included. There was considerable heterogeneity of PFMT protocols, outcome measures and follow-up periods. Hence, a qualitative analysis was undertaken. PFMT provided a significant reduction of OAB symptoms in five studies with a reduction in urinary frequency (n=1), and urgency urinary incontinence (n=4). PFM function was assessed in three studies, and two studies found improvement in favor of PFMT. LIMITATIONS A meta-analysis was not possible due to huge heterogeneity of included studies. CONCLUSION PFMT might reduce OAB symptoms, however, due to many limitations of the published studies it is not possible to clearly determine the effect of PFMT on OAB symptoms and PFM function. Systematic Review Registration Number PROSPERO CRD42018085640.
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A Controlled Clinical Trial on the Effects of Exercise on Lower Urinary Tract Symptoms in Women With Multiple Sclerosis. Am J Phys Med Rehabil 2019; 98:777-782. [DOI: 10.1097/phm.0000000000001189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xu D, Huang L, Gao J, Li J, Wang X, Wang K. Effects of an education program on toileting behaviors and bladder symptoms in overactive bladder patients with type 2 diabetes: A randomized clinical trial. Int J Nurs Stud 2018; 87:131-139. [PMID: 30096579 DOI: 10.1016/j.ijnurstu.2018.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Overactive bladder is more common in patients with type 2 diabetes than in those without diabetes. Many patients with diabetes adopt unhealthy toileting behaviors to empty their bladder that may contribute to the onset or worsening of overactive bladder. OBJECTIVE To investigate whether an education program targeting toileting behaviors is effective for helping overactive bladder patients with type 2 diabetes in terms of adopting healthy toileting behaviors, improving bladder symptoms, and enhancing quality of life. DESIGN The study was a parallel, pragmatic, open-label randomized trial. SETTINGS The trial was conducted in a hospital-based endocrinology outpatient department in Jinan, China. PARTICIPANTS A total of 104 patients were randomly assigned to a 6-week education program or a control group. METHODS Primary outcomes included toileting behaviors and bladder symptoms, including dry/wet overactive bladder and severity of urgency. Secondary outcomes were overactive bladder-specific and general quality of life. The patients were reassessed on the outcome variables at the end of the intervention and at 3 months and 6 months following the intervention. The analysis followed the intent-to-treat principle. To account for the longitudinal data with repeated measures, group comparisons for continuous outcomes were evaluated using linear mixed models. Group differences in binary outcomes were examined using mixed-effects logit models. RESULTS Compared with the control group, the education program group showed significant changes in three unhealthy toileting behaviors: premature voiding (-0.7, p < 0.001), place preference for voiding (-0.5, p = 0.007), and delayed voiding (-0.2, p = 0.011). The program significantly relieved the bladder symptoms (-2.2, p < 0.001) and decreased the probability of having wet overactive bladder (-0.3, p < 0.001) and the severity of urgency (-0.4, p < 0.001). It also significantly improved the overactive bladder-specific quality of life by 10.8 points (p = 0.001). Regarding patients' general quality of life, the physical aspect was enhanced by 3.0 points (p = 0.049); however, no effect on the mental well-being aspect was observed. CONCLUSIONS Among overactive bladder patients with type 2 diabetes, the 6-week education program targeting toileting behaviors resulted in the adoption of healthy toileting behaviors, relief of bladder symptoms and improvement in quality of life in the 6 months following the intervention compared with routine care alone. The education program was highly successful and may represent an effective, acceptable, feasible, and safe intervention for improving bladder health and quality of life during diabetes care, given that the toileting behavioral changes were maintained during the 6-month follow-up period.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Shandong University, Jinan, Shandong Province, China; School of Nursing, Purdue University, West Lafayette, IN, United States
| | - Liqun Huang
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Jie Gao
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Jingjing Li
- School of Nursing, Shandong University, Jinan, Shandong Province, China; Department of Surgical Nursing, Ningbo College of Health Science, Ningbo, Zhejiang Province, China
| | - Xiaojuan Wang
- School of Nursing, Shandong University, Jinan, Shandong Province, China; School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Kefang Wang
- School of Nursing, Shandong University, Jinan, Shandong Province, China.
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