McClurg D, Ashe R G, Lowe-Strong A S
Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Northern Ireland, UK.
Neurourol Urodyn. 2008;27(3):231-7. doi: 10.1002/nau.20486.
Lower urinary tract dysfunction affects up to 75% of the multiple sclerosis population. Results from our recent Pilot Study (McClurg et al., 2006) indicated that a combined programme of pelvic floor muscle training, electromyography biofeedback and neuromuscular electrical stimulation modalities may alleviate some of the distressing symptoms within this population. This clinical trial aimed to evaluate further the efficacy of these interventions and to establish the benefit of neuromuscular electrical stimulation above and beyond that of EMG biofeedback and pelvic floor muscle training.
74 multiple sclerosis patients who presented with lower urinary tract dysfunction were randomly allocated to one of two groups - Group 1 received Pelvic Floor Muscle Training, Electromyography Biofeedback and Placebo Neuromuscular Electrical Stimulation (n=37), and Group 2 which received Pelvic Floor Muscle Training, Electromyography Biofeedback, and Active Neuromuscular Electrical Stimulation (n=37). Treatment was for nine weeks with outcome measures recorded at weeks 0, 9, 16 and 24. The Primary Outcome Measure was the number of leakage episodes. Within group analysis was by Paired Samples t-test. Group differences were analysed using Repeated Measures Analysis of Variance and Post-hoc tests were used to determine the significance of differences between Groups at each time point.
The mean number of incontinence episodes were reduced in Group 2 by 85% (p=0.001) whereas in Group 1 a lesser reduction of 47% (p=0.001) was observed. However, there was a statistically superior benefit in Group 2 when compared to Group 1 (p=0.0028). This superior benefit was evident in all other outcome measures.
The addition of Active Neuromuscular Electrical Stimulation to a programme of Pelvic Floor Muscle Training and Electromyography Biofeedback should be considered as a first-line option in alleviating some of the symptoms of lower urinary tract dysfunction associated with multiple sclerosis.
下尿路功能障碍影响多达75%的多发性硬化症患者群体。我们近期的初步研究（麦克勒格等人，2006年）结果表明，盆底肌肉训练、肌电图生物反馈和神经肌肉电刺激相结合的方案可能会缓解该群体中的一些痛苦症状。这项临床试验旨在进一步评估这些干预措施的疗效，并确定神经肌肉电刺激相对于肌电图生物反馈和盆底肌肉训练的额外益处。
74名出现下尿路功能障碍的多发性硬化症患者被随机分为两组——第1组接受盆底肌肉训练、肌电图生物反馈和安慰剂神经肌肉电刺激（n = 37），第2组接受盆底肌肉训练、肌电图生物反馈和主动神经肌肉电刺激（n = 37）。治疗为期9周，在第0、9、16和24周记录结果指标。主要结果指标是漏尿发作次数。组内分析采用配对样本t检验。组间差异采用重复测量方差分析进行分析，事后检验用于确定各时间点两组之间差异的显著性。
第2组尿失禁发作的平均次数减少了85%（p = 0.001），而第1组观察到的减少幅度较小，为47%（p = 0.001）。然而，与第1组相比，第2组在统计学上有更显著的益处（p = 0.0028）。这种更显著的益处在所有其他结果指标中都很明显。
在盆底肌肉训练和肌电图生物反馈方案中加入主动神经肌肉电刺激，应被视为缓解与多发性硬化症相关的下尿路功能障碍某些症状的一线选择。
