Anne Moseley talked to Professor Kari Bø (Norges Idrettshøgskole, Norway) whose trial evaluating pelvic floor muscle training for urinary incontinence is one of the 15 most significant trials in physiotherapy.
Anne: Explain what you did in the study
Kari: This was a four arm assessor blind randomised controlled trial comparing the effect of a 6 month intervention with either pelvic floor muscle training, use of vaginal weighted cones, electrical stimulation or untreated control. 8 physiotherapists and 5 urologists/gynaecologists conducted the study. The urologists/gynaecologists who evaluated the main outcome were blinded to group allocation. All interventions followed best practice for that method (for example, use of best practice for electrical stimulation parameters).
Anne: What was the main finding?
Kari: The main finding was that only pelvic floor muscle training was effective in improving pelvic floor muscle strength and reducing urinary incontinence in women with stress urinary incontinence (measured by pad test with standardised bladder volume). The women in the pelvic floor muscle training group were also more satisfied and wanted less further treatment. There was no discomfort or side effects in the pelvic floor muscle training group.
Anne: Why do you think the study is important?
Kari: It is important because it was shown in a blinded randomised controlled trial that pelvic floor muscle training was more effective than other methods that required more expensive equipment. Pelvic floor muscle training was the only method that showed an effect over that of an untreated control. The effect size based on the pad test was good.
Anne: What lead you to do the study?
Kari: When I published my first trial on pelvic floor muscle training in 1990 it was one of very few trials in the world on this topic. I compared two different approaches to pelvic floor muscle training and found that more intensive training with close follow up once a week was more effective than a less intensive approach. After that there was a boom of studies (usually non-randomised and pre-post-test designs) emerging which had direct influence on clinical practice. Methods like electrical stimulation and vaginal weighted cones were marketed as effective (there was more money behind these than simple strength training which was not marketed at all) although pelvic floor muscle training in my opinion had a much stronger theoretical rationale. A four arm randomised controlled trial comparing all these methods with an untreated control was therefore necessary.
Anne: What studies are you conducting now?
Kari: We have just finished a cohort study following 300 first time pregnant women with measurement of pelvic floor muscle function using transperineal ultrasound and vaginal pressure measurements plus a lot of other clinical assessments and questionnaires. The women have been assessed at gestational week 21 and 37 and 6 weeks, 6 months and 12 months postpartum. In addition we have finished an assessor blinded randomised controlled trial starting 6 weeks postpartum and lasting for 4 months. We have measured different outcomes, with urinary incontinence being the primary outcome. We also have data on diastasis recti abdominis, pelvic organ prolapse, pelvic pain, sexual dysfunction, pelvic girdle pain, low back pain and physical activity level. I am also supervising a physiotherapist at the University of Lisboa, Patricia Mota, who has submitted her PhD thesis on diastasis recti abdominis and have a new PhD student in Iceland, Thorbjørgur Sigurdardottir, working on a project in sports women and urinary incontinence and a randomised controlled trial on pelvic floor muscle training to treat faecal incontinence. In addition, I have 3 PhD students in gynaecology and 2 physiotherapists. I appreciate very much the collaboration with medical professionals. Sometimes we are not interested in the same question (which is good) and sometimes we disagree, but I am sure this collaboration makes both professions better. We must talk the same language and be in the same room to do the best for our patients.
Anne: Kari, thank you for making such a valuable contribution to physiotherapy.