Exercise intervention in the management of urinary incontinence in older women in villages in Bangladesh: a cluster randomised trial

To determine the effectiveness of pelvic floor muscle training (PFMT) with or without biofeedback or electrostimulation in reducing urinary incontinence and pelvic floor muscle con-traction in non-pregnant women with urinary incontinence. Methods: The following electronic databases were searched: PubMed, Cochrane Central, ClinicalTrials.gov, EU Clinical Trials Register, and sources from NICE, FDA, EMA, and SMC (articles only in English, 2000–2021). Search terms were: urinary incontinence, pelvic floor muscle training or exercises, biofeedback, electrostimulation. We used the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for this systematic review. Relevant articles were selected, data were extracted, and quality was assessed. Data were extracted in predesigned form, followed by narrative synthesis. Results: Following the search, 15 RCTs were retrieved using the strict inclusion and exclusion criteria, assessing 2441 non-pregnant women with urinary incontinence. Of the 15 studies, 7 were low risk, 5 were medium risk, and 3 were high-risk studies. Of the 2441 patients, 970 were in PFMT, 69 were in extracorporeal magnetic innervation (ExMi) or with PFMT + BF, 30 were in electrostimulation (ES), 21 were in whole body vibration training (WBVT), 23 were in pelvic floor muscle + abdominal muscle therapy (PFM + AMT), 326 were in PFMT + biofeedback, 93 were in vaginal cones (VC), 362 were in PFMT + education, 318 were in education, and 229 were in control groups. The most often measures employed were pad tests, bladder diary, and questionnaire on the quality of life. Stress, urge and mixed urinary incontinence were studied. In all RCT, PFMT significantly reduced urinary incontinence, essentially SIU and MUI, when compared with the control group before and after treatment. Overall, out of 997 PFMT or PFMT + education patients, 504 patients (50.5%) showed improvement in urinary incontinence, and 218 became continent (21.8%) (negative pad test). In total, 62% of patients significantly reduced their urinary incontinence or cured it and improved their pelvic floor muscle contraction. All other physiotherapist techniques also significantly reduced urinary leakages, e.g., vaginal cones, biofeedback, ExMI, and WBVT when compared with the control group. There were no significant differences between these methods in reducing the severity of urinary incontinence. Conclusion: PFMT alone or with bio-feedback or electrostimulation was effective in reducing urinary incontinence and improving pelvic floor muscle contraction. PFMT when compared with other interventions such as bio-feedback, VC, and WBVT did not show significant differences but was superior to the control group. RCT studies with similar parameters used for measuring the outcomes need to be included.

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Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback or Electrostimulation in Women: A Systematic Review

In 2007, the World Health Organization published a guide on age‐friendly cities. However, little is known about interventions that have been implemented to promote age‐friendly communities in rural and remote areas. This paper presents the findings from a scoping review undertaken to locate available evidence of interventions, strategies, and programs that have been implemented in rural and remote areas to create age‐friendly communities.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/ajag.13101

Age‐friendly interventions in rural and remote areas: A scoping review

Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications.The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment.The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference. Experts from multidisciplinary fields examined cognitive function, higher neural control of the OAB patient, risk factors for cognitive impairment in older patients, cognitive effects of antimuscarinic medications for OAB treatment, OAB phenotyping, conservative and advanced OAB therapies, and the need for a multidisciplinary approach to person-centered treatment. Translational topics included the blood-brain barrier, purine metabolome, mechanotransduction, and gene therapy for OAB targets.Research surrounding OAB treatment efficacy in cognitively impaired individuals is limited. Short- and long-term outcomes regarding antimuscarinic effects on cognition are mixed; however, greater anticholinergic burden and duration of use influence risk. Oxybutynin is most consistently associated with negative cognitive effects in short-term, prospective studies. Although data are limited, beta-adrenergic agonists do not appear to confer the same cognitive risk.The 2021 SOS summary report provides a comprehensive review of the fundamental, translational, and clinical research on OAB with emphasis on cognitive impairment risks to antimuscarinic medications. Duration of use and antimuscarinic type, specifically oxybutynin when examining OAB treatments, appears to have the most cognitive impact; however, conclusions are limited by the primarily cognitively intact population studied. Given current evidence, it appears prudent to minimize anticholinergic burden by emphasizing nonantimuscarinic therapeutic regimens in the older population and/or those with cognitive impairment. 

Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report

Prior studies of the association between intimate partner violence (IPV) and depressive symptoms have typically excluded economic coercion (EC), a prevalent form of IPV worldwide. Here, we used structural equation models (SEM) to estimate the association of EC with depressive symptoms, with and without adjustment for physical/psychological/sexual IPV, among women in rural Matlab, Bangladesh. Data were collected from cross-sectional surveys with married women 15-49 years, conducted between November 2018 and January 2019. Prior-week depressive symptoms were measured using the 10-item Centre for Epidemiologic Studies Depression short-form. Lifetime EC was assessed using a bi-dimensional, 36-item scale developed in Matlab. Lifetime physical/sexual/psychological IPV was assessed using the 20-item WHO Domestic Violence module. Covariates were age, age at marriage, and schooling; partner's schooling; and household wealth. Among 929 women, lifetime experience of EC ranged from 41.9% (control over access to work, schooling, and training) to 50.0% (control over use/maintenance of economic resources), while any lifetime physical/psychological/sexual IPV was 89.5%. Coercion involving the use and maintenance of economic resources had a significant, adjusted association with depressive symptoms (standardized coefficient = 0.491, p<0.001, R2=0.221). The standardized association of any physical/psychological/sexual IPV with depressive symptoms, adjusted for covariates and cluster sampling, was 0.346 (p <0.001, R2=0.143). When further adjusted for the two measures of EC, the association was attenuated and non-significant (0.049, p = 0.817). These findings suggest that EC is prevalent, significantly associated with depressive symptoms, and attenuates the association of other forms of IPV with depressive symptoms. Addressing EC with other forms of IPV may be necessary to reduce depressive symptoms in exposed women.

Women’s experiences of economic coercion and depressive symptoms in Matlab, Bangladesh

Hypothesis / aims of study Urinary diaries allow a relatively non-expensive, non-invasive means of investigating lower urinary tract symptoms [1]. They are commonly used in continence care and are a useful adjunct to the urinary history [2]. Diaries are usually completed in a fashion which renders them subject to minimal recall bias and are variably used as a method of monitoring response to intervention or reinforcement for bladder retraining. Although diaries are extensively used in research and clinical practice there are none which have been used in a largely illiterate adult population. We wished to develop a bladder diary suitable for use in the field for illiterate subjects which was both paper free and able to be concealed for the preservation of confidentiality for those with incontinence, where the condition is viewed with much stigma. The aim of this study was to develop such a diary in preparation for testing in the field

Development and testing of a continence record for use with illiterate older women in rural Bangladesh

Aims Pelvic floor and mobility exercises were shown to be effective in managing incontinence in a cluster-randomized trial (CRT) of village women aged 60 to 75 years in Bangladesh. The present analysis examines continence 12 months after the CRT and exercise program implementation with village paramedics as preceptors. Methods Women from nine villages in the exercise arm of the CRT were followed-up 12 months after the 6-month intervention. They provided information about exercise since the CRT and a 3-day continence record (3DCR). Posttrial, a further 6-month exercise intervention led by village paramedics was initiated in 20 villages. Women completed the two-item Sandvik severity questionnaire before and after the intervention. Paramedics kept a record of each woman's attendance at the 48 exercise sessions RESULTS: A total of 130 of 150 women from the CRT completed the 12-month follow-up; 61.5% were dry on the 3DCR at follow-up. Total continence was related to the continuation of exercises carried out in the home and absence of urinary tract infection at follow-up. Those exercising at follow-up had an odds ratio (OR) of 3.49 (95% confidence interval [CI], 1.86-6.58) of being continent at follow-up. Higher end-of-CRT body mass index was associated with greater follow-up leakage. In the 20-village roll-out, with 316 incontinent women, improvement in both severity and total continence on the Sandvik questionnaire were related to a total number of sessions attended (OR = 1.09; 95% CI, 1.05-1.13). At roll-out, 38.6% achieved continence, comparable to 43.0% in the CRT using physiotherapy preceptors CONCLUSIONS: Group exercise classes led by paramedics resulted in a marked improvement in continence but maintenance requires exercise postintervention.

Promoting and maintaining urinary continence: Follow‐up from a cluster‐randomized trial of elderly village women in Bangladesh

Hypothesis / aims of study Urinary incontinence (UI) is highly prevalent in older persons and is associated with considerable morbidity and impairment of quality of life. In a recent study of disability amongst elderly villagers in Bangladesh, UI was reported as troublesome by 28% of villagers, particularly women, and UI was strongly related to reported feelings of depression in 40% compared to 15% without. Whilst there is accumulating evidence for the efficacy of multi-component exercise based interventions for urinary incontinence in developed societies [1] there is little information about such interventions in the developing world. This study assessed the feasibility, delivery and acceptability to women of an exercise based intervention delivered by locally trained community physiotherapists in a single non-governmental organisation in Bangladesh

Fardous Kabir

Papers

Exercise intervention in the management of urinary incontinence in older women in villages in Bangladesh: a cluster randomised trial

Development and testing of a continence record for use with illiterate older women in rural Bangladesh

Promoting and maintaining urinary continence: Follow‐up from a cluster‐randomized trial of elderly village women in Bangladesh

Development and testing of a community based exercise intervention for urinary incontinence in elderly village women in rural Bangladesh