OBJECTIVE: 

To examine the role of physical function impairments on the change in urinary incontinence (UI) symptoms after pelvic floor muscle training in older women.

METHODS: 

This is a prospective cohort study of 70 community-dwelling participants, older than age 70 years, with at least moderate incontinence symptoms. A comprehensive pelvic floor and physical function assessment was done at baseline. Individualized pelvic floor muscle training prescriptions with behavioral management strategies to reduce incontinence episodes were provided for 12 weeks. Baseline physical function was determined using the SPPB (Short Physical Performance Battery). A total score of 9 or lower out of 12 indicated impaired physical function, and scores higher than 9 indicated normal physical function. A 3-day bladder diary established daily incontinence episodes. The between-group difference in the change in number of UI episodes, from baseline to 6 weeks, was our primary outcome. Descriptive analyses compared important demographic and clinical characteristics. Longitudinal mixed model linear regression analyses determined the change in incontinence episodes and estimates of improvement based on the presence of impaired physical function and adjusted for age, race, and body mass index (BMI).

RESULTS: 

Participants' mean±SD age was 76.9±5.4 years, and 15.7% identified as African American, with no significant differences in age or race between groups. Participants with impaired physical function had higher mean±SD BMI (33.6±14.5 vs 27.4±5.8; P=.03) and more baseline incontinence episodes (4.5±2.9 vs 2.7±2.1 episodes per day; P=.005) than in women without functional impairment. After 6 weeks of pelvic floor exercises, the change in number of incontinence episodes per day was not different between participants with physical functional impairment compared with women with normal physical function (mean [95% CI] −1.2 [−2.0 to −0.5] vs −0.4 [−1.1 to 0.3], P=.31). Overall, after 12 weeks of pelvic floor muscle training, complete satisfaction with incontinence symptom improvement was low for both groups (41.8% with physical function impairments vs 44.8% with normal physical function; P=.90).

CONCLUSION: 

Behavioral therapy including pelvic floor muscle training may not significantly decrease UI symptoms to a degree that is satisfactory in women who are older than 70 years and are seeking treatment for UI, regardless of the presence of physical function impairments.

CLINICAL TRIAL REGISTRATION: 

ClinicalTrials.gov, NCT03057834.

中文翻译：

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探讨非手术疗法在治疗老年尿失禁中的作用

客观的： 

旨在检查老年女性盆底肌肉训练后身体功能损伤对尿失禁 (UI) 症状变化的作用。

方法： 

这是一项前瞻性队列研究，对象为 70 名社区居民，年龄超过 70 岁，至少有中度失禁症状。在基线时进行了全面的盆底和身体功能评估。提供个性化盆底肌肉训练处方和行为管理策略，以减少失禁发作，为期 12 周。使用 SPPB（短期身体机能电池）确定基线身体机能。12分中总分9分或以下表明身体机能受损，分数高于9分表明身体机能正常。三天的膀胱日记确定每天都有失禁发作。从基线到 6 周，UI 发作次数变化的组间差异是我们的主要结果。描述性分析比较了重要的人口统计学和临床​​特征。纵向混合模型线性回归分析根据身体功能受损的情况确定失禁发作的变化和改善的估计，并根据年龄、种族和体重指数 (BMI) 进行调整。

结果： 

参与者的平均±标准差年龄为 76.9±5.4 岁，其中 15.7% 为非裔美国人，组间年龄或种族没有显着差异。与女性相比，身体功能受损的参与者平均±SD BMI（33.6±14.5 vs 27.4±5.8；P =.03）更高，并且基线失禁发作次数更多（4.5±2.9 vs 2.7±2.1 次/天；P =.005）无功能障碍。经过 6 周的盆底锻炼后，与身体功能正常的女性相比，身体功能受损的参与者每天失禁发作次数的变化没有差异（平均 [95% CI] -1.2 [-2.0 至 -0.5] 与−0.4 [−1.1 至 0.3]，P =.31)。总体而言，经过 12 周的盆底肌肉训练后，两组对失禁症状改善的完全满意度都很低（身体功能障碍者为 41.8%，身体功能正常者为 44.8%；P =.90 ）。

结论： 

对于年龄超过 70 岁且正在寻求 UI 治疗的女性，无论是否存在身体功能损伤，包括盆底肌肉训练在内的行为疗法可能无法将 UI 症状显着降低到令人满意的程度。

临床试验注册： 

临床试验.gov，NCT03057834。