Dynamic Neuromuscular Stabilization Exercises in Women With Urinary Incontinence

Официальное название

Effects of Dynamic Neuromuscular Stabilization Exercises on Urinary Symptoms and Pelvic Floor Muscle Functions in Women With Stress Urinary Incontinence: A Single-Blind Non-Inferiority Clinical Study

Обзор

Stress urinary incontinence (SUI) is defined by the International Continence Society as the complaint of involuntary leakage of urine during physical exertion, including sports activities, or during sneezing or coughing. In continent women, an automatic response-namely, a reflex pelvic floor muscle (PFM) contraction, also known as pre-contraction-occurs either prior to or during physical exertion. Although there is strong evidence supporting the effectiveness of pelvic floor muscle training (PFMT) in the treatment of SUI, there has been a growing interest in exploring alternative exercise-based interventions. Dynamic Neuromuscular Stabilization (DNS) is a manual and rehabilitative approach developed by Professor Pavel Kolar. It is grounded in the scientific principles of developmental kinesiology and aims to optimize the function of the movement system. Currently, DNS is successfully employed in the rehabilitation of various neurological, musculoskeletal, pediatric, and sports-related injuries. DNS incorporates the subconscious and synergistic activation of the deep core muscles responsible for intra-abdominal pressure (IAP) regulation and spinal stability-namely, the diaphragm, transversus abdominis, multifidus, and pelvic floor muscles-as well as the global musculature. Considering the potential mechanisms of DNS, we hypothesize that DNS exercises, through IAP regulation directed toward the pelvic cavity and contributing to stabilization, could serve as an effective and innovative approach for women with SUI. The hypotheses of this study are as follows: H1.1: DNS is as effective as PFMT in reducing urinary symptoms in women with SUI. H1.2: DNS is as effective as PFMT in improving PFM function in women with SUI.

Вмешательства

• Поведенческое Pelvic floor muscle training
  Women in this group will undergo pelvic floor muscle training (PFMT) using the NeuroTrac MyoPlus 4 PRO EMG biofeedback device. Prior to the training, diaphragmatic breathing will be taught to all participants in this position to facilitate relaxation and prepare for PFMT. During the training, participants will perform pelvic floor muscle contractions while observing the real-time feedback of slow and fast contractions, as well as relaxation phases, on the computer screen connected to the device.
• Поведенческое Dynamic neuromuscular stabilization
  Women in this group will be instructed in exercises based on the principles of Dynamic Neuromuscular Stabilization (DNS). Prior to the exercises, intra-abdominal pressure regulation through breathing techniques will be demonstrated. In this study, the Core 360 belt with OhmTrack sensors will be used. Both breathing exercises and DNS exercises will be taught with the belt in place. In a corrected posture, participants will be instructed to gently press the abdominal wall toward the sensors and to

Первичные конечные точки

• Change of Pelvic Floor Pre-contraction during valsalva [Срок оценки: From enrollment to the end of treatment at 8 weeks]

Вторичные конечные точки (6)

• Pelvic floor muscle strength (Vaginal palpation) [Срок оценки: From enrollment to the end of treatment at 8 week]
• Resting EMG activity [Срок оценки: From enrollment to the end of treatment at 8 weeks]
• Maximum voluntary contraction [Срок оценки: From enrollment to the end of treatment at 8 weeks]
• Change in Urinary Incontinence Severity [Срок оценки: From enrollment to the end of treatment at 8 weeks]
• Change in urinary symptoms and impact on quality of life [Срок оценки: From enrollment to the end of treatment at 8 weeks]
• Change of contraction onset time [Срок оценки: From enrollment to the end of treatment at 8 weeks]

Критерии участия

Критерии включения

• Female gender,
• Voluntary participation in the study,
• Aged between 18 and 62 years,
• Ability to read and write in Turkish,
• No mental disorders that would impair cooperation or comprehension,
• Complaint of stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence.

Критерии исключения

• Prior history of pelvic floor muscle training,
• Presence of any neurological disorder,
• Pelvic organ prolapse stage II or higher,
• Presence of fecal incontinence,
• Pregnancy,
• Lower extremity conditions that may affect pelvic alignment (e.g., leg length discrepancy, total hip arthroplasty),
• Active lower urinary tract infection,
• Presence of respiratory disorders such as chronic obstructive pulmonary disease or asthma,
• History of hysterectomy.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Лечение

Центры проведения

Turkey (Türkiye) · 1 центр

• Izmir University of Economics — Izmir

Идентификаторы

NCT: NCT07009249 · SYY_IEU_5

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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