A model identifying characteristics predictive of successful pelvic floor muscle training outcomes among women with stre
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ORIGINAL ARTICLE
A model identifying characteristics predictive of successful pelvic floor muscle training outcomes among women with stress urinary incontinence Kaylee C. L. Brooks 1 & Kevin Varette 2 & Marie-Andrée Harvey 3 & Magali Robert 4 & Robert J. Brison 5 & Andrew Day 6 & Kevin Baker 7 & Vincent Della Zazzera 8 & Eric Sauerbrei 9 & Linda McLean 1,2 Received: 31 August 2020 / Accepted: 20 October 2020 # The Author(s) 2020
Abstract Introduction and hypothesis The aim of this study was to prospectively identify aspects of baseline demographic, clinical, and pelvic morphology of women with stress urinary incontinence (SUI) that are predictive of cure with physiotherapist-supervised pelvic floor muscle training (PFMT). Methods Women ≥18 years old with SUI were recruited from urogynecology and pelvic health physiotherapy clinics. Participants completed a 3-day bladder diary, the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), a standardized pad test, manual assessment of pelvic floor muscle (PFM) strength and tone, and transperineal ultrasound (TPUS) assessment of their urogenital structures at rest while in a supine position and standing, and during contraction, straining, and coughing. Participants attended six physiotherapy sessions over 12 weeks and performed a home PFMT program. The assessment was repeated after the intervention; cure was defined as a dry (≤2 g) pad test. Results Seventy-seven women aged 50 (±10) years completed the protocol; 38 (49%) were deemed cured. Based on univariate testing, four predictors were entered into a binary logistic regression model: ICIQ-UI-SF, PFM tone, bladder neck (BN) height in a quiet standing position, and BN height during a cough in a standing position. The model was significant (p < 0.001), accurately classifying outcome in 74% of participants. The model, validated through bootstrapping, performed moderately, with the area under the receiver operating characteristic curve = 0.80 (95% CI: 0.69–0.90; p = 0.00), and with 70% sensitivity and 75% specificity. Conclusions Women with better bladder support in a standing position and less severe symptoms were most likely to be cured with PFMT. Clinical trial registration #NCT01602107. An abstract based on this work was presented as a short oral presentation at the American Urogynecology Association/International Urogynaecology Association meeting, Nashville, USA, 25–28 September 2019 The study was conducted in Ottawa and Kingston, ON, Canada and Calgary, AB, Canada * Linda McLean [email protected] 1
School of Rehabilitation Sciences, University of Ottawa, Rm E260C, Building E, 200 Lees Avenue, Ottawa, ON K1N 6N5, Canada
2
School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
3
Department of Obstetrics and Gynaecology, Kingston General Hospital, Kingston, Canada
4
Department of Obstetrics and Gynaecology, Foothills General Hospital, Calgary, Canada
5
Department of Emergency Medicine, Kingston General Hospital, Kingston, Canada
6
Depart
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