The effect of dynamic neuromuscular stabilization-based training combi̇ned with pelvic floor muscle training on lower urinary system symptoms, pelvic floor and diaphragm functions in women with multiple sclerosis

The aim of this study was to investigate the effectiveness of Dynamic Neuromuscular Stabilization (DNS)-based training in addition to pelvic floor muscle training (PFMT) in women diagnosed with Multiple Sclerosis (MS). A total of 24 women with MS, aged 28-54, participated in the study. For the assessment of lower urinary tract symptoms (LUTS), uroflowmetry test, postvoid residual (PVR) measurement, Urinary Symptom Profile (USP), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Overactive Bladder-V8 Questionnaire (OAB-V8) were used. To evaluate pelvic floor functions, vaginal palpation according to the PERFECT scheme and electromyography (EMG) measurements were conducted. Diaphragm functions were assessed using magnetic resonance imaging (MRI) and the DNS diaphragm assessment form. The participants were divided into two groups: the PFMT group (n=16), who received only PFMT, and the PFMT+DNS group (n=8), who received DNS-based stabilization training in addition to PFMT. Both groups followed a remotely monitored PFMT program for 8 weeks. The PFMT+DNS group performed DNS-based stabilization exercises under the supervision of a physiotherapist three times a week. At the end of the study, the improvement in uroflowmetric test and PVR results in all groups was not statistically significant (p>0.05). Improvements in USP scores were observed in all groups. Improvements in USP-total scores and OAB-V8 scores were statistically greater in PFMT+DNS group (p<0.05). The decreases in ICIQ-SF scores were similar in both groups (p>0.05). Improvements in the parameters of the PERFECT scheme and EMG measurements were statistically greater in the PFMT+DNS group (p<0.05). MRI measurements and DNS form results indicated improvements in diaphragm function in the PFMT+DNS group (p<0.05). In conclusion, this study showed that DNS-based stabilization training combined with PFMT could increase the effectiveness of the treatment in improving LUTS and pelvic floor functions in women with MS.