title: Impact of a Pelvic Floor Training Program Among Women with Multiple Sclerosis: A Controlled Clinical Trial.
abstract: OBJECTIVE
  The objective of this study was to investigate the effects of two programs for strengthening the pelvic floor on the urinary incontinence of patients with multiple sclerosis (MS).
  
  
  METHODS
  This is a prospective study of the clinical trial type, monitored for 6 mos, in which 24 women in the moderate stage of MS participated in a program of exercises for strengthening the pelvic floor-associated (experimental group) or not (control group) with electrotherapy. The variables analyzed were as follows: quality-of-life, overactivity of the bladder, perineal contraction, and level of anxiety and depression. The statistical procedures involved multivariate analyses of repeated measurements, with a significance of 5%.
  
  
  RESULTS
  Initial homogeneity being observed in the anthropometric and clinical variables, both protocols resulted in improvements in quality-of-life (P = 0.001), overactive bladder (P = 0.001), perineal contraction (P = 0.004), and level of anxiety (P = 0.001) and depression (P = 0.001), in relation to the initial comparison. The association of electrotherapy with strengthening exercises increased the improvement of the patients regarding overactive bladder (P = 0.039) and perineal contraction (P = 0.001), in comparison with the control group.
  
  
  CONCLUSIONS
  The results reinforce the benefit of exercises for strengthening the musculature of the pelvic floor in women with overactive bladder in MS and demonstrate a potential of the action when associated with electrotherapy.
  Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Identify common dysfunctions of the lower urinary tract in women with multiple sclerosis; (2) Discuss the relationship between quality-of-life, level of anxiety and depression, degree of perineal contraction, and overactive bladder; and (3) Recognize the benefits promoted by physical therapy for strengthening the pelvic floor in patients with multiple sclerosis.
  Advanced
  : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.
authors.affiliation: From the Graduate Program in Health and Development (APSF, GC) and Multiple Sclerosis Outpatient Clinic (PRS), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil; Dom Bosco Catholic University (UCDB), Campo Grande, Mato Grosso do Sul, Brazil (ABGdSP); and Integra Care Center, Bauru, São Paulo, Brazil (FSC).
authors.forename: Ana Paula Silva
authors.initials: AP
authors.lastname: Ferreira
authors.forename: Ana Beatriz Gomes de Souza
authors.initials: AB
authors.lastname: Pegorare
authors.forename: Pedro Rippel
authors.initials: PR
authors.lastname: Salgado
authors.forename: Filemón Silva
authors.initials: FS
authors.lastname: Casafus
authors.forename: Gustavo
authors.initials: G
authors.lastname: Christofoletti
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D009103:Multiple Sclerosis / Q000503:physiopathology*; D009119:Muscle Contraction / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D017773:Pelvic Floor / Q000503:physiopathology*; D011446:Prospective Studies; D011788:Quality of Life; D014549:Urinary Incontinence / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*