Reducing fatigue following acquired brain injury: A feasibility study of high intensity interval training for young adults.

The aim was to evaluate feasibility of high-intensity interval training (HIIT) in fatigued adults (20-40 years old) with acquired brain injury (ABI). A prospective pre-post single-arm intervention trial was conducted, including 6-8 months follow-up assessment and interview. Intervention was 18 sessions of intermittent exercise on a cycle ergometer over six weeks. Six out of ten participants without motor impairments completed the intervention (all females, mean age = 30.2 years, months post-injury = 22). On average, participants attended 88% of sessions and achieved high intensity (93% of max heart rate). VO2max improved by 0.53 l/min (SD = 0.29), and participants continued exercising post-intervention. All participants were satisfied with HIIT, were more inclined to exercise, and reported positive effects of exercising for self-management of fatigue. Three sessions a week were demanding to some participants. Findings support feasibility of HIIT as a promising intervention for young adults with post-ABI fatigue.

A quality of life questionnaire for patients with scapula alata (SA-Q): development and validation.

BACKGROUND: No quality of life (QoL) questionnaire exists for patients with scapula alata (SA). The objective of this study was to develop and validate a QoL questionnaire for SA patients. METHODS: A team consisting of experts (n = 7) and SA patients (n = 7) developed, through five continuous phases, a QoL questionnaire for SA patients (SA-Q). The developed questionnaire consists of 21 items, grouped in five domains: physical symptoms (five items), work (four items), sport and leisure activities (four items), life style (four items) and emotions (four items). Content and face validity for the SA-Q questionnaire were evaluated by a sample of 48 (90%) out of 53 SA patients recruited from a university hospital. The Content Validity Index (CVI) and modified kappa index (κ*) assessed the relevance of SA-Q questionnaire. RESULTS: The SA patients evaluated 20 (95%) out of 21 items as excellent for content validity (I-CVI > 0.78, κ* > 0.74), one (5%) item was considered as good (I-CVI < 0.78, 0.60 < κ* < 0.74). The average scale (S-CVI/ave) for the entire SA-Q questionnaire was 0.93 indicating an excellent content validity. CONCLUSIONS: This study presents the development and validation of content validity of the first QoL questionnaire for SA patients. The SA-Q questionnaire has potential clinical implications for detected changes concerning the different items during rehabilitation. CLINICAL TRIALS: Not relevant.

Lower Urinary Tract Symptoms, Erectile Dysfunction, and Quality of Life in Poststroke Men: A Controlled Cross-Sectional Study.

The aim of the current study was to compare lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and quality of life (QoL) in poststroke and healthy men. Thirty poststroke men with stroke-related LUTS, and as controls, 96 healthy men participated in this controlled, cross-sectional study. Participants filled in the Danish Prostate Symptom Score (DAN-PSS-1) Questionnaire, the International Index of Erectile Function (IIEF-5), the 36-Item Short Form (SF-36), the Nocturia Quality-of-Life (N-QoL) Questionnaire. In the age group ≤55 years, comparing poststroke men with healthy controls both with LUTS, the results indicated DAN-PSS-1, total score median 13 (4-17) versus 3 (2-6), p = .05; IIEF-5 25 (14-25) versus 24 (23-25), p = .06; SF-12, total score 499 (360-679) versus 695 (644-734), p = .02; and N-QoL 98 (70-100) versus 96 (90-100), p = .65. In the age group >55 years, comparing poststroke men with healthy controls both with LUTS, the results indicated DAN-PSS-1, total score 13 (8-24) versus 5 (2-7), p < .01; IIEF-5 13 (5-20) versus 25 (24-25), p < .01; SF-36, total score 585 (456-718) versus 742 (687-772), p < .01; and N-QoL, total score 81 (66-95) versus 98 (80-100), p < .01. The results demonstrated that in age group above, but not below 55 years, poststroke men with LUTS had significantly higher frequency of severe and bothersome LUTS and ED than the healthy controls with LUTS, while QoL and N-QoL were significantly lower in comparison. It is recommended to identify and assess older poststroke men for LUTS, ED, and QoL.

