Examination of the Significant Placebo Effect in the Treatment of Interstitial Cystitis/Bladder Pain Syndrome. Bosch P. UROLOGY 84:321-326, 2014.

Michelle Spicka, DPT

October 8th

Pelvic Physical Therapy Distance Journal Club

Objective: To examine the significant “placebo effect” in a randomized, double-blind, placebo-controlled interstitial cystitis (IC)/bladder pain syndrome (BPS) trial.  Randomized clinical trials are the reference standard for therapeutic impact assessment however, proving efficacy of treatments for IC/BPS with rigorous placebo-controlled trials is difficult due to a significant effect of the placebo intervention.

In past studies, a significant effect has been repeatedly observed in patients who only received placebo interventions in IC/BPS trials and the placebo global response assessment overall response ranged from 12% to 20%.

Another study by this same author in 2014 showed 50% of the placebo patients had an over 50% overall improvement in the global response assessment. 

The significant improvement with only advice and support is higher than many commonly used medications for the treatment of IC/BPS.

Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline from the American College of Physicians. Qaseem A, Dallad P, Forciea MA, Starkey M, et al. Ann Intern Med. 2014;161:429-440

Michelle Spicka, DPT

October 8^th, 2014  

Pelvic Physical Therapy Distance Journal Club

Description: This guideline from the American College of Physicians (ACP) presents the available evidence on the nonsurgical (pharmacologic and nonpharmacologic) treatment of UI in women in the primary care setting.   

Nonpharmacologic Treatments for UI

1)      PFMT

a.       Instruction on the voluntary contraction of pelvic floor muscles

2)      PFMT with biofeedback using vaginal EMG

a.       PFMT with vaginal probe

3)      Bladder training

a.       Behavioral therapy that includes extending the time between voiding

4)      Continence service        

a.       Treatment program involving nurses and clinicians trained in identifying, diagnosing and appropriately treatment patients with UI

 

AUA IC Guideline Update Sept 2014

Thanks to the IC Association for providing the updated summary of the AUA IC guidelines.
PT is still prominently encouraged. Good marketing tool.

http://www.ichelp.org/file/AUAICGuideline.pdf

Check out www.ichelp.org for more resources for professionals and patients.

IUGA / AUGS Annual Meeting

Highlights of the IUGA / AUGS Annual Meeting webinar is a review of some of the best research from the meeting in Washington DC July 2014. John DeLancey gives a great state of the art on imaging.  It's free, take a look and LIKE to IUGA page for more updates and free stuff.

https://www.facebook.com/iugaoffice

Do stages of menopause affect the outcomes of pelvic floor muscle training?

Tosum OC, Mutle EK, Tosun G, Ergenoglu AM, Yeniel AO, Malkoc M, Askar N, Itil IM.  Menopause.  2014; 22(2): 1-10. DOI: 10.1097/gme.0000000000000278.

Ann Dunbar PT, DPT, MS, WCS

September 10, 2014

Introduction: UI is a common complaint. Numerous hormonal changes occur during the menopause transition.  A relationship exists between hormone levels and the urinary system.  A relationship also exists between hormonal changes and muscle mass including decreases in the ratio of connective tissues to muscle fibrils in the urethral stricture and pelvic floor.  Pelvic floor exercise is recommended as the first line of treatment for stress urinary incontinence (SUI).  Little research exists on the impact of menopausal changes on PFMT.

Primary Aim:  (1) Determine impact of pelvic floor muscle training (PFMT) on increases in PFM strength during different stages of menopause.

Subjects: 122 women with stress and mixed urinary incontinence; separated into 3 groups according to stage of menopause

Study Design:  Prospective controlled clinical trial