Monday, October 23, 2017 Researchers Find No Evidence for Popular Treatment for UI, POP There are solid evidence-based treatments for pelvic floor dysfunctions such as urinary incontinence (UI) and pelvic organ prolapse (POP), but 1 treatment popular in Europe, South America, and Canada isn’t among them. In fact, researchers write, the treatment—called abdominal Hypopressive technique (AHT)—is at best an approach still “in development,” with no significant data to back it up. In an article published in the British Journal of Sports Medicine (BJSM) (abstract only available for free), researchers described their attempts to track down studies on AHT, a group of breathing and posture exercises created in the 1980s. The exercise involves diaphragm inspiration followed by total air expiration and gradual contraction of the transversus abdominis (TrA) and intercostal muscles. Proponents of AHT believe the decreased abdominal pressure created through the exercise sparks a reflex response of muscles in the abdominal wall and pelvic floor, which in turns reduces UI and POP. But according to authors of the BJSM article, there’s a problem: no published evidence exists that supports the effectiveness of AHT. Searches on multiple research databases including PubMed and the Physiotherapy Evidence Database (PEDro) turned up only 2 studies that involved AHT—an experimental study that added AHT to a regiment of pelvic floor musical training (PFMT), and a randomized controlled trial involving the addition of AHT to PFMT among 58 women with stage II POP. Both studies found no effect from the addition of AHT. “At this stage, AHT is based on a theory with 20 years of clinical practice,” authors write. “We conclude that at present, there is no scientific evidence to recommend its use to patients.” Carrie Pagliano, PT, DPT, vice president of the APTA Section on Women ‘s Health, says while it’s true that the evidence isn’t there for AHT as a standalone or first-line treatment, clinicians shouldn’t be quick to dismiss some of the principles that underlie AHT. “There is some anecdotal, case-by-case support for this technique, and clinicians that use it in practice do identify Hypopressives as a small component of treatment,” Pagliano said. “Despite the small number of studies with little support for AHT, this shouldn’t discount the use of Hypopressives in conjunction with a thorough evaluation of the patient and a sound critical hypothesis.” While not as prevalent in the US, AHT is described by authors of the BJSM study as a treatment that has “worldwide huge interest [among] the public and clinical community.” The approach is marketed through a website that offers provider training on the technique, and is now taught by more than 1500 coaches in 14 countries, according to the BJSM article. In contrast to AHT, there is an approach that does in fact have high-level evidence for effectiveness, according to the reseachers: PFMT. Still, they write, “despite the strong evidence for PFMT for [UI and POP], several other exercise regimens have been proposed and advocated.” The problem, authors point out, is that for AHT, what’s being advocated hasn’t yet been associated with a strong foundation in research. “This particular treatment currently illustrates the phenomenon that not all recommended treatments are evidence based,” authors write. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.