Date Presented 03/28/20
UI is a common pelvic-floor disorder that affects up to 50 percent of women age 50 years and older and significantly diminishes quality of life. This quantitative randomized controlled trial will assess whether a multimodal therapeutic exercise program combined with pelvic floor physical therapy is more effective than providing the standard of care. This research has the potential to expand OT scope of practice, improve QOL for women with UI, and contribute to evidence-based practice in women’s health.
Primary Author and Speaker: Jessica Alden
Contributing Authors: Tatiana Sanses, Sharee Pearson, Shannon Gopaul, Alice Ukaegbu
BACKGROUND: Urinary continence (UI) is a common pelvic floor disorder (PFD) that affects up to 50% of women age 50 years and older and significantly diminishes quality of life. The number of American women with UI is projected to rise 55% from 2010 to 2050; from 18.3 to 28.4 women expected to be living with UI. Currently, the frontline strategies used to manage UI are medication, surgery, and physical therapy. There is a critical gap in knowledge as to how UI affections functional performance and quality of life, and as to how multimodal rehabilitation interventions may impact upon UI symptoms.
PURPOSE: The overall aim of this research study is to determine whether the implementation of a muscle strengthening and aerobic conditioning rehabilitation program designed to improve endurance and lower body mobility combined with the strengthening of pelvic floor muscles will reduce pelvic floor and lower body muscle dysfunction and weakness, enhance strength and endurance, and improve UI and mobility in older women. The primary aims of the study are to evaluate changes in UI and mobility after a three-month multimodal strengthening and aerobic conditioning rehabilitation program combined with pelvic floor muscle training (PFMT) and patient education. We will test the hypothesis that the multimodal rehabilitation program with PFMT is more effective in reducing UI episodes as opposed to PFMT alone.
DESIGN: This is a quantitative randomized controlled trial of a multimodal intervention with women age 65 and older living with urinary incontinence. The experimental group will participate in pelvic floor physical therapy, and a tailored rehabilitative exercise program for 12 weeks, and the control group will receive the standard of care (pelvic floor physical therapy for 12 weeks). Participants are women age 65 and older living with UI in a large metropolitan area.
METHODS: The participants will undergo a battery of assessments before and after intervention including: a physical, MRI scan of pelvic floor, mobility assessments (TUG, 6 minute walk, Yale Assessment of Physical Activity), UI assessments (bladder diary, Incontinence Impact Questionnaire Form (IIQ), Urogenital Distress Form (UDI-6) and Patient Global Impression of Severity and Improvement (PGISI)). Inferential statistics will be used to identify any correlations or cause and effect relationships between variables.
RESULTS: For this presentation, a summary of preliminary findings from the initial evaluation will be discussed. At present, n=12, although this number is expected to be much higher by April 2020. Early review of findings indicate that there is not a positive relationship between number of UI episodes per day (bladder diary entries) and quality of life as measured by UDI.
IMPACT STATEMENT: Women’s health is an emerging practice area within the field of occupational therapy. Occupational therapists are uniquely trained to address this multifactorial chronic disease with a holistic perspective. There is a critical need to identify the relationship between UI and functional performance and quality of life in order to promote expansion of the OT role in women’s health.
References
Hsiao S-M, Hsiao C-F, Chen C-H, Chang T-C, Wu W-Y, Lin H-H (2013) Evaluation of Bladder Diary Parameters Based on Correlation with the Volume at Strong Desire to Void in Filling Cystometry. PLoS ONE 8(7): e69946. https://doi.org/10.1371/journal.pone.0069946
Laura Mateu Arrom, Lluís Peri Cusi, Luis López-Fando, Agustín Franco de Castro, Miguel Ángel Jiménez Cidre and Antonio Alcaraz, Validation of a 3 day electronic bladder diary as an app for smart-phone, Neurourology and Urodynamics, 38, 2, (764-769), (2019). DOI: 10.1002/nau.20994
