Tibaek-04, 05 [13, 14]

Assessor-blinded two-arm RCT:

1. PFMT n = 14

2. Control n = 12

No treatment for UI, standard rehabilitation program

26 women. Mean age 60 years (range 56–74) after ischemic stroke

UI assessed by IIQ-7 (urgency, stress, and mixed incontinence)

12 weeks of PFMT

6-, 3-, and 30-s contractions. Every contraction 4–8 times in different positions. Conducted in groups + individual assessment with vaginal palpation and home exercise 1–2 times/day

2 dropouts (8%)

Statistically significant increase in PFM endurance compared with control

Statistically significant improvement in PFMT in frequency of daytime voiding from 7 to 6 (p = 0.018), 24-h pad test from 8 to 2 g (p = 0.013)

No effect in SF-36 or IIQ-7

Tibaek-07

[15]

6-month follow-up of assessor-blinded RCT

1. PFMT n = 12

2. Control n = 12

24 women with postischemic stroke

UI assessed by IIQ-7

Same as Tibaek (2005)

8%

Telephone interview: Trend, but not statistically significant difference between groups in Short form SF-36 or IIQ-7

Shin-16 [16]

Assessor-blinded two-arm RCT:

1. PFMT (n = 16) general rehabilitation + PFMT

2. Control (n = 15) general rehabilitation

31 female patients >3 months post-stroke

SUI assessed by B-FLUTS

6 weeks of PFMT

3 dropouts

After intervention:

Manometry (mmHg):

1. 18.35 (5.24)

2. 8.46 (3.50)

sEMG ((μV):

1. 12.09 (2.24)

2. 9.33 (3.40)

B-FLUTS Change of scores:

inconvenience:

1. −15.00 (6.25)

2. −0.17 (1.59)

Score of symptoms:

1. −4.17 (4.00)

2. −0.25 (1.29) p < 0.05

Tibaek-16

Tibaek-17 [17, 18]

Assessor-blinded two-arm RCT

1. Control: General rehabilitation, n = 15

2. General rehabilitation + PFMT, n = 15

31 post-stroke men, median age 68

3 months of 12-weekly 60-min sessions of group PFMT with physical therapist including anal assessment + home exercise

1 dropout

Median PFMT adherence 11/12 (92%)

Anal palpation

Statistically significant better improvement (p > 0.03) in PFM function in PFMT than control in short term, but not long term

DAN-PSS-1:

No sign difference in change between groups

SF-36 and nocturia QoL questionnaire: No statistically significant difference between groups

Vahtera-97 [19]

Not blinded two-arm RCT:

1. PFMT + interferential ES, n = 40

2. No treatment for LUTD, n = 40

50 women and 30 men with MS, age range 25–68

LUTS by self-administered questionnaire

6 months of 10 times 3-s contractions, 5 times 5-s contractions, 5 times 15-s contraction in different positions.

ES: interferential, carrier frequency: 2000 Hz, frequency, 5–19 Hz, 10–50 Hz, and 50 Hz (10 min of each). Six sessions during 21 days outpatient. Home exercise: 20 contractions 3–5 days/week in sitting and standing position

2/40 in treatment group

No information about controls

62.5%

sEMG

Sign improvement over control, p < 0.01

Significant improvement in intervention over control group in UI, nocturia, and urgency p < 0.001, QoL (traveling, social shame, and need for pads)

McClurg-06 [20]

Not blinded three-arm RCT:

1. PFMT + advice n = 10

2. PFMT + advice + EMG biofeedback n = 10

3. PFMT + advice + sEMG biofeedback + ES n = 10

30 women with MS, age range 33–67

Leakage on voiding diary, 24-h pad test, uroflowmetry

9-week treatment period, assessment at weeks 0, 9, 16, 24

ES: biphasic constant current, 5–30 min daily, two parameter settings: 40 Hz, 5-s on, 10-s off

10 Hz, 10-s on, 3-s off

2/30

Vaginal palpation

Number of leaks (p = 0.014) and pad test (p = 0.001) significantly better in group 3 compared to group 1 and between groups 2 and 1 for pad test (p = 0.001)

McClurg-08 [21]

Assessor and subject-blinded two-arm RCT:

