The aim of this study was to prospectively identify aspects of baseline demographic, clinical, and pelvic morphology of women with stress urinary incontinence (SUI) that are predictive of cure with physiotherapist-supervised pelvic floor muscle training (PFMT).
Women ≥18 years old with SUI were recruited from urogynecology and pelvic health physiotherapy clinics. Participants completed a 3-day bladder diary, the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), a standardized pad test, manual assessment of pelvic floor muscle (PFM) strength and tone, and transperineal ultrasound (TPUS) assessment of their urogenital structures at rest while in a supine position and standing, and during contraction, straining, and coughing. Participants attended six physiotherapy sessions over 12 weeks and performed a home PFMT program. The assessment was repeated after the intervention; cure was defined as a dry (≤2 g) pad test.
Seventy-seven women aged 50 (±10) years completed the protocol; 38 (49%) were deemed cured. Based on univariate testing, four predictors were entered into a binary logistic regression model: ICIQ-UI-SF, PFM tone, bladder neck (BN) height in a quiet standing position, and BN height during a cough in a standing position. The model was significant (p < 0.001), accurately classifying outcome in 74% of participants. The model, validated through bootstrapping, performed moderately, with the area under the receiver operating characteristic curve = 0.80 (95% CI: 0.69-0.90; p = 0.00), and with 70% sensitivity and 75% specificity.
Women with better bladder support in a standing position and less severe symptoms were most likely to be cured with PFMT.
International urogynecology journal. 2020 Nov 25 [Epub ahead of print]
Kaylee C L Brooks, Kevin Varette, Marie-Andrée Harvey, Magali Robert, Robert J Brison, Andrew Day, Kevin Baker, Vincent Della Zazzera, Eric Sauerbrei, Linda McLean
School of Rehabilitation Sciences, University of Ottawa, Rm E260C, Building E, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada., School of Rehabilitation Therapy, Queen's University, Kingston, Canada., Department of Obstetrics and Gynaecology, Kingston General Hospital, Kingston, Canada., Department of Obstetrics and Gynaecology, Foothills General Hospital, Calgary, Canada., Department of Emergency Medicine, Kingston General Hospital, Kingston, Canada., Department of Population Health Sciences, Queen's University, Kingston, Canada., Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa, Canada., Department of Obstetrics and Gynaecology, Hôpital Montfort, Ottawa, Canada., Department of Radiology, Kingston General Hospital, Kingston, Canada., School of Rehabilitation Sciences, University of Ottawa, Rm E260C, Building E, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada. .