A pilot study to evaluate the effectiveness of dynamic lumbo-pelvic stability training as a treatment strategy for women with stress incontinence: a randomised controlled trial

INTERVENTION: 1. Control Group will be taught standard static pelvic floor training exercises 2. Intervention Group will learn dynamic lumbo‐pelvic stability training exercises (modified Pilates method) Accessible participants will be informed about the research trial using a research subject information sheet submitted in a question and answer format. Women not wishing to take part in the trial will be offered standard physiotherapy treatment through the normal patient booking procedures. Consenting women will complete the Kings Health Questionnaire, a validated and reliable tool to measure stress incontinence symptoms and quality of life and attend the physiotherapy department for a full physiotherapy urogynaecological assessment with the chief investigator or a research assistant. A second, senior, postgraduate qualified physiotherapist will attend the urogynaecological assessment to perform a vaginal examination of the pelvic floor muscles and assessment of muscle action (strength and endurance) as is standard physiotherapy procedure. During this vaginal assessment all women will be taught correct pelvic floor muscle contraction, shown the extent of the muscle, cuing techniques will be used to maximise muscle recruitment. Fast contractions and slow contractions without accessory muscles or breath holding will be facilitated. The patient will be instructed how to self‐examine the pelvic floor. Patients' questions about how to activate the pelvic floor will be answered. After these cuing/teaching activities a final grade will be given for strength and endurance. The grading will be carried out using a reliable and validated method. The measurements will be recorded and kept securely but the chief investigator will not view the measurements until the analysis procedure at the end of the trial. Those scoring Grade 0 ,1 or 2 on pelvic floor assessment will be unable to take part in the trial and will be offered the appropriate physiotherapy treatment of biofeedback/stim CONDITION: Urological and Genital Diseases: Stress incontinence ; Urological and Genital Diseases PRIMARY OUTCOME: Not provided at time of registration SECONDARY OUTCOME: Not provided at time of registration INCLUSION CRITERIA: Participants will be recruited from January 2004 to June 2004 subject to Local Research Ethics Committee approval. Women over 16 years referred to the Addenbrookes Hospital physiotherapy department with stress urinary incontinence will be invited to participate in the trial.