Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece.
Neurourol Urodyn. 2023 Apr;42(4):856-874. doi: 10.1002/nau.25150. Epub 2023 Feb 18.
To investigate the effectiveness of supervised remote rehabilitation programs comprising novel methods of pelvic floor muscle (PFM) training for women with urinary incontinence (UI).
A systematic review and meta-analysis including randomized controlled trials (RCTs), involving novel supervised PFM rehabilitation programs as intervention groups (e.g., mobile applications programs, web-based programs, vaginal devices) versus more traditional PFM exercise groups (acting as control); both sets of groups being offered remotely.
Data have been searched and retrieved from the electronic databases of Medline, PUBMED, and PEDro using relevant key words and MeSH terms. All included study data were handled as reported in the Cochrane Handbook for Systematic Reviews of Interventions and the evaluation of their quality was undertaken utilizing the Cochrane risk-of-bias tool 2 (RoB2) for RCTs. The included RCTs, involved adult women with stress UI (SUI) or mixed urinary incontinence, where SUI were the most predominant symptoms. Exclusion criteria involved pregnant women or up to 6-month postpartum, systemic diseases and malignancies, major gynecological surgeries or gynecological problems, neurological dysfunction or mental impairments. The searched outcomes included subjective and objective improvements of SUI and exercise adherence in PFM exercises. Meta-analysis was conducted and included studies pulled by the same outcome measure.
The systematic review included 8 RCTs with 977 participants. Novel rehabilitation programs included mobile applications (1 study), web-based programs (1 study) and vaginal devices (6 studies) versus more traditional remote PFM training, involving home-based PFM exercise programs (8 studies). Estimated quality with Cochrane's RoB2, presented the 80% of the included studies as "some concerns" and the 20% as "high risk." Meta-analysis included 3 studies with no heterogeneity (I = 0) across them. Weak-evidenced results presented home PFM training equally effective with novel PFM training methods (mean difference: 0.13, 95% confidence interval: -0.47, 0.73), with small total effect size (0.43).
Novel PFM rehabilitation programs presented as effective (but not superior) to traditional ones in women with SUI, both offered remotely. However, individual parameters of novel remote rehabilitation including supervision by the health professional, remains in question and larger RCTs are required. Connection between devices and applications in combination with real-time synchronous communication between patient and clinician during treatment is challenged for further research across novel rehabilitation programs.
探讨新型盆底肌（pelvic floor muscle，PFM）训练方法的监督远程康复方案对尿失禁（urinary incontinence，UI）女性的有效性。
系统评价和 meta 分析，包括随机对照试验（randomized controlled trials，RCTs），以新型监督 PFM 康复方案为干预组（例如移动应用程序、基于网络的程序、阴道设备），以更传统的 PFM 运动组为对照组（作为对照）；两组均提供远程服务。
使用相关关键词和 MeSH 术语，从 Medline、PUBMED 和 PEDro 电子数据库中搜索和检索数据。所有纳入研究的数据均按 Cochrane 干预系统评价手册报告，并使用 Cochrane 偏倚风险工具 2（RoB2）对 RCTs 进行质量评估。纳入的 RCTs 涉及患有压力性尿失禁（stress UI，SUI）或混合性尿失禁的成年女性，其中 SUI 是最主要的症状。排除标准包括孕妇或产后 6 个月内、系统性疾病和恶性肿瘤、重大妇科手术或妇科问题、神经功能障碍或精神障碍。搜索的结果包括 SUI 和 PFM 锻炼依从性的主观和客观改善。进行了 meta 分析，并纳入了使用相同结果测量的研究。
系统评价纳入了 8 项 RCT，共 977 名参与者。新型康复方案包括移动应用程序（1 项研究）、基于网络的程序（1 项研究）和阴道设备（6 项研究），与更传统的远程 PFM 训练（涉及家庭 PFM 运动方案的 8 项研究）相比。根据 Cochrane 的 RoB2 估计质量，80%的纳入研究为“存在一些关注”，20%为“高风险”。meta 分析纳入了 3 项无异质性（I ² = 0）的研究。结果表明，家庭 PFM 训练与新型 PFM 训练方法同样有效（平均差异：0.13，95%置信区间：-0.47，0.73），总效应量较小（0.43）。
在提供远程服务的情况下，新型 PFM 康复方案对 SUI 女性的效果与传统方案相当（但并非更优）。然而，新型远程康复方案中健康专业人员监督等个别参数仍存在疑问，需要进行更大规模的 RCT。还需要进一步研究新型康复方案中设备和应用之间的连接，以及患者和临床医生在治疗过程中的实时同步通信。
