Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study

Nagib, Anita Bellotto Leme; Silva, Valeria Regina; Martinho, Natalia Miguel; Marques, Andrea; Riccetto, Cassio; Botelho, Simone

doi:10.1055/s-0041-1733979

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 43 (07) • July 2021 • https://doi.org/10.1055/s-0041-1733979 copy

Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study

O treinamento por meio de gameterapia pode aliviar os sintomas de incontinência urinária em mulheres climatéricas? Um estudo de viabilidade

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To investigate the feasibility of pelvic floor muscle training (PFMT) through gametherapy for relieving urinary symptoms of climacteric women with stress ormixed urinary incontinence (UI).

Methods

Randomized clinical trial, divided into two groups: Gametherapy (G_Game) and Control (G_Control). Both groups received recommendations about unsupervised PFMT, and G_Game also received supervised PFMT through gametherapy. After 5 consecutive weeks, the feasibility was investigated considering participant adherence, urinary symptoms (evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF] questionnaire), and pelvic floor function (PERFECT Scheme: power, endurance, repetition and fast). The Fisher exact, Kruskal-Wallis, Wilcoxon sign paired, and Mann-Whitney U tests were used by intention-to-treat analysis, using STATA 15.1 (StataCorp, College Station, TX, USA) software.

Results

The present study included 20 women per group and observed a higher adherence in G_Game. In the intragroup analysis, a decrease in the ICIQ-UI-SF score was observed in both groups (14.0 to 10.0; 13.5 to 0), associated with increased endurance (2.5 to 3.5; 2.5 to 4.0) in G_Control and G_Game, respectively. Moreover, there was a concomitant increase in pelvic floor muscles (PFMs) power (2.0 to 3.0), repetition (3.0 to 5.0), and fast (10.0 to 10.0) in G_Game. In the intergroup analysis, a reduction of UI was observed (p<0.001; r=0.8), as well an increase in PFM power (p=0.027, r=0.2) and endurance (p=0.033; r=0.3) in G_Game.

Conclusion

The feasibility of supervised PFMT through gametherapy was identified by observing participant adherence, relief of urinary symptoms, and improvement in PFM function.

Keywords:
pelvic floor dysfunctions; urinary incontinence; pelvic floor muscle; gametherapy; climacteric; rehabilitation

	G_Control(n = 20)		G_Game(n = 20)		p-value ^a
	N (%)	95%CI	N (%)	95%CI	p-value ^a
DEMOGRAPHIC DATA
Skin color
White	16 (80.0)	56.4– 92.5	18 (90.0)	66.5– 97.6	0.661
Other	4 (20.0)	7.5– 43.6	2 (10.0)	2.4– 33.5	0.661
Marital status
Single	1 (5.0)	0.7– 29.5	2 (10.0)	2.4– 33.5	1.000
Married/cohabitating	14 (70.0)	46.5– 86.2	13 (65.0)	41.8– 82.8
Divorced/widower	5 (25.0)	10.5– 48.7	5 (25.0)	10.5– 48.7
Level of education
Illiterate	0 (0.0)	0.0– 0.0	0 (0.0)	0.0– 0.0	0.052
Elementary school	12 (60.0)	37.3– 79.1	6 (30.0)	13.7– 53.6
High school	2 (10.0)	2.4– 33.4	10 (50.0)	28.7– 71.3
Higher education	6 (30.0)	13.8– 53.5	4 (20.0)	7.4– 43.7
Physical activity
Does not practice	11 (55.0)	33.0– 75.2	9 (45.0)	24.7– 67.1	0.752
Up to twice a week	9 (45.0)	24.7– 67.1	11 (55.0)	32.9– 75.3	0.752
HORMONAL DATA
Menopause
No	8 (40.0)	20.9– 62.7	4 (20.0)	7.4– 43.7	0.301
Yes	12 (60.0)	37.3– 79.1	16 (80.0)	56.3– 92.6	0.301
Hormonal replacement
No	16 (80.0)	56.4– 92.5	16 (80.0)	56.3– 92.6	1.000
Yes	4 (20.0)	7.5– 43.6	4 (20.0)	7.4– 43.7	1.000
OBSTETRIC DATA
Pregnancies
0	1 (5.0)	0.7– 29.5	3 (15.0)	4.7– 38.6	0.094
1	2 (10.0)	2.4– 33.4	3 (15.0)	4.7– 38.6
2	3 (15.0)	4.7– 38.6	8 (40.0)	20.9– 62.7
3	14 (70.0)	46.5– 86.2	6 (30.0)	13.7– 53.6
Number of vaginal deliveries
0	11 (55.0)	33.0– 75.2	8 (40.0)	20.9– 62.7	0.546
1	1 (5.0)	0.7– 29.5	3 (15.0)	4.7– 38.6
2–3	8 (40.0)	20.9– 62.7	9 (45.0)	24.7– 67.1
Number of cesarean deliveries
0	9 (45.0)	24.7– 67.1	10 (50.0)	28.7– 71.3	0.054
1	2 (10.0)	2.4– 33.4	7 (35.0)	17.2– 58.2
2–3	9 (45.0)	24.7– 67.1	3 (15.0)	4.7– 38.6
PERSONAL DATA	Median	IQR	Median	IQR	*p-value* ^b
Age (years old)	49.5	41.0– 61.0	57.0	51.5– 61.0	0.116
BMI (kg/m2)	25.4	21.7– 30.5	24.6	22.0– 29.2	0.818

