Lausen Adi, Marsland Louise, Head Samantha, Jackson Joanna, Lausen Berthold
Department of Affective Neuroscience and Psychophysiology, Institute for Psychology, University of Goettingen, Gosslerstr. 14, 37073, Goettingen, Germany.
Department of Mathematical Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
BMC Womens Health. 2018 Jan 12;18(1):16. doi: 10.1186/s12905-017-0503-y.
Urinary incontinence (UI) is a distressing condition affecting at least 5 million women in England and Wales. Traditionally, physiotherapy for UI comprises pelvic floor muscle training, but although evidence suggests this can be effective it is also recognised that benefits are often compromised by patient motivation and commitment. In addition, there is increasing recognition that physical symptoms alone are poor indicators of the impact of incontinence on individuals' lives. Consequently, more holistic approaches to the treatment of UI, such as Modified Pilates (MP) have been recommended. This study aimed to provide preliminary findings about the effectiveness of a 6-week course of MP classes as an adjunct to standard physiotherapy care for UI, and to test the feasibility of a randomised controlled trial (RCT) design.
The study design was a single centre pilot RCT, plus qualitative interviews. 73 women referred to Women's Health Physiotherapy Services for UI at Colchester Hospital University NHS Foundation Trust were randomly assigned to two groups: a 6-week course of MP classes in addition to standard physiotherapy care (intervention) or standard physiotherapy care only (control). Main outcome measures were self-reported UI, quality of life and self-esteem at baseline (T1), completion of treatment (T2), and 5 months after randomisation (T3). Qualitative interviews were conducted with a subgroup at T2 and T3. Due to the nature of the intervention blinding of participants, physiotherapists and researchers was not feasible.
Post-intervention data revealed a range of benefits for women who attended MP classes and who had lower symptom severity at baseline: improved self-esteem (p = 0.032), decreased social embarrassment (p = 0.026) and lower impact on normal daily activities (p = 0.025). In contrast, women with higher symptom severity showed improvement in their personal relationships (p = 0.017). Qualitative analysis supported these findings and also indicated that MP classes could positively influence attitudes to exercise, diet and wellbeing.
A definitive RCT is feasible but will require a large sample size to inform clinical practice.
ISRCTN74075972 Registered 12/12/12 (Retrospectively registered).
尿失禁（UI）是一种令人苦恼的疾病，在英格兰和威尔士至少影响着500万女性。传统上，针对尿失禁的物理治疗包括盆底肌肉训练，尽管有证据表明这种方法可能有效，但人们也认识到，患者的积极性和投入程度常常会影响治疗效果。此外，人们越来越认识到，仅身体症状并不能很好地反映尿失禁对个人生活的影响。因此，有人推荐采用更全面的尿失禁治疗方法，如改良普拉提（MP）。本研究旨在提供初步结果，以探讨为期6周的MP课程作为尿失禁标准物理治疗辅助手段的有效性，并测试随机对照试验（RCT）设计的可行性。
本研究设计为单中心试点随机对照试验，并辅以定性访谈。73名转诊至科尔切斯特医院大学国民保健服务基金会信托妇女健康物理治疗服务中心治疗尿失禁的女性被随机分为两组：除标准物理治疗外，参加为期6周的MP课程（干预组）或仅接受标准物理治疗（对照组）。主要结局指标包括基线时（T1）、治疗结束时（T2）以及随机分组后5个月（T3）的自我报告尿失禁情况、生活质量和自尊。在T2和T3时对一个亚组进行了定性访谈。由于干预措施的性质，对参与者、物理治疗师和研究人员进行盲法处理不可行。
干预后数据显示，参加MP课程且基线症状严重程度较低的女性有一系列益处：自尊得到改善（p = 0.032）、社交尴尬感降低（p = 0.026）以及对正常日常活动的影响较小（p = 0.025）。相比之下，症状严重程度较高的女性在个人关系方面有所改善（p = 0.017）。定性分析支持了这些发现，还表明MP课程可对运动、饮食和健康态度产生积极影响。
进行确定性随机对照试验是可行的，但需要大样本量才能为临床实践提供依据。
ISRCTN74075972，于2012年12月12日注册（追溯注册）。
