Treatment of Urinary Incontinence in Women With Spinal Cord Injury

NCT ID: NCT02427230

Last Updated: 2017-08-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

27 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-05-31

Study Completion Date

2017-03-31

Brief Summary

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The purpose of this study is to determine whether pelvic floor muscle training (PFMT) and intravaginal neuromuscular electrical stimulation (NMES) are effective in reducing urinary incontinence and improving quality of life in women with spinal cord injury (SCI).

Detailed Description

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SCI patients often experience neurogenic bladder dysfunction with neurogenic detrusor overactivity or areflexic bladder. Due to this, 40-50 % of the SCI population suffers from urinary incontinence, which often reduces the patient's quality of life.

In order to manage the neurogenic bladder dysfunction, SCI patients use specialized bladder emptying methods, most frequently clean intermittent catheterization. To reduce the symptoms of neurogenic detrusor overactivity and urinary incontinence in patients with a SCI, medical anticholinergic therapy can be assessed, but the effect is sparse and many adverse effects have been reported. Injection of Botulinum-A toxin in the bladder has shown great potential in minimizing the symptoms of neurogenic detrusor overactivity and urinary incontinence, though it is an expensive and invasive method that needs to be repeated due to its temporary effect.

PFMT and NMES of the pelvic muscles are non-invasive and cheap treatments without side effects and several studies have demonstrated the positive effect of intravaginal NMES and/or PFMT on urinary incontinence in able-bodied women as well as women with neurological disorders like multiple sclerosis.

Despite the fact that NMES of weak or paralyzed striated muscles has been used for decades in patients suffering from SCI, to our knowledge, no study has previously investigated the effect of PFMT and intravaginal NMES in women with SCI.

The aim of this study is to evaluate the effect of PFMT and intravaginal NMES on Urinary Incontinence and Quality of Life in women with SCI. In particular, we will investigate the potential additional effect of intravaginal NMES, when NMES is conducted in combination with PFMT.

This study is designed as a randomized clinical trial, investigating the effect of PFMT alone and in combination with intravaginal NMES. We will include 40 female patients with an incomplete SCI and urinary incontinence. After physiotherapeutic guidance, the patients perform PFMT or PFMT + NMES daily at home for 12 weeks with follow-up evaluations every fourth week.

Conditions

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Spinal Cord Injury Urinary Incontinence

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators

Study Groups

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Pelvic floor muscle training (PFMT)

Pelvic floor muscle training daily during 12 weeks.

Group Type ACTIVE_COMPARATOR

Pelvic floor muscle training

Intervention Type BEHAVIORAL

The intervention in group 1 consists of three private lessons in PFMT conducted by a physiotherapist every 4th week.

At each consultation the physiotherapist will use manual palpation of the pelvic floor muscles and Electromyography Biofeedback (EMG). Patients will be instructed to carry out three series of approximately 10 near-maximal pelvic floor muscle contractions held for approximately 6-8 seconds daily during 12 weeks.

PFMT and electrical stimulation

Pelvic floor muscle training and intravaginal neuromuscular electrical stimulation daily during 12 weeks.

Group Type ACTIVE_COMPARATOR

Pelvic floor muscle training

Intervention Type BEHAVIORAL

The intervention in group 2 consist of three private lessons in PFMT and intravaginal NMES conducted by a physiotherapist every 4th week.

At each consultation the physiotherapist will use manual palpation of the pelvic floor muscles and Electromyography Biofeedback (EMG). Patients will be instructed to carry out three series of approximately 10 near-maximal pelvic floor muscle contractions held for approximately 6-8 seconds daily during 12 weeks.

Additionally, patients will be instructed on how to use intravaginal NMES and each patient receives a vaginal electrical stimulator (CefarPeristim Pro). The NMES settings consist of two different frequencies, 40 Hz and 10 Hz, and patients are instructed to use both settings daily for maximum 30 minutes during 12 weeks.

vaginal electrical stimulator (CefarPeristim Pro)

Intervention Type DRUG

electrical stimulation

Interventions

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Pelvic floor muscle training

The intervention in group 1 consists of three private lessons in PFMT conducted by a physiotherapist every 4th week.

At each consultation the physiotherapist will use manual palpation of the pelvic floor muscles and Electromyography Biofeedback (EMG). Patients will be instructed to carry out three series of approximately 10 near-maximal pelvic floor muscle contractions held for approximately 6-8 seconds daily during 12 weeks.

Intervention Type BEHAVIORAL

Pelvic floor muscle training

The intervention in group 2 consist of three private lessons in PFMT and intravaginal NMES conducted by a physiotherapist every 4th week.

