Urinary Incontinence, Mobility & Muscle Function in Older Women

尿失禁、活动能力

• 批准号: 9326882
• 负责人: Tatiana V.D. Sanses
• 金额: $ 1.62万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2018-02-09
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9326882
• 关键词: Admission activity; Aerobic; Affect; Aging; Atrophic; Award; Behavior Therapy; Biological Markers; Caring; Clinical Research; Communities; Development; Etiology; Fatty acid glycerol esters; Fostering; Functional disorder; Goals; Health Professional; Hospitalization; Infiltration; Institute of Medicine (U.S.); Intervention; Knowledge; Lead; Magnetic Resonance Imaging; Maintenance; Medical; Mission; Muscle; Muscle Weakness; Muscle function; Nursing Homes; Operative Surgical Procedures; Outcome; Outcome Study; Pelvic Floor Disorders; Pelvic Floor Muscle; Pelvic floor structure; Perioperative Nursing; Pessaries; Pharmaceutical Preparations; Physical Function; Principal Investigator; Program Evaluation; Public Health; Quality of life; Randomized Controlled Trials; Rehabilitation therapy; Research; Risk; Role; Severities; Symptoms; Testing; Training; Urinary Incontinence; Urine; Woman; Women' s Health; aged; base; conditioning; design; effective therapy; exercise rehabilitation; functional decline; improved; improved mobility; incontinence symptom; innovation; levator ani muscle; multi-component intervention; multimodality; muscle strength; novel; older patient; older women; primary outcome; programs; secondary outcome; strength training; treatment strategy

Summary: Urinary incontinence (UI) has a profound negative impact on quality of life and associated with increased risk of hospitalizations or nursing home admissions in older women. UI leads to functional decline and mobility limitations. More importantly, mobility limitations are predictive of UI onset and severity. The bidirectional relation between UI and mobility limitations in older women suggests common causal mechanisms with generalized poor muscle function contributing to the development of UI and mobility limitations. The current UI treatments in older women miss the critical components to improve mobility in older women suffering from UI. Therefore, older women with UI and mobility limitations may not have optimal improvement of their symptoms, especially in the context of maintenance of functional independence. Our long-term goal is 1) to improve quality of life in older women suffering from UI and mobility limitations that have common etiological causes and 2) to evaluate the role and contribution of atrophy and fat infiltration in pelvic floor (levator ani, internal obturator) and lower body (gluteus maximus, medius, minimus) muscles as causal mechanisms in the development of UI and mobility limitations in older women. Our central hypothesis is that a muscle strengthening and aerobic conditioning rehabilitation program designed to improve endurance and lower body mobility combined with the strengthening of pelvic floor muscles will reduce pelvic floor and lower body muscle dysfunction and weakness, enhance strength and endurance, and improve continence and mobility in older women. The rationale for the proposed research is that a multimodal rehabilitation program targeting to improve physical function through strengthening pelvic floor and lower body muscles will have greater efficacy in reducing UI symptoms and improving physical function than current PFMT alone in older women suffering from UI. We will test our hypothesis with a randomized controlled trial in older women with symptomatic UI with the following aims: 1) Evaluate UI symptoms and mobility limitations after a three-month multimodal strengthening and aerobic conditioning rehabilitation program combined with PFMT as compared to current standard PFMT alone in women ≥ 70 years with symptomatic UI; 2) Examine changes in the quality of pelvic floor and gluteal muscles before and after a three-month multimodal strengthening and aerobic conditioning rehabilitation program combined with PFMT and PFMT alone based on muscle Magnetic Resonance Imaging. The primary outcome in the study is the reduction UI episodes after the intervention. This proposal is innovative because we propose a multimodal rehabilitation program that will treat both UI and mobility as well as new biomarkers in lower body muscles dysfunction in older women with UI and mobility limitations. The study will allow the PI to transition to independent research to improve quality of live in older women with UI by decreasing UI and mobility limitations. The knowledge obtained from this research will enhance our fundamental understanding in the development of UI and mobility limitations. This proposal will fulfill the Institute of Medicine goals to increase clinical research that will lead to improved care and more effective treatments for older patients with multiple medical conditions.

概括： 尿失禁（UI）对生活质量产生深远的负面影响，并与风险增加有关 老年妇女的住院或护理家庭入院。 UI导致功能下降和流动性 限制。更重要的是，移动性限制可以预测UI发作和严重性。双向 UI与老年妇女的流动性限制之间的关系表明，常见的因果机制 普遍的肌肉功能有助于UI和活动限制的发展。当前的UI 老年妇女的治疗方法错过了关键组成部分，以提高患有UI的老年妇女的流动性。 因此，具有UI和活动限制的老年妇女可能无法最佳改善其症状， 特别是在维持功能独立性的背景下。 我们的长期目标是1）改善患有UI和流动性限制的老年妇女的生活质量 具有常见的病因和2）评估萎缩和脂肪浸润的作用和贡献 骨盆底（Levator ANI，内腹球）和下半身（Maximus，Medius，minimus）肌肉 老年妇女的UI发展和流动性限制的因果机制。我们的中心假设是 旨在提高耐力的肌肉增强和有氧运动康复计划 下半身的迁移率结合骨盆底肌肉的增强将减少骨盆底和 下半身的肌肉功能障碍和弱点，增强力量和耐力，并提高持续性和 老年妇女的流动性。拟议研究的理由是多式联运康复计划 通过增强骨盆底和下半身肌肉来改善身体功能的靶向 与单独的PFMT相比，仅在较旧的PFMT的情况下，降低UI症状和改善身体功能的效率更高 患有UI的妇女。我们将通过一项随机对照试验检验我们的假设 有症状的UI具有以下目的：1）三个月后评估UI症状和活动性限制 与PFMT相比 ≥70岁的女性有症状性UI的当前标准PFMT； 2）检查质量的变化 在三个月的多模式增强和有氧运动之前和之后，骨盆底和臀部肌肉 调节康复计划与PFMT和PFMT相结合，基于肌肉磁 共振成像。研究中的主要结果是干预后的减少UI发作。 该提议具有创新性，因为我们提出了一项多式联运康复计划 在下半身肌肉功能障碍中，UI和活动能力的下半身肌肉功能障碍的新生物标志物以及新的生物标志物 限制。该研究将使PI可以过渡到独立研究，以提高较旧的生活质量 UI的女性通过降低UI和活动性限制。从这项研究中获得的知识将 增强我们对UI和流动性限制发展的基本理解。该提议将 实现医学研究所，以增加临床研究，从而改善护理和更多 对患有多种医疗状况的老年患者的有效治疗。