A randomized clinical trial comparing Pelvic Floor Muscle training to a Pilates exercise program for improving pelvic muscle strength

A randomized clinical trial comparing Pelvic Floor Muscle training to a Pilates exercise program for improving pelvic muscle strength  Culligan PJ, Scherer J, Dyer K, Priestley JL, Guingon-White G, Delvecchio D, Vangeli M. Int Urogynecol J 2010;21:401-408.

April 4, 2011 Pelvic PT Journal Club Jane O’Brien, PT, presented by Cindy Neville

Primary Aim

To compare Pilates exercise program to PFMT for improving pelvic muscle strength.

Subjects: 

52 females over 18, (62 enrolled, 10 dropped out) with little to no PFM dysfunction

Study Design/Method – randomized clinical study – feasibility study

            Randomly assigned to 1 of 2 groups

1.      PFMT with Physical Therapist

2.      Pilates exercise with Pilates instructor.

3.      Both had 24, 1 hour sessions bi-weekly.

4.      PFM strength measured pre and post via Perineometry (Pathway CT 2000) by one clinical research nurse.

PFMT Group:

• Computerized biofeedback, vaginal manip (Thiels massage??) , NM re-ed, manual PT on pelvic floor—strength measured each time. TrA and hip external rotation training
• Pilates Group: Mat exercises
• Neither group was blinded, nor were therapists.

Outcome Measures

1. Mean PFM strength
2. PFDI-20 (Pelvic floor distress inventory 20) worst outcome = 300
3. PFIQ-7  Pelvic Floor Impact Questionaire—same.

Pilates Group                                      PFMT

            1.  Pre  12.5 ± 10.4 cmH²0                  14.9 ± 12.5 cm H²0

            Post—improved by 6.6 ± 7.4              6.2 ± 7.5 cm H²0

                        no significant difference p=0.85 PFM closure pressure

            2.  Pre  59.2 ± 42.3                              51.9 ± 37.8

            Post improved by 28.4 ± 36 pts.         27.4 ± 24.7 (53%)

                                            (48%)

                        no significant difference p=0.86 PFDI

            3.  25 ± 29.9                                        22.4 ± 31.1

            Post improved by 10.9 ± 28 (44%)     12.3 ± 30.9 pts. (55%)

                        No significant difference  p=0.91 PFIQ

Assessing Outcome

1.      No “intention to treat” analysis because drop outs left before final data was collected.

2.      Drop Outs             Pilates (2)                                PFMT (8)

Sick child                                            Did not care for invasive treatment  

Injured wrist

Results

Both groups had increased PFM strength     

More studies needed to determine if Pilates can treat PFD

Conclusion

Group discussed programs like Total Control and Roll for Control for wellness PFM health and post PT strength training. 

It was pointed out that it is necessary to make sure participants can perform the PFM contraction correctly before starting a group class

Individual versus group Pilates was also questioned as results may be different in a class

Clinical Significance

1. Would patients be more compliant, or is there more appeal, to a long term more active program that benefits full body (results they can see)?
2. Would this be a good program for mild to no PFM dysfunction – wellness
3. Would this type of program help extend results after PT