At each consultation the physiotherapist will use manual palpation of the pelvic floor muscles and Electromyography Biofeedback (EMG). Patients will be instructed to carry out three series of approximately 10 near-maximal pelvic floor muscle contractions held for approximately 6-8 seconds daily during 12 weeks.

Additionally, patients will be instructed on how to use intravaginal NMES and each patient receives a vaginal electrical stimulator (CefarPeristim Pro). The NMES settings consist of two different frequencies, 40 Hz and 10 Hz, and patients are instructed to use both settings daily for maximum 30 minutes during 12 weeks.

Intervention Type BEHAVIORAL

vaginal electrical stimulator (CefarPeristim Pro)

electrical stimulation

Intervention Type DRUG

Other Intervention Names

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Group 1 Group 2

Eligibility Criteria

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Inclusion Criteria

* Incomplete SCI graded C, D og E on ASIA Impairment Scale, sustained minimum 3 months ago
* urinary incontinence, corresponding to a total ICIQ-UI-SF score ≥ 8

Exclusion Criteria

* Regular treatment with botox bladder injections or \< 1 year since last botox injection
* Lack of urodynamic investigation after the SCI
* Pregnancy
* Pacemaker
* Lack of ability to contract the pelvic floor muscles during objective clinical examination
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Herlev Hospital

OTHER

Sponsor Role collaborator

University of Copenhagen

OTHER

Sponsor Role collaborator

Rigshospitalet, Denmark

OTHER

Sponsor Role collaborator

Glostrup University Hospital, Copenhagen

OTHER

Sponsor Role lead

Responsible Party

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Marlene Elmelund

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Marlene Elmelund, MD

Role: PRINCIPAL_INVESTIGATOR

Clinic for Spinal Cord Injuries, Glostrup University Hospital/Rigshospitalet and Department of Gynaecology and Obstetrics, Herlev University Hospital

Fin Biering-Sørensen, MD DMSc Prof

Role: STUDY_DIRECTOR

Clinic for Spinal Cord Injuries, Glostrup University Hospital/Rigshospitalet

Niels Klarskov, MD Lecturer

Role: STUDY_DIRECTOR

Department of Gynaecology and Obstetrics, Herlev University Hospital

Locations

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Department of Gynaecology and Obstetrics, Herlev University Hospital

Herlev, , Denmark

Site Status

Countries

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Denmark

References

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Hansen RB, Biering-Sorensen F, Kristensen JK. Urinary incontinence in spinal cord injured individuals 10-45 years after injury. Spinal Cord. 2010 Jan;48(1):27-33. doi: 10.1038/sc.2009.46. Epub 2009 Jun 2.

Reference Type BACKGROUND
PMID: 19488052 (View on PubMed)

Jerez-Roig J, Souza DL, Espelt A, Costa-Marin M, Belda-Molina AM. Pelvic floor electrostimulation in women with urinary incontinence and/or overactive bladder syndrome: a systematic review. Actas Urol Esp. 2013 Jul-Aug;37(7):429-44. doi: 10.1016/j.acuro.2012.08.003. Epub 2012 Dec 13. English, Spanish.

Reference Type BACKGROUND
PMID: 23246103 (View on PubMed)

McClurg D, Ashe RG, Marshall K, Lowe-Strong AS. Comparison of pelvic floor muscle training, electromyography biofeedback, and neuromuscular electrical stimulation for bladder dysfunction in people with multiple sclerosis: a randomized pilot study. Neurourol Urodyn. 2006;25(4):337-48. doi: 10.1002/nau.20209.

Reference Type BACKGROUND
PMID: 16637070 (View on PubMed)

McClurg D, Ashe RG, Lowe-Strong AS. Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis--a double blind, placebo controlled, randomised clinical trial. Neurourol Urodyn. 2008;27(3):231-7. doi: 10.1002/nau.20486.

Reference Type BACKGROUND
PMID: 17705160 (View on PubMed)

Bo K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999 Feb 20;318(7182):487-93. doi: 10.1136/bmj.318.7182.487.

Reference Type BACKGROUND
PMID: 10024253 (View on PubMed)

Klarskov N, Lose G. Urethral pressure reflectometry; a novel technique for simultaneous recording of pressure and cross-sectional area in the female urethra. Neurourol Urodyn. 2007;26(2):254-61. doi: 10.1002/nau.20283.

Reference Type BACKGROUND
PMID: 17016844 (View on PubMed)

Other Identifiers

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20.941

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

H-2-2014-113

Identifier Type: -

Identifier Source: org_study_id

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