Is Pelvic Floor Muscle Training Effective for Men With Poststroke Lower Urinary Tract Symptoms? A Single-Blinded Randomized, Controlled Trial.

The aim of the current study was to evaluate the effect of pelvic floor muscle training in men with poststroke lower urinary tract symptoms. Thirty-one poststroke men, median age 68 years, were included in this single-blinded randomized controlled trial. Thirty participants, 15 in each group, completed the study. The intervention consisted of 3 months (12 weekly sessions) of pelvic floor muscle training in groups and home exercises. The effect was evaluated by the DAN-PSS-1 (Danish Prostate Symptom Score) questionnaire, a voiding diary, and digital anal palpation of the pelvic floor muscle. The DAN-PSS-1, symptom score indicated a statistical significant improvement ( p < .01) in the treatment group from pretest to posttest, but not in the control group. The DAN-PSS-1, total score improved statistically significantly in both groups from pretest to posttest (treatment group: p < .01; control group: p = .03). The median voiding frequency per 24 hours decreased from 11 at pretest to 7 (36%; p = .04) at posttest and to 8 (27%; p = .02) at follow-up in treatment group, although not statistical significantly more than the control group. The treatment group but not the control group improved statistically significantly in pelvic floor muscle function ( p < .01) and strength ( p < .01) from pretest to posttest and from pretest to follow-up ( p = .03; p < .01). Compared with the control group the pretest to posttest was significantly better in the treatment group ( p = .03). The results indicate that pelvic floor muscle training has an effect for lower urinary tract symptoms, although statistical significance was only seen for pelvic floor muscle.

Can pelvic floor muscle training improve quality of life in men with mild to moderate post­stroke and lower urinary tract symptoms?

BACKGROUND: Lower urinary tract symptoms (LUTS) have a significant impact on quality of life (QoL) in post­stroke patients. AIM: The aim of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on QoL parameters in men with post­stroke LUTS. DESIGN: Randomized, controlled and single­blinded trial. SETTING: Outpatients, University Hospital. POPULATION: Thirty­one men, median age 68 (interquartile range 60-74) years, with post­stroke LUTS were included. Thirty participants completed the study. METHODS: The participants randomized to the treatment group were treated in a systematic, controlled and intensive PFMT program over 3 months (12 weekly sessions). The participants randomized to the control group did not receive specific LUTS treatment. The effect was measured on the 36-Item Short Form Health Survey (SF-36) and the Nocturia Quality­of­Life (N­QoL) Questionnaire. RESULTS: The results on SF-36 indicated significant improvement within pre- and post­test in the domains emotional role (median 77 to 100, P=0.03) and vitality (median 65 to 70, P=0.03) in the treatment group, but not the control group. There were no statistically significant differences between groups at pre­test, post­test or 6-month follow­up. The results on N­QoL indicated statistically significant differences between pre- and post­test in the bother/concern domain in both groups and in sleep/energy for the control group, but not the treatment group. There were no statistically significant differences between groups. CONCLUSIONS: PFMT may improve the emotional health and vitality domains of QoL in men with mild to moderate post­stroke and LUTS; however the improvements in the treatment group were not significantly better than for the control group. PFMT did not improve nocturia­related QoL. CLINICAL REHABILITATION IMPACT: This study is the first to evaluate the effect of PFMT on QoL parameters in men with mild to moderate post­stroke and LUTS. The results indicate some short­term effect on SF-36 but none on N­QoL. However, further studies with larger sample sizes and with less restrictive inclusion and exclusion criteria are requested.

Validity of a shoulder-specific quality of life questionnaire, the Western Ontario Rotator Cuff Index, for patients with scapula alata.

