A Randomized, Double Blind, Placebo Controlled Trial of Pelvic Floor Exercises in the Treatment of Genuine Stress Incontinence.

This was one of the articles that was cited in the last Pelvic Physiotherapy Distance Journal club discussion on Optimizing pelvic floor muscle exercises.  This article randomized 44 patients to perform home exercises of 4 second PFM exercises or 4 second hip abductor exercises. 

·         Both groups had 64% of patients reporting improvement (no formal outcome measure, no specifics of how much change). 

·         No difference in 2 groups perineometry scores – both got better – no numbers given

·         Pad test better in abductor group, worse in PFM exercise group – WOW

·         The really interesting point is the adherence to exercises.  – on average participants did 52 exercises per week – 7 or 8 per day.  I think we can all agree (including the authors) this is not enough.

Overall I would say the study design was poor and though the results are intriguing, I would have to see a better study to believe that hip abductor exercises are as effective as PFM exercises in decreasing SUI.   Read for yourself.

November 9, 2011 Pelvic Physiotherapy Distance Journal Club

Discussion centered on PFM exercise routines.  Still more questions than answers.  Check out the outlines posted on this blog.  Also make sure to answer the survey about the journal club if you received the link.  Next month’s meeting is December 7^th.  Already planning for next year.  2012 schedule is below. 

This month’s discussion

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux MC. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence. Arch Phys Med Rehabil 2010;91:1059-1063.

Dumoulin C, Glazner, C, Jenkinson D. Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence. Neurourol and Urodynam 2011;30:746-753.

Listening / downloading recordings

• Meetings will be recorded so they can be shared with others who were not able to attend
• https://www.freeconferencecall.com
• Top right corner – “log in”
• Access code – 436790

Dial-in number – (209) 647-1000

Subscriber PIN – 883352

• Choose the date you want to access – you can playback or download in several formats.  If you want to save it to your computer you click “wav” and choose “save” – name the file and choose the location to save it. 

2012 schedule

January 11 – Cindy Neville

February 8 - No journal club this month

March 7 – Beth Shelly

April 4 – Jane O’Brien

May  9 – Ann Dunbar

June  6 – Michelle Spicka

July 11 –

August 8 –

September 5 -Ann Dunbar

October 10 – MJ Strauhal

November 7 – Beth Shelly

December 5 – Michelle Spicka

Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence.

Dumoulin C, Glazner, C, Jenkinson D. Neurourol and Urodynam 2011;30:746-753.

Beth Shelly November 9, 2011

Second International Consultation on Incontinence Research Society Bristol June 2010 – experts in the field chosen to present and debate and eventually summarize selected topics. 

“It is no longer a question of whether PFM training programs work but what components (including adjunct therapies) and combinations there of are most effective.” Page 752

Comparing PFM exercises for SUI to no treatment

·         Women who were treated were 17 times more likely to report cure or improvement

·         They experienced between 0.8 and 3 few leaks per 24 hours

·         Were 5 to 16 times more likely to be continent on pad test

Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence.

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux MC. Arch Phys Med Rehabil 2010;91:1059-1063.

Beth Shelly November 9, 2011

Background

·         Women who continue with UI 3 months post-partum have a significant risk of symptoms persisting 5 years later.

·         Cochrane review – PFM exercises decrease SUI

Error in terminology

“Pelvic floor physiotherapy uses graded muscle training, either alone ….”  This sentence (written by physiotherapists) creates and contributes to the confusion other professional have about what we do and what it should be called.  Pelvic floor physiotherapy is a treatment for the pelvic floor provided by physiotherapists.  So can a nurse provide pelvic floor physiotherapy?    Certainly we would say “no” but nurse can provide “graded muscle training, either alone or ….”.  More appropriate alternative would be - “Pelvic floor physiotherapists use graded muscle training, either alone…”

Center for Evidenced Based Medicine

The Centre for Evidence-based Medicine was established in Oxford as the first of several UK centers with the aim of promoting evidence-based health care. The CEBM provides free support and resources to doctors, clinicians, teachers and others interested in learning more about EBM.

EBM Tools section has a great deal of information

·         Asking Focused Questions

·         Finding the Evidence

·         Critical Appraisal

·         Making a Decision

·         Evaluating Performance

·         Designing Research

The critical appraisal section is quite good and has documents to help you review articles and understand terminology better.  http://www.cebm.net/index.aspx?o=1157 

Also of note is the 2011 Levels of Evidence Chart.

http://www.cebm.net/mod_product/design/files/CEBM-Levels-of-Evidence-2.1.pdf 

This is a great web site.