Hypothesis / aims of study
Pelvic floor muscle training (PFMT) is recommended for people with lower urinary tract (LUT) dysfunction secondary to neurological conditions where they have the potential to voluntarily contract their pelvic floor (1). Yet, the implementation of services providing specialist pelvic health physiotherapy to individuals with neurological conditions is not yet mainstay. In 2017, a Pelvic Health Physiotherapy Clinic was established at a Spinal Cord Injury Centre in the UK. This is a unique clinic, established following the results of a ‘proof of principle study’ investigating PFMT in incomplete Spinal Cord Injured (SCI) subjects (2). The purpose of this service evaluation was to review the bladder and bowel outcomes of patients who have attended this clinic.
Study design, materials and methods
This project was categorised as a service evaluation and did not require approval from a Research Ethics Committee. Patients with neurogenic bladder and/or bowel dysfunction, referred to the clinic, completed The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI) and Neurogenic Bowel Dysfunction (NBD) at their initial assessment (T0) and subsequent follow-up appointment/s (T1 = 38 +/- 32 weeks (n=76) (mean +/- SD), T2 = 65 +/- 50 weeks (n=23)).
Patients received a tailored home exercise programme at their initial assessment, with face to face and telephone follow-up consultations. Treatment included patient education, bladder, bowel, and pelvic floor muscle retraining, manual therapy, and biofeedback, with the aim of improving bladder, bowel, and sexual function.
The scores were expressed as mean +/- SD and compared using paired t-tests. A p-value of <0.05 was considered statistically significant.
Results
Seventy-six patients attended the clinic between 2017 and 2022, completing questionnaires at a minimum of two time points. A decrease in ICIQ-UI and NBD score indicates an improvement in symptoms. At initial assessment, mean ICIQ-UI score was 11.7 +/- 4.9, decreasing to 9.6 +/- 5.2 at T1 (p=0.0002, 95% confidence interval (CI): 1.0, 3.3). Mean NBD score was 10.0 +/- 7.1, and 8.5 +/- 7.5 (p=0.019, 95% CI: 0.1, 3.0), at initial assessment and T1, respectively.
Patients were categorised by diagnosis, Cauda Equina Syndrome (CES) (n=52), and upper motor neuron (UMN) SCI (n=24). Patients with CES improved ICIQ-UI and NBD scores, decreasing by 2.1 +/- 4.5 (p=0.002, 95% CI: 0.8, 3.4) and 2.0 +/- 4.7 (p=0.002, 95% CI: 0.7, 3.4), respectively. Patients with UMN SCI showed trends in improving ICIQ-UI, and NBD score however these were not statistically significant.
Twenty-three patients (CES n=11, UMN n=12) completed questionnaires at initial assessment, T1 and T2. Between each time point, there were trends in improving both ICIQ-UI and NBD score, other than ICIQ-UI score between T1 and T2 (mean increase 1.2 +/- 3.8).
Interpretation of results
Overall, there were significant improvements in ICIQ-UI and NBD scores after tailored pelvic health physiotherapy for patients with SCIs. Patients with CES demonstrated significant improvements in questionnaire scores, whereas those with UMN SCI did not. There was no additional improvement in questionnaire scores with later follow-up assessments.