- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03194789
The Effect of Footwear Generated Biomechanical Manipulation on Symptoms of Stress Urinary Incontinence (SUI)
Study Overview
Status
Detailed Description
FGBMM (footwear generated biomechanical manipulation) effects neuromuscular patterns of pelvic muscles. While there have been no published studies to our knowledge investigating the effect of FGBMM on urinary incontinence, FGBMM has been shown to cause perturbations in balance and gait that create dynamics similar to dynamic lumbosacral stabilization exercises. In support of this theory, although not published, one of the founders of the technique, Avi Elbaz, has noted anecdotal evidence that patients who had SUI (stress urinary incontinence) and underwent FGBMM for knee or low back pain reported improvement of incontinence. The investigators propose that FGBMM induces the same bio-mechanical improvements as LPSE (lumbopelvic stabilization exercises) which have shown benefit for incontinence. The pods on the footwear can be positioned to challenge the patients balance in a manner similar to the way trampolines are utilized in LPSE. Instead of instructing patients to co-contract the lower trunk and pelvic floor muscles as commonly done for LPSE, the shoes used in FGBMM can be calibrated in a way that causes this co-contraction to occur without the patient realizing. Beneficial pelvis and spine positioning can also be accomplished by strategic placement of the pods without having to instruct the patient on complicated maneuvers. An additional advantage of FGBMM is that this exercise is done with increased intra-abdominal pressure mimicking the condition and the setting when incontinence occurs rather than static exercise that is used in PFT. While performing regular activities, people are naturally squatting and doing other activities that increase intra-abdominal pressure. Furthermore, FGBMM is more practical for people with busy schedules because it can be accomplished with a much smaller time commitment from the patient than traditional PFT since it is done during normal activity. Capitalizing on the excellent adherence and clinical benefits of FGBMM on related conditions, the investigators propose to evaluate the effects of FGBMM in addition to pelvic floor therapy for improving the symptoms of stress urinary incontinence in an urban inner city population.
A potential use of FGBMM using shoes as a addition to traditional pelvic floor therapy may yield a more effective therapy with better adherence. Problems with traditional therapy include poor patient adherence (patients often do not complete the sessions and have poor adherence (about 50%), lack of the continuation in an ongoing program, leading to relapse and need for re treatment or even little clinical benefit. Additionally, access to pelvic floor therapy is limited for many patients since there are not enough available outpatient therapy services to meet the needs of all patients. Finding an additional exercise program that will increase adherence and improve patient outcomes with better clinical benefits is a high priority from both patient care and cost management perspectives.
FGBMM using shoes potentially overcomes many of these issues with improving/modifying abnormal biomechanics of pelvic floor muscles (therefore decreasing incontinence), and a home based exercise program utilizing footwear that causes exercise with normal activity by promoting perturbation. This bio-mechanical approach may significantly improve the symptoms of urinary incontinence in patients with Stress SUI or Mixed urinary incontinence. Capitalizing on the reported excellent adherence and clinical benefit of FGBMM in patients with related conditions, the investigators propose to evaluate the bio-mechanical exercise (wearing an appropriately calibrated shoe at home for a prescribed amount of time each day) as a conservative treatment that may supplement traditional pelvic floor therapy, medications and even surgical intervention for the same in an inner urban city population.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Atira H. Kaplan, MD
- Phone Number: 917-331-0611
- Email: akaplan@montefiore.org
Study Contact Backup
- Name: Anna M. Lasak, MD
- Phone Number: 718-920-9171
- Email: alasak@montefiore.org
Study Locations
-
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New York
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Bronx, New York, United States, 10461
- Montefiore Medical Center - Medical Park Campuses
-
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Stress or Mixed Urinary Incontinence, based on UDI-6.
- Females between the ages of 18-75 years.
- Weight less than 350 lbs.
- Ambulatory and active patients that can participate in a rehabilitation program that includes daily walking
- Able to walk at least 50 meters and scored positive on the STEADI test
- Able to understand, read and sign the informed consent form
- English or Spanish speaking
Exclusion Criteria:
- Prior surgery for incontinence
- Pelvic Floor Therapy within past 6 months.
- Currently pregnant
- Predominantly Urge Incontinence.
- Patients with more than 3 falls in the last 52 weeks, OR any balance related fall with an injury in the last 52 weeks.
- Patients exhibiting a lack of physical or mental ability to perform or comply with the study procedure.
- Patients with a history of pathological osteoporotic fracture
- Any major cardiovascular comorbidities prohibiting enrollment in an active exercise program
- Active heart disease (ischemia or heart failure admissions within 24 weeks) and Active COPD (exacerbation within 24 weeks)
- Active malignancies on ongoing treatment
- Patient with neurological gait pattern.
- Patient requiring assistive device during gait analysis.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Traditional Pelvic Floor Therapy
up to six sessions, with one session every alternate week.
|
Participant will receive traditional pelvic floor therapy of six sessions, up-to one sessions every alternate week.
This will involve exercise and modalities as decided by medical providers and therapists.
Participants will also have a home exercise program prescribed along with each session and for the remainder of six months.
|
Experimental: FGBMM plus Traditional pelvic floor therapy
Treatment with FGBMM using shoes with pertupods daily at home along with traditional pelvic floor therapy sessions.
|
Participants will have FGBMM using shoes with pertupods along with traditional pelvic floor therapy over the course of six months.
This will include five sessions of gait assessment and re-calibration with daily at home exercise with the device (shoes) over the course of six months.
Along with that, participant will receive traditional pelvic floor therapy of six sessions, up-to one sessions every alternate week.
This will involve exercise and modalities as decided by medical providers and therapists.
Participants will also have a home exercise program prescribed along with each session and for the remainder of six months.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Severity of Stress Urinary Incontinence
Time Frame: Six months
|
Improvement in symptoms of Stress Urinary Incontinence (SUI) measured by Urinary Distress Inventory) UDI - 6 questionnaire
|
Six months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pelvic Floor Muscle Activity
Time Frame: Six months
|
Assessment of Pelvic Floor Muscle Activity by surface EMG (electromyography)
|
Six months
|
Gait assessment
Time Frame: Six months
|
Objective assessment of patient's gait measured by gait analysis equipment.
|
Six months
|
Adherence to treatment
Time Frame: Six months
|
Compliance to FGBMM and PFT using questionnaire.
|
Six months
|
6 minute walk test
Time Frame: Six months
|
objective assessment using maximum distance comfortably walked in 6 minutes on a 100 foot closed course
|
Six months
|
Medication costs
Time Frame: six months
|
changes in medication costs assessed by patient interview
|
six months
|
Healthcare utilization
Time Frame: six months
|
Changes in healthcare facility utilization assessed by patient interview
|
six months
|
Quality of Life as determined by the Urinary Impact Questionnaire (UIQ-7)
Time Frame: Six months
|
Change in Quality of Life from baseline will be determined with the use of the UIQ-7 questionnaire.
Specifically, the UIQ-7 questionnaire is used to measure the impact of bladder, bowel, and vaginal symptoms on a woman's daily activities, relationships and emotions.
The UIQ-7 is a subscale of the PFIQ-7 and consists of 7 questions related to urinary symptoms and its effect on function, social health, and mental health.
Responses for each question range from 0 (=not at all) to 3 (=quite a bit).
Scores are summarized.
A lower score indicates less impact on quality of life based on urinary symptoms.
|
Six months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Anna M Lasak, MD, Montefiore Medical Center
Publications and helpful links
General Publications
- Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56. Epub 2003 Nov 14.
- Tsao H, Hodges PW. Immediate changes in feedforward postural adjustments following voluntary motor training. Exp Brain Res. 2007 Aug;181(4):537-46. doi: 10.1007/s00221-007-0950-z. Epub 2007 May 3.
- Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005 Jul;193(1):103-13. doi: 10.1016/j.ajog.2004.12.025.
- Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004 Feb;9(1):3-12. doi: 10.1016/s1356-689x(03)00131-0.
- Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995;14(2):131-9. doi: 10.1002/nau.1930140206.
- Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010 Jan;21(1):5-26. doi: 10.1007/s00192-009-0976-9. Epub 2009 Nov 25.
- Ng K, Cheung RYK, Lee LL, Chung TKH, Chan SSC. An observational follow-up study on pelvic floor disorders to 3-5 years after delivery. Int Urogynecol J. 2017 Sep;28(9):1393-1399. doi: 10.1007/s00192-017-3281-z. Epub 2017 Feb 14.
- de Souza Abreu N, de Castro Villas Boas B, Netto JMB, Figueiredo AA. Dynamic lumbopelvic stabilization for treatment of stress urinary incontinence in women: Controlled and randomized clinical trial. Neurourol Urodyn. 2017 Nov;36(8):2160-2168. doi: 10.1002/nau.23261. Epub 2017 Mar 27.
- Barzilay Y, Segal G, Lotan R, Regev G, Beer Y, Lonner BS, Mor A, Elbaz A. Patients with chronic non-specific low back pain who reported reduction in pain and improvement in function also demonstrated an improvement in gait pattern. Eur Spine J. 2016 Sep;25(9):2761-6. doi: 10.1007/s00586-015-4004-0. Epub 2015 May 16.
- Ghaderi F, Mohammadi K, Amir Sasan R, Niko Kheslat S, Oskouei AE. Effects of Stabilization Exercises Focusing on Pelvic Floor Muscles on Low Back Pain and Urinary Incontinence in Women. Urology. 2016 Jul;93:50-4. doi: 10.1016/j.urology.2016.03.034. Epub 2016 Apr 5.
- Silva VR, Riccetto CL, Martinho NM, Marques J, Carvalho LC, Botelho S. Training through gametherapy promotes coactivation of the pelvic floor and abdominal muscles in young women, nulliparous and continents. Int Braz J Urol. 2016 Jul-Aug;42(4):779-86. doi: 10.1590/S1677-5538.IBJU.2014.0580.
