Hay-Smith E J C, Dumoulin C
Department of Women's and Children's Health, DSM, University of Otago, PO Box 913, Dunedin, New Zealand.
Cochrane Database Syst Rev. 2006 Jan 25(1):CD005654. doi: 10.1002/14651858.CD005654.
Pelvic floor muscle training is the most commonly used physical therapy treatment for women with stress urinary incontinence. It is sometimes recommended for mixed and less commonly urge urinary incontinence.
To determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison to no treatment, placebo or sham treatments, or other inactive control treatments.
The Cochrane Incontinence Group Specialised Trials Register was searched. The date of the most recent search was 1 December 2004.
Randomised or quasi-randomised trials in women with stress, urge or mixed urinary incontinence (based on symptoms, signs, or urodynamics). One arm of the trial included pelvic floor muscle training (PFMT). Another arm was a no treatment, placebo, sham, or other inactive control treatment arm.
Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross-checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook (Higgins 2005). Trials were subgrouped by diagnosis. Formal meta-analysis was not undertaken because of study heterogeneity.
Thirteen trials involving 714 women (375 PFMT, 339 controls) met the inclusion criteria, but only six trials (403 women) contributed data to the analysis. Most studies were at moderate to high risk of bias, based on the trial reports. There was considerable variation in interventions used, study populations, and outcome measures. Women who did PFMT were more likely to report they were cured or improved than women who did not. PFMT women also experienced about one fewer incontinence episodes per day. There were too few data to draw conclusions about effects on other outcomes such as condition specific quality of life. Of the few adverse effects reported, none were serious. The trials in stress urinary incontinent women which suggested greater benefit recruited a younger population and recommended a longer training period than the one trial in women with detrusor overactivity (urge) incontinence.
AUTHORS' CONCLUSIONS: Overall, the review provides some support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence. Statistical heterogeneity reflecting variation in incontinence type, training, and outcome measurement made interpretation difficult. The treatment effect might be greater in younger women (in their 40's and 50's) with stress urinary incontinence alone, who participate in a supervised PFMT programme for at least three months, but these and other uncertainties require testing in further trials.
盆底肌训练是压力性尿失禁女性最常用的物理治疗方法。有时也推荐用于混合性尿失禁以及较少见的急迫性尿失禁。
确定与不治疗、安慰剂或假治疗或其他非活性对照治疗相比，盆底肌训练对尿失禁女性的效果。
检索了Cochrane尿失禁组专业试验注册库。最近一次检索日期为2004年12月1日。
针对有压力性、急迫性或混合性尿失禁（基于症状、体征或尿动力学）的女性进行的随机或半随机试验。试验的一组包括盆底肌训练（PFMT）。另一组为不治疗、安慰剂、假治疗或其他非活性对照治疗组。
独立评估试验的入选资格和方法学质量。提取数据后进行交叉核对。分歧通过讨论解决。数据按照Cochrane手册（Higgins 2005）中的描述进行处理。试验按诊断进行亚组分析。由于研究的异质性，未进行正式的荟萃分析。
13项涉及714名女性（375名接受PFMT，339名对照）的试验符合纳入标准，但只有6项试验（403名女性）为分析提供了数据。根据试验报告，大多数研究存在中度至高度偏倚风险。所采用的干预措施、研究人群和结局指标存在很大差异。接受PFMT的女性比未接受的女性更有可能报告自己已治愈或病情改善。接受PFMT的女性每天的尿失禁发作次数也大约少一次。关于对其他结局如特定疾病生活质量的影响，数据太少无法得出结论。在报告的少数不良反应中，没有严重的不良反应。在压力性尿失禁女性中显示出更大益处的试验招募的人群更年轻，且推荐的训练期比一项关于逼尿肌过度活动（急迫性）尿失禁女性的试验更长。
总体而言，本综述为广泛推荐的将PFMT纳入压力性、急迫性或混合性尿失禁女性的一线保守治疗方案提供了一些支持。反映失禁类型、训练和结局测量差异的统计异质性使得解释困难。对于仅患有压力性尿失禁、年龄在40多岁和50多岁、参加至少三个月的有监督PFMT方案的年轻女性，治疗效果可能更大，但这些以及其他不确定性需要在进一步试验中进行检验。
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