第一百期:盆底肌训练配合反馈或生物反馈,有利于强化女性尿失禁的治疗
点击:50  添加时间:2019-03-29 09:42:00  信息来源:

中文译文
盆底肌训练配合反馈或生物反馈,有利于强化女性尿失禁的治疗
研究人员:Roselien Herderschee,
E. Jean C. Hay-Smith,
F.  G Peter Herbison,
G. Jan Paul Roovers,
H.  Maas Jan Heineman.
研究机构:荷兰阿姆斯特丹大学妇产科学术医学中心;
新西兰惠灵顿奥塔哥大学医学系康复教研室;
新西兰达尼丁奥塔哥大学达尼丁医学院预防与社会医学系


摘要

背景:

盆底肌训练(PFMT)是治疗女性压力性型尿失禁的有效疗法。虽然大多数盆底肌肉训练试验都是在有压力型尿失禁的妇女中进行的,但也有一些试验证据表明盆底肌训练对急迫型尿失禁和混合型尿失禁有效。反馈或生物反馈是常见的辅助手段,与盆底肌训练配合使用,以帮助教导自愿盆底肌肉进行有意识收缩或提高训练性能效果。


目标:
      研究盆底肌训练配合反馈或生物反馈对女性尿失禁的疗效是否有所加强。比较不同形式的反馈或生物反馈的有效性。


检索方法:
      我们检索了Cochrane(科克伦尿)专属实验登记册(2010年5月13日搜索),参考文章清单中的有关文献。


选择标准:
      随机或准随机试验在有压力型、紧急型或混合型尿失禁的妇女中进行(基于症状、体征或尿动力学)。至少有两组试验包括盆底肌训练。此外,至少有一组包括口头反馈或由设备中继的生物反馈。


数据收集和分析:
      对试验的资格和偏见的误差风险进行了独立评估。数据由两位审核人提取并反复相互审查核对。如对数据有分歧,则通过讨论或第三位审查员的意见得到解决。数据分析按照Cochrane(科克伦干预式)系统评价手册5.1.0版进行。亚组内的分析是基于两个组间盆底肌训练是否存在差异。


      主要结果:
      本研究包含了对符合条件的1583名女性进行的24项试验;其中17项试验为主要成果提供了数据分析。所有的试验都提供了一个或多个次要结果的数据。报告指出,接受生物反馈的女性与那些仅接受PFMT的女性相比,她们的尿失禁更有可能得到治愈或改善(风险系数0.75,95%置信区间为0.66至0.86)。通常,与非生物反馈组的女性相比,生物反馈组的女性与卫生专业人员的接触更多。基于试验报告,许多试验都会存在有中度至高误差风险。仅在PFMT中添加反馈或生物反馈的方案有很多不同,通常不清楚实际的干预包括什么或者干预的目的是什么。


      作者结论:
      反馈或生物反馈可能对患有尿失禁的女性的盆底肌肉训练有额外的好处。然而,还需要进一步的研究来区分到底是反馈还是生物反馈导致了有益的效果,还是试验组之间的其他差异(比如更多地接触卫生专业人员)。




英文原文
Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women (Review)
Herderschee R, Hay-Smith EJC, Herbison GP, Roovers JP, Heineman MJ
Department of Obstetrics & Gynaecology Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.
Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand


Abstract


    Background:
    Pelvic floor muscle training (PFMT) is an effective treatment for stress urinary incontinence in women. Whilst most of the PFMT trials have been done in women with stress urinary incontinence, there is also some trial evidence that PFMT is effective for urgency urinary incontinence and mixed urinary incontinence. Feedback or biofeedback are common adjuncts used along with PFMT to help teach a voluntary pelvic floor muscle contraction or to improve training performance.


    Objective:
    To determine whether feedback or biofeedback adds further benefit to PFMT for women with urinary incontinence.To compare the effectiveness of different forms of feedback or biofeedback.


    Search methods:
    We searched the Cochrane Incontinence Group Specialised Trials Register (searched 13 May 2010) and the reference lists of relevant articles.


    Selection criteria:
    Randomised or quasi-randomised trials in women with stress, urgency or mixed urinary incontinence (based on symptoms, signs or urodynamics). At least two arms of the trials included PFMT. In addition, at least one arm included verbal feedback or device-mediated biofeedback.


    Data collection and analysis:
    Trials were independently assessed for eligibility and risk of bias. Data were extracted by two reviewers and cross-checked. Disagreements were resolved by discussion or the opinion of a third reviewer. Data analysis was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Intervention (version 5.1.0). Analysis within subgroups was based on whether there was a difference in PFMT between the two arms that had been compared.


    Main results:

    Twenty four trials involving 1583 women met the inclusion criteria; 17 trials contributed data to analysis for one of the primary outcomes. All trials contributed data to one or more of the secondary outcomes. Women who received biofeedback were significantly more likely to report that their urinary incontinence was cured or improved compared to those who received PFMT alone (risk ratio0.75 , 95% confidence interval 0.66 to 0.86). However, it was common for women in the biofeedback arms to have more contact with the health professional than those in the non-biofeedback arms. Many trials were at moderate to high risk of bias, based on trial reports. There was much variety in the regimens proposed for adding feedback or biofeedback to PFMT alone, and it was often not clear what the actual intervention comprised or what the purpose of the intervention was.


    Authors’ conclusions:
    Feedback or biofeedback may provide benefit in addition to pelvic floor muscle training in women with urinary incontinence. However, further research is needed to differentiate whether it is the feedback or biofeedback that causes the beneficial effect or some other difference between the trial arms (such as more contact with health professionals).


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