Do Physical Therapy Interventions Affect Urinary Incontinence and Quality of Life in People with Multiple Sclerosis?: An Evidence-Based Review.

Abstract

Multiple sclerosis (MS) presents with many debilitating symptoms, including urinary incontinence (UI), that physical therapy (PT) may address; UI is widely prevalent, but PT management of symptoms lacks consensus. A meta-analysis of long-term nonsurgical and nonpharmaceutical treatment options may supply this deficiency. We analyzed the current evidence for effectiveness of PT to decrease UI and improve quality of life (QOL) in people with MS. An electronic search conducted through November 26, 2013, included the following search terms: incontinence, bladder dysfunction, urinary incontinence, multiple sclerosis, MS, physical therapy, physiotherapy, therapy, and rehabilitation. Criteria for inclusion were as follows: MS diagnosis, intervention involved PT for UI or bladder dysfunction, outcomes assessed QOL or UI, and at least a 4 of 10 on the Physiotherapy Evidence Database scale or a 2b level of evidence. Outcomes were combined across studies, and effect sizes are depicted in forest plots. Six studies met the inclusion criteria. Between-group analysis revealed statistically significant differences in incontinence episodes and QOL, but did not reach significance for functional control mechanisms (eg, electromyography data on strength of contraction, relaxation, and endurance). Incontinence leakage episodes and QOL participation improved within groups. Meta-analysis indicates support for PT for minimizing incontinence compared with pretreatment and affecting incontinence and QOL more than control in people with MS. Protocols were heterogeneous regarding duration and type of PT intervention and were applied in different types of MS. Further research may reveal the most effective combination and variety of PT interventions for people with MS.