Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT06399887 |
Other study ID # |
2022-06/12 |
Secondary ID |
|
Status |
Completed |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
October 20, 2022 |
Est. completion date |
February 6, 2023 |
Study information
Verified date |
May 2024 |
Source |
Inonu University |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Lower urinary tract dysfunction (LUTD) is present in 2-40% of healthy children. If left
untreated, it can lead to health problems such as recurrent urinary tract infections,
vesicoureteral reflux and chronic renal failure. Pelvic floor physiotherapy is a globally
accepted treatment for adults and children. In addition to locomotor skills, functional
exercises such as motor control, core stability and balance training are important to support
toilet training. Dynamic Neuromuscular Stabilization (DNS), a current stabilization approach,
is a neurophysiological rehabilitation strategy based on developmental kinesiology, using
ontogenetic models to both diagnose and treat dysfunction in the locomotor system in infants
and adult patients. Today, DNS is successfully used in the rehabilitation of various
neurological, musculoskeletal, pediatric and sports injuries. However, there are no studies
in the literature examining the effectiveness of DNS training in children diagnosed with
LUTD. The aim of this study was to evaluate the effectiveness of DNS training in children
diagnosed with LUTD and to compare it with EMG-Biofeedback treatment method. The children
participating in the study will be randomly divided into 3 groups. Children in Group I will
exercise 3 days a week for 45 minutes according to DNS principles. Children in Group II will
receive EMG Biofeedback training 1 day a week. Children in Group III will receive
EMG-Biofeedback training 1 day a week in addition to exercises with DNS principles 3 days a
week. In the study, data on symptoms, demographic data of the individuals before treatment
and at 4th week, 8th week and 12th week after treatment will be obtained from each child
participating in the study through a questionnaire, symptoms related to voiding disorder and
urinary incontinence with Dysfunctional Voiding and Incontinence Scoring System (DVISS),
activation of deep trunk muscles with Stabilizer Pressure Biofeedback Unit, urine flow curve
and voiding parameters of the patients with uroflowmeter application will be evaluated.
Kruskal-Wallis analysis of variance will be used to compare the three groups in terms of
variables. Wilcoxon signed-rank test will be used to analyze the statistical significance of
the difference between all values before and after treatment. For all results, p<0.05 will be
considered as significance level.
Description:
The sample of the study will consist of children between the ages of 6-15 years who were
admitted to Malatya Inönü University Turgut Özal Medical Center Pediatric
Urodynamics/Urotherapy Unit and diagnosed with LUTD by a pediatric nephrology specialist.
Inclusion criteria: Being between the ages of 6-15 years, having a normal neurologic
examination, being diagnosed with LUTD, having a DVISS of 8.5 and above, not having received
any medication or other treatment for enuresis before. Exclusion criteria were as follows:
patients with primary nocturnal enuresis, patients with uncontrolled systemic disease,
patients with neurologic disease (muscle disease, epilepsy, etc.), patients with inflammation
of the vagina, anus and urinary tract, patients with febrile illness or active urinary tract
infection, presence of underlying psychological causes, presence of mental retardation,
inability to comply with treatment. Children who meet the inclusion criteria will be included
in the study by non-probability random sampling method. The inclusion of the three clusters
formed according to the registration number of the Pediatric Urodynamics/Urotherapy Unit will
be determined by lottery method. After the children and their parents/guardians who meet the
inclusion criteria are informed about the study content, they will be asked to sign the
informed consent forms for the child and the informed consent forms for the parents/guardians
if they agree to participate in the study.
The individuals participating in the study will be divided into 3 groups. Children in Group I
will exercise according to DNS principles 3 days a week for 12 weeks, with sessions of 45
minutes. Children in Group II will receive animated EMG biofeedback training with the Aymed
Medikal Locum Wireless System v.2.69.0.12 device. For animated biofeedback application, two
electrodes will be placed at 3 and 9 o'clock in the perineum region and 1 reference electrode
will be placed on the inner side of the thigh (42). The training protocol will be applied
once a week for a total of 12 sessions for 3 months. In addition to exercises with the DNS
principle 3 days a week, the children in Group III will receive biofeedback training with
animation once a week with the Aymed Medikal Locum Wireless System v.2.69.0.12 device for a
total of 3 months. Demographic data of the individuals participating in the study will be
obtained through a questionnaire from each child participating in the study. The questions in
the questionnaire are personal information of the child, toilet training age, frequency of
urinary tract infections, whether they have received treatment for urinary incontinence
before, whether they have chronic constipation, whether their parents have a history of
urinary incontinence at a young age and some personal information specific to the parents.
The Dysfunctional Voiding and Incontinence Scoring System (DVISS) will be used for symptoms
of voiding dysfunction and urinary incontinence. The DVISS is a 13-item questionnaire. It
originally includes 14 questions about symptoms and 1 question about quality of life. In the
scoring system developed by Akbal et al. for the pediatric population and adapted to Turkish,
there are 13 symptom and 1 quality of life question.
Evaluation of uroflowmeter parameters will be performed with the uroflowmeter application of
the Aymed Medikal Locum Wireless System v.2.69.0.12 EMG device and the urine flow curve and
voiding parameters of the patients will be evaluated. These parameters are maximum flow rate,
time to reach maximum flow, mean flow rate, voiding volume and voiding time. In our study,
urine volume of 100 ml or more will be considered valid. Evaluation of deep trunk muscles
(transversus abdominis, multifidus and deep neck flexors) will be performed with the
Stabilizer Pressure Biofeedback Unit (Chattanooga Stabilizer, USA). Before the test, each
participant will be taught how to contract the transversus abdominis muscle with the corset
method in the supine and quadripedal position and how to contract the multifidus muscle in
the supine position. Measurements will be made for 10 seconds and 3 repetitions, three
measurements will be recorded and averaged. For the measurement of the deep neck flexors, the
patients will first be taught the correct craniocervical flexion movement without activation
of the superficial muscles. The change in pressure will be recorded and the highest value
from 3 trials will be taken. Individuals will be evaluated before treatment, at 4 weeks, 8
weeks and 12 weeks after treatment. The aim here is to measure how long it takes to show the
effectiveness of the treatment(s) applied and to determine whether the treatments are
superior in terms of time.