title: Pelvic floor morphometry: a predictor of success of pelvic floor muscle training for women with stress and mixed urinary incontinence.
abstract: OBJECTIVE
  The aim of this study was to determine if pelvic floor muscle (PFM) morphometry at baseline, as measured by MRI, can predict response to PFM training in women with stress or mixed urinary incontinence (UI).
  
  
  METHODS
  This study was a prospective quasi-experimental pre-test, post-test cohort study of women with UI, aged 60 years and older. All participants completed a baseline assessment of UI severity and impact, using the 72-h bladder diary and the Incontinence Impact Questionnaire. They underwent a pelvic MRI examination to assess the PFM anatomy. Women then participated in a 12-week PFM training program. Finally, they attended a post intervention assessment of UI severity and impact. The association between morphometry and PFM training response was assessed by univariate analysis, multivariate analysis, and receiver operating characteristic (ROC) curve analysis.
  
  
  RESULTS
  The urethro-vesical junction height at rest, as measured by MRI before treatment, was associated with response to PFM training both on univariate (p ≤ 0.005) and multivariate analyses (p = 0.007). The area under the ROC curve was 0.82 (95% confidence interval [CI]: 0.67-0.96). Using a cut-off point of 11.4 mm, participants' response to PFM training was predicted with a sensitivity of 77% and a specificity of 83%. Incontinent women with a urethro-vesical junction height above this threshold were 35% more likely to respond to PFM training (OR 1.35; 95% CI: 1.08-1.67).
  
  
  CONCLUSIONS
  In older women with UI, a urethro-vesical junction height at rest of at least 11.4 mm appears to be predictive of PFM training response.
authors.affiliation: School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. chantal.dumoulin@umontreal.ca.|Urogynecological Health and Aging Canadian Research Chair, Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada. chantal.dumoulin@umontreal.ca.
authors.forename: Chantale
authors.identifier: http://orcid.org/0000-0002-4594-5775
authors.initials: C
authors.lastname: Dumoulin
authors.affiliation: Faculty of Medicine, Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors.forename: An
authors.initials: A
authors.lastname: Tang
authors.affiliation: School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.|Urogynecological Health and Aging Canadian Research Chair, Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Pontbriand-Drolet
authors.affiliation: School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Madill
authors.affiliation: School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Morin
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000473:pathology; D065228:Non-Randomized Controlled Trials as Topic; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000473:pathology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D055070:Resistance Training / Q000379:methods*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014521:Urethra / Q000000981:diagnostic imaging / Q000473:pathology; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000473:pathology; D014549:Urinary Incontinence / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy
keywords: Morphometry; Older women; Pelvic floor muscle training; Physiotherapy; Predictors; Urinary incontinence