BACKGROUND: No validated shoulder-specific quality of life measurements exist for patients with scapula alata (SA). The objective was to investigate the content validity of the Western Ontario Rotator Cuff (WORC) Index for SA patients. METHODS: Content validity was evaluated by an expert panel of medical doctors and physiotherapists (n = 6) and a sample of SA patients (n = 44). The Content Validity Index (CVI) and a modified kappa index (κ*) assessed the relevance of WORC Index. RESULTS: The experts evaluated ten of 21 items as excellent for content validity (I-CVI > 0.78, κ* > 0.74), five items as fair (I-CVI < 0.78, 0.40 < κ* < 0.60), and six were considered content invalid (I-CVI < 0.78, κ* < 0.40). The average scale (S-CVI/Ave) for the entire WORC Index was 0.72.The SA patients evaluated four of 21 items as excellent for content validity (I-CVI > 0.78, κ* > 0.74), nine items as good (I-CVI < 0.78, 0.60 > κ* < 0.74), six as fair (I-CVI < 0.78, 0.40 < κ* < 0.59) and two were considered content invalid (I-CVI < 0.78, κ* < 0.40). The S-CVI/Ave was 0.56. CONCLUSION: This study is the first step evaluating content validity in the WORC Index for SA patients. The results indicated that half of the 21 items had excellent or good content validity. Several items need to be discussed by an SA team aiming to find consensus for changing or removing, leaving the possibility to develop a new quality of life measure, the first for SA patients.

Scapula alata: description of a physical therapy program and its effectiveness measured by a shoulder-specific quality-of-life measurement.

BACKGROUND: To date, there are no published outcomes-based treatment programs to guide clinicians when managing patients with scapula alata. The purposes of this study were to describe a physical therapy program in patients with scapula alata and to evaluate its effect using a shoulder-specific quality-of-life measurement. METHODS: In this case series and retrospective study, 22 patients (11 female patients) with a median age of 34 years (interquartile range, 28-44 years), diagnosed with scapula alata caused by injury to the long thoracic nerve, were successively referred as outpatients to a physical therapy program at a university hospital. The program included (1) physical examination, (2) thoracic brace treatment, and (3) muscular rehabilitation. The treatment frequency and duration were determined individually. The effect was evaluated by a shoulder-specific quality-of-life questionnaire, the Western Ontario Rotator Cuff (WORC) Index. The WORC Index is grouped into 5 domains: physical symptoms, sport/leisure time, work, lifestyle, and emotional health. RESULTS: The results showed a highly significant improvement (P < .001) from pretest to post-test as measured by all 5 domains in the WORC Index. CONCLUSIONS: This study described in detail a physical therapy program; the program showed significant benefit. Further research is needed before recommending the program as a potential treatment option.

Pelvic floor muscle function in women with pelvic floor dysfunction: a retrospective chart review, 1992-2008.

INTRODUCTION AND HYPOTHESIS: The objectives of this study were to investigate the level of pelvic floor muscle (PFM) function in women with pelvic floor dysfunction (PFD) referred by gynaecologists and urologists for in-hospital pelvic floor muscle training (PFMT), and to identity associated factors for a low level of PFM function. METHODS: Data of women with PFD referred to a PFMT programme were included in a retrospective chart review. Measurement of PFM function performed by digital vaginal palpation included: voluntary PFM contraction, PFM strength (Modified Oxford Grading Scale) and PFM static endurance. RESULTS: Data of 998 women, mean age 56 (SD 13) years, with PFD (urinary incontinence, n = 757, anal incontinence, n = 36, pelvic organ prolapse, n = 111, other PFD, n = 94) were analysed. In all, 690 women (70%) were, at baseline, unable to perform correct voluntary PFM contraction, mean PFM strength was 1.5 (SD 1.0) points, mean PFM static endurance was 16.7 (SD 16.1) seconds. Age ≥ 65 years and year of referral > 2000 were significantly (p < 0.01) associated with the ability to perform correct PFM contraction. Likewise, year of referral was significantly associated with high PFM strength (p < 0.01). CONCLUSIONS: The majority of the women were unable to perform correct voluntary PFM contraction and almost all had low PFM strength. The most important factor associated with a low level of PFM function was age.

Does progressive resistance strength training as additional training have any measured effect on functional outcomes in older hospitalized patients? A single-blinded randomized controlled trial.