1. Control: PFMT, biofeedback + placebo ES, n = 37

2. ES: PFMT, biofeedback + ES, n = 37

74 women with MS, age range 27–72

Leakage on voiding diary, 24-h pad test, uroflowmetry

9-week treatment, assessment at weeks 0, 9, 16, 24

ES: biphasic constant current, 5–30 min daily, two parameter settings: 40 Hz, 5-s on, 10-s off

10 Hz, 10-s on, 3-s off

2/74

Vaginal palpation, sEMG

Sign difference in favor of ES for leakage, 24-h pad test

Khan-10

[22]

Not blinded two-arm RCT:

1. Bladder rehab, n = 40

2. Control: usual care, n = 34

74 women with MS, age range 29–65

Inpatient program: 3 h/day over 6 weeks

Outpatient program: 30 min 2–3 times/week

Therapy: individual, assessment of bladder type, diary with strict fluid, PFMT, timed voiding

22%

Significant difference in favor of intervention in UDI-16, NSD, AUA, IIQ-7 (p < 0.01). Improvement in bladder function, overactivity and QoL

Lucio-10, -11 [23, 24]

Assessor-blinded two-arm RCT

1. PFMT with vaginal manometry, n = 18

2. Sham PFMT: Insertion of vaginal instrument with no contraction, n = 17

35 women with MS, age range 20–49

Lower urinary tract dysfunction assessed with urodynamics

30 min 2 times/week for 12 weeks (outpatient)

PFMT with vaginal manometer: 30 slow contractions, 3 min of fast contractions, supine position. Home exercise: 3 × 30 slow contractions, 3 min with fast contractions

22.8%

Vaginal manometry. Statistically significant improvement in muscle strength, endurance, resistance, number of fast contractions, p < 0.001

Between-group differences in favor of PFMT:

Pad test: 87.5–6.03 vs. 69.46–75.88, p < 0.001

Number of pads: 3.61–2.15 vs. 3.42–3.28, p = <0.01

Nocturia events: 2.38–0.46 vs. 2.55–2.47, p > 0.001, ICIQ, OAB questionnaire, medical outcome study, QoL: Qualiveen questionnaire.

No sign difference in urodynamics

Gaspard-14 [25]

Assessor-blinded RCT:

1. PFMT + biofeedback n = 16

2. Transcutaneous posterior tibia nerve stimulation n = 15

31 participants

EDSS score <7 and lower urinary tract symptoms

9 session of 30 weekly sessions

1. Muscle endurance and relaxation

2. Rectangular alternative biphasic current with low frequency

No information. Article in French. Abstract in English.

Statistically significant improvement in QoL, frequency of urgency episodes, but no difference between groups

Ferreira-15 [26]

Assessor-blinded RCT:

1. PFMT + ES

2. Home PFMT

24 women, mean age 43.2 years (10.68)

Moderate stage of MS, 3.0–5.0 EDSS

48 sessions 2 times /week over 6 months with physical therapist

Electrostimulation, 2 Hz, 1 ms pulse duration, tolerable intensity on S4 dermatome- perineum + 3 sets of 10 PFM contractions per day

Control group; 10 sets of home PFM contractions per day

Vaginal palpation. Group 1 had statistically significant improvement over the control group in al sub-scores, p < 0.001

QoL: Only statistical significant difference in “Restrictions,” p = 0.0031, OAB: statistically significant difference in change in favor of Group 1, p = 0.039.

Hospital anxiety and depression: no statistically significant difference between groups

Lucio-16 [27]

Assessor-blinded RCT

1. PFMT with sEMG biofeedback + sham ES, n = 10

2. PFMT with sEMG biofeedback + ES, n = 10

3. PFMT with sEMG + transcutaneous tibial nerve stimulation, n = 10

30 women with MS, 42–52 years old

MS with EDSS score <6.5

LUTS: score ≥ 9 on

OAB –V8

Urodynamic assessment

ICIQ-UI-SF

12-week intervention with physical therapist 50 min twice a week

5 dropouts

Ability to contract PFM: vaginal palpation.

Statistically significant improvement in Group 2 in PFM tone, flexibility, ability to relax PFM

24-h pad test: no difference between groups

OAB-V8: Group 2 significant improvement over other groups, p < 0.01