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The Comparison of Individual and Group Hybrid Telerehabilitation Methods in Women with Urinary Incontinence

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Abstract

Introduction and Hypothesis

The aim is to compare the effects of the progressive training program (PTP), a new protocol, with two different hybrid telerehabilitation methods, on the parameters related to urinary incontinence in women with urinary incontinence.

Methods

A total of 50 participants with stress or mixed urinary incontinence participated in this two-arm, parallel-group, randomized, non-inferiority trial. Individual hybrid training (IHT) or group hybrid training (GHT) was given to women for 8 weeks. The Power, Endurance, Repetitions, Fast contractions, and Every Contraction Timed (PERFECT) scheme and surface electromyography were used to assess pelvic floor muscle function, whereas quality of life, exercise adherence, and symptoms were assessed by questionnaires and a 3-day bladder diary. An intention-to-treat analysis was performed. Linear mixed model analysis with the factors “time” and “group” was used to determine the effects of IHT and GHT.

Results

The primary outcome was changes in pelvic floor muscle function as evaluated using the PERFECT scheme and surface electromyography at the 4th and 8th weeks relative to baseline. No statistical difference was found between the groups except for “power” of the PERFECT scheme and “nocturnal urination frequency” (p > 0.05). The GHT showed significant improvement in P and nocturnal urination frequency at the end of the 8th week (p < 0.05). From baseline to week 8, the effect size for the P value was found to be small (Cohen’s d = 0.33).

Conclusion

Eight weeks of PTP did not lead to different results in incontinence-related parameters in either of the training methods. It may be better to conduct GHT in terms of implementing PTP in incontinence and training programs in terms of time, staff workload, and applicability.

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References

  1. Haylen BT, De Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. https://doi.org/10.1002/nau.20798.

    Article  PubMed  Google Scholar 

  2. Dumoulin C, Hay-Smith J, Habée-Séguin GM, Mercier J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn. 2015;34(4):300–8. https://doi.org/10.1002/nau.22700.

    Article  PubMed  Google Scholar 

  3. García-Sánchez E, Ávila-Gandía V, López-Román J, Martínez-Rodríguez A, Rubio-Arias JÁ. What pelvic floor muscle training load is optimal in minimizing urine loss in women with stress urinary incontinence? A systematic review and meta-analysis. Int J Environ Res Public Health. 2019;16(22):4358. https://doi.org/10.3390/ijerph16224358.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zachovajeviene B, Siupsinskas L, Zachovajevas P, Venclovas Z, Milonas D. Effect of diaphragm and abdominal muscle training on pelvic floor strength and endurance: results of a prospective randomized trial. Sci Rep. 2019;9(1):1–9. https://doi.org/10.1038/s41598-019-55724-4.

    Article  CAS  Google Scholar 

  5. Bø K. Physiotherapy management of urinary incontinence in females. J Physiother. 2020;66(3):147–54. https://doi.org/10.1016/j.jphys.2020.06.011.

    Article  PubMed  Google Scholar 

  6. Brennan D, Tindall L, Theodoros D, et al. A blueprint for telerehabilitation guidelines. Int J Telerehabil. 2010;2(2):31–4. https://doi.org/10.5195/ijt.2010.6063.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Thomas RJ, Petersen CE, Olson TP, Beatty AL, Ding R, Supervia M. Asynchronous and synchronous delivery models for home-based cardiac rehabilitation: a scientific review. J Cardiopulm Rehabil Prev. 2021;41(6):407–12. https://doi.org/10.1097/HCR.0000000000000656.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Santiago M, Cardoso-Teixeira P, Pereira S, Firmino-Machado J, Moreira S. A hybrid-telerehabilitation versus a conventional program for urinary incontinence: a randomized trial during COVID-19 pandemic. Int Urogynecol J. 2022;34(3):717–27. https://doi.org/10.1007/s00192-022-05108-6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Stamey TA. Endoscopic suspension of the vesical neck for urinary incontinence in females. Report on 203 consecutive patients. Ann Surg. 1980;192(4):465–71. https://doi.org/10.1097/00000658-198010000-00005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Özlü A, Yıldız N, Öztekin Ö. Comparison of the efficacy of perineal and intravaginal biofeedback assisted pelvic floor muscle exercises in women with urodynamic stress urinary incontinence. Neurourol Urodyn. 2017;36(8):2132–41. https://doi.org/10.1002/nau.23257.

    Article  PubMed  Google Scholar 

  11. Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87(12):631–42. https://doi.org/10.1016/S0031-9406(05)61108-X.

