title: Comparison of pelvic floor muscle training, electromyography biofeedback, and neuromuscular electrical stimulation for bladder dysfunction in people with multiple sclerosis: a randomized pilot study.
abstract: OBJECTIVE
  Bladder dysfunction affects up to 90% of the multiple sclerosis (MS) population. Interventions such as Pelvic Floor Training and Advice (PFTA), Electromyography (EMG) Biofeedback, and Neuromuscular Electrical Stimulation (NMES) have received limited research attention within this population. This study aimed to determine the effectiveness of a combined programme of PFTA, EMG Biofeedback, and NMES for bladder dysfunction in MS.
  
  
  METHODS
  Females (n = 30) who fulfilled strict inclusion/exclusion criteria were recruited. Outcome measures (weeks 0, 9, 16, and 24) included: 3-day Voiding Diary; 24 hr Pad-Test; Uroflowmetry; Pelvic Floor Muscle Assessment; Incontinence Impact Questionnaire (IIQ); Urogenital Distress Inventory (UDI); King's Health Questionnaire (KHQ), and the Multiple Sclerosis Quality of Life-54 Instrument (MSQoL-54). Following baseline (week 0) assessment, participants were randomly allocated, under double blind conditions, to one of the three groups: Group 1 (PFTA); Group 2 (PFTA and EMG Biofeedback); and Group 3 (PFTA, EMG Biofeedback, and NMES). Treatment was for 9 weeks.
  
  
  RESULTS
  Baseline severity (measured by number of leaks and pad weight) showed some variation between groups, although not statistically significant (P > 0.05); with the caveat that this baseline imbalance makes interpretation difficult, a picture emerges that at week 9, Group 3 demonstrated superior benefit as measured by the number of leaks and pad test than Group 2, with Group 1 showing less improvement when compared to week 0; this was statistically significant between Groups 1 and 3 for number of leaks (P = 0.014) and pad tests (P = 0.001), and Groups 1 and 2 for pad tests (P = 0.001). A similar pattern was evident for all other outcome measures.
  
  
  CONCLUSIONS
  Results suggest that these treatments, used in combination, may reduce urinary symptoms in MS. Further research will establish the effectiveness of these interventions.
authors.affiliation: Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Northern Ireland.
authors.forename: D
authors.initials: D
authors.lastname: McClurg
authors.forename: R G
authors.initials: RG
authors.lastname: Ashe
authors.forename: K
authors.initials: K
authors.lastname: Marshall
authors.forename: A S
authors.initials: AS
authors.lastname: Lowe-Strong
mesh_terms: D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology / Q000379:methods*; D004326:Drinking; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography; D005260:Female; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D010173:Palpation; D017773:Pelvic Floor / Q000502:physiology*; D010865:Pilot Projects; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics; D014621:Vagina