Title: Modified Pilates as an adjunct to Standard Physiotherapy Care for Urinary Incontinence: a pilot study
Funder: Department of Health (England)

Abstract: Background Urinary incontinence (UI) is a distressing, socially embarrassing condition affecting 1 in 3 women over 40 [1]. Recent studies have shown that UI is associated with reduced quality of life [2] and may be an important barrier to regular physical and fitness activities [3] thus threatening women’s general health and wellbeing [4]. Recently the mind-body technique of Modified Pilates (MP) has been suggested as a ‘compelling full-body intervention for the treatment and prevention of pelvic floor dysfunction’ [5]. MP focuses on slow controlled movements, postural awareness, and breathing with low intensity abdominal and pelvic floor control avoiding detrimental activities such as breath holding. It is therefore suggested that MP holds potential as a clinically effective group treatment for UI. Aims A mixed methods approach will provide preliminary findings about the effectiveness of participating in a 6 week course of MP classes as an adjunct to standard physiotherapy care (SPC). 1) A pilot study for a randomised clinical trial (RCT) will: a) assess the feasibility of the trial protocol, b) assess variation of the main outcome measures in order to inform sample size for a full RCT, c) provide preliminary data about the effect of MP classes on symptom severity, frequency of incontinence, quality of life, self esteem, Body Mass Index (BMI), and number of individual treatment sessions. 2) Semi-structured interviews will: a) identify benefits/limitations of MP compared to SPC, b) explore the acceptability of MP classes compared to SPC for patients suffering UI. Plan of Investigation A pilot RCT will provide preliminary findings about the effectiveness of a 6 week course of MP classes as an adjunct to SPC, compared with SPC alone, for women aged 18 and over referred to a women’s health physiotherapy service for UI. 100 patients will be recruited and, following stratification by BMI and symptom severity, randomly allocated to each arm. Data collection by self-complete questionnaires will be at baseline (T1), completion of intervention (T2), and 5 months after randomisation (T3), and will include: symptom severity; frequency of incontinence; quality of life; self-esteem, BMI, and number of individual treatment sessions. Qualitative data about the experience of MP and SPC will be collected through semi-structured interviews at T2 and T3. Potential Impact This study will provide information for planning a definitive RCT to evaluate MP classes for UI which, if proved to be effective, could be implemented throughout the NHS with little modification. For NHS practitioners, MP could provide a cost effective strategy of health promotion for appropriate patients. For sufferers of UI the trial has the potential to widen patient choice and potentially break into the distressing cycles of UI by encouraging social interaction, and regaining confidence of physical activity and body awareness. Consequently, MP could have wide public health benefits, acting as a precursor to more frequent and intense activity, since even small improvements in the wellbeing of women can impact on the overall health of the nation [6].


Research activity codes: 6.7 PHYSICAL
Health categories: RENAL AND UROGENITAL