    Article  Google Scholar 

  12. Padilla-Fernandez B, Gomez-Garcia A, Hernandez-Alonso M, et al. Biofeedback with pelvic floor electromyography as complementary treatment in chronic disorders of the inferior urinary tract. In: Türker H, editor., et al., Electrodiagnosis in new frontiers of clinical research. London: InTech; 2013. p. 287–304. https://doi.org/10.5772/56237.

    Chapter  Google Scholar 

  13. Tincello DG, Williams KS, Joshi M, Assassa RP, Abrams KR. Urinary diaries: a comparison of data collected for three days versus seven days. Obstet Gynecol. 2007;109(2 Part 1):277–80. https://doi.org/10.1097/01.AOG.0000252832.21986.c8.

    Article  PubMed  Google Scholar 

  14. Çetinel B, Özkan B, Can G. ICIQ-SF Türkçe versiyonu validasyon (geçerlilik) çalışması. Turk J Urol. 2004;30(3):332–8.

    Google Scholar 

  15. Cam C, Sakalli M, Ay P, Cam M, Karateke A. Validation of the short forms of the incontinence impact questionnaire (IIQ-7) and the urogenital distress inventory (UDI-6) in a Turkish population. Neurourol Urodyn. 2007;26(1):129–33. https://doi.org/10.1002/nau.20292.

    Article  PubMed  Google Scholar 

  16. Tarcan T, Mangır N, Özgür MÖ, Akbal C. OAB-V8 Aşırı aktif mesane sorgulama formu validasyon çalışması. Üroloji Bülteni. 2012;21(21):113–6.

    Google Scholar 

  17. Zengin N. İdrar Kaçıran Kadınlarda Hemşirelik Eğitimi Ve Davranışsal Tedavinin Konfor Pelvik Taban Kas Egzersizi Uygulaması Öz-Etkililik Algısı Ve Yaşam Kalitesine Etkisi Marmara Universitesi, Turkey. 2008.

  18. Piaggio G, Elbourne DR, Pocock SJ, Evans SJW, Altman DG. CONSORT Group ft. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA. 2012;308(24):2594–604. https://doi.org/10.1001/jama.2012.87802.

    Article  CAS  PubMed  Google Scholar 

  19. Dufour S, Fedorkow D, Kun J, Deng SX, Fang Q. Exploring the impact of a mobile health solution for postpartum pelvic floor muscle training: pilot randomized controlled feasibility study. JMIR Mhealth Uhealth. 2019;7(7):e12587. https://doi.org/10.2196/12587.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wang X, Ji X. Sample size estimation in clinical research: from randomized controlled trials to observational studies. Chest. 2020;158(1):S12–20. https://doi.org/10.1016/j.chest.2020.03.010.

    Article  PubMed  Google Scholar 

  21. Cohen J. Statistical power analysis for the behavioral sciences. Hoboken: Taylor and Francis; 2013.

    Book  Google Scholar 

  22. Lim R, Liong ML, Lim KK, Leong WS, Yuen KH. The minimum clinically important difference of the international consultation on incontinence questionnaires (ICIQ-UI SF and ICIQ-LUTSqol). Urology. 2019;133:91–5. https://doi.org/10.1016/j.urology.2019.08.004.

    Article  PubMed  Google Scholar 

  23. Allan BB, Bell S, Husarek K. Early feasibility study to evaluate the Viveve System for female stress urinary incontinence: interim 6-month report. J Womens Health. 2020;29(3):383–9. https://doi.org/10.1089/jwh.2018.7567.

    Article  Google Scholar 

  24. Figueiredo VB, Nascimento SL, Martínez RF, Lima CT, Ferreira CH, Driusso P. Effects of individual pelvic floor muscle training vs individual training progressing to group training vs group training alone in women with stress urinary incontinence: a randomized clinical trial. Neurourol Urodyn. 2020;39(5):1447–55. https://doi.org/10.1002/nau.24370.

    Article  PubMed  Google Scholar 

  25. Bech SR, Villadsen D, Laursen HH, et al. The effect of group or individualised pelvic floor exercises with or without ultrasonography guidance for urinary incontinence in elderly women—a pilot study. J Bodyw Mov Ther. 2021;28:34–41. https://doi.org/10.1016/j.jbmt.2021.07.032.

    Article  PubMed  Google Scholar 

  26. Thompson JA, O’Sullivan PB, Briffa NK, Neumann P. Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J. 2006;17:624–30. https://doi.org/10.1007/s00192-006-0081-2.

    Article  Google Scholar 

  27. Navarro Brazález B, Torres Lacomba M, de la Villa P, et al. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: a reliability and correlation study. Neurourol Urodyn. 2018;37(1):269–77. https://doi.org/10.1002/nau.23287.

