What evidence is there for physiotherapeutic treatments, applied to pelvic floor, for whatever pelvic floor dysfunction in people with Multiple Sclerosis? A systematic review
Martín-González, AB1; Rojo, B; Herrero, AJ2; Menéndez, H2; Ferrero, CM2
1: European University Miguel de Cervantes (Valladolid, Spain), Spain; 2: Department of Health Sciences. European University Miguel de Cervantes, Spain; Research Centre on Physical Disability, ASPAYM Castilla y León Foundation, Spain.
Objective: To systematically review the effectiveness of different physiotherapeutic treatments in patients with Multiple Sclerosis (MS) who present whatever pelvic floor dysfunction (PFD).
Material and Methods: The literature search was carried out during May 2017, in the electronic databases of Cochrane and PEDro, and the search engines PubMed and Web of Science. Only randomized clinical trials (RCTs) were included in the present review. In this sense, the sample of the correspondent study should be composed of patients with MS and PFD. Finally, measures of at least one key outcome related with PFD were used as an inclusion criteria too. On the other hand, studies which age sample was under 18 years old were excluded from the review process. In case that the PFD´s observed were not the consequence of MS pathology, the study was finally excluded. If drugs or surgery were used as part of the intervention, the articles were also rejected. Subsequently, the methodological quality was evaluated using the PEDro scale. Finally, the sample characteristics, interventions and measurements were analyzed in order to compare the different therapeutic options from the available literature.
Results: Seven RCTs were included, six on the approach to urinary tract dysfunction (UTD) and one on sexual dysfunction (SD). One article obtained an excellent methodological quality (9/10), 5 were assessed as good (6-8/10) and two as fair (4/10). The most important physiotherapeutic treatments used on the selected articles were pelvic floor active exercises with biofeedback, electric stimulation, local vibration and abdominal pressure. It was observed significant improvements regarding urodynamics outcomes. However, strong differences in the PERFECT scale, electromyographic biofeedback, or the quality of life values were detected, suggesting relevant differences in the available scientific evidence of the existing therapies.
Conclusion: The combination of pelvic floor active exercises, biofeedback and electrotherapy seems to produce the greatest effects in the treatment of the PFD, both in UTD and SD, in patients with MS.
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