Vibrotherapy improves quality of life for women with stress urinary incontinence
The research project described here was carried out at Rasool-e-Akram Hospital. Forty-three women referred by a gynaecologist after primary clinical assessment participated. The study was designed as a randomised clinical trial. The women were randomly allocated to two groups: with vibrotherapy and with a pelvic floor muscle strengthening exercise programme. The aim of the study was to compare the effects of these treatment interventions on improving muscle function and quality of life in the women studied.
- Quality of life (vibrotherapy from 43.52±26.64 to 64.02 ± 26.5, exercise from 56.66± 22.57 to 74.47±16.71) and pelvic floor muscle strength increased in both the group with vibrotherapy included and the group performing pelvic floor muscle training (vibrotherapy from 2.45±0.9 to 4.10±0.7, exercise from 2.66±0.96 to 4.18±0.85).
- The final effects of both exercise protocols (vibrotherapy and pelvic floor muscle exercises) were similar.
- There were no differences between the exercise and vibration groups after three months of follow-up.
Compiled from:
A Comparative Study of Whole Body Vibration Training and Pelvic Floor Muscle Training on Women’s Stress Urinary Incontinence: Three- Month Follow-Up Farzinmehr A; Moezy A, Koohpayehzadeh J, Kashanian M. Journal of Family and Reproductive Health Vol. 9, No. 4, November 2015
Study population
The study participants were women aged 36 – 68 years who had suffered from stress urinary incontinence for 4.5 years. The mean BMI of the study women was 28.6 (overweight). The women were married, without sexual infections, and with no history of vibrotherapy. The women were informed about the study methods and signed a consent to participate. The women were randomly allocated to two groups: with vibrotherapy and with a pelvic floor muscle training programme.
Study procedure
Prior to the project, participants had their pelvic floor muscle strength measured by a trained physiotherapist using digital palpation. The women were asked to rate the severity of their condition using a VAS scale, where 0 meant no incontinence symptoms, 10 a major incontinence problem. The incontinence quality of life questionnaire (I-QOL), which consists of 22 items assessing concerns about incontinence, was used to assess quality of life. Scores were then converted into scales from zero to 100, with a score of 100 representing the best possible QOL and 0 representing the worst score. Following these tests, both study groups with vibration therapy and pelvic floor exercises included began an exercise programme: the vibration group performed exercises on a vibration platform, the non-vibration group performed an exercise programme that consisted of static contraction exercises of the hip adductors, gluteal and abdominal muscles in the standing, lying and sitting positions. The group was trained to perform 3 -4 sets of exercises with 15 – 20 repetitions of each set and with a 60-second break between sets. The entire exercise programme lasted for four weeks with three workouts per week.
During the three-month follow-up period, all women participated in one-hour pelvic floor muscle exercises once a month. The participants were also encouraged to perform the exercises at least once a day at home. In order to better monitor these activities, the subjects were asked to document the time and the chosen set, which was prepared in the form of a video for each woman.
Use of vibration therapy in the study
The vibration group performed the programme based on the protocol shown in the table. The duration and frequency of vibration applied increased with successive sessions (30 to 60 seconds, 30 to 50 Hz).
Study results
No significant differences in test results were found between the vibration and exercise groups. However, significant test results emerged in both groups when comparing them before and after the experiment. Quality of life as measured by the I-QOL test increased in the vibrotherapy group from 43.52±26.64 to 64.02±26.5, in the exercise group from 56.66±22.57 to 74.47±16.71). Pelvic floor muscle strength measured by digital palpation increased in both groups (vibrotherapy from 2.45±0.9 to 4.10±0.7, exercise from 2.66±0.96 to 4.18±0.85). Subjective pain sensation decreased in the vibration group from 7.95 ± 1.9 to 4.14 ± 1.9 and in the exercise group from 7.42±1.64 to 3.05±1.46. After a 3-month follow-up, the effects of both protocols were similar.
Comment
Stress urinary incontinence affects physical, social, psychological and sexual health. It is defined by sufferers as the involuntary leakage of urine from the urethra. Treatment of this condition includes conservative interventions, i.e. pelvic floor muscle training, lifestyle improvements and pharmaceutical and surgical interventions. The main cause of stress urinary incontinence is pelvic floor muscle dysfunction. In half of the women, the cause of pelvic floor muscle weakness was pregnancy and childbirth. Pelvic floor muscle training is an essential tool in working with patients to improve their strength and urethral sphincter strength. Vibrotherapy can be helpful in this activity. This non-invasive method has a positive effect on improving muscle strength, endurance and neuromuscular conduction. This effectiveness has been studied not only in healthy people, but also in people with various chronic diseases, who are often unable to train themselves.
The four-week intervention resulted in improved muscle strength in both groups: the group with vibration therapy and the group performing sets of exercises to improve pelvic floor muscle strength. Improving the strength of these muscles is essential in the setting of a sudden increase in intra-abdominal pressure. Vibrotherapy appears to be a good method for combating stress urinary incontinence. The change in pelvic floor muscle strength is not the only effect of vibrotherapy. It is also possible that other aspects such as timing, coordination, endurance and speed of contraction may contribute to improving the quality of life of people with this condition. The results of other studies confirm the effect of low-frequency vibration on increasing muscle strength and temperature. Vibrotherapy is a stimulus that improves proprioception, and the Ia and II lead fibres of the pelvic floor muscle spindles are sensitive to small changes in muscle length stimulated by vibration. The improvement in muscle function in the vibration group may also be due to its effects on the neuromuscular system (tonic vibration reflex – cyclic states of contraction and relaxation, synchronisation of muscle units), muscle growth, stimulation of propriospinal reflex pathways.
Although there was no significant difference in results between the groups, the study revealed the acceptance of vibrotherapy as a method that has a positive effect on reducing the complaints of stress urinary incontinence and thereby improving quality of life. The therapeutic effects persisted 3 months after treatment and patients were satisfied with the treatment, which was a strength of this research programme.
Vibrotherapy proved to be as effective a treatment for stress urinary incontinence as pelvic floor muscle training.
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