Read about the research

 
Read about the research

Read about the research

 
Read about the research

The latest issue of the Journal of Physiotherapy has something for everyone, and as usual some of the authors answer questions about their research.



COST-EFFECTIVENESS OF PFMT FOR POSTPARTUM INCONTINENCE


This systematic review found that group-based pelvic floor muscle training (PFMT) during pregnancy is likely more efficient than individual postnatal PFMT for women with incontinence. Q&A with Robyn Brennen.


Your systematic review the most cost-effective ways to provide pelvic floor muscle training to prevent or treat postpartum incontinence. How common is incontinence after childbirth?


Thirty-three per cent of women experienced urinary incontinence in the first three months after childbirth (Thom & Rortveit 2010), while reported rates of faecal incontinence after childbirth range from 3 to 29 per cent (Eason et al 2002, Guise et al 2007).


Is pelvic floor muscle training the first choice for both types of incontinence in these women?


PFMT is recommended as first-line management for both urinary and faecal incontinence in adults.


There is National Health and Medical Research Council (NHMRC) level 1 evidence and Grade A recommendation from the International Continence Society that PFMT should be offered to all continent pregnant women to reduce the risk of postnatal urinary incontinence, and for PFMT to treat urinary incontinence in adult women in general (not specific to pregnancy or postnatal; Abrams et al 2017, Woodley et al 2017).


Treatment options for faecal incontinence include conservative therapies such as PFMT, lifestyle changes, and bowel training, with NHMRC level 2 evidence and Grade B recommendation from the International Continence Society for PFMT to treat faecal incontinence in adults (Abrams et al 2017).


What models for delivering the therapy were effective in the studies you reviewed?


The models that were clinically effective were:



  • individual PFMT during pregnancy for prevention or mixed prevention and treatment of urinary incontinence

  • group-based PFMT during pregnancy for prevention of urinary incontinence

  • individual postnatal PFMT for treatment or mixed prevention and treatment of urinary incontinence

  • individual postnatal PFMT for treatment or mixed prevention and treatment of faecal incontinence.


And what was the most effective model for urinary incontinence?


Individual PFMT delivery during pregnancy to prevent urinary incontinence was the most cost-effective model for overall costs.


Group-based PFMT during pregnancy to prevent urinary incontinence was the most cost-effective model from a health service perspective, depending on the number of women attending the group-based intervention and the out-of-pocket costs charged.


Group-based PFMT during pregnancy for prevention is more cost- effective for a health service compared to individual PFMT during pregnancy for prevention if:



  • at least five women can attend the group sessions and the service charges $10 per session

  • at least eight women can attend the group sessions and the service charges $5 per session

  • at least 13 women can attend the group sessions and there is no charge per session.


What about faecal incontinence?


There was insufficient data to compare different models of PFMT to prevent or treatment faecal incontinence.


The cost to a health service for individual postnatal PFMT for mixed prevention and treatment of faecal incontinence was $2784 per case of faecal incontinence prevented or cured.


Where should research in this area be heading?


We need to investigate the clinical and cost-effectiveness of PFMT during pregnancy for prevention or treatment of faecal incontinence and early postnatal PFMT that commences while the consumer is still in the hospital. Research into PFMT for women with incontinence during pregnancy should include regular supervision at recommended levels.


An experienced physiotherapist and midwife, Robyn Brennen is a passionate advocate for access to quality healthcare for women. She has worked in clinical leadership and teaching roles in women’s health and continence at Monash Health, the University of Melbourne and University of South Australia, and is undertaking her PhD at Monash University.



References


Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. Vol 89. Oxford, UK2010:1511-1522.

Eason E, Labrecque M, Marcoux S, Mondor M. Anal incontinence after childbirth. CMAJ. 2002;166(3):326-330.

Guise JM, Morris C, Osterweil P, Li H, Rosenberg D, Greenlick M. Incidence of fecal incontinence after childbirth. Obstet Gynecol. 2007;109(2 Pt 1):281-288.

Abrams P, Cardozo, L., Wagg, A., Wein, A., ed. Incontinence, 6th Edition. Vol 2. Bristol, United Kingdom: International Continence Society; 2017:1176 – 1180.

Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. The Cochrane database of systematic reviews. 2017;12(12):CD007471.





 




 


 

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