Relevance of Leg Rehabilitation to Modulating Neurogenic Lower Urinary Tract Symptoms: A Systematic Review

TL;DR

This systematic review explores whether leg rehabilitation can help improve bladder control in people with neurological disorders.

Contribution

The study is the first to systematically review evidence linking lower limb training to improvements in neurogenic lower urinary tract symptoms.

Findings

Two cohort studies and one randomized controlled trial showed preliminary improvement in bladder function after lower limb training.

Exoskeleton and weight-suspension walking training were associated with bladder function improvements.

Results suggest potential benefits but require confirmation with larger studies.

Abstract

Neurogenic lower urinary tract dysfunction (NLUTD) is a secondary complication of a wide range of neurological disorders, which affects patients’ everyday life and self-efficacy. Some brain imaging studies have shown an overlap between motor activation of the pelvic floor and lower limbs. This systematic review sought to examine the possibility of improving overactive bladder outcomes through a conservative approach based on lower limb training. We conducted a systematic literature review, following the PRISMA guidelines. The following databases were searched: PEDro, PubMed, TRIP, Cochrane Library, EDS base index, Google Scholar, and CINAHL. The PEDro Scale and Cochrane Risk of Bias Assessment Tool were used to assess the overall study quality and sources of bias. A total of 5567 records were retrieved through the systematic search, of which 104 were sought for retrieval; two cohort studies and one randomized controlled trial were finally included. Urodynamics and specific bladder functionality questionnaires showed preliminary evidence of improvement following lower limb stimulation, implemented according to different treatment types (exoskeleton training and weight-suspension walking training). Lower limb-focused exercises showed promising results for improving bladder function, despite the small number of studies and small sample sizes. Future research should confirm this hypothesis using larger samples.

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