Physiotherapist and exercise scientist Kari Bø is a Professor in the Norwegian School of Sport Sciences in Oslo, Norway. She has published over 270 peer-reviewed articles in the field of continence and women’s health (topics include pelvic floor dysfunction, treatment of incontinence and back/pelvic pain, exercise during pregnancy and after childbirth, diastasis recti abdominis, measurement methodology). Kari has received numerous international awards, including one of her randomised controlled trials on pelvic floor muscle training being named as a PEDro 15 top trials (2014), the Mildred Elson Award from the World Confederation of Physiotherapy (2015), and the International Continence Society Lifelong Achievement Award (2016).
Kari attended the International Continence Society’s annual conference in Gothenburg, Sweden in September 2019. Two randomised controlled trials and a long-term follow-up study caught her eye.
Dumoulin C, et al. Group physiotherapy compared to individual physiotherapy to treat urinary incontinence in older women: a non-inferiority randomized controlled trial. Presented at ICS 2019; Gothenburg, Sweden; 3-6 September 2019. (Note: the trial is registered and the protocol has been published.)
This well-designed non-inferiority, multicenter randomised controlled trial compared individual pelvic floor muscle training to group training for women with stress and mixed urinary incontinence. Participants undertook 12 weeks of 1-hour weekly one-on-one or group training sessions (note: before starting group training, participants had an individual session with a trained physiotherapist). Participants in both groups did exercises at home. Participants in both groups attended almost 100% of sessions and completed 86% of the home exercise. At one year follow-up the median reduction in the frequency of incontinence was 70% in individual training compared to 74% for group training. There were no differences between the groups in any outcome measures. Kari says: “since I published my trial in 1990, physiotherapists have debated the effect of group vs individual training. This trial clearly shows that group training is not inferior to individual training.” Some advantages of group pelvic floor muscle training is that it is less resource intense than individual training, is motivating for both participants and the physiotherapist, and the training can be combined with health education and many other exercises important for women’s health.
Hagen S et al: Effectiveness and cost-effectiveness of biofeedback-assisted pelvic floor muscle training for female urinary incontinence: a muticentre randomized controlled trial. Presented at ICS 2019; Gothenburg, Sweden; 3-6 September 2019. (Note: the trial was registered and the protocol has been published.)
This large-scale (n=600), multicentre trial compared electromyography (EMG) biofeedback-assisted pelvic floor muscle training to pelvic floor muscle training alone for women with stress or mixed urinary incontinence. Each participant was offered 6 appointments over 16-week period, received an individually tailored program, and undertook home training. Participants in the EMG biofeedback group also received biofeedback during the appointments and were given biofeedback units for home use. Outcome data were collected via questionnaire at 6 months, 1 and 2 years. There were no differences between the groups in any outcome at any time-point. The trial concluded that adding EMG biofeedback to pelvic floor muscle training offers no benefit over pelvic floor muscle training alone in terms of long term continence outcome. Kari says: “this high-quality trial has an important message for physiotherapists treating women with urinary incontinence – pelvic floor muscle training is the key element of treatment.”
This is a 10-year follow-up of women with pelvic organ prolapse who were participants in the POPPY trial that compared pelvic floor muscle training to control (receiving a prolapse lifestyle advice leaflet). Only the Scottish part of the trial (11 out of 23 centres) was included in the follow-up. Linking to outpatient and inpatient hospital activity data between the date of randomisation and the end of the linkage period was carried out. Compared to control, a lower proportion of participants in the pelvic floor muscle training group had received hospital treatment (adjusted odds ratio 0.60, 95% confidence interval 0.36 to 0.98). The median time to first treatment or censoring in the intervention group was 3,008 days (interquartile range 589 to 3,396) compared to 2,242 days for the control group (628.5 to 3279). Kari says: “despite there being level 1 evidence supporting the use of pelvic floor muscle training as the first line treatment of pelvic organ prolapse, the long-term effects of physiotherapy interventions is always questioned. The results of this long-term follow up study are important, especially today when there is a global concern about the devastating complications that occur after mesh surgery. There is a need for more trained physiotherapists to offer evidence-based pelvic floor muscle training to this patient group.”