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The effects of physiotherapy for female urinary incontinence: individual compared with group treatment
C C Janssen1, A L Lagro-Janssen, A J Felling
1Science for Policy and Society (ITS), and Department of General Practice, Nijmegen University, The Netherlands. toosjanssen@mailbox.kun.nl
Objectives:
To compare, in a randomized trial, the effects of individual and group physiotherapy for urinary incontinence in women referred by their general practitioner (GP).
Patients And Methods:
The study included women of all ages (mean 47.8 years) with stress, urge or mixed incontinence; 126 received individual and 404 group treatment. Both groups undertook the same pelvic floor exercises and bladder training, and received the same information. The effects were measured soon after treatment and again 9 months later. The main outcome measures were objective changes in the severity of incontinence, frequency of urine loss and frequency of nocturnal urine loss. The trial was nationwide; 25 physiotherapists and 337 GPs participated.
Results:
There were no significant differences in effect between the groups; after individual treatment the severity of incontinence improved in 60% of the patients and the mean (95% confidence interval, CI) frequency of urine loss decreased, by -8.7 (-6.4 to -11.1) times/week. After group therapy continence improved in 57% and the frequency of urine loss decreased, by -8.4 (-6.8 to -10.0) times/week. For women who had nocturnal urine loss (at baseline), the frequency decreased after individual treatment by -11.2 (4 to -26.4) and after group therapy by -14 (-9.1 to -18.9) times/month. All improvements persisted in full for up to 9 months.
Conclusion:
Individual and group physiotherapy are equally effective for at least 9 months in improving incontinence in women. Factors should be sought that can predict the effectiveness of therapy, and thus better select those patients most likely to benefit from therapy.