The main aims of this prospective, multicentre, analytical observational study were to investigate the outcomes of physiotherapy treatment for stress urinary incontinence by continence physiotherapists in clinical settings, to estimate the costs of treatment and to develop a predictive model for treatment outcomes. / A systematic review of the relevant literature of the last 10 years, revealed a paucity of literature world-wide on the clinical effectiveness of physiotherapy despite strong evidence from randomized controlled trials of the efficacy of pelvic floor muscle training either alone, or in combination with other treatment modalities. Furthermore, no reports were found on the costs of physiotherapy management of stress urinary incontinence. A review of factors possibly associated with treatment outcome was undertaken to inform baseline data collection for later predictive modelling. / Two preliminary studies were carried out. A tool to objectively measure urine loss in the clinical setting, the Expanded Paper Towel Test, was developed as the pad tests recommended by the International Continence Society were impractical for clinicians to use. This new test proved to be efficient and simple to apply in clinical practice and allowed sensitive and accurate measurement of urine loss under provocation. It was reproducible to within one millilitre. The new test was found to have clinical applicability, providing continence physiotherapists with a robust measure of urine loss for women with mild to moderate stress urinary incontinence. / In a second preliminary study, physiotherapists who expressed interest in participating in the main study were tested for their reliability in the digital assessment of pelvic floor muscle strength. This was carried out in six centres around Australia and was a prerequisite for study participation. The results suggested that agreement was adequate to have confidence in baseline measures of pelvic floor muscle strength for subsequent regression analysis. / An observational study design was employed in the main study to investigate the outcomes of treatment by clinicians at the end of an episode of care, and at follow-up one year later. A before-after study design was employed using subjective, objective and quality of life outcome measures. Data were also collected on the characteristics of patients and episodes of care. Costs of treatment were calculated for comparison with the costs of surgery. / Thirty nine continence physiotherapists in private practice and public institutions around Australia participated in the study and, through 1999-2000, 274 adult women with either a clinical or urodynamic diagnosis of stress urinary incontinence were recruited. The inclusion criteria were broad to represent the type of subjects commonly treated in clinical practice. / Treatment was a physiotherapy management package which could include any form of conventional treatment for stress urinary incontinence. The content of this package and the length of treatment were the responsibility of the treating physiotherapist, and were based on a clinically reasoned process. No restriction was placed on the nature or length of treatment, or the number of occasions of service in an episode of care. However, all data collection protocols were standardised. / The results of this study support the implementation of continence physiotherapy as first-line treatment for stress urinary incontinence in Australia. Considering all outcome measures, treatment was effective for approximately 80% of women who completed treatment both at end of an episode of care and at one year follow-up. Five percent of subjects had surgery for their stress incontinence within the timeframe of the study. There were no reports of adverse events or complications. / The number of treatments in a typical episode of care was established, information which was hitherto lacking from randomized controlled trials, but necessary to underpin cost calculations. From a health economics perspective, the finding that physiotherapy was effective, had no serious risks and was approximately one-twentieth the estimated cost of surgery, provides a strong basis for health policy development to promote physiotherapy as first line treatment for stress urinary incontinence. Other characteristics of a continence physiotherapy management package in Australian clinical practice were also described. Predictive modelling was based on real-life data and identified factors associated with improved treatment outcomes where scant evidence previously existed. Areas for future research were identified, including the investigation of the referral patterns of medical practitioners for women with stress urinary incontinence and the adequacy of existing physiotherapy training and services within Australia. / Thesis (PhDHealthSciences)--University of South Australia, 2006.
| Identifer | oai:union.ndltd.org:ADTP/267286 |
| Creators | Neumann, Patricia. |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | copyright under review |
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