농촌지역 요실금 여성의 골반저 근육강화 방법에

Abstract

ABSTRACT

Comparison of the Effects of Pelvic Floor Muscle Strengthening Therapies for Urinary Incontinence among Women in a Rural Community

Park, Kwang-he Advisor Kang, Myung-geun, MD, PhD Department of Public Health, Graduate School of Chosun University

The purpose of this study was to compare the effects of 3 pelvic floor muscles strengthening therapies for women with urinary incontinence(UI) in a rural community setting of Gwangju city, Korea by quasi-experimental study design. The study subjects were 61 women consisted of 3 experimental groups applied combined therapy of biofeedback and extracorporeal magnetic innervation(group A, 20 subjects), therapy of extracorporeal magnetic innervation alone(group B, 25subjects) and therapy of collective behavioral training alone(group C, 16 subjects) over 6 weeks, from whom have received the documented informed consents. The outcome measures to compare the effects of 3 groups of therapies were the subjective indices such as UI situation score(USS), self-efficacy towards UI self-control(SEUI), UI-related quality of life(QoLUI), degree of improvement in symptoms, maintenance of strengthening exercise trained at 3 months after completion and the objective indices such as maximum and mean pressure on vaginal contraction(cmH2O; VPmax, VPmean), maintaining time of vaginal contraction(sec.; VCT). As the methods of statistical analyses, paired t-test for the change from pre- to post-experimental values of 3 groups respectively, ANCOVA for comparing mean differences between pre- and post-experimental outcome values among 3 groups after adjusting the covariates with non-equivalent baseline values, repeated measure ANOVA for analysing individual changes of USS were used. The major findings of this study were as follows; 1) USS decreased significantly after interventions in all 3 groups(p<0.001, respectively). But regarding the mean difference in USS, there was no significant difference among 3 groups(p=0.681). 2) VPmax increased in all 3 groups(p<0.001, respectively). VPmean increased in both group A and B(p<0.001), but in the case of group C, increased partially(p=0.081). VCT increased in group A, B(p<0.001), and group C(p=0.004). Regarding the mean difference in VPmax(p=0.169), VPmean(p=0.133), and VCT(p=0.833), there were no significant difference among 3 groups. 3) SEUI increased significantly after interventions in all 3 groups (p<0.001, respectively). But regarding the mean difference in SEUI, there was no significant difference among 3 groups(p=0.150). As a result of post hoc test(LSD), group B showed somewhat more increase than group C. 4) QoLUI increased in group A, B(p<0.001, respectively), and group C(p=0.003). Regarding the mean difference in QoLUI , there was a partial difference among 3 groups(p=0.059). As a result of post hoc test(LSD), group A showed more increase than group B and group C. 5) The symptoms of UI improved in all 3 groups(proportion of subjects with feeling of improvement=86.9%). 6) There was signigicant difference in degree of improvement in symptoms among 3 groups(p=0.001). Especially, in the case of group B, 68.0% of subjects said that they might be cured 'completely'. As a result of follow-up telephone survey at the time of 3 months after completion of each programs, 3 groups showed no significant difference in the maintenance of strengthening exercise trained(p=0.925). USS at 3 months after completion was not different from that at immediately after completion in all 3 groups. In conclusion, as the results of assessment of the effectiveness through both subjective and objective outcome measures, the 3 pelvic floor muscle strengthening therapies had similar effectiveness to strengthen pelvic floor muscles. Therefore, we suggested that behavioral training therapy be requested to women with UI in rural community-setting, in that this therapeutic modality was less invasive and more expensive than other 2 modalities and was similar to them in effectiveness. ---------------- Key words : urinary incontinence, behavioral training, extracorporeal magnetic innervation, strengthening pelvic floor muscles, rural women