Development and validation of a clinical prediction rule to guide and improve the treatment of female stress urinary incontinence

Aim(s):

To develop and test a clinical prediction rule to identify before treatment, those women likely to benefit from PFM training.

Summary:

Urinary incontinence (UI) affects 1 in 3 women 18 years and over. UI can lead to significant social problems, embarrassment, and negative self-perception; reduces social interactions and physical activities; and, among older women, increases nursing-home admissions. UI interferes with quality of life and healthy aging; left untreated, it can also lead to the need for surgery. The treatment of UI and related problems alone adds $1.9 billion to Canada’s healthcare costs. Pelvic floor muscle (PFM) training, taught to women by a specially-trained physiotherapist is effective, cost-effective and is recommended as the first-line treatment option. Research indicates training strengthens PFMs and reduces/eliminate leakages in 76% of women, but there is currently no way to identify which women would benefit. Consequently, many women are steered towards more costly and potentially risky surgical options. Other women may be offered PFM training when ultimately surgery is required. Based on previous research, this study aims to develop and test a clinical prediction rule to help researchers and clinicians identify before treatment, those women likely to benefit from PFM training, increasing their chances of conservative treatment success. The rule will use information from demographic, clinical and biomechanical data to make the predictions. 465 women with stress UI will complete a pre-treatment UI assessment, then 12 weekly 1-hour group-based PFM training sessions. One-year after, the women’s UI will be reassessed. Using the post-treatment results as an outcome, a clinical prediction rule will be developed to inform clinicians on the pre-treatment factors which best distinguish women who will or will not benefit from group-based PFM training. 

Principal Investigator: University of Montreal

NMAHP Research Unit Collaborators: Professor Suzanne Hagen

External Collaborators: Desmeules F - Université de Montréal, Mayrand M - Université de Montréal, Morin M - Université de Sherbrooke, Mâsse B - Université de Montréal, Svabik K - Charles University in Prague, Tang A - Université de Montréal, Campeau L - Jewish General Hospital (Montreal), Girard I - Université de Sherbrooke, Lemieux M - Hôpital Maisonneuve-Rosemont, Leroux N - CHU Ste-Justine, Reichetzer B - Centre hospitalier de l'Université,  de Montréal, Tu L - Université de Sherbrooke, Walter E, McGill.

Funder: Canadian Institutes for Health Research (CIHR)