Atlanta VA Medical Center, Decatur, GA 30033, USA.
Neurology. 2011 May 10;76(19):1631-4. doi: 10.1212/WNL.0b013e318219fab3.
To assess the feasibility and efficacy of exercise-based behavioral therapy to treat urinary incontinence (UI) in older adults with Parkinson disease (PD).
Participants with PD ≥50 years with ≥4 UI episodes on a 7-day bladder diary were recruited from movement disorders clinics. In 5 visits over 8 weeks, participants learned pelvic floor muscle exercises using computer-assisted EMG biofeedback, and bladder control strategies including urge suppression. Bladder diaries were used to reinforce techniques and monitor the primary outcome of UI frequency. Secondary outcomes included additional reporting of lower urinary tract symptoms, symptom bother, and quality of life (QOL) using the International Consultation on Incontinence Questionnaire for overactive bladder (ICIQ-OAB).
Twenty participants were enrolled (90% male, age 66.5 ± 6.2 [mean ± SD], with PD for 6.9 ± 5.4 years) and 17 completed the study. The median (interquartile range) weekly frequency of baseline UI episodes was 9 (4-11) and following intervention was 1 (0-3), representing an 83.3% reduction (45.5-100.0, p = 0.0001). QOL scores on the ICIQ-OAB improved from 71.1 ± 23.9 to 54.7 ± 15.4 (p = 0.002).
In this uncontrolled pilot study of an exercise-based, biofeedback-assisted behavioral intervention, older participants with PD demonstrated statistically significant and clinically meaningful reductions in frequency of UI and improvement in QOL. Randomized controlled trials to assess behavioral therapies for UI in patients with PD are warranted.
This study provides Class IV evidence that exercise-based, biofeedback-assisted behavioral intervention can reduce UI frequency in patients >50 years old with PD.
评估基于运动的行为疗法治疗帕金森病（PD）老年患者尿失禁（UI）的可行性和疗效。
从运动障碍诊所招募≥50 岁、7 天膀胱日记中≥4 次 UI 发作且 PD 病程≥5 年的患者。在 8 周的 5 次就诊中，参与者使用计算机辅助肌电图生物反馈学习盆底肌锻炼，并学习膀胱控制策略，包括抑制急迫感。使用膀胱日记来加强技术并监测 UI 频率的主要结果。次要结果包括使用逼尿症国际咨询问卷过度活动膀胱部分（ICIQ-OAB）报告下尿路症状、症状困扰和生活质量（QOL）的额外情况。
共纳入 20 名参与者（90%为男性，年龄 66.5±6.2[均值±标准差]，PD 病程 6.9±5.4 年），17 名参与者完成了研究。基线 UI 发作的每周频率中位数（四分位距）为 9（4-11），干预后为 1（0-3），减少 83.3%（45.5-100.0，p=0.0001）。ICIQ-OAB 的 QOL 评分从 71.1±23.9 提高到 54.7±15.4（p=0.002）。
在这项针对 PD 老年患者的基于运动、生物反馈辅助的行为干预的非对照初步研究中，参与者的 UI 发作频率明显且具有临床意义地减少，生活质量得到改善。需要进行随机对照试验来评估针对 PD 患者 UI 的行为疗法。
本研究提供了 IV 级证据，表明基于运动的、生物反馈辅助的行为干预可以减少>50 岁 PD 患者的 UI 发作频率。
