Strategies to assist uptake of pelvic floor muscle training for people with urinary incontinence: A clinician viewpoint

Slade, Susan C; Hay‐Smith, Jean; Mastwyk, Sally; Morris, Meg E.; Frawley, Helena

doi:10.1002/nau.23716

Cited by 11 publications

(13 citation statements)

References 48 publications

(111 reference statements)

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“…Authors often mentioned their effectiveness to alleviate UI symptoms without explaining the reasoning behind this efficacy, which may reflect an overall lack of understanding of the pathophysiology of UI in women as well as the mechanism of action of PFMT. Tailoring and modification: Tailoring of the exercise intervention was consistently omitted and should be clearly explained; this includes tailoring protocols and rules for intervention modifications and progressions. While most clinicians in pelvic health think individualization and tailoring of exercise prescription parameters for their patients is essential, the majority of studies appeared to include generic protocols involving maximal effort PFM contractions performed daily for a period of between 8 and 12 weeks (eg, three sets of 10 repetitions per day). When tailoring an exercise program, it is important to understand the circumstances around each woman's leakage to adjust her exercises and, possibly, achieve better outcomes.…”

Section: Discussionmentioning

confidence: 99%

How well do published randomized controlled trials on pelvic floor muscle training interventions for urinary incontinence describe the details of the intervention? A review

Charette

Bérubé

Brooks

et al. 2019

Neurourology and Urodynamics

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Context: Pelvic floor muscle training (PFMT) is strongly recommended for the management of mild to moderate urinary incontinence (UI) in women, yet the specific elements of PFMT that lead to improvement have not been identified. This gap in knowledge may be related, at least in part, to the lack of detail provided on intervention parameters reported in randomized controlled trials (RCTs)Objective: Using three different instruments: the Consensus on Exercise Reporting Template (CERT), the template for intervention description and replication (TIDieR) checklist, and the Consensus on Therapeutic Exercise Training (CONTENT) scale, the purpose of this study was to assess the completeness of exercise reporting among moderate to high quality RCTs on PFMT for women with UI.Methods: Two raters independently scored all 65 RCTs (n = 65) retrieved by the most up-to-date Cochrane Systematic Review on PFMT for women with UI, and only those of moderate to high quality (>6 on the PEDro scale) were retained. Eighteen articles met the inclusion criteria and were scored by two independent reviewers using the CERT, TIDieR, and CONTENT instruments.The completeness of intervention reporting was evaluated using descriptive statistics. Results: Over half of the items on each instrument were reported less than 50% of the time. Overall, completeness of exercise reporting was 31% (5.8/16 ± 2.4) on CERT, 47% (5.6/12 ± 1.5) on TIDieR, and 46% (4.1/9 ± 1) on CONTENT. The least frequently reported items were the provider of the intervention, the equipment used, the tailoring of exercises, the rationale behind the intervention, and adherence to the intervention.Conclusion: PFMT parameters are not adequately reported in the primary RCTs that currently guide clinical practice. K E Y W O R D SCERT, CONTENT, exercise reporting, pelvic floor muscle training, TIDieR, urinary incontinence

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Section: Discussionmentioning

confidence: 99%

How well do published randomized controlled trials on pelvic floor muscle training interventions for urinary incontinence describe the details of the intervention? A review

Charette

Bérubé

Brooks

et al. 2019

Neurourology and Urodynamics

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“…All the physiotherapists described the need for an individual training program tailored to the needs of each woman. They reported that patients have different goals and motivations . It is also possible that patients have different characteristics and require different rehabilitation programs.…”

Section: Discussionmentioning

confidence: 99%

“…In their study, women reported more improvement when they received more health professional contact. 45 Slade et al 46 were interested in the experiences of clinicians who use PMFT. All the physiotherapists described the need for an individual training program tailored to the needs of each woman.…”

Section: Figurementioning

confidence: 99%

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Pelvic floor muscle activation in stress urinary incontinent women: Impact of a distraction task

