Sixty-one women between the ages of 35 and 78 with complaints of urinary incontinence were selected and underwent one of two treatments: The APR protocol, carried out in individual sessions with a combination of kinesiotherapy with biofeedback, electrical stimulation, vaginal cones and home exercises, over a period of three months; or group exercises (GE), carried out in groups of three to five participants, over a period of six months. The volunteers were divided into three groups according to the pelvic floor muscle (PFM) force and the treatment undertaken: APRa (n=14) patients with force 0 or 1, and treated with APR protocol; APRb (n=21) patients with force between 2 and 5, and treated with APR protocol; and GE (n=26) patients with force between 2 and 5, and treat with group exercises.
Active Perineal Rehabilitation is composed by 14 sessions, that respects the 3 phases of rehabilitation: sessions 1 to 4 - teaching the correct movement; sessions 5 to 8 - muscle agility; sessions 9 to 14 - muscle strength. In each session, the patient will make kinesiotherapy with EMG biofeedback and electrical stimulation with a vaginal or anal probe. To home, they will perform a series of exercises and will use vaginal cones. All the 14 sessions gradually increase the intensity of exercises and last for 12 weeks. In the first month the sessions take place twice a week, in the second month they are weekly, and in the last month, they are every two weeks. Each of the 14 sessions is programmed in a medical device. Because it uses EMG biofeedback each session is individualized for each patient using a percentage of her/his maximum muscle strength. The user can constantly monitor his/her performance and the biofeedback graphics make the session more interesting as well as help in the exercise performance.
The APR protocol is based on exercise physiology, taking in consideration the cognitive, neuromuscular, and metabolic alterations caused by the rehabilitation, with the objective of rehabilitating pelvic floor muscles so that they are able to perform all their functions.
It can be used by both female and male users to prevent or to treat urinary incontinence, sexual dysfunction, fecal incontinence, constipation, pelvic pain, and pelvic organs prolapse in women. When these conditions are in a more advanced stage and surgery is required, the protocol is recommended before and after surgery as a complementary treatment.
There is no medical device on the marketing with a protocol that the user can follow session by session; the protocols that are available only offer isolated exercises without a sequence of use. A device using Active Perineal Rehabilitation will be a significant innovation because the user will have a list of sessions, from 1 to 14, and he/she will know exactly what is required in each session; and will follow a sequence, session by session.