Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women.

Abstract

OBJECTIVE:

To compare the effectiveness of an intensive group physical therapy program with individual biofeedback training for female patients with urinary stress incontinence.

DESIGN:

Randomized study of two therapeutic interventions consisting of a specific physical therapy program (PT) or biofeedback training (BF) daily for 4 wk, followed by a 2-mo, unsupervised home exercise program in both groups in an outpatient clinic of a large university hospital. Forty women, referred by gynecologists for nonoperative treatment of genuine stress incontinence of mild-to-moderate severity, were included. Measurements of daytime/nocturnal urinary frequency and subjective improvement of incontinence were the main outcome measures at initial presentation, after completion of the therapy program, and at follow-up after 3 mo. Standardized examinations of digital contraction strength, speculum tests, and manometric measurements were documented as secondary outcome measures.

RESULTS:

In the PT group, the daytime urination frequency decreased 22% after 4 wk of therapy and 19% after 3 mo (P < 0.05) from baseline. The nocturnal urination frequency was reduced by 66% after 4 wk of therapy and 62% after 3 mo (P < 0.001). In the BF group, the daily urination frequency decreased 10% after 4 wk of therapy and 5% after 3 mo (P > 0.05). The nocturnal urination frequency declined 36% after 4 wk of therapy and 66% after 3 months (P < 0.05). Subjective assessment after 3 mo showed that in the PT group, 28% of patients were free of incontinence episodes, 68% reported improved symptoms (incontinence episodes improved by >50%), and 4% were unchanged. In the BF group, 62% were free of incontinence episodes, and 38% were improved. Results of the digital contraction strength assessments, speculum tests, and manometric measurements showed statistically significant improvement in all variables in both groups after 3 months.

CONCLUSION:

Four weeks of both intensive group physical therapy or individual biofeedback training followed by an unsupervised home exercise program for 2 mo are effective therapies for female urinary stress incontinence and result in a significantly reduced nocturnal urinary frequency and improved subjective outcome. Only group physical therapy resulted in reduced daytime urinary frequency. BF therapy resulted in a better subjective outcome and higher contraction pressures of the pelvic floor muscles.

• Authors: I H Pages, S Jahr, M K Schaufele, E Conradi
• Journal: American journal of physical medicine & rehabilitation (Am J Phys Med Rehabil) Vol. 80 Issue 7 Pg. 494-502 (Jul 2001) ISSN: 0894-9115 [Print] United States
• PMID: 11421517 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Topics

• Adult
• Aged
• Aged, 80 and over
• Biofeedback, Psychology (methods)
• Exercise Therapy (methods)
• Female
• Follow-Up Studies
• Home Care Services
• Humans
• Manometry
• Middle Aged
• Muscle Contraction
• Patient Education as Topic (methods)
• Pelvic Floor
• Psychotherapy, Group (methods)
• Referral and Consultation
• Severity of Illness Index
• Treatment Outcome
• Urinary Incontinence, Stress (classification, diagnosis, physiopathology, rehabilitation)
• Urodynamics