Dewaele

Deffieux

Villot

et al. 2019

Neurourology and Urodynamics

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Aims Our purpose was to explore the involvement of cognition in voluntary and involuntary pelvic floor muscle (PFM) contraction in stress urinary incontinent women. Methods PFM contraction monitored by surface electromyography (EMG) was measured without a mental distraction task (DT), and with a DT called “paced auditory serial additional test” (PASAT). Forty stress incontinent women performed voluntary contractions of the external anal sphincter (EAS), and reflex EAS contractions induced by means of coughing were studied using the external intercostal muscle (EIC) EMG pattern. Results A DT altered PFM pre‐activation when coughing: the reaction time between EIC muscle contraction and EAS contraction (called RT3) was respectively −54.94 ms (IQR −87.12; 3.12) without the PASAT and −3.99 ms (IQR: −47.92; 18.69) with a DT (P = 0.02, Wilcoxon's test). Concerning voluntary contraction, women activated their PFM sooner without than with a DT. Conclusion The PASAT altered voluntary and reflex contractions of the PFM in stress urinary incontinent women. Our study suggests that cognition plays a role in urinary pathophysiology. Future studies should investigate rehabilitation programs that consider the role of cognition in stress urinary incontinent women.

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“…The importance of selecting the right treatment for the right patient has been widely acknowledged in the incontinence literature. [21][22][23] Lack of careful consideration on appropriate patient selection for surgery may lead to complications and poor outcomes, 24 which have resulted in the development of evidence-informed algorithms for best practice management. 25 The GPAS pathway not only has the potential to reduce the number of review appointments required before conversion to surgery but also ensured that the patients who were accessing this management option were the most appropriate candidates with a greater chance of a successful clinical outcome because of their pre-operative physiotherapy input.…”

Section: Discussionmentioning

confidence: 99%

<p>Timing is everything: an audit of process and outcomes from a pilot advanced scope physiotherapy model of care for women with pelvic floor conditions</p>

Goode¹,

Beaumont²,

Kumar³

2019

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Introduction: Incontinence and pelvic organ prolapse (POP) commonly affect many people for whom physiotherapy may be an important, front-line management strategy. However, traditional referral pathways in the tertiary health care system limit or delay access to this management option resulting in poor outcomes. Objective: The aim of this pilot study was to determine the impact of an advanced scope of practice physiotherapy model of care for women referred with incontinence and/or POP symptoms compared to traditional referral pathways in a tertiary hospital in Australia. Methods: A prospective audit was conducted with consecutive sampling of those triaged into the physiotherapy-led clinic during the trial period. A database was created to record patient demographic information, key dates in the patient pathway, and the clinical outcome measures obtained. Results: Forty-one women were assessed in the physiotherapy-led clinic during the trial period October 2015-March 2016. The results indicate improved access to care (time between referral to first consult during the trial was 27.3 days, compared with 169.6 days first consult using the traditional referral pathway), improved adherence to conservative management (96% attending their individual consultation compared to 55%) and positive patient satisfaction. Conclusion: This pilot study demonstrated that an advanced scope physiotherapy-led model of care such as the Gynecology Physiotherapy Assessment Service can result in improved access to care while positively impacting experiences of women with incontinence and/or POP symptoms.

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Strategies to assist uptake of pelvic floor muscle training for people with urinary incontinence: A clinician viewpoint

Cited by 11 publications

References 48 publications

How well do published randomized controlled trials on pelvic floor muscle training interventions for urinary incontinence describe the details of the intervention? A review

How well do published randomized controlled trials on pelvic floor muscle training interventions for urinary incontinence describe the details of the intervention? A review

Pelvic floor muscle activation in stress urinary incontinent women: Impact of a distraction task

<p>Timing is everything: an audit of process and outcomes from a pilot advanced scope physiotherapy model of care for women with pelvic floor conditions</p>

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