title: Physiotherapy for female stress urinary incontinence: individual therapy at the outpatient clinic versus home-based pelvic floor training: a 5-year follow-up study.
abstract: OBJECTIVE
  To compare the long-term effects of individual physiotherapy at an outpatient clinic, including electrical stimulation (ES), active pelvic floor muscle exercises (PFMEs), and training with a vaginal ball (VB), with home-based active PFMEs and training with a VB, in cases of female stress urinary incontinence (SUI).
  
  
  METHODS
  Thirty-three women with SUI (outpatient clinic group [Group I, n = 16] and home group [Group II, n = 17]) participated in the 5-year follow-up study. Both groups had an active PFME program and they used a VB during daily activities for intensive pelvic floor muscle (PFM) training. Group I was also treated at the outpatient clinic with maximal interferential ES, using frequencies varying from 10 to 50 Hz, and individually instructed exercises with biofeedback were carried out at the same time, once a week, an average of nine times in the first year. After baseline examinations, both groups visited the outpatient clinic at 4 months, 12 months, and at 5 years.
  
  
  RESULTS
  At 12 months, there were no statistically significant differences between the study groups in any of the outcome variables, but within the groups both the subjective and objective results were significantly better in comparison with the initial values. After 12 months, two (3%) patients in Group I continued physiotherapy and seven (41%) patients in Group II needed physiotherapy because of an unsatisfactory outcome. At 5 years, according to the urinary incontinence severity score (UISS) questionnaire, subjective discomfort had decreased in both groups (P < 0.01) and 21 of the 33 women (64%) perceived a subjective cure or improvement in their condition. The mean objective urine leakage verified by the pad test decreased from 23.0 to 1.0 g in Group I and from 13.0 to 1.0 g in Group II (P < 0.001 for both groups). The strength of PFMs tested in a standing position increased by 26% in Group I and by 19% in Group II (P values 0.001 and 0.084, respectively), and in a lying position by 28% in Group I and by 32% in Group II (P values 0.001 and 0.008, respectively).
  
  
  CONCLUSIONS
  Home-based PFMEs and training with a VB proved to be equally effective as once-a-week supervised therapy, and the 5-year follow-up results demonstrated a successful response in the treatment of female SUI.
authors.affiliation: Department of Obstetrics and Gynaecology, Kainuu Central Hospital, Kajaani, Finland. arja.parkkinen@kainuu.fi
authors.forename: A
authors.initials: A
authors.lastname: Parkkinen
authors.forename: E
authors.initials: E
authors.lastname: Karjalainen
authors.forename: M
authors.initials: M
authors.lastname: Vartiainen
authors.forename: J
authors.initials: J
authors.lastname: Penttinen
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D001676:Biofeedback, Psychology; D004599:Electric Stimulation Therapy; D004576:Electromyography; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016496:Incontinence Pads; D008875:Middle Aged; D017773:Pelvic Floor / Q000502:physiology*; D026741:Physical Therapy Modalities; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics