Lumbopelvic stabilization-based physiotherapy and rehabilitation and urotherapy for lower urinary tract dysfunction in Duchenne Muscular Dystrophy: a randomized controlled trial

TL;DR

This study tested if adding lumbopelvic stabilization exercises to urotherapy improves urinary and bowel symptoms in children with Duchenne Muscular Dystrophy.

Contribution

The study is the first to evaluate lumbopelvic stabilization-based physiotherapy alongside urotherapy in children with Duchenne Muscular Dystrophy and lower urinary tract dysfunction.

Findings

Urotherapy significantly reduced severity and frequency of lower urinary tract symptoms.

Lumbopelvic stabilization improved functional mobility and muscle strength but did not enhance urotherapy outcomes.

Neither intervention improved Gower’s time or daytime voiding frequency.

Abstract

This randomized controlled trial investigated the effectiveness of supervised lumbopelvic stabilization and urotherapy on factors associated with lower urinary tract symptoms in children with Duchenne Muscular Dystrophy and lower urinary tract dysfunction (LUTD).

The study included 32 children aged 5–12 years, who were ambulatory and had a Dysfunctional Voiding and Incontinence Symptom Scale (DVISS) of 8.5 or higher. Lower urinary tract symptoms were assessed using the DVISS, a three-day bladder diary, and a nocturnal enuresis diary. Bowel symptoms were assessed with a seven-day bowel diary. Moreover, physical performance tests, the strength of pelvis-related muscle groups, and participation in activities of daily living were evaluated using validated measurement tools. Participants were randomized into two groups: the active control group (n:16, weight:25.81±9.53 kg, height:121.25±18.22 cm) received only urotherapy, while the treatment group (n:16, weight:25.88±9.67 kg, height: 122.69±16.63 cm) additionally performed lumbopelvic stabilization-based exercises for eight weeks under the supervision of a physiotherapist.

Urotherapy significantly reduced LUTD severity (p < 0.001), enuresis frequency (p = 0.014), and the number of symptoms associated with LUTD (p = 0.001). However, adding lumbopelvic stabilization exercises conferred no superiority over urotherapy alone (p > 0.05). Supervised lumbopelvic stabilization improved functional mobility (p < 0.003), muscle strength (p < 0.05), and participation in activities of daily living (p < 0.049). However, neither urotherapy nor lumbopelvic stabilization training had a significant effect on Gower’s time or daytime voiding frequency (p > 0.05).

Both interventions were effective in improving bladder and bowel outcomes in children with Duchenne Muscular Dystrophy and LUTD, with no superiority observed on lower urinary tract symptoms.

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