- Solomonow-Avnon D, Levin D, Elboim-Gabyzon M, Rozen N, Peled E, Wolf A. Neuromuscular response of hip-spanning and low back muscles to medio-lateral foot center of pressure manipulation during gait. J Electromyogr Kinesiol. 2016 Jun;28:53-60. doi: 10.1016/j.jelekin.2016.02.010. Epub 2016 Mar 9.
- Tahtinen RM, Cartwright R, Tsui JF, Aaltonen RL, Aoki Y, Cardenas JL, El Dib R, Joronen KM, Al Juaid S, Kalantan S, Kochana M, Kopec M, Lopes LC, Mirza E, Oksjoki SM, Pesonen JS, Valpas A, Wang L, Zhang Y, Heels-Ansdell D, Guyatt GH, Tikkinen KAO. Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol. 2016 Jul;70(1):148-158. doi: 10.1016/j.eururo.2016.01.037. Epub 2016 Feb 10.
- Utomo E, Korfage IJ, Wildhagen MF, Steensma AB, Bangma CH, Blok BF. Validation of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) in a Dutch population. Neurourol Urodyn. 2015 Jan;34(1):24-31. doi: 10.1002/nau.22496. Epub 2013 Oct 26.
- Bush HM, Pagorek S, Kuperstein J, Guo J, Ballert KN, Crofford LJ. The Association of Chronic Back Pain and Stress Urinary Incontinence: A Cross-Sectional Study. J Womens Health Phys Therap. 2013 Jan;37(1):11-18. doi: 10.1097/JWH.0b013e31828c1ab3.
- Timmermans L, Falez F, Melot C, Wespes E. Validation of use of the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) for impairment rating: a transversal retrospective study of 120 patients. Neurourol Urodyn. 2013 Sep;32(7):974-9. doi: 10.1002/nau.22363. Epub 2012 Dec 31.
- Hides J, Stanton W, Mendis MD, Sexton M. The relationship of transversus abdominis and lumbar multifidus clinical muscle tests in patients with chronic low back pain. Man Ther. 2011 Dec;16(6):573-7. doi: 10.1016/j.math.2011.05.007. Epub 2011 Jun 8.
- Eliasson K, Elfving B, Nordgren B, Mattsson E. Urinary incontinence in women with low back pain. Man Ther. 2008 Jun;13(3):206-12. doi: 10.1016/j.math.2006.12.006. Epub 2007 Mar 23.
- Hajebrahimi S, Corcos J, Lemieux MC. International consultation on incontinence questionnaire short form: comparison of physician versus patient completion and immediate and delayed self-administration. Urology. 2004 Jun;63(6):1076-8. doi: 10.1016/j.urology.2004.01.005.
- Fultz NH, Burgio K, Diokno AC, Kinchen KS, Obenchain R, Bump RC. Burden of stress urinary incontinence for community-dwelling women. Am J Obstet Gynecol. 2003 Nov;189(5):1275-82. doi: 10.1067/s0002-9378(03)00598-2.
- van der Vaart CH, de Leeuw JR, Roovers JP, Heintz AP. Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn. 2003;22(2):97-104. doi: 10.1002/nau.10038.
- Persson J, Wolner-Hanssen P, Rydhstroem H. Obstetric risk factors for stress urinary incontinence: a population-based study. Obstet Gynecol. 2000 Sep;96(3):440-5. doi: 10.1016/s0029-7844(00)00950-9.
- Brown JS, Grady D, Ouslander JG, Herzog AR, Varner RE, Posner SF. Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Heart & Estrogen/Progestin Replacement Study (HERS) Research Group. Obstet Gynecol. 1999 Jul;94(1):66-70. doi: 10.1016/s0029-7844(99)00263-x.
- Lemack GE, Zimmern PE. Predictability of urodynamic findings based on the Urogenital Distress Inventory-6 questionnaire. Urology. 1999 Sep;54(3):461-6. doi: 10.1016/s0090-4295(99)00246-0.
- Eisenstein SM, Engelbrecht DJ, el Masry WS. Low back pain and urinary incontinence. A hypothetical relationship. Spine (Phila Pa 1976). 1994 May 15;19(10):1148-52. doi: 10.1097/00007632-199405001-00010.
- Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res. 1994 Oct;3(5):291-306. doi: 10.1007/BF00451721.
- Minaire P, Jacquetin B. [The prevalence of female urinary incontinence in general practice]. J Gynecol Obstet Biol Reprod (Paris). 1992;21(7):731-8. French.
- Norton PA, MacDonald LD, Sedgwick PM, Stanton SL. Distress and delay associated with urinary incontinence, frequency, and urgency in women. BMJ. 1988 Nov 5;297(6657):1187-9. doi: 10.1136/bmj.297.6657.1187. No abstract available.
- Thom D. Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc. 1998 Apr;46(4):473-80. doi: 10.1111/j.1532-5415.1998.tb02469.x.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Behavioral Symptoms
- Mental Disorders
- Urologic Diseases
- Lower Urinary Tract Symptoms
- Urological Manifestations
- Urination Disorders
- Pregnancy Complications
- Elimination Disorders
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Urinary Incontinence
- Enuresis
- Urinary Incontinence, Stress
- Pelvic Floor Disorders
Other Study ID Numbers
- 2016-7163
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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