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Promoting urinary continence in women after delivery: randomised controlled trial [with consumer summary]
Chiarelli P, Cockburn J
BMJ 2002 May 25;324(7348):1241-1246
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To test the effectiveness of a physiotherapist delivered intervention designed to prevent urinary incontinence among women three months after giving birth. DESIGN: Prospective randomised controlled trial with women randomised to receive the intervention (which entailed training in pelvic floor exercises and incorporated strategies to improve adherence) or usual postpartum care. SETTING: Postpartum wards of three tertiary teaching hospitals in the Hunter region, New South Wales, Australia. PARTICIPANTS: Women who had forceps or ventouse deliveries or whose babies had a high birth weight (>= 4,000 g), or both -- 676 (348 in the intervention group and 328 in the usual care group) provided endpoint data at three months. MAIN OUTCOME MEASURES: Urinary incontinence at three months measured as a dichotomous variable. The severity of incontinence was also measured. Self report of the frequency of performance of pelvic floor exercises was recorded. RESULTS: At three months after delivery, the prevalence of incontinence in the intervention group was 31.0% (108 women) and in the usual care group 38.4% (125 women); difference 7.4% (95% confidence interval 0.2% to 14.6%, p = 0.044). At follow up significantly fewer women with incontinence were classified as severe in the intervention group (10.1% versus 17.0%, difference 7.0%, 1.6% to 11.8%). The proportions of women reporting doing pelvic floor exercises at adequate levels was 84% (80% to 88%) for the intervention group and 58% (52% to 63%) for the usual care group (p = 0.001). CONCLUSIONS: The intervention promoting urinary continence reduced the prevalence of urinary incontinence after giving birth, particularly its severity, and promoted the performance of pelvic floor exercises at adequate levels; both continence and adherence to the programme were measured at three months after delivery in women who had forceps or ventouse deliveries or babies weighing 4,000 g or more.
Reproduced with permission from the BMJ Publishing Group.

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