Randomized controlled trial of physiotherapy for postpartum stress incontinence: 7-year follow-up§

Authors

  • Chantale Dumoulin,

    Corresponding author
    1. Faculty of Medicine, School of Rehabilitation, University of Montreal, Montreal, Québec, Canada
    2. Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montreal, Québec, Canada
    • Faculty of Medicine, School of rehabilitation, University of Montreal, C.P. 6128 Succ. Centre-ville, Montréal, Québec, Canada H3C 3J7.
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  • Claudine Martin,

    1. Faculty of Medicine, School of Rehabilitation, University of Montreal, Montreal, Québec, Canada
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  • Valérie Elliott,

    1. Faculty of Medicine, School of Rehabilitation, University of Montreal, Montreal, Québec, Canada
    2. Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montreal, Québec, Canada
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  • Daniel Bourbonnais,

    1. Faculty of Medicine, School of Rehabilitation, University of Montreal, Montreal, Québec, Canada
    2. Montreal Rehabilitation Institute, a Research Site of the Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, Québec, Canada
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  • Mélanie Morin,

    1. Faculty of Medicine and Health Sciences, School of Rehabilitation, Sherbrooke University, Sherbrooke, Québec, Canada
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  • Marie-Claude Lemieux,

    1. Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Montreal and Maisonneuve-Rosemont Hospital, Montreal, Québec, Canada
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  • Robert Gauthier

    1. Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Montreal and Ste-Justine's Hospital, Montreal, Québec, Canada
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  • Mickey Karram led the peer-review process as the Associate Editor responsible for the paper.

  • Disclosure: Chantale Dumoulin was supported by a New investigator fellowship from the Fonds de la Recherche en Santé du Québec (FRSQ) and the Canadian Institute for Health Research (CIHR).

  • §

    Conflict of interest: none.

Abstract

Objective

To estimate the long-term effect of intensive, 6-week physiotherapy programs, with and without deep abdominal muscle (TrA) training, on persistent postpartum stress urinary incontinence (SUI).

Methods

The study was a single-blind randomized controlled trial. Fifty-seven postnatal women with clinically demonstrated persistent SUI 3 months after delivery participated in 8 weeks of either pelvic floor muscle training (PFMT) (28) or PFMT with deep abdominal muscle training (PFMT + TrA) (29). Seven years post-treatment, 35 (61.4%) participants agreed to the follow-up; they were asked to complete a 20-min pad test and three incontinence-specific questionnaires with an assessor blinded to each participant's group assignment.

Results:

Of the 35 (61.4%) who agreed to the follow-up: 26 (45.6%) took the 20-min pad test (12 PFMT and 14 PFMT + TrA) and 35 (61.4%) completed the questionnaires (18 PFMT and 17 PFMT + TrA). The baseline clinical characteristics of the follow-up and non-follow-up participants were not significantly different; nor did they differ between PFMT and PFMT + TrA participants enrolled in the follow-up study. At 7 years, the pad test scores for the PFMT group did not differ statistically from those of the PFMT + TrA group. When combining both treatment groups, a total of 14/26 (53%) follow-up participants were still continent according to the pad test.

Conclusion

The addition of deep abdominal training does not appear to further improve the outcome of PFM training in the long term. However, benefits of physiotherapy for postpartum SUI, although not as pronounced as immediately after the initial intervention, is still present 7 years post-treatment. Neurourol. Urodynam. 32: 449–454, 2013. © 2013 Wiley Periodicals, Inc.

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