A feasibility study of the physiotherapy management of urinary incontinence in athletic women: trial protocol for the POsITIve study

Abstract

Background Urinary incontinence (UI) affects up to 40% of adult women within the UK, and pelvic floor muscle training can be effective as a treatment. The prevalence of UI is higher in athletic women than in their sedentary counterparts, but there is little research into reasons for this or into treatment within this population. The aim of this study is to investigate the feasibility of conducting a future randomised controlled trial of physiotherapeutic management of UI in athletic women. Methods This is a mixed methods study with three distinct but related phases. Phase 1: Semi-structured interviews with health care professionals in the community will explore current management practices of UI in women and particularly in female athletes in order to inform the control arm of a future study. It will also establish community health care professionals’ understanding of pelvic health physiotherapy. Phase 2: Athletic and regularly exercising women recruited directly from gyms and sports clubs will undergo a course of physiotherapy to manage UI. This will establish study recruitment, eligibility, consent, attendance, attrition, and data completion rates. It will provide information regarding appropriate clinical venues and outcome measures to use for this patient group. Phase 3: Semi-structured interviews with purposefully selected participants from phase 2 will investigate participant satisfaction with recruitment procedures, the intervention, outcome measures and the venues. Further, we will collect data regarding the use of a smartphone ‘app’ for adherence and monitoring of home exercises and participants’ beliefs around randomisation in a future study. We will explore the impact of UI on life and sport in more detail. Discussion This study will establish the ease and acceptability of recruiting athletic women directly from gyms and sports clubs and identify attrition rates. It will also explore the acceptability of the intervention, clinical venues and outcome measures. Data collected will be used to inform a future randomised controlled trial. Trial registration NCT03986411 ( clinicaltrials.gov ). Registered on 14 June 2019

What is known from the existing literature about the available interventions for pelvic floor dysfunction among female athletes? A scoping review

“…As presented in the PRISMA 2020‐flow diagram (Figure 1), from 2625 records identified by the initial literature searches, 2590 were excluded and 35 articles were included 3,15–48 . The reasons for exclusion and the corresponding references are reported in online Supporting Information File S2.…”

“…As presented in the PRISMA 2020‐flow diagram (Figure 1 ), from 2625 records identified by the initial literature searches, 2590 were excluded and 35 articles were included. 3 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 The reasons for exclusion and the corresponding references are reported in online Supporting Information File S 2 .…”

“…In particular, the majority of research designs were narrative review ( n = 19; 54.3%), while seven (20%) were primary research ranging from case reports to randomized controlled trials (RCTs), and only two systematic reviews on the topic were published. 3 , 17 Regarding ongoing studies, searches identified one mixed‐method protocol 45 for athletic women with stress urinary incontinence (SUI).…”

Benefits of Physiotherapy on Urinary Incontinence in High-Performance Female Athletes. Meta-Analysis

“…Several authors argue that strength training of the pelvic floor muscles is effective in the treatment of SUI in women [ 15 , 16 , 17 , 18 , 19 , 20 ].…”

Management of urinary incontinence in athletic women: the POsITIve feasibility study

“…In the absence of a definitive aetiology, we propose that athletes with UI require specialist assessment and tailored PFM training (PFMT). We report results from a mixed-methods study (The POsITIve Study) [14] to investigate the feasibility of conducting a future trial to explore the physiotherapeutic management of UI in athletic women. We present data regarding recruitment methods, information about consent procedures, outcome measures, the acceptability of the intervention and the retention of participants.…”