School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Research Center of the Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Québec, Canada.
Neurourol Urodyn. 2021 Jan;40(1):245-255. doi: 10.1002/nau.24542. Epub 2020 Oct 19.
To compare the effects of group-based and individual physiotherapy for stress or mixed urinary incontinence (UI) on pelvic floor morphometry, pelvic floor muscle (PFM) function, and related self-efficacy, immediately after treatment and at 1 year.
This is a planned secondary analysis of the group rehabilitation or individual physiotherapy study, an assessor-blinded, randomized, noninferiority trial. Eligible participants included 362 community-dwelling older women with symptoms of stress/mixed UI. After learning how to contract PFMs, participants completed 12 weeks of PFM training, either individually (one-on-one) or as part of a group (eight women). Pelvic floor transperineal ultrasound volumes (morphometry), PFM intravaginal dynamometric data (function), and self-efficacy in performing PFM exercises were acquired at baseline, posttreatment, and at 1 year.
Groups were comparable at all time points. Immediately posttreatment, both groups demonstrated significant changes in pelvic floor morphometry during coughs, and in PFM function during contractions and coughs. Participants also reported improved self-efficacy in performing PFM exercises. Results were sustained at 1 year. When participants coughed, pelvic floor structures were better supported (reflected by less caudal movement of the puborectalis sling and a smaller opening of the levator hiatus) in a pattern consistent with the "knack" strategy. Furthermore, both interventions resulted in stronger, faster, more coordinated, and more endurant PFMs.
In older women with stress or mixed UI, both individual and group-based PFM training resulted in comparable improvements in overall PFM function, pelvic floor morphometry during coughs, and related self-efficacy in performing PFM exercises, which were sustained at 1 year.
比较基于小组和个体的物理疗法对压力性或混合性尿失禁（UI）的疗效，即在治疗后即刻和 1 年时，比较其对盆底形态学、盆底肌肉（PFM）功能以及相关自我效能的影响。
这是一项基于小组康复或个体物理疗法研究的计划二次分析，是一项评估者设盲、随机、非劣效性试验。符合条件的参与者包括 362 名有压力/混合性 UI 症状的社区居住的老年女性。在学会如何收缩 PFM 后，参与者完成了 12 周的 PFM 训练，要么是个体（一对一），要么是小组（8 名女性）。在基线、治疗后和 1 年时，获得了盆底经会阴超声容积（形态学）、PFM 阴道内动力数据（功能）和执行 PFM 锻炼的自我效能数据。
两组在所有时间点均具有可比性。治疗后即刻，两组在咳嗽时的盆底形态学和收缩时以及咳嗽时的 PFM 功能均发生了显著变化。参与者还报告称，执行 PFM 锻炼的自我效能得到了提高。这些结果在 1 年后仍持续存在。当参与者咳嗽时，盆底结构得到了更好的支撑（反映在耻骨直肠悬带的尾端运动减少和提肛肌裂孔开口减小），符合“诀窍”策略。此外，两种干预措施都导致了更强大、更快、更协调和更持久的 PFM。
在有压力性或混合性 UI 的老年女性中，个体和基于小组的 PFM 训练都导致了整体 PFM 功能、咳嗽时的盆底形态学以及执行 PFM 锻炼的相关自我效能的类似改善，这些改善在 1 年后仍持续存在。
