Department of Medicine, Dentistry and Health Sciences, University of Melbourne and Royal Melbourne Hospital, Parkville, Melbourne, VIC 3052, Australia.
J Neurol Neurosurg Psychiatry. 2010 Sep;81(9):1033-8. doi: 10.1136/jnnp.2010.206623. Epub 2010 Jun 11.
A stratified, randomised, waitlist controlled study over 12 months assessed the effectiveness of a 6 week bladder rehabilitation programme in persons with multiple sclerosis (pwMS) in an Australian community cohort.
Patients with definite MS and bladder issues (n=74) recruited from a tertiary hospital database were randomised to a treatment group (n=40) for an individualised bladder rehabilitation programme or to a control waitlist group (n=34). The Urogenital Distress Inventory (UDI6), Neurological Disability Scale (NDS) and the American Urological Association Symptom Index (AUA) assessed bladder impairment and 'activity limitation'; a single Quality of life (QoL) item in the AUA and the Incontinence Impact Questionnaire (IIQ7) measured restriction in 'participation'. Primary outcome measures were assessed at baseline and at 12 months.
Analysis of per protocol data from 58 patients (treatment n=24, control n=34) showed reduced disability in the treatment group, with significant differences (p<0.001) and large effect sizes (>0.5) in post-treatment UDI6, NDS, AUA total, AUA QoL and IIQ7 scores for the two groups. The treatment group compared with the control group showed improvement: 78% versus 27% for UDI6 and 59% versus 17% improved for IIQ7. More patients in the control group deteriorated over the study period on the UDI6 (30% vs 0%; p<0.001) and IIQ7 (39 vs 0%; p=0.001).
A multifaceted, individualised bladder rehabilitation programme reduces disability and improves QoL in pwMS compared with no intervention after 12 months of follow-up. Information on specific interventions in different bladder types in MS and the impact on QoL need further evaluation. Australian Clinical trials Registry ACTRNO12605000676617.
一项为期 12 个月的分层、随机、等待对照研究评估了在澳大利亚社区队列中对多发性硬化症患者（pwMS）进行 6 周膀胱康复计划的有效性。
从三级医院数据库中招募了患有明确 MS 和膀胱问题的患者（n=74），并将他们随机分为治疗组（n=40），接受个体化膀胱康复计划，或对照组（n=34），等待名单。使用尿生殖窘迫量表（UDI6）、神经功能障碍量表（NDS）和美国泌尿协会症状指数（AUA）评估膀胱损伤和“活动受限”；AUA 中的单一生活质量（QoL）项目和失禁影响问卷（IIQ7）测量“参与”受限。主要结局指标在基线和 12 个月时进行评估。
对 58 名患者（治疗组 n=24，对照组 n=34）的方案数据进行分析显示，治疗组的残疾程度降低，两组之间的 UDI6、NDS、AUA 总分、AUA QoL 和 IIQ7 评分在治疗后存在显著差异（p<0.001）和较大的效应量（>0.5）。与对照组相比，治疗组有改善：UDI6 为 78%对 27%，IIQ7 为 59%对 17%。在研究期间，对照组 UDI6（30%对 0%；p<0.001）和 IIQ7（39%对 0%；p=0.001）恶化的患者更多。
与 12 个月随访期内无干预相比，多方面、个体化的膀胱康复计划可降低 pwMS 的残疾程度并提高生活质量。需要进一步评估 MS 不同膀胱类型的具体干预措施及其对 QoL 的影响。澳大利亚临床试验注册 ACTRNO12605000676617。
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