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个体和团体盆底肌训练与女性压力性尿失禁的无治疗对照:一项随机对照初步研究。

Individual and group pelvic floor muscle training versus no treatment in female stress urinary incontinence: a randomized controlled pilot study.

机构信息

Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):465-71. doi: 10.1016/j.ejogrb.2011.09.003. Epub 2011 Oct 1.

Abstract

OBJECTIVE

To compare the effects of pelvic floor muscle training (PFMT) performed during group treatment sessions (GT) and individual treatment sessions (IT) to a control group (CG) of women with stress urinary incontinence (SUI).

HYPOTHESIS

The group treatment sessions would have better effects compared to individual treatment sessions.

STUDY DESIGN

This randomized controlled pilot study included women aged over 18 years, who complained of urinary leakage on stress and who had not undergone physical therapy for SUI before. Forty-nine women were randomly allocated to the PFMT in group treatment session (GT) (n=17), PFMT in individual treatment session (IT) (n=17) and control group (CG) (n=15). The study was carried out in an outpatient physical therapy department in São Carlos, Brazil. Subjects on intervention groups were treated with the same PFMT protocol for 6 weeks, with two 1-h weekly sessions. The GT group carried out the PFMT in group treatment session and IT group in individual treatment session. The CG did not receive any treatment during the corresponding time. They were evaluated before and after treatment for primary outcome, urinary loss, and secondary outcomes, King's Health Questionnaire, pressure perineometry, pelvic floor muscle strength by digital palpation and subjective satisfaction. Participants, evaluator and the physical therapist were not blinded. Forty-five women completed the study and were included in the analysis. The statistical analysis was performed using Wilcoxon test for intragroup analysis and Kruskal-Wallis and Mann-Whitney test for intergroup analysis (p<0.05).

RESULTS

In intragroup analysis, there was a significant reduction in urinary loss measured by pad test only in the IT group. For primary outcome, there was a significant difference only after treatment between GT and CG (p<0.0001; effect size -0.91; 95% confidence interval from 0.56 to 5.80) as well as between IT and CG (p<0.0001; effect size -0.90; 95% confidence interval from 0.54 to 5.84). There were differences after treatment in GT and IT groups for secondary outcomes: perineometry, muscle strength and in the domains of the quality of life questionnaire. For the CG group, there were not significant differences in any variables. In intergroup analysis for all variables, there were no differences between GT and IT groups. The two treated groups had similar subjective satisfaction (86%). There were no complaints of adverse effects due to treatment from either group.

CONCLUSION

The results indicated similar improvement in clinical variables and in satisfaction with the treatment between IT and GT.

摘要

目的

比较团体治疗(GT)和个体治疗(IT)与压力性尿失禁(SUI)对照组(CG)的盆底肌训练(PFMT)对女性的影响。

假设

团体治疗组的效果会优于个体治疗组。

研究设计

这是一项随机对照的初步研究,包括年龄在 18 岁以上、有压力性尿失禁漏尿且之前未接受过物理治疗的女性。49 名女性被随机分配到 GT 组(n=17)、IT 组(n=17)和 CG 组(n=15)。该研究在巴西圣卡洛斯的一家门诊物理治疗部门进行。干预组的受试者接受了为期 6 周的相同 PFMT 方案,每周进行两次 1 小时的治疗。GT 组进行团体治疗,IT 组进行个体治疗。CG 组在相应时间内未接受任何治疗。在治疗前后,他们通过垫试验评估主要结局(尿失禁量)和次要结局(King's 健康问卷、压力会阴测量、数字触诊盆底肌肉力量和主观满意度)。参与者、评估者和物理治疗师均未设盲。45 名女性完成了研究并纳入分析。使用 Wilcoxon 检验进行组内分析,使用 Kruskal-Wallis 和 Mann-Whitney 检验进行组间分析(p<0.05)。

结果

组内分析显示,仅 IT 组垫试验尿失禁量显著减少。主要结局仅在 GT 组治疗后有显著差异(p<0.0001;效应量-0.91;95%置信区间为 0.56 至 5.80),以及 IT 组与 CG 组之间(p<0.0001;效应量-0.90;95%置信区间为 0.54 至 5.84)。GT 和 IT 组治疗后,次要结局(会阴测量、肌肉力量和生活质量问卷的各个领域)也存在差异。CG 组各变量无显著差异。组间分析时,GT 组和 IT 组的所有变量均无差异。两组治疗组的主观满意度相似(86%)。两组均未报告因治疗而出现不良反应。

结论

结果表明,IT 组和 GT 组的临床变量改善和对治疗的满意度相似。

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