OBJECTIVE: To evaluate the effect of progressive resistance strength training as additional training measured on functional outcomes in older hospitalized patients. DESIGN: A single-blinded randomized controlled trial. SETTING: Department of Geriatric Rehabilitation in university hospital. PARTICIPANTS: A sample of 71 patients were successively included and randomized either to the treatment group (TG) (n = 36) or the control group (CG) (n = 35). Fifteen participants dropped out (TG n = 7; CG n = 8), leaving 56 participants with a mean age of 79 (SD 7). INTERVENTION: Participants in the treatment group were treated in groups with progressive resistance strength training in addition to standard care. Progressive resistance strength training of the lower extremities was performed in three sets of 12-15 repetitions, intensity 60-70% of one repetition maximum, in four 50-minute sessions per week. MAIN MEASURES: The effect was evaluated by timed up & go test, 30-second chair-stand test, 10-m walk test, three tasks (transfer, walking, stairs) of the Barthel Index, and use of walking aids. RESULTS: Significant improvements in the 10-m walk test (P < 0.01) and Barthel Index (walking) (P = 0.01) were demonstrated within the treatment group but not in the control group. Both groups had significant improvements in timed up & go, 30-second chair-stand (modified) and Barthel Index (transfer and walking). No significant difference was found between groups except for the Barthel Index (stairs) (P = 0.05). Analysis by the mixed-effects model showed that the treatment group improved more than the control group in all outcome variables. CONCLUSION: The results indicate that for older hospitalized patients progressive resistance strength training as additional training may have an effect compared to standard care, but no statistically significant effects were demonstrated when measured by functional outcomes.

Do women with pelvic floor dysfunction referred by gynaecologists and urologists at hospitals complete a pelvic floor muscle training programme? A retrospective study, 1992-2008.

INTRODUCTION AND HYPOTHESIS: For decades women with pelvic floor dysfunction (PFD) have been referred to pelvic floor muscle training (PFMT), but there is only little information on whether the women complete the programmes and why. The objectives of this study were to investigate to which extent women completed a PFMT programme to which they were referred by gynaecologists and urologists and to identify associated factors for completion. METHODS: In a hospital-based, retrospective clinical design women with PFD referred to a free PFMT programme as outpatients were included. The PFMT programme consisted of: (a) vaginal digital palpation test of PFM, (b) individual instructions, (c) introduction (theory), (d) weekly supervised PFMT in groups for 3 months (12 sessions) and (e) progressive home exercises (10 sets). RESULTS: Data were analysed in 1,544 women, mean age 54 (SD 13) years, with PFD (urinary incontinence, n = 1,214; anal incontinence, n = 41; pelvic organ prolapse, n = 162; other PFD, n = 127). In total 747 (48 %) subjects completed (attended ≥8 sessions) the PFMT programme, 466 (30 %) dropped out and 331 (22 %) cancelled or stayed away. Age, year of referral and nationality were significantly different (p < 0.01) between completers and non-completers. Likewise, year of referral, distance from home to hospital, waiting list times and diagnosis were significantly different (p < 0.01) between dropouts and subjects who cancelled or stayed away. CONCLUSIONS: The results showed that less than half of the women with PFD completed a PFMT programme to which they were referred by gynaecologists and urologists. The most important associated factors for completion were age, year of referral and nationality.

Is Barthel Index a relevant measure for measuring prevalence of urinary incontinence in stroke patients?

