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A randomised controlled trial: outcomes of bladder rehabilitation in persons with multiple sclerosis

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Summary
A stratified, randomized, waitlist controlled study over 12 months assessed the effectiveness of a 6 week bladder rehabilitation program in persons with multiple sclerosis (pwMS) in an Australian community cohort. Khan F, Pallant JF, Pallant JI, Brand C, Kilpatrick TJ. J Neurol Neurosurg Psychiatry. 2010 Sep;81(9):1033-8. Epub 2010 Jun 11.

Details
Patients with definite MS and bladder issues (n=74) recruited from a tertiary hospital database were randomized to a treatment group (n=40) for an individualized bladder rehabilitation program or to a control waitlist group (n=34). The Urogenital Distress Inventory (UDI6), Neurological Disability Scale (NDS) and the American Urological Association Symptom Index (AUA) assessed bladder impairment and 'activity limitation'; a single Quality of life (QoL) item in the AUA and the Incontinence Impact Questionnaire (IIQ7) measured restriction in 'participation'. Primary outcome measures were assessed at baseline and at 12 months.

Analysis of per protocol data from 58 patients (treatment n=24, control n=34) showed reduced disability in the treatment group, with significant differences (p<0.001) and large effect sizes (>0.5) in post-treatment.

A multifaceted, individualized bladder rehabilitation program reduces disability and improves QoL in pwMS compared with no intervention after 12 months of follow-up. Information on specific interventions in different bladder types in MS and the impact on QoL need further evaluation.

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