Indirect training of the pelvic floor muscles via transversus abdominis for females with urinary incontinence: a randomized controlled trial
|Keywords:||尿失禁;腹橫肌;骨盆底肌;隨機分配試驗;Urinary incontinence;Transversus abdominus;Pelvic floor muscles;Randomized controlled trial||Issue Date:||2006||Abstract:||
對照組除於第一次評估時教導正確之骨盆底肌運動，並給予衛教單張外，在介入期間皆不主動與之聯絡。訓練組則進行四個月之運動療程，於第 1, 2, 4, 6, 8, 10, 13, 16週進行約30∼60分鐘之個別化運動訓練，以確定受試者之運動正確性、強度及進展。介入方式採用經由腹橫肌間接訓練骨盆底肌模式，分為腹式呼吸、強直誘發期、肌力訓練期、功能性吐氣訓練模式、衝擊性活動五個階段進展。
所有資料分析皆以SPSS 11.0版進行，以描述性統計呈現訓練組與對照組兩組之特性，並利用Shapiro-Wilk test檢定依變項是否呈常態分佈；以獨立兩樣本t檢定(independent two samples t-test)或卡方檢定(chi-square)來檢定訓練組與對照組兩組間在各干擾因子上是否有差異；以two-way mixed ANOVA檢定兩組受試者治療前後之常態分佈連續依變項是否有差異；以Wilcoxon signed-rank test檢定兩組受試者治療前後之有序依變項是否有差異；以卡方檢定或Mann-Whitney rank-sum test分析非連續數或非常態分佈之依變項之組間差異。
Urinary incontinence (UI) is the complaint of any involuntary leakage of urine. Stress urinary incontinence (SUI) is the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing. The prevalence of female UI is greater than that of male, and the commonest type is SUI. UI has significant impact on the quality of life including physical, mental and social issues. SUI may also lead to withdraw from regular physical exercise and fitness activities that are important in the prevention of osteoporosis, coronary heart disease, and so on. The cause of SUI is related to the impairment of pelvic floor muscles (PFM). So far, the effects of intensive pelvic floor muscle training for female SUI were proved in many randomized controlled trials. However, training of accurate contraction of PFM depends on vaginal palpation. The willingness to seek for medical help may be lowered due to being embarrassed with vaginal palpation. Sapsford proposed a concept to treat SUI via transversus abdominis (TrA) that does not need to palpate the vagina. Maybe the new intervention can promote the willingness to seek medical help. However, to date there is no randomized controlled trial comparing the effect of indirect training of the PFM via TrA with either untreated control or other intervention. Therefore, the purpose of this study is to compare the effect of indirect training of PFM via TrA with control group for female UI.
Seventy-one women with UI were recruited in this study and randomized to intervention or control group after being stratified by the moving direction of PFM during contraction of TrA. All subjects were evaluated pre- and post- 4-month intervention. The measurements included basic data and comprehensive urogynaecological history, women’s observations, quantification of symptoms, clinician’s measures and quality of life.
Women in the control group learned correct contraction of pelvic floor muscles in first evaluation and received customary information of PFM exercise. The intervention group followed a specially designed exercise course including diaphragmatic breathing, tonic activation, muscle strengthening, functional expiratory patterns and impact activities. They were individually trained by a physical therapist for 30-60 minutes eight times during the intervention period.
Descriptive and inferential statistics were completed using SPSS for windows, version 11.0. Descriptive statistics was computed for subject demographics. Normality was evaluated by using the Shapiro-Wilk test for all variables. The confounding factors between two groups were tested by the independent t-test or Chi-square test. A two-way mixed analysis of variance (ANOVA) and Wilcoxon signed-rank test were used to assess possible differences between pre- and post- intervention and two groups. The Chi-square and Mann-Whitney rank-sum test were used to assess the discrete dependent variables.
The present study found the self-reported incontinence severity, self-reported stress incontinence severity, frequency of incontinence during 72 hours diary, leaking amount of 1-hour pad test and 20-minute pad test were statistically significant lowered (p＜0.05), and the endurance of pelvic floor muscles and quality of life were statistically significant improved more for intervention group compared to control group. The women in the control group who had administered 80% PFM exercise sessions also found the urinary incontinence better, and the maximal voluntary strength of pelvic floor muscles improved.
The women with urinary incontinence who are not suitable for vaginal palpation can be trained via TrA. These who are suitable for vaginal palpation can learn correct pelvic floor muscle exercise only once, and who has high exercise compliance also improve the incontinence.
|Appears in Collections:||物理治療學系所|
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