Investigation of the effects of urotherapy and lumbopelvic stabilization exercises in children with duchenne muscular dystrophy and lower urinary tract dysfunction

In this randomized controlled trial, the aim was to investigate the effectiveness of lumbopelvic stabilization exercises and urotherapy training in children diagnosed with Duchenne Muscular Dystrophy (DMD) who also presented with lower urinary tract dysfunction (LUTD). Thirty-two ambulatory children over five years old with DMD and a Dysfunctional Voiding Symptom Score (DVSS) ≥8.5 were included. Lower urinary tract symptoms were assessed using the DVSS, an evaluation form, a bladder diary, and a enuresis diary. Bowel symptoms were evaluated through Rome IV criteria and a bowel diary; physical performance was measured using Timed Up and Go Test and Gowers Test; muscle strength was assessed with a microFET2 hand-held dynamometer; lumbar lordosis angle was measured with a Baseline inclinometer; participation was evaluated using Barthel Index; and both child's and parent's perceived well-being were assessed with Facial Affective Scale. Participants were randomized into two groups. The active control group received only urotherapy and applied lifestyle modifications for eight weeks. The treatment group additionally performed lumbopelvic stabilization exercises for eight weeks. Urotherapy significantly reduce LUTD severity (p<0.001), the frequency of enuresis (p=0.014), constipation (p<0.001), and the severity of urinary (p=0.018) and fecal (p=0.034) incontinence. Lumbopelvic stabilization exercises, led to improvements in functional mobility (p<0.003), increases in muscle strength (p<0.05), and enhanced participation in daily living activities (p<0.049). In conclusion, both urotherapy and the combined application of lumbopelvic stabilization exercises were found to be effective in reducing bladder- and bowel-related symptoms in children with DMD and LUTD. It is recommended that these exercises be integrated into urotherapy programs to further support improvements in physical performance, muscle strength, and independence.