Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study

Abstract

Objective To investigate the feasibility of pelvic floor muscle training (PFMT) through gametherapy for relieving urinary symptoms of climacteric women with stress or mixed urinary incontinence (UI). Methods Randomized clinical trial, divided into two groups: Gametherapy (G_Game) and Control (G_Control). Both groups received recommendations about unsupervised PFMT, and G_Game also received supervised PFMT through gametherapy. After 5 consecutive weeks, the feasibility was investigated considering participant adherence, urinary symptoms (evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF] questionnaire), and pelvic floor function (PERFECT Scheme: power, endurance, repetition and fast). The Fisher exact, Kruskal-Wallis, Wilcoxon sign paired, and Mann-Whitney U tests were used by intention-to-treat analysis, using STATA 15.1 (StataCorp, College Station, TX, USA) software. Results The present study included 20 women per group and observed a higher adherence in G_Game. In the intragroup analysis, a decrease in the ICIQ-UI-SF score was observed in both groups (14.0 to 10.0; 13.5 to 0), associated with increased endurance (2.5 to 3.5; 2.5 to 4.0) in G_Control and G_Game, respectively. Moreover, there was a concomitant increase in pelvic floor muscles (PFMs) power (2.0 to 3.0), repetition (3.0 to 5.0), and fast (10.0 to 10.0) in G_Game. In the intergroup analysis, a reduction of UI was observed (p < 0.001; r = 0.8), as well an increase in PFM power (p = 0.027, r = 0.2) and endurance (p = 0.033; r = 0.3) in G_Game. Conclusion The feasibility of supervised PFMT through gametherapy was identified by observing participant adherence, relief of urinary symptoms, and improvement in PFM function.

Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence — a systematic review and meta-analysis

“…All studies included a group with supervised sessions under the supervision of a physiotherapist [ 17 – 21 , 23 ]. With regard to the duration of treatment, it varied from 5 weeks to 1 year, with a weekly frequency of 1 to 2 times and sessions of 30 [ 21 ] to 50 [ 20 ] minutes.…”

“…Three studies reported that participants in both supervised and unsupervised groups were educated about the correct contraction of PFMs through biofeedback [ 23 ], digital palpation [ 21 ], or one supervised session at the beginning [ 18 , 22 ]. Others only received exercise diaries [ 17 , 19 , 20 ].…”

“…Almost all studies received PFME in horizontal positions, and progressed the program by changing the position to vertical and increasing the hold time of contractions [ 17 , 18 , 20 , 21 , 23 ]. Some of the included studies applied both low and high-intensity contractions in their program [ 18 , 19 , 21 , 23 ], but others just asked participants to do the maximum contraction [ 19 , 20 ]. Three included studies asked participants to do PFMs contraction with coughing (Knack maneuver) [ 18 , 21 , 23 ].…”

“…Some of the included studies applied both low and high-intensity contractions in their program [ 18 , 19 , 21 , 23 ], but others just asked participants to do the maximum contraction [ 19 , 20 ]. Three included studies asked participants to do PFMs contraction with coughing (Knack maneuver) [ 18 , 21 , 23 ].…”

“…Three included studies reinforced the treatment with a monthly reassessment of PFMs through vaginal palpation performed by the physiotherapist in both supervised and unsupervised groups [ 17 – 19 ]. Two studies educated participants of both groups to do a self-digital assessment [ 21 , 23 ].…”