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Impact of a Pelvic Floor Training Program Among Women with Multiple Sclerosis: A Controlled Clinical Trial

Ferreira, Ana Paula Silva MsC; Pegorare, Ana Beatriz Gomes de Souza MsC, PhD; Salgado, Pedro Rippel Spec; Casafus, Filemón Silva Spec; Christofoletti, Gustavo MsC, PhD

American Journal of Physical Medicine & Rehabilitation: January 2016 - Volume 95 - Issue 1 - p 1–8
doi: 10.1097/PHM.0000000000000302
Original Research Articles: CME Article . 2016 Series . Number 1

Objective The objective of this study was to investigate the effects of two programs for strengthening the pelvic floor on the urinary incontinence of patients with multiple sclerosis (MS).

Design This is a prospective study of the clinical trial type, monitored for 6 mos, in which 24 women in the moderate stage of MS participated in a program of exercises for strengthening the pelvic floor—associated (experimental group) or not (control group) with electrotherapy. The variables analyzed were as follows: quality-of-life, overactivity of the bladder, perineal contraction, and level of anxiety and depression. The statistical procedures involved multivariate analyses of repeated measurements, with a significance of 5%.

Results Initial homogeneity being observed in the anthropometric and clinical variables, both protocols resulted in improvements in quality-of-life (P = 0.001), overactive bladder (P = 0.001), perineal contraction (P = 0.004), and level of anxiety (P = 0.001) and depression (P = 0.001), in relation to the initial comparison. The association of electrotherapy with strengthening exercises increased the improvement of the patients regarding overactive bladder (P = 0.039) and perineal contraction (P = 0.001), in comparison with the control group.

Conclusions The results reinforce the benefit of exercises for strengthening the musculature of the pelvic floor in women with overactive bladder in MS and demonstrate a potential of the action when associated with electrotherapy.

To Claim CME Credits: Complete the self-assessment activity and evaluation online at

CME Objectives: Upon completion of this article, the reader should be able to: (1) Identify common dysfunctions of the lower urinary tract in women with multiple sclerosis; (2) Discuss the relationship between quality-of-life, level of anxiety and depression, degree of perineal contraction, and overactive bladder; and (3) Recognize the benefits promoted by physical therapy for strengthening the pelvic floor in patients with multiple sclerosis.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s) . Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Graduate Program in Health and Development (APSF, GC) and Multiple Sclerosis Outpatient Clinic (PRS), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil; Dom Bosco Catholic University (UCDB), Campo Grande, Mato Grosso do Sul, Brazil (ABGdSP); and Integra Care Center, Bauru, São Paulo, Brazil (FSC).

All correspondence and requests for reprints should be addressed to: Gustavo Christofoletti, MsC, PhD, Biological and Health Sciences Centre, Federal University of Mato Grosso do Sul, Avenida Universitária, s/n, Setor Universitário, Caixa postal 549, 79060-900 Campo Grande, Mato Grosso do Sul, Brazil.

The authors express their gratitude to CAPES (Coordination for the Improvement of Higher Education Personnel) for the grants and for the financial support.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.