1. CLINICAL SIGNIFICANCE
DO PHYSICAL THERAPY INTERVENTIONS AFFECT FUNCTIONAL INCONTINENCE AND QUALITY OF LIFE IN PEOPLE WITH MULTIPLE SCLEROSIS? AN EVIDENCE-BASED REVIEW
V Block, PT, M Rivera, PT, DPTSc, M Melnick, PT, PhD and D D Allen, PT, PhD.
Department of Physical Therapy and Rehabilitation Science, University of California San Francisco / San Francisco State University
PURPOSE/HYPOTHESIS
Multiple sclerosis (MS) presents with many debilitating symptoms, including urinary incontinence (UI), which physical therapy (PT) may address. UI is prevalent but consensus is lacking regarding effectiveness of non-surgical or pharmaceutical interventions. A meta-analysis of long-term, conservative treatment options may supply this deficiency. Our purpose was to analyze the current evidence for effectiveness of PT to decrease UI and improve quality of life (QoL) in persons with MS.
Figure 1: Forest Plot Showing The Combined Effects for Between Sub-groups of Quality of Life and Incontinence variables
RESULTS
Six studies met the inclusion criteria. Between-group analysis (Figure 1) revealed statistically significant differences in incontinence episodes and both measures of QoL, though failed to reach significance for functional control mechanisms. Incontinence leakage episodes and QoL participation improved within groups (Figure 2).
CONCLUSIONS
This meta-analysis supports PT for affecting incontinence and measures of QoL in persons with MS more than control groups and minimizing incontinence compared to pre-treatment. Limitations include heterogeneity regarding the duration and dose of PT intervention, and differences in MS phenotypes. Treatment protocols vary, lacking a definitive technique. Further research may reveal the most effective combination and variety of PT interventions for persons with MS, and could help solidify the benefits of non-pharmaceutical or surgical interventions for this population.
METHODS AND MATERIALS
An electronic search conducted through , included search terms: incontinence, bladder dysfunction, urinary incontinence, multiple sclerosis, MS, physical therapy, physiotherapy, therapy and rehabilitation. Criteria for inclusion: diagnosis of MS, intervention involved PT focusing on UI or bladder dysfunction, outcomes assessed QoL and/or UI, and at least a 4/10 on the PEDro scale or a 2b level of evidence. Outcomes were combined across studies and effect sizes were depicted in forest plots. No date limits were used.
Figure 2: Forest Plot for Within Sub-groups of Quality of Life and Incontinence variables
QoL Participation level
Leakage episodes
Statistically significant
Not statistically significant
PRISMA DIAGRAM SHOWING SEARCH TIMELINE
CLINICAL SIGNIFICANCE
Persons with MS have a high risk of UI and conventional medications have side effects that promote low adherence; therefore the problem persists. PT interventions can be an effective, safe, first line treatment option to improve UI and QoL.
For all the outcomes, a lower value corresponds to either a reduction in incontinence
(e.g., number of leakages per 24 hours) or an increase in Quality of Life.
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