Brooks Kaylee C L, Varette Kevin, Harvey Marie-Andrée, Robert Magali, Brison Robert J, Day Andrew, Baker Kevin, Della Zazzera Vincent, Sauerbrei Eric, McLean Linda
School of Rehabilitation Sciences, University of Ottawa, Rm E260C, Building E, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
Int Urogynecol J. 2021 Mar;32(3):719-728. doi: 10.1007/s00192-020-04583-z. Epub 2020 Nov 25.
The aim of this study was to prospectively identify aspects of baseline demographic, clinical, and pelvic morphology of women with stress urinary incontinence (SUI) that are predictive of cure with physiotherapist-supervised pelvic floor muscle training (PFMT).
Women ≥18 years old with SUI were recruited from urogynecology and pelvic health physiotherapy clinics. Participants completed a 3-day bladder diary, the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), a standardized pad test, manual assessment of pelvic floor muscle (PFM) strength and tone, and transperineal ultrasound (TPUS) assessment of their urogenital structures at rest while in a supine position and standing, and during contraction, straining, and coughing. Participants attended six physiotherapy sessions over 12 weeks and performed a home PFMT program. The assessment was repeated after the intervention; cure was defined as a dry (≤2 g) pad test.
Seventy-seven women aged 50 (±10) years completed the protocol; 38 (49%) were deemed cured. Based on univariate testing, four predictors were entered into a binary logistic regression model: ICIQ-UI-SF, PFM tone, bladder neck (BN) height in a quiet standing position, and BN height during a cough in a standing position. The model was significant (p < 0.001), accurately classifying outcome in 74% of participants. The model, validated through bootstrapping, performed moderately, with the area under the receiver operating characteristic curve = 0.80 (95% CI: 0.69-0.90; p = 0.00), and with 70% sensitivity and 75% specificity.
Women with better bladder support in a standing position and less severe symptoms were most likely to be cured with PFMT.
#NCT01602107.
本研究的目的是前瞻性地确定压力性尿失禁（SUI）女性的基线人口统计学、临床和盆腔形态学方面的特征，这些特征可预测在物理治疗师监督下进行盆底肌肉训练（PFMT）能否治愈。
从泌尿妇科和盆底健康物理治疗诊所招募年龄≥18岁的SUI女性。参与者完成一份3天的膀胱日记、国际尿失禁咨询问卷尿失禁简表（ICIQ-UI-SF）、标准化的尿垫试验、盆底肌肉（PFM）力量和张力的手动评估，以及在仰卧位和站立位休息时、收缩时、用力时和咳嗽时经会阴超声（TPUS）对其泌尿生殖结构的评估。参与者在12周内参加6次物理治疗课程，并进行家庭PFMT计划。干预后重复评估；治愈定义为尿垫试验结果为干燥（≤2g）。
77名年龄为50（±10）岁的女性完成了该方案；38名（49%）被判定治愈。基于单变量测试，将四个预测因素纳入二元逻辑回归模型：ICIQ-UI-SF、PFM张力、安静站立位时膀胱颈（BN）高度以及站立位咳嗽时BN高度。该模型具有显著性（p < 0.001），能准确分类74%参与者的结果。通过自举法验证的该模型表现中等，受试者工作特征曲线下面积 = 0.80（95%CI：0.69 - 0.90；p = 0.00），敏感性为70%，特异性为75%。
站立位膀胱支持较好且症状较轻的女性最有可能通过PFMT治愈。
#NCT01602107