	Intragroup analysis								Intergroup estimates
	G_Control(n = 20)				G_Game(n = 20)				Intergroup estimates
	Median	IQR	p-value ^a	Effect size^c	Median	IQR	p-value ^a	Effect size^c	p-value ^b	Effect size^d
ICIQ UI-SF
Preintervention	14.0	12.0–15.0	< 0.001	0.317	13.5	12.0–17.5	< 0.001	0.393	0.560	0.446
Postintervention	10.0	6.0–12.5	< 0.001	0.317	0.0	0.0–4.5	< 0.001	0.393	< 0.001	0.863
ICIQ-OAB
Preintervention	4.5	2.0–8.0	0.058	0.194	3.0	1.0–5.5	0.002	0.290	0.317	0.593
Postintervention	3.0	1.5–5.5	0.058	0.194	2.0	1.0–3.0	0.002	0.290	0.074	0.665

	Intragroup analysis								Intergroup estimates
	G_Control(n = 20)				G_Game(n = 20)				Intergroup estimates
	Median	IQR	p-value ^a	Effect size^c	Median	IQR	p-value ^a	Effect size^c	p-value ^b	Effect size^d
Power
Preintervention	2.0	2.0–3.0	0.250	0.173	2.0	2.0–2.0	< 0.001	0.407	0.256	0.605
Postintervention	2.5	2.0–3.0	0.250	0.173	3.0	3.0–3.0	< 0.001	0.407	0.027	0.295
Endurance
Preintervention	2.5	2.0–4.0	0.016	0.256	2.5	2.0–3.0	< 0.001	0.383	0.598	0.549
Postintervention	3.5	2.5–4.0	0.016	0.256	4.0	3.5–6.0	< 0.001	0.383	0.033	0.302
Repetition
Preintervention	3.5	2.5–5.0	0.114	0.163	3.0	3.0–4.0	< 0.001	0.376	0.579	0.551
Postintervention	4.0	3.0–6.0	0.114	0.163	5.0	4.0–6.5	< 0.001	0.376	0.055	0.323
Fast
Preintervention	10.0	7.0–10.0	0.922	0.031	10.0	5.0–10.0	0.008	0.280	0.607	0.547
Postintervention	10.0	7.0–10.0	0.922	0.031	10.0	10.0–10.0	0.008	0.280	0.250	0.394

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[1] Address for correspondence Simone Botelho, PhD, Professor, Av. Jovino Fernandes Sales, 2600, 37130-000, Santa Clara, Alfenas, MG, Brazil (e-mail: simone.botelho@unifal-mg.edu.br).