Estabilização lombo-pélvica dinâmica para tratamento da incontinência urinária de esforço em mulheres: ensaio clínico controlado e randomizado

Abstract

INTRODUCTION: Urinary incontinence frequently triggers a decline in women’s quality of life. Physiotherapeutic treatment for stress incontinence based on pelvic floor muscles training tends to lose effectiveness over time. Lumbopelvic stabilization, whether associated or not with pelvic floor muscle training, has shown favorable results even after interruption of treatment. OBJECTIVE. To compare the results of dynamic lumbopelvic stabilization exercises with those for the pelvic floor muscle in women with stress urinary incontinence. PATIENTS AND METHOD. Randomized Controlled trial, parallel, and carried out blindly with longitudinal delineation involving women experiencing urinary stress loss. The primary outcome was incontinence severity. Quality of life, hyperactive bladder, strength of pelvic floor muscles and perception of improvement were secondary outcomes. The experimental (dynamic lumbopelvic stabilization exercise protocol) and control (pelvic floor muscle exercise protocol) groups were evaluated prior to treatment, immediately afterwards, and 90 days after intervention. For descriptive data, measurements of central tendency, average ± standard deviation, and median were used. To test differences between the groups, the Chi- Squared for qualitative variables and the Student’s t-test for quantitative variables were used. The experimental protocol’s effects were verified by means of the 2x3 ANOVA factorial of repeated measurements (group vs. measurement). The principal effects and/or significant interactions were analyzed using multiple comparisons. The effect’s size was calculated by eta squared (η2) and by Cohen’s d (d). Two-way tables at each point in the evaluation analyzed pelvic floor muscle strength. To test the differences in intergroup perception of improvement, the Wilcoxonn test was used and the Mann Whitney test for intergroup differences. A significance level of 5% (p ≤ 0.05) was adopted. RESULTS. For sociodemographic and clinical variables, significant differences between groups (p>0.05) were not observed, except for the climacterium, the most prevalent variable in the experimental group (82% vs. 44%; p=0.02). The groups behaved similarly in outcomes for severity of loss, frequency of day- and nighttime losses, quality of life, hyperactive bladder, pelvic floor muscle strength, and perception of improvement, showing an increase when comparing the initial and finally analyses, as well as in maintenance of favorable results 90 days after treatment only in the experimental group. The difference observed between the groups 90 days after treatment was of a moderate magnitude (d = 0.64) for severity of losses and elevated magnitude for the frequency of day and nighttime losses (d = 2.67 and d = 2.50, respectively). CONCLUSIONS. In post-treatment evaluation, lumbopelvic stabilization exercises have a similar effect to exercises for the pelvic floor muscles in outcomes for severity of loss and quality of life. Nevertheless, stabilization exercises associated with pelvic floor muscle exercises were superior in the outcomes of the post-90-day evaluation.