ABSTRACT
OBJECTIVE: To review current management of neurogenic lower urinary tract dysfunction (NLUTD) in MS patients and give recommendations on the joint role of the neurologist and urologist in NLUTD management. METHODS: An algorithm for evaluation and referral of MS patients to urologists was created. It is an outcome of discussions about current knowledge, existing guidelines, and key issues during two Belgian consensus meetings attended by neurologists, urologists and other stakeholders involved in MS management. At these meetings, updated information on management of NLUTD in MS was exchanged and the neurologists' opinion on how to integrate this in the other aspects of care in MS patients was explored. RESULTS: Short evaluation of NLUTD in MS patients by neurologists and appropriate referral to urologists could accelerate proper diagnosis and treatment. Neurologists can play a central role in the inter-disciplinary communication on interactions between disease manifestations of MS and their treatments. CONCLUSION: The coordinating role of neurologists in NLUTD management may considerably improve QoL in MS patients. More research is needed to evaluate outcomes of urological assessments and treatment.
Subject(s)
Lower Urinary Tract Symptoms/therapy , Multiple Sclerosis/complications , Urinary Bladder, Neurogenic/therapy , Botulinum Toxins, Type A/therapeutic use , Consensus , Gait Disorders, Neurologic/etiology , Guidelines as Topic , Humans , Lower Urinary Tract Symptoms/diagnosis , Lower Urinary Tract Symptoms/etiology , Neurology , Neuromuscular Agents , Physicians , Prevalence , Referral and Consultation , Risk Factors , Urinary Bladder/surgery , Urinary Bladder, Neurogenic/diagnosis , Urinary Bladder, Neurogenic/etiology , Urologic Surgical Procedures , UrologyABSTRACT
BACKGROUND: Exercise therapy in persons with multiple sclerosis (MS) is effective for improving muscle strength and functional mobility. OBJECTIVE: To investigate, in MS patients attending an in-patient rehabilitation program, the additional effects of a 3-week exercise program, performed on a whole body vibration platform, on muscle strength and functionality. METHODS: Median Expanded Disability Status Scale (EDSS) of participating patients was 5.5. This randomized controlled trial differentiated a MS control group (n = 17) and two exercise groups performing exercises on a vibration platform (WBV-full group, n = 20) and on the platform additionally covered by a damping mat (WBV-light group, n = 18). Exercise groups performed, during 10 training sessions, six static and dynamic exercises standing on a platform vibrating at high frequency and low amplitude. Isometric muscle strength of quadriceps, hamstrings, tibialis anterior and gluteus medius was measured with a hand-held dynamometer. Functional mobility was measured with Berg Balance Scale (BBS), 3-minute walk test and Timed Get up and Go test. RESULTS: Eight drop-outs occurred in the exercise groups (WBV-full = 4, WBV-light = 4), but were unrelated to WBV as type of intervention. Across groups, significant time effects were found for all muscle groups. For maximal quadriceps and hamstrings muscle strength, interaction effects were found with post-hoc tests indicating exercise group-significant improvements in the WBV-full group only. Significant time effects were found for all functional tests. Improvements on the BBS and 3-minute walk test were larger in training than in control groups, but no significant interactions were found. CONCLUSIONS: A 3-week exercise program on a vibration plate significantly improved muscle strength, but not functionality, in persons with MS.