AIMS: To compare the prevalence of urinary incontinence (UI) measured by Barthel Index and the Danish Prostate Symptom Score (DAN-PSS-1) questionnaire in stroke patients. METHODS: A cross-sectional, hospital based survey was initiated whereby 407 stroke patients, average age 67 (SD 12) years with a mean interval of 101 days since onset of last stroke at inclusion. The stroke patients self-reported the prevalence of UI by Barthel Index and the DAN-PSS-1 questionnaire. RESULTS: The prevalence of UI was 10.5% measured by the Barthel Index and 49% by the DAN-PSS-1 questionnaire. Furthermore, the DAN-PSS-1 questionnaire distinguished between types of UI (38% urge UI, 28% stress UI, and 14% other UI). There were significantly fewer stroke patients who reported UI by the Barthel Index compared to the DAN-PSS questionnaire in term of urge UI (P < 0.001), stress UI (P < 0.001), and other UI (P < 0.001). CONCLUSIONS: The results showed that DAN-PSS-1 questionnaire contains more specific UI information compared to the Barthel Index. Fewer stroke patients reported UI by the Barthel Index compared to the DAN-PSS-1 questionnaire and moreover the DAN-PSS-1 questionnaire enables identification of different UI-types. The Barthel Index is not sensitive to the UI prevalence; instead the authors suggest using a more specific instrument such as the DAN-PSS-1 questionnaire.

Intra- and interrater reliability and agreement of the Danish version of the Dynamic Gait Index in older people with balance impairments.

OBJECTIVES: To examine the intrarater and interrater reliability and agreement of the Danish version of the Dynamic Gait Index (DGI) in hospitalized and community-dwelling older people with balance impairments. DESIGN: Reliability study. SETTING: University hospital and outpatient rehabilitation. PARTICIPANTS: A convenience sample of older people (≥65y); 24 subjects from a hospital and 24 from an outpatient rehabilitation center. All subjects had either 1 or more falls within the last year or balance impairments evaluated by a physical therapist. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All subjects carried out the DGI twice with a 1.5-hour interval. Each subject was rated by 3 physical therapists in the first attempt (1 for intrarater and 2 for interrater comparison) and by the intrarater in the second attempt, in both settings. The reliability was calculated using the intraclass correlation coefficient (ICC, 2.1), while agreement was calculated as the smallest real difference (SRD). RESULTS: The ICC for intrarater and interrater reliability of the total DGI was .90 and .92 at the hospital, while the SRD was 2.72 and 2.58 points, respectively. Correspondingly, the ICC for intrarater and interrater reliability of the total DGI at the rehabilitation center was .89 and .82, while the SRD was 3.49 and 3.99 points, respectively. CONCLUSIONS: The intrarater and interrater reliability of the total DGI ranged from good to excellent in hospitalized and community-dwelling older people. Improvements of 3 and 4 DGI points for hospitalized and community-dwelling older people, respectively, should be regarded as a real change (with a 95% certainty).

Is well-being associated with lower urinary tract symptoms in patients with stroke?

OBJECTIVE: This study aimed to assess self-reported well-being in a clinical sample of stroke patients and to identify possible associations with prevalence, severity and bother of lower urinary tract symptoms (LUTS). MATERIAL AND METHODS: A cross-sectional, clinical survey was initiated whereby stroke patients were invited to complete The WHO-Five Well-Being Index (WHO-5) and a LUTS instrument, the Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire. Of 519 stroke patients invited, 482 subjects were eligible and 407 (84%) respondents answered the questionnaires. RESULTS: Poor well-being (sum score <13) was reported by 22% of all stroke patients, for women 29% and for men 14%. Depression (sum score <8) was reported by 10%, for women 11% and for men 8%. Poor well-being was significantly (p < 0.01) associated with severity and bother of LUTS. Likewise, poor well-being was significantly (p < 0.001) associated with the prevalence of four different symptom groups of LUTS. CONCLUSIONS: The results indicate that poor well-being is present in stroke patients with LUTS, especially in women. Likewise, the data showed significant association between poor well-being and LUTS. Screening for well-being and LUTS in stroke patients is strongly recommended.

Are activity limitations associated with lower urinary tract symptoms in stroke patients? A cross-sectional, clinical survey.

