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| Author/Association: | Marques SAA, Silveira SRBD, Passaro AC, Haddad JM, Baracat EC, Ferreira EAG |
| Title: | Effect of pelvic floor and hip muscle strengthening in the treatment of stress urinary incontinence: a randomized clinical trial [with consumer summary] |
| Source: | Journal of Manipulative and Physiological Therapeutics 2020 Mar;43(3):247-256 |
| Method: | clinical trial |
| Method Score: | 5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
| Consumer Summary: | PRACTICAL APPLICATIONS: The scientific evidence shows that pelvic floor muscle (PFM) contraction should occur in isolation. This study agrees with that assumption, but suggests that isolated exercises for the hip muscles are also important to ensure that these muscles have strength enough for maintaining the correct synergism of the PFM. The correct synergy of the PFM is very important for functionality and urinary continence, and exercises for strengthening the gluteus muscles and adductors of the hip should be added to physical therapy treatment for urinary incontinence. The reduction in symptoms of stress urinary incontinence may be due not solely to muscular strength and peak of contraction but also to improvement in other aspects of pelvic floor functionality, such as muscular synergy for biomechanical and functional performance. Understanding how the synergic action of the hip muscles occurs in relation to the PFM may contribute to greater effectiveness of physical therapy treatment of stress urinary incontinence. |
| Abstract: | OBJECTIVE: To investigate the effectiveness of strengthening the hip muscles in addition to strengthening the pelvic floor muscles (PFM) in the treatment of stress urinary incontinence. METHODS: This study used a prospective, assessor-blind, randomized clinical trial with parallel groups. We randomly allocated 47 individuals with stress urinary incontinence to 2 groups: 1 performing only pelvic floor strengthening exercises (PF, n = 21) and the other performing pelvic floor strengthening exercises plus exercises for the gluteus maximus and medius and hip adductor muscles (PFH, n = 22). Four individuals did not complete the study. Frequency of urine leakage was the primary outcome (3-day voiding diary and a follow-up voiding diary). Secondary outcomes were pelvic floor muscle strength (Ortiz scale, PERFECT scheme (Oxford Scale), and perineometry) and quality of life (QoL; International Consultation on Incontinence Questionnaire-Short Form and King's Health Questionnaire), which were evaluated by a blinded assessor before and after 20 sessions over 10 weeks. RESULTS: Regarding the daily frequency of urine loss evaluated by the follow-up voiding diary, an effect of group was observed (p < 0.001), with the PFH group showing a significant decrease in daily loss frequency, although no significant differences were found in the comparison between groups for the 3-day voiding diary, QoL, or functional assessment of the PFM. CONCLUSION: Strengthening the PFM together with the hip synergic muscles showed better results for frequency of daily urine loss throughout the sessions, although there was no accompanying superiority in improvement of strength, perineometry, or QoL over the group that performed only PFM-strengthening exercises. Reprinted from the Journal of Manipulative and Physiological Therapeutics with copyright permission from the National University of Health Sciences. Full text (sometimes free) may be available at these link(s):  help |
