فیزیوتراپی برای بی اختیاری استرسی بعد از زایمان سخت

Physiotherapy for Persistent Postnatal Stress Urinary Incontinence: A Randomized Controlled Trial

Abstract :

OBJECTIVE: The aim of this study was to compare the effectiveness of multimodal supervised physiotherapy programs with the absence of treatment among women with persistent postnatal stress urinary incontinence.

METHODS: This was a single-blind randomized controlled trial. Sixty-four women with stress urinary incontinence were randomly assigned to 8 weeks of either multimodal pelvic floor rehabilitation (n = 21), multimodal pelvic floor rehabilitation with abdominal muscle training (n = 23), or control non–pelvic floor rehabilitation (n = 20). The primary outcome measure consisted of a modified 20-minute pad test. The secondary outcome measures included a Visual Analog Scale describing the perceived burden of incontinence, the Urogenital Distress Inventory, the Incontinence Impact Questionnaire, and pelvic floor muscle function measurements.

RESULTS: Two patients dropped out, leaving 62 for analysis. At follow-up, more than 70% of the women in the treatment groups (14/20 in the pelvic floor and 17/23 in the pelvic floor plus abdominal group) were continent on pad testing compared with 0% of women in the control group. Scores on the pad test, Visual Analog Scale, Urogenital Distress Inventory, and Incontinence Impact Questionnaire improved significantly in both treatment groups (all P < .002), whereas no changes were observed in the control group. Pelvic floor muscle function, however, did not improve significantly in either active group.

CONCLUSION: Multimodal supervised pelvic floor physiotherapy is an effective treatment for persistent postnatal stress urinary incontinence.

LEVEL OF EVIDENCE: I

In Brief :

Physiotherapy is an effective treatment for postnatal persistent stress urinary incontinence.

 

Author Information :

From the *School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada; †Rehabilitation Institute of Montreal, Research Center for Interdisciplinary Research in Rehabilitation of Montreal, Montreal, Canada; ‡Department of Obstetrics and Gynecology, Maisonneuve-Rosemont Hospital, Montreal, Canada; §Faculty of Medicine, University of Montreal, Montreal, Canada; ¶Department of Community Health Sciences, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Canada; and ∥Research Center on Aging, Sherbrooke University Geriatric Institute, Sherbrooke, Canada.

Supported by the Canadian Institutes of Health Research and Laborie Medical Technologies Inc. through a Canadian Institutes of Health Research–Industry grant. C. Dumoulin was supported by studentships from the Canadian Institutes of Health Research and from the Fonds de la Recherche en Santé du Québec.

The authors thank Dr. Robert Gauthier and members of the Department of Obstetrics and Gynecology of Sainte-Justine’s Hospital in Montreal, Canada, for their assistance with data collection.

Address reprint requests to: Chantale Dumoulin, Rehabilitation Institute of Montreal, Research Center for Interdisciplinary Research in Rehabilitation of Montreal, 6300 Darlington, Montreal, Quebec, Canada H3S 2J4; e-mail: dumoulin@sympatico.ca.

Received March 9, 2004. Received in revised form April 29, 2004. Accepted May 7, 2004.

Dumoulin, Chantale PhD, PT*†; Lemieux, Marie-Claude MD, FRCSC‡§; Bourbonnais, Daniel PhD, OT*†; Gravel, Denis PhD, PT*†; Bravo, Gina PhD¶∥; Morin, Mélanie MSc, PT*†

doi: 10.1097/01.AOG.0000135274.92416.62
Original Research
http://journals.lww.com/greenjournal/Abstract/2004/09000/Physiotherapy_for_Persistent_Postnatal_Stress.12.aspx