OBJECTIVE: To assess self-reported activity limitations in a clinical sample of stroke patients and to identify their association with prevalence, severity and impact on daily life of lower urinary tract symptoms (LUTS). MATERIAL AND METHODS: A cross-sectional, clinical survey was initiated whereby stroke patients were invited to complete four activity limitations measurements: Barthel Index, mobility velocity, mobility distance, mobility aids and one LUTS measurement: the Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire. Of 519 stroke patients, 482 subjects were eligible. RESULTS: The response rate was 84%. The activity limitations were reported by 17-34% depending on the measurement. Mobility velocity was highly significantly associated (p=0.01) with severity of LUTS. In the LUTS incontinence symptom group, Barthel Index and mobility velocity were significantly associated with prevalence [p=0.03, odds ratio (OR) 2.08 and p=0.05, OR 1.87, respectively]. Barthel Index and mobility distance were also associated with severity (p=0.03 and p=0.04, respectively) and Barthel Index was associated with the prevalence of bother (p=0.02, OR 2.12). CONCLUSION: This study indicate for the first time that activity limitations are closely related to LUTS in stroke patients and that rehabilitation should also be directed towards the treatment of LUTS.

Prevalence of lower urinary tract symptoms (LUTS) in stroke patients: a cross-sectional, clinical survey.

AIMS: The aims of this study were primarily to investigate the prevalence, severity and impact on daily life of Lower Urinary Tract Symptoms (LUTS) in a clinical sample of stroke patients and secondly to identify factors associated with LUTS. MATERIALS AND METHODS: This was a cross-sectional, hospital based survey whereby stroke patients were invited by letter to complete The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire at least 1 month following their stroke. Subjects were asked to report the frequency and severity of their symptoms (symptom score) and the impact of each symptom on their daily life (bother score) over the previous fortnight. Of 519 stroke patients invited, 482 subjects were eligible. RESULTS: The response rate was 84%. The period prevalence of at least one symptom was 94%; the most frequent symptom was nocturia (76%) followed by urgency (70%) and daytime frequency (59%). The most severe symptom was urgency followed by nocturia and daytime frequency. Among respondents who had at least one symptom, the prevalence of bother was 78%. Likewise the most frequent bothersome symptom was nocturia (53%), followed by urgency (48%) and daytime frequency (40%). Paresis in legs, symptoms of urinary incontinence on admission, and use of analgesics were significantly associated with severity, whereas the prevalence and bother of LUTS could not be associated with other patient characteristics. CONCLUSION: LUTS are highly prevalent in stroke patients and have a major impact on daily life.

Pelvic floor muscle training before transurethral resection of the prostate: a randomized, controlled, blinded study.

UNLABELLED: OBJECTIVE To evaluate the effect of preoperative pelvic floor muscle training (PFMT) in men scheduled for transurethral resection of the prostate (TURP) in a randomized, single-blind study. MATERIAL AND METHODS: Fifty-eight men with benign prostatic obstruction were included, and 49 completed the study (training group, n=26; control group, n=23). The preoperative training included a 1-h individual lesson, three 1-h group lessons and a home training programme. Postoperatively and before discharge from hospital both groups received verbal instructions regarding PFMT. Pelvic floor muscle function was assessed by anal examination before and 4 weeks after surgery by one physiotherapist who was blinded to the randomization. The primary outcome parameter was the total score on the Danish Prostatic Symptom Score questionnaire. Secondary outcome measures were other subjective and objective voiding and incontinence parameters and four tests of the pelvic floor muscle: function; strength; static endurance; and dynamic endurance. RESULTS: Baseline characteristics were similar in the two groups. Improved static endurance occurred in the training group but not in the control group (p=0.004). Regarding dynamic endurance, a difference in favour of training developed between the groups (p=0.049). Many men produced results that were outside the test scales. At follow-up at 2 and 4 weeks and 3 months there were no differences between the groups in any of the lower urinary tract parameters. CONCLUSIONS: Preoperative PFMT produced a significant improvement in pelvic floor muscle endurance after TURP, but clinically relevant storage or voiding improvements did not occur. Pelvic floor muscle assessment tests need to be sex-specific.

The Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire is reliable in stroke patients.

