Hypothesis / aims of study
Multiple sclerosis (MS) is a demyelinating disease characterized by the presence of multiple demyelination plaques in white matter of the brain and spinal cord, these lesions damage the information conductions among neurons causing disabilities including urinary symptoms. HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a progressive neurodegenerative disease that causes lower urinary tract symptoms (LUTS). It is known that LUTS affect negatively the quality of life (QoL) when presented making its treatment necessary and conservative managements are the first line treatment. For this reason, the aim of this study was to evaluate the effect of a pelvic floor muscle (PFM) training program in the treatment of LUTS in women with MS and HTLV-1.
Study design, materials and methods
Twenty women participated of this randomized controlled trial were the included women were over 18 years old, with relapsing remitting form of MS (EDSS up to 6.5) or positive serology for HTLV-1, presenting LUTS for at least 6 months (relating at least three of the following symptoms: urgency, urge urinary incontinence, urinary frequency, nocturia and nocturnal enuresis). Pregnant women, those with pelvic prolapse and those submitted to gynecological surgery in the last six months were excluded. Participants were randomized into two groups: treatment group (G1,N=10) and control group (G2, N=10), the G1 underwent sessions of treatment twice a week during six months performing PFM training and intravaginal electrostimulation with frequency of 35Hz, pulse width 500 µs and intensity according to patients’ tolerance. The G2 was instructed to perform PFM training, also during 6 months, at home twice a week and to register by themselves in a schedule the days and time the exercises were performed. The assessment tool were: OAB-V8 questionnaire and PFM function by PERFECT scheme. All participants were evaluated before and after the treatment by a physiotherapist unaware of group’s allocation. Data analysis: Non parametric tests were used, to compare the improvement of groups before and after the treatment the U_Mann Whitney test was used and to compare results after the treatment the qui-square test was used. A level of significance of 5% was considered.
Interpretation of results
In this study the intervention group showed better results when compared with a PFM training protocol performed with no professional assistance at home. The difference in the findings of both groups leads to two assumptions: Probably the G2 didn’t show differences in the PERFECT scheme because as the neurological damages in these population causes difficulties in the conscious of their muscles and a supervised program would benefit neurological population better than performing exercises alone. Second, previous studies showed that the treatment of LUTS with PFM training is greater when added electrostimulation therapy, so the fact that G1 presented better results in both assessment tools can be associated to the use of electrostimulation, as the presence of the electrical current enhances de proprioception of PFM.
This study corroborates with previous finding were the group that showed improvement of PFM function measured by PERFECT scheme also showed improvement of OAB-V8 symptoms, whereas the group that didn’t show improvement in the PFM function also didn’t show improvement in OAB-V8 scores.