Use of Virtual Reality-Based Therapy in Patients with Urinary Incontinence: A Systematic Review with Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selections
- P—Population: adult individuals with urinary incontinence
- Intervention: virtual reality
- C—Comparison: no intervention or all other treatments
- Outcomes:
- ○
- Assessment of muscle function (“maximal contraction”, “Vaginal manometry”, “vaginal dynamometer”, “perineometer”, “electromyography”, “EMG”)
- ○
- Symptoms of UI (“urine loss”, “Pad test”, “bladder diary”)
- ○
- Quality of life (“International Consultation on Incontinence Questionnaire-UI”, “ICIQ-UI SF”, “International Consultation on Incontinence Questionnaire Overactive Bladder”, “ICIQ-OAB”, “International Consultation on Incontinence Questionnaire Overactive Bladder Quality of Life Module”, “ICIQ-OABqol”).
2.3. Outcome Measures
- Maximal voluntary contraction (MVC): The attempt to recruit as many fibers in a muscle as possible for the purpose of developing force. MVC of the pelvic floor can be assessed by vaginal palpation, dynamometers and manometers.
- Pelvic floor manometry/perineometer: Measurement of resting pressure or pressure rise generated during contraction of the PFM using a manometer connected to a sensor, which is inserted into the vagina, rectum or urethra. Pelvic floor manometric tools measure pressure in mmHg, hPa or cmH2O.
- Pelvic floor dynamometry: Measurement of PFM resting and contractile forces using strain gauges mounted on a speculum (a dynamometer), which is inserted into the vagina. Dynamometry measures force in Newton units (N = 1 kg × m/s2).
- EMG Electromyographic diagnosis: Made by evaluating the state of the muscle by recording and analyzing the electrical activity generated by the muscle. Surface electromyography: electrodes placed on the skin of the perineum or inside the urethra, vagina or rectum [14].
- Symptoms of UI (urine loss):
- Bladder diary: includes fluid intake, pad usage, number incontinence episodes, and the degree of incontinence.
- Pad testing: quantification of the amount of urine lost over the duration of testing by measuring the increase in weight of the perineal pads used (weighted pre- and post-testing) [14].
- Quality of life:
- The International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) is a short, new questionnaire (five questions) proposed by the World Health Organization with the aim of providing a clinically easy-to-use set of modules covering all aspects of the assessment of urinary incontinence severity and its impact on QoL. ICIQ-SF has a maximum score of 21; the higher the score, the more severe is the UI [31].
- The “International Consultation on Incontinence Questionnaire Overactive Bladder” (ICIQ-OAB) is a questionnaire for evaluating overactive bladder and related impact on quality of life (QoL) and outcome of treatment. It consists of 4 questions and an overall score ranging from 0 to 16, with greater values indicating increased symptom severity [32].
- The International Consultation on Incontinence Questionnaire Overactive Bladder Quality of Life Module (ICIQ-OABqol) explores in detail the impact of an overactive bladder on patients’ lives. It consists of 26 questions (overall score ranging from 25 to 160), with greater values indicating increased impact on quality of life [32].
2.4. Assessment of Risk of Bias in Included Studies
2.5. Data Extraction, Management and Synthesis
3. Results
3.1. Included Studies
3.2. Excluded Studies
3.3. Methodological Quality
3.4. Effects of Intervention
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria |
---|---|
Study design: RCT, quasi RCT, CCT, non-RCT, pilot study, clinical control prospective study | Study design: case report, review, study protocol, case series, clinical trial, feasibility study |
Population: adults and children with urinary incontinence, stress urinary incontinence, mixed urinary incontinence, urgency urinary incontinence. | Population: patients with schizophrenia, anorexia, autism, depression, cancers, anxiety, neurological disorders, healthy subjects without UI symptoms |
Intervention: virtual reality immersive and non-immersive interventions | Intervention: robotics, smartphone applications |
Comparison: all other treatments (non-VR) or no treatments | Lack of control group, equal intervention |
Outcome: assessment of muscle function, Symptoms of UI, Quality of life | Outcome: all outcomes not related to urinary incontinence |
Reference | Participants/Age Range (yy) | Type of UI | VR Type | Treatments | Treatment Duration | Outcome Measures | Main Findings |
---|---|---|---|---|---|---|---|
Bezerra et al. 2021 [36] | 32 women/45–75 yy | MUI | Wii Fit Plus | PFMT + GT (EG) (n = 16) PFMT (CG) (n = 16) | 8 weeks | Manometry, QoL-ICIQ-SF, 1 h pad-test | PFMT associated with GT did not show better improvements than PFMT isolated in PFM quality of life, pressure and urinary loss. Both interventions proved to be effective for the treatment of women with MUI. |
Martinho 2014 [37] | 47 women/53–69 yy | MUI | Wii Fit Plus | PFMT + VR (n = 27) PFMT (n = 20) | 5 weeks | ICIQ UI-SF, ICIQ-OAB, Dynamometry, DP | PFMT through virtual reality equates to PFMT through kinesiotherapy regarding the improvement of pelvic floor muscle strength, voiding symptoms, anterior wall prolapse and quality of life, proving to be effective for postmenopausal women. |
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Rutkowska, A.; Salvalaggio, S.; Rutkowski, S.; Turolla, A. Use of Virtual Reality-Based Therapy in Patients with Urinary Incontinence: A Systematic Review with Meta-Analysis. Int. J. Environ. Res. Public Health 2022, 19, 6155. https://doi.org/10.3390/ijerph19106155
Rutkowska A, Salvalaggio S, Rutkowski S, Turolla A. Use of Virtual Reality-Based Therapy in Patients with Urinary Incontinence: A Systematic Review with Meta-Analysis. International Journal of Environmental Research and Public Health. 2022; 19(10):6155. https://doi.org/10.3390/ijerph19106155
Chicago/Turabian StyleRutkowska, Anna, Silvia Salvalaggio, Sebastian Rutkowski, and Andrea Turolla. 2022. "Use of Virtual Reality-Based Therapy in Patients with Urinary Incontinence: A Systematic Review with Meta-Analysis" International Journal of Environmental Research and Public Health 19, no. 10: 6155. https://doi.org/10.3390/ijerph19106155