AIMS: To investigate the test-retest reliability of Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire in a sample of stroke patients. METHODS: A prospective study design was used in which the stroke patients were invited to complete a postal self-administrated DAN-PSS-1 questionnaire twice. The questionnaire consists of 12 questions related to lower urinary tract symptoms (LUTS). The participants were asked to state the frequency and severity of their symptoms (symptom score) and its impact on their daily life (bother score). Seventy-one stroke patients were included and 59 (83%) answered the questionnaire twice. The reliability test was done in two aspects: (a) detecting the frequency of each symptom and its bother factor, the scores were reduced to a two-category scale (=0, >0) and simple kappa statistics was used; (b) detecting the severity of each symptom and its bother factor, the total scale (0-3) and weighted kappa statistics was used. RESULTS: The proportion of agreement for the frequency symptom scores ranged from 76% to 97% and the simple kappa coefficient ranged from poor (kappa = 0.00) to excellent (kappa = 0.91). The proportion of agreement for the corresponding bother scores ranged from 76% to 95% and the simple kappa coefficient ranged from good (kappa = 0.61) to excellent (kappa = 0.84). The weighted kappa coefficient for the severity symptom scores ranged from moderate (kappa(w) = 0.43) to good (kappa(w) = 0.75) and the corresponding bother scores ranged from moderate (kappa(w) = 0.48) to good (kappa(w) = 0.68). CONCLUSIONS: The DAN-PSS-1 questionnaire had acceptable test-retest reliability and may be suitable for measuring the frequency and severity of LUTS and its bother factor in stroke patients.

Pelvic floor muscle training is effective in women with urinary incontinence after stroke: a randomised, controlled and blinded study.

AIMS: The aim of this study was to evaluate the effect of Pelvic Floor Muscle Training (PFMT) in women with urinary incontinence (UI) after ischemic stroke. MATERIALS AND METHODS: Three hundred and thirty-nine medical records of stroke patients were searched. Twenty-six subjects were randomised to a Treatment Group (14 subjects) or a Control Group (12 subjects) in a single blinded, randomised study. The intervention included 12 weeks of standardised PFMT. The outcome measures were: (1) diary recording the frequency of voiding, the number of incontinence episodes and used pads; (2) 24-hr home pad test; and (3) vaginal palpation of pelvic floor muscle evaluating function, strength, static and dynamic endurance. RESULTS: Twenty-four subjects with urge, stress and mixed stress/urge incontinence, completed the study, 12 in each group. A significant improvement in frequency of voiding in daytime (Treatment Group/Control Group: 7/8 at pre-test, 6/9 at post-test (median values), P=0.018), 24-hr pad test (Treatment Group/Control Group: 8/12 to 2/8 g P=0.013) and dynamic endurance of pelvic floor muscle (Treatment Group/Control Group: 11/20 to 20/8 contractions of Pelvic Floor Muscle, P=0.028) was demonstrated in the Treatment Group compared to the Control Group. A significant improvement in frequency of voiding in daytime (decreased from seven to six, P=0.036), pelvic floor muscle function (P=0.034), strength (P=0.046), static endurance increased from 9 to 30 sec (P=0.028) and dynamic endurance increased from 11 to 20 contractions (P=0.020) was also demonstrated within the Treatment Group, but not in the Control Group. CONCLUSION: PFMT had a significant effect in women with UI after stroke measured by diaries, pad tests and vaginal palpation.

Can quality of life be improved by pelvic floor muscle training in women with urinary incontinence after ischemic stroke? A randomised, controlled and blinded study.

The purpose of this study was to evaluate the effect of pelvic floor muscle training in women with urinary incontinence after ischemic stroke measured by quality of life (QoL) parameters. Three hundred thirty-nine medical records of stroke patients were searched. Twenty-six subjects were randomised to a Treatment Group or a Control Group in a single blinded, randomised study design. The intervention included 12 weeks of standardised pelvic floor muscle training. The outcome was measured by the Short Form 36 (SF-36) Health Survey Questionnaire and The Incontinence Impact Questionnaire (IIQ). Twenty-four subjects completed the study. The SF-36 and IIQ did not show significant difference between the two groups. Despite the high prevalence of stroke with urinary incontinence, it is difficult to include these patients in such studies. The samples were too small to detect any significant differences. Development of specific instruments for QoL in stroke patients with urinary incontinence can be recommended.