    Article  PubMed  Google Scholar 

  28. Dumoulin C, Morin M, Danieli C, et al. Group-based vs individual pelvic floor muscle training to treat urinary incontinence in older women: a randomized clinical trial. JAMA Intern Med. 2020;180(10):1284–93. https://doi.org/10.1001/jamainternmed.2020.2993.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tenfelde S, Janusek LW. Yoga: a biobehavioral approach to reduce symptom distress in women with urge urinary incontinence. J Altern Complement Med. 2014;20(10):737–42. https://doi.org/10.1089/acm.2013.0308.

    Article  PubMed  Google Scholar 

  30. Johnson TM, Burgio KL, Redden DT, Wright KC, Goode PS. Effects of behavioral and drug therapy on nocturia in older incontinent women. J Am Geriatr Soc. 2005;53(5):846–50. https://doi.org/10.1111/j.1532-5415.2005.53260.x.

    Article  PubMed  Google Scholar 

  31. Zuluaga L, Caicedo JI, Mogolló MP, et al. Anxiety and depression in association with lower urinary tract symptoms: results from the COBaLT study. World J Urol. 2023;41(5):1381–8. https://doi.org/10.1007/s00345-023-04351-w.

    Article  PubMed  Google Scholar 

  32. Goldman HB, Wyndaele JJ, Kaplan SA, Wang JT, Ntanios F. Defining response and non-response to treatment in patients with overactive bladder: a systematic review. Curr Med Res Opin. 2014;30(3):509–26. https://doi.org/10.1185/03007995.2013.860021.

    Article  CAS  PubMed  Google Scholar 

  33. Yalcin I, Peng G, Viktrup L, Bump RC. Reductions in stress urinary incontinence episodes: what is clinically important for women? Neurourol Urodyn. 2010;29(3):344–7. https://doi.org/10.1002/nau.2074.

    Article  PubMed  Google Scholar 

  34. Krhut J, Gärtner M, Mokris J, et al. Effect of severity of urinary incontinence on quality of life in women. Neurourol Urodyn. 2018;37(6):1925–30. https://doi.org/10.1002/nau.23568.

    Article  PubMed  Google Scholar 

  35. Dumoulin C, Morin M, Mayrand MH, Tousignant M, Abrahamowicz M. Group physiotherapy compared to individual physiotherapy to treat urinary incontinence in aging women: study protocol for a randomized controlled trial. Trials. 2017;18(1):544. https://doi.org/10.1186/s13063-017-2261-4.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cacciari LP, Morin M, Mayrand MH, Tousignant M, Abrahamowicz M, Dumoulin C. Pelvic floor morphometrical and functional changes immediately after pelvic floor muscle training and at 1-year follow-up, in older incontinent women. Neurourol Urodyn. 2021;40(1):245–55. https://doi.org/10.1002/nau.24542.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Emel METE and all participants who contributed to the study. Berivan Beril Kiliç is supported by “Turkey’s Council of Higher Education—YÖK 100/2000 Doctoral Scholarship Program” and “The Scientific and Technological Research Council of Turkey—TUBİTAK BİDEB 2211-A General National PhD Scholarship Program” within the scope of doctoral education.

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Authors and Affiliations

  1. Faculty of Health Sciences, Department of Physiotherapy Rehabilitation, Marmara University, Istanbul, Turkey

    Berivan Beril Kilic, Aysel Yildiz Ozer & Mine Gulden Polat

  2. Gynecology and Obstetrics Clinic, Goztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey

    Cemalettin Ozarpaci

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  1. Berivan Beril Kilic
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Contributions

B.B.K.: project development, data collection, manuscript writing; A.Y.O.: project development, statistical analysis, manuscript writing; C.O.: manuscript writing/editing; M.G.P.: manuscript writing/editing. All authors read and approved the final manuscript.

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Correspondence to Berivan Beril Kilic.

Ethics declarations

Ethical Approval

Ethical approval was obtained from the Scientific Research Ethical Committee of the Faculty of Medicine of Marmara University (approval date and number: 30.11.2020/09.2021.1195). This study was conducted in compliance with the Declaration of Helsinki (Clinical trial registry number: NCT05154760).

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Informed consent was obtained from all individual participants included in the study.

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Handling Editor: Rufus Cartwright

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Appendix

Appendix

Table 4 The progressive training program
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Kilic, B.B., Yildiz Ozer, A., Ozarpaci, C. et al. The Comparison of Individual and Group Hybrid Telerehabilitation Methods in Women with Urinary Incontinence. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05808-1

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