[Physiotherapy and neurogenic lower urinary tract dysfunction in multiple sclerosis patients: a randomized controlled trial]

Abstract

Aim: This randomized controlled trial compare the efficacy of pelvic floor muscle training vs. transcutaneous posterior tibial nerve stimulation.

Patients and methods: Inclusion criteria were EDSS score<7 and presence of lower urinary tract symptoms. Exclusion criteria were multiple sclerosis relapse during the study, active urinary tract infection and pregnancy. The primary outcome was quality of life (SF-Qualiveen questionnaire). Secondary outcomes included overactive bladder (USP questionnaire) score and frequency of urgency episodes (3-day bladder diary). Sample size was calculated after 18 patients were included. Data analysis was blinded. Each patient received 9 sessions of 30 minutes weekly. Patients were randomized in pelvic floor muscles exercises with biofeedback group (muscle endurance and relaxation) or transcutaneous posterior tibial nerve stimulation group (rectangular alternative biphasic current with low frequency).

Results: A total of 31 patients were included. No difference appeared between groups for quality of life, overactive bladder and frequency of urgency episodes (respectively P=0.197, P=0.532 et P=0.788). These parameters were significantly improved in pelvic floor muscle training group (n=16) (respectively P=0.004, P=0.002 et P=0.006) and in transcutaneous posterior tibial nerve stimulation group (n=15) (respectively P=0.001, P=0.001 et P=0.031).

Conclusions: Pelvic floor muscle training and transcutaneous posterior tibial nerve stimulation improved in the same way symptoms related to urgency in MS patients with mild disability.

Level of evidence: 2.

Keywords: Exercices du plancher pelvien; Kinésithérapie; Lower urinary tract dysfunction; Multiple sclerosis; Nerf tibial postérieur; Pelvic floor muscles training; Physiotherapy; Posterior tibial nerve; Rehabilitation; Réadaptation; Sclérose en plaques; Troubles du bas appareil urinaire.