Do physical therapy interventions improve urinary incontinence and quality of life in patient with multiple sclerosis: A systematic literature review

Background: Multiple sclerosis (MS) presents with many symptoms, including urinary incontinence (UI) that physical
therapy can play very important role, which is widely prevent, but the physical therapy management for UI in MS population
lacks consensus. We analyzed the current evidence for effectiveness of physical therapy to decrease UI and improve quality
of life (QOL) in population with MS.
Purpose: To systematically review the literature and present the best available evidence for the efficacy and effectiveness
of physical therapy intervention in treating the urinary incontinence for MS population and improve QOL.
Data Source: Pub Med, Cochrane library, BMJ Group, BioMed Central, Wiley online library, Cumulative Index to Nursing
and Allied Health Literature, and PEDro.
Study Selection: 5 randomized, control trials (RCTs) and one clinical trial published in English from 2006- May 2019.
Data Extraction: Any study concentrated on surgical or pharmaceutical treatment interventions, focused on bowel
incontinence or were not within the physical therapy scope of practice.
Data Synthesis: The study focuses on physical therapy intervention for MS patients with UI and randomized control study.
Limitation of the Study: The reviewed study is limited to 6 randomized control trials.
Conclusion: There is significant evidence that physical therapy interventions in MS patients with urinary incontinence are
very effective and had significant change in reducing UI and increasing QOL.


Completed Appraisal Checklist Study Identification:
Forough F, Moosa S, Habib S, Payam S, Mahnaz S (2017) Pelvic floor muscle training instruction to control urinary incontinence and its resulting, anxiety and depression in patients with multiple sclerosis. Jundishapur J Chronic Dis Care. 2017 Guideline Topic: Physical therapy intervention in treatment of urinary incontinence in MS patients Checklist completed by: NAJWA ALFARRA Section 1: Internal validity In a well conducted RCT study In this study this criterion is: The study addresses an appropriate and clearly focused question Well covered

1.2
The assignment of subjects to treatment groups is randomized Well covered 1.3 An adequate concealment method is used Adequately covered

Subjects and investigators are kept 'blind' about treatment allocation
Single-arm clinical trial

1.5
The treatment and control groups are similar at the start of the trial NA

1.6
The only difference between groups is the treatment under investigation NA 1.7 All relevant outcomes are measured in a standard, valid and reliable way.

Well covered
1.8 What percentage of the individuals or clusters recruited into each treatment arm of the study dropped out before the study was completed? Well covered All the subjects analyzed in the groups to which they were randomly allocated (often referred to as intention to treat analysis) NA

What comparison are made in the study rehabilitation program 2-3/week for 6 weeks, continue with maintenance program for twelve months v maintenance program only
3.5 How long are patients followed up in the study?

3.7
What size of the effect is identified in the study?
The treatment group compared with the control group showed improvement: 78% versus 27% for UDI6 and 59% versus 17% improved for IIQ7. More patients in the control group deteriorated over the study period on the UDI6 (30% vs 0%; p<0.001) and IIQ7 (39 vs 0%; p=0.001).

3.8
How was this study funded/ Not stated 3.9 Does this study help to answer the key question? Yes Guideline topic: Physical therapy intervention in treatment of urinary incontinence in MS patients Checklist completed by: NAJWA ALFARRA Section 1: Internal validity In a well conducted RCT study In this study this criterion is: The study addresses an appropriate and clearly focused question Well covered

1.2
The assignment of subjects to treatment groups is randomized Well covered. What percentage of the individuals or clusters recruited into each treatment arm of the study dropped out before the study was completed?

patients
1.9 All the subjects analyzed in the groups to which they were randomly allocated (often referred to as intention to treat analysis)

Well covered
1.10 Where the study is carried out at more than one site, results are comparable for all sites Not applicable

What size of the effect is identified in the study?
Group 3 demonstrated superior benefit as measured by the number of leaks and pad test than Group 2, with Group 1 showing less improvement when compared to week 0; this was statistically significant between Groups 1 and 3 for number of leaks (P = 0.014) and pad tests (P = 0.001), and Groups 1 and 2 for pad tests (P = 0.001). A similar pattern was evident for all other outcome measures.

3.8
How was this study funded/ Not stated 3.9 Does this study help to answer the key question? Yes. Taking into account clinical considerations, your evaluation of the methodology used, and the statistical power of the study, is you certain that the overall effect is due to the study intervention? Clinical improvement of OAB was shown in 82.6% and 83.3% of the patients on D30 and D90, respectively, with significant improvement of primary and secondary outcomes compared to baseline.

3.8
How was this study funded/ Not stated 3.9 Does this study help to answer the key question? Evidence derived shows that MS patients have better urinary incontinence prognosis compared to non-intervention group Copyright: ©2019 Alfarra N. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.