Vocational School of Health Services, Physiotherapy, Izmir University of Economics, Izmir, Turkey.
Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey.
Int Urogynecol J. 2022 Oct;33(10):2895-2903. doi: 10.1007/s00192-022-05213-6. Epub 2022 May 2.
This study was aimed at comparing the efficacy of Knack maneuver training taught using different techniques on pelvic floor muscle (PFM) function, urinary symptoms, and perception of improvement in women with stress urinary incontinence (SUI).
We conducted a prospective nonrandomized study of 46 women with SUI. Assessments included: PFM functions (secondary outcome, SO) using a Myomed 932 EMG biofeedback device, urinary incontinence symptoms using the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form (ICIQ-SF; primary outcome), the Urogenital Distress Inventory-6 (UDI-6; SO), and the Incontinence Severity Index (ISI; SO), and perception of improvement using the Global Perceived Impact scale. The women were divided into three groups according to their preference: group 1 (Knack maneuver training with electromyography biofeedback), group 2 (Knack maneuver training with verbal instruction), and group 3 (Knack maneuver training with vaginal palpation). An education program was also given to all women individually. The training program was 1 day per week for 4 weeks.
There was an improvement in UDI-6, ICIQ-SF, and ISI scores in all groups (p<0.05). The maximum voluntary contraction (MVC) of the PFMs increased in group 2 (p=0.002), whereas both the MVC of PFMs and PFM contraction during Valsalva increased in group 3 (p=0.011 and p=0.042).
Regardless of the teaching methods, the Knack maneuver and education programs were effective on urinary symptoms in women with mild to moderate SUI. The Knack maneuver training with vaginal palpation and verbal instruction improved MVC of PFMs. All three different teaching methods might be used in SUI treatment programs.
本研究旨在比较不同技术教授 Knack 手法训练对盆底肌（PFM）功能、尿失禁症状以及压力性尿失禁（SUI）女性对改善的感知的疗效。
我们对 46 名 SUI 女性进行了前瞻性非随机研究。评估包括：使用 Myomed 932 EMG 生物反馈设备评估 PFM 功能（次要结果，SO），使用国际尿失禁咨询问卷尿失禁简短表（ICIQ-SF；主要结果）评估尿失禁症状，使用尿生殖窘迫量表-6（UDI-6；SO）和失禁严重程度指数（ISI；SO），使用整体感知影响量表评估改善感知。根据她们的偏好将女性分为三组：组 1（肌电图生物反馈 Knack 手法训练）、组 2（口头指导 Knack 手法训练）和组 3（阴道触诊 Knack 手法训练）。还对所有女性进行了个体教育计划。训练计划为每周 1 天，持续 4 周。
所有组的 UDI-6、ICIQ-SF 和 ISI 评分均有所改善（p<0.05）。组 2 的 PFM 最大自主收缩（MVC）增加（p=0.002），而组 3 的 PFM MVC 和 Valsalva 期间的 PFM 收缩均增加（p=0.011 和 p=0.042）。
无论采用何种教学方法，Knack 手法和教育计划对轻度至中度 SUI 女性的尿失禁症状均有效。阴道触诊和口头指导的 Knack 手法训练可改善 PFM 的 MVC。这三种不同的教学方法都可以用于 SUI 治疗计划。
