Group-based and individual pelvic floor muscle training (PFMT) are similarly effective for managing urinary incontinence in older women, according to a recent study.1

Individual PFMT is the recommended first-line treatment for stress or mixed urinary incontinence in women, “but human and financial resources limit its delivery,” Chantale Dumoulin, PhD, of the University of Montreal in Canada, and colleagues stated in a paper published in JAMA Internal Medicine. Widespread use of group-based training “may help increase continence-care affordability and treatment availability,” they concluded.

The findings are from the Group Rehabilitation or Individual Physiotherapy (GROUP) study, a single-blind, randomized, noninferiority trial conducted in 2 Canadian research centers from July 1, 2012, to June 2, 2018. The trial enrolled 362 community-dwelling women aged 60 years or older (mean age 68 years) with symptoms of stress of mixed urinary incontinence. Patients first received an individual session to instruct them in how to contract pelvic floor muscles. Then, under the direction of an experienced pelvic floor physiotherapist, the women participated in 12-week PFMT either in individual sessions (184 women) or in groups (178 women).

Of the 362 participants, 319 (88%) completed the 1-year follow-up and were included in a per-protocol analysis. The median percentage reduction in urinary incontinence episodes was 70% (95% CI, 44-89) among those receiving individual PFMT and 74% (95% CI, 46-86) among those receiving group-based PFMT, a between-group difference that was not statistically significant (P =.58), confirming noninferiority, according to the investigators.


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Further, the authors pointed out that study participants demonstrated a high level of adherence to treatment sessions and home exercises, with a small proportion of patients lost to follow-up, “indicating acceptability of both interventions.”

“Overall, these findings provide encouraging evidence that older incontinent women can engage successfully in group-based PFMT and reap benefits for incontinence that are comparable to those of individual PFMT training, Alison J. Huang, MD, MAS, of the University of California, San Francisco, commented in an accompanying editorial.2

Although the study is not the first to evaluate group-based PFMT, “it is the first to evaluate it rigorously against individual PFMT in an adequately powered sample with extended follow-up and in isolation from other treatment strategies,” she wrote.

In addition, Dr Huang noted that group-based PFMT presents its own logistical challenges. For example, patients have to engage in training on shared days and times instead of scheduling training according to individual availability. “Therapists also have less flexibility to tailor therapy to patients’ individual weaknesses or learning difficulties.”

References

  1. Dumoulin C, Morin M, Danieli C, et al. Group-based vs individual pelvic floor muscle training to treat urinary incontinence in older women. JAMA Intern Med. 2020;180:1284-1293. doi:10.1001/jamainternmed.2020.2993
  2. Huang AJ. Pelvic floor therapy for older women with urinary incontinence — Can group-based training reduce the population-level burden of this condition. JAMA Intern Med. 2020;180:1293-1294. doi:10.1001/jamainternmed.2020.2983