Feasibility of Telerehabilitation-Based Pelvic Floor Muscle Training for Urinary Incontinence in People With Multiple Sclerosis: A Randomized, Controlled, Assessor-Blinded Study.

BACKGROUND AND PURPOSE: Urinary incontinence is a common symptom in people with multiple sclerosis. The primary aim was to investigate feasibility of telerehabilitation-based pelvic floor muscle training (Tele-PFMT) and compare its effects on leakage episodes and pad usage with home exercise-based pelvic floor muscle training (Home-PFMT) and control groups. METHODS: Forty-five people with multiple sclerosis with urinary incontinence were randomized into 3 groups. Tele-PFMT and Home-PFMT groups followed the same protocol for 8 weeks, but Tele-PFMT performed exercises 2 sessions/week under a physiotherapist's supervision. The control group did not receive any specific treatment. Assessments were made at baseline, weeks 4, 8, and 12. Primary outcome measures were feasibility (compliance to exercise, patient satisfaction, and number of participants included in the study), number of leakage episodes, and pad usage. Secondary outcomes included severity of urinary incontinence and overactive bladder symptoms, sexual function, quality of life, anxiety, and depression. RESULTS: Participant eligibility rate was 19%. Patient satisfaction and compliance to exercise were significantly higher in Tele-PFMT than in Home-PFMT ( P < 0.05). No significant differences in the change of leakage episodes and pad usage were found between Tele-PFMT and Home-PFMT. No significant differences in secondary outcomes were found between PFMT groups. Participants in both the Tele-PFMT and Home-PFMT groups had significantly better scores for some measures of urinary incontinence, and overactive bladder and quality of life in compared with the control group. DISCUSSION AND CONCLUSIONS: Tele-PFMT was feasible and acceptable in people with multiple sclerosis, and this mode of delivery was associated with greater exercise compliance and satisfaction compared with Home-PFMT. However, Tele-PFMT did not exhibit superiority in terms of leakage episodes and pad usage compared with Home-PFMT. A large trial comparing Home-PFMT and Tele-PFMT is warranted.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A440 ).

Pelvic floor muscle training on urinary incontinence and sexual function in people with multiple sclerosis: A systematic review.

OBJECTIVE: This systematic review evaluates and summarizes the effects of pelvic floor muscle training on urinary incontinence and sexual function in people with multiple sclerosis. DATA SOURCES: PubMed, Scopus, PEDro, CINAHL, Web of Science, and ULAKBIM databases with keywords multiple sclerosis, urinary incontinence, sexual function, and pelvic floor muscle training were screened for randomized controlled studies and clinical trials from the beginning until July 2020 (updated in August 2021). REVIEW METHODS: Two authors independently made the study selection. Turkish and English publications were taken into consideration. The risk of bias for the included studies was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEXT) was used to assess the methodological quality of studies. Data extraction was performed by two researchers independently. RESULTS: Initial search identified a total of 2831 studies, after removing duplicates, 2180 records were screened and 7 studies with 248 participants [mean age (years): 50.0 ± 11.11 and range: 20-67; mean Expanded Disability Status Scale score: 4.2 ± 1.64 and range: 1.5-7.5] met the inclusion criteria. Only one study included male people with multiple sclerosis. Five studies were judged as being of some concerns and two studies were judged as being of high risk of bias. The TESTEXT scores ranged from 5 to 9 out of 15. The outcome measures were the health-related quality of life (6 studies), severity of overactive bladder (5 studies), leakage episodes (4 studies), severity of urinary incontinence (3 studies), 24-h pad test (2 studies), pad usage, sexual function, and anxiety and depression (1 study). Significant improvements were observed in all specified outcome measures in the groups that received pelvic floor muscle training in majority of the studies. CONCLUSION: Current evidence suggests that pelvic floor muscle training seems to be an effective treatment modality for improving health-related quality of life and reducing the severity of urinary incontinence and overactive bladder symptoms in people with multiple sclerosis. It also can reduce leakage episodes, pad usage, anxiety, and depression and improve sexual function. However, it should be noted that all included studies had some concerns or a high risk of bias in at least one domain of risk of bias assessment, and most of the studies did not have high quality.