***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to determine the efficacy of the Paula method of circular muscle training in the management of  stress incontinence ( SI ) . The theory behind this method states that activity of distant sphincters affects other muscles . In a pilot study , 59 women , mainly hospital employees , were r and omly assigned to participate in exercises according to the Paula method or pelvic floor training .  Efficacy was measured by reports of incontinence , quality of life ( I-QOL ) , pad test , and pelvic floor muscle strength ( assessed by perineometer and digital examination ) . Both the Paula exercises and pelvic floor training produced significant changes in urinary leakage compared to baseline as measured by the pad test [ mean decrease of 5.4 g ( p=0.002 ) and 9.5 g ( p=0.003 ) , respectively ] . Women r and omized to the Paula method reported improvement in I-QOL scores . The Paula method was found to be efficacious for SI in a population of Israeli women . Larger community-based studies will be required to confirm these results and enable evaluation of between-group differences AIMS The purpose of the present study was to compare the effectiveness of instruction to contract the pelvic floor muscles ( PFM ) , the transversus abdominis ( TrA ) , and the TrA + PFM visualized as displacement of the pelvic floor by ultrasound . MATERIAL S AND METHODS Twenty female physical therapists , mean age 41.1 years ( range 26 - 56 ) participated in the study . A 3.5 MHz 35 mm curved linear array ultrasound transducer ( Dornier Medtech ) was placed in the mid-sagittal plane immediately suprapubically , angled at 15 - 30 degrees from the vertical depending on subcutaneous fat and anatomical variations , to image the pelvic floor . Six trials of three maneuvers in r and om order were performed : contraction of PFM , TrA , and TrA + PFM . RESULTS In spite of correct contractions assessed by palpation and clinical observation , one subject demonstrated a downward movement of the pelvic floor during PFM contraction on ultrasound . Six subjects ( 30 % ) showed a downward movement during a TrA- contraction , and two during the combined TrA + PFM contraction . Instruction to contract PFM produced significantly greater mean displacement : 11.2 mm ( 95 % CI 7.2 - 15.3 ) than TrA 4.3 mm ( 95 % CI -0.2 - 8.8 ) , P < 0.01 , and combination : 8.5 mm ( 95 % CI 5.2 - 12 ) , P = 0.04 . Hence , instruction of PFM contraction produced a 61.6 % greater displacement of the pelvic floor in the correct direction than a TrA contraction . CONCLUSIONS It is concluded that ultrasound is a more valid method than palpation and clinical observation to assess PFM function , and that instruction to contract the PFM produces a significantly more effective pelvic floor muscle contraction than instruction to perform a TrA contraction This article reports further experience with a Version 2 digital test performed on 208 community-residing women , 25 to 87 years old . Test-retest ( n = 208 ) and interrater reliability ( n = 36 ) scores for pressure , displacement , and duration were r = .54 , .51 , and .53 and r = .67 , .73 , and .55 , respectively . Interrater reliability percentage agreement figures were exact for 94 % of the women on pressure and 67 % on displacement . With duration permitted to vary by 1 second , agreement was 75 % . Validity was tested using vaginal electromyography score with correlation coefficients ranging from .37 to .63 . A weak but significant correlation was found between the digital score and the st and -up test pad gain ( r = -.12 ) . No significant relationship was found between the digital test and a history of being able to stop the urine stream or other leakage measures . To address limitations in Version 2 , a third version of the digital scale is proposed Urinary incontinence ( UI ) is a common chronic condition among women . Treatment of UI can involve behavioral techniques , pharmacological strategies , or surgical intervention . Clinical ly , treatment strategies should start with the simplest and least invasive measures . To overcome the deficiencies in previous research and provide definitive information for clinical practice , a r and omized clinical trial is currently underway . This clinical trial uses a pretest-posttest design to first determine the effectiveness of self-monitoring techniques  before subjects are r and omized into one of two treatment groups or an attentional control group with a 1-year followup . The study design , sampling plan , and interventions used in an ongoing clinical trial to assess the effectiveness of self-monitoring and efficacy of biofeedback to treat UI in women are described . Innovative techniques to assess adherence to the pelvic muscle exercise protocol are addressed BACKGROUND Although research has documented the efficacy of maximal voluntary contraction ( MVC ) exercise for improved pelvic floor muscle ( PFM ) strength , the efficacy of submaximal voluntary contraction ( SVC ) exercise for treatment of genuine stress urinary incontinence ( GSUI ) has not been described . OBJECTIVE To compare the training-induced changes in endurance , strength , and muscle activity recruitment , and continence control in groups of women with GSUI who exercised the PFM using either near-maximal voluntary contraction ( NMVC ) or SVC effort . METHODS Training-induced changes in PFM response to exercise were tested by using a quasi-experimental design . Thirty-two women , r and omly assigned to either the SVC or NMVC exercise protocol group , were tested before and after training on endurance , muscle contraction strength , muscle activity recruitment , 10-hour weighed pad test for grams of urine loss , and subject-rated severity and frequency of leakage episodes . Repeated measures of specific study variables were retrieved and analyzed from home-training device computer memory and diary records . Changes in muscle activity recruitment , measured as microvolts of electromyogram ( EMG ) amplitude , were correlated with changes in muscle contraction strength and endurance . RESULTS Increases in muscle contraction strength ( t = 1.75 ; p = 0.045 ) and decreases in grams of urine leakage ( t = -1.86 ; p = 0.036 ) were significant for the SVC group . No significant differences were found between the groups for changes in endurance , muscle activity recruitment , frequency of leakage episodes , or subject-rated severity of urine loss based on a 7-point Likert scale . CONCLUSIONS Study findings suggest that SVC exercise design ed with specificity for gain in neuromuscular control may be beneficial for strengthening the PFM and increasing endurance of contractions to attain and maintain continence in women with GSUI The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . Introduction and hypothesisPelvic floor muscle training ( PFMT ) is a treatment for stress urinary incontinence ( SUI ) that can be done individually or in a group . The aim of this study was to compare these two types of treatment . Methods Sixty women 30 to 75 years old with SUI were r and omly assigned to participate in the two groups . They were evaluated before and after the treatment with the Oxford grading system , pad test , voiding diary , and the King ’s Health Question naire . Results Both groups experienced significant reductions in urinary leakage as measured by the pad test and bladder diary . A negative pad test was observed in about 50 % of patients in both groups . There were statistically significant improvements in both muscle strength and quality of life . When the groups were compared , there were no differences in the results between them . Conclusions Individual treatment and group PFMT appear to be equally effective for improving SUI Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field This study was a r and omized controlled trial to investigate the effect of treating women with stress or mixed urinary incontinence ( SUI or MUI ) by diaphragmatic , deep abdominal and pelvic floor muscle ( PFM ) retraining .  Seventy women were r and omly allocated to the training ( n = 35 ) or control group ( n = 35 ) . Women in the training group received 8 individual clinical visits and followed a specific exercise program . Women in the control group performed self-monitored PFM exercises at home . The primary outcome measure was self-reported improvement . Secondary outcome measures were 20-min pad test , 3-day voiding diary , maximal vaginal squeeze pressure , holding time and quality of life . After a 4-month intervention period , more participants in the training group reported that they were cured or improved ( p < 0.01 ) . The cure/improved rate was above 90 % . Both amount of leakage and number of leaks were significantly lower in the training group ( p < 0.05 ) but not in the control group . More aspects of quality of life improved significantly in the training group than in the control group . Maximal vaginal squeeze pressure , however , decreased slightly in both groups . Coordinated retraining diaphragmatic , deep abdominal and PFM function could improve symptoms and quality of life . It may be an alternative management for women with SUI or MUI Abstract Background / Objective : Limited research evidence is available to show the effectiveness of the many specific interventions provided in spinal cord injury ( SCI ) rehabilitation ; what is available typically focuses on effects of the full rehabilitation package but not specific therapy interventions , medical procedures , patient education , or counseling . Given the problems of conducting r and omized controlled trials ( RCTs ) in rehabilitation , practice -based evidence ( PBE ) research has been suggested as an alternative methodology for identifying which rehabilitation interventions are associated most strongly with positive outcomes , after controlling for patient differences . Using the PBE research methodology , the SCIRehab project attempts to " open the black box " of acute SCI rehabilitation , provide detailed information on treatments delivered by all rehabilitation disciplines , and contribute to outcomes -based guidelines for clinical decision-making . Methods : The SCIRehab project includes 1,500 patients with acute SCI , consecutively admitted to 1 of 6 US inpatient rehabilitation facilities . Details of the rehabilitation process are captured by clinicians from multiple disciplines documenting their interventions in h and held personal digital assistants after sessions with their patients . Outcome data are abstract ed from medical records ( clinical outcomes data ) and obtained from patient interviews at 6 and 12 months after injury . Extensive patient , injury , and other treatment characteristics are abstract ed from medical records . SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team . Results : SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team . These findings are presented in a series of 9 articles . Conclusions : To date , SCIRehab 's major contribution is a system for categorizing specific contributions of each discipline and a technology for documenting that detail . After data collection is complete , future manuscripts will relate those process elements to outcomes . The SCIRehab Project is an important step toward establishing outcomes -based guidelines for SCI rehabilitation AIM To assess the efficacy of self-monitoring techniques to reduce urine loss and increase quality of life for women with urinary incontinence . METHODS The design was a two arm , r and omized , clinical trial with a wait list control group and 3-week intervention . Participants were 224 community-dwelling women 18 and older with UI .  Self-monitoring was individualized counseling about fluid and caffeine intake , quick pelvic floor muscle contraction , voiding frequency , and management of constipation . The primary outcome measure was grams of urine loss . Secondary outcomes included episodes of urine loss , quality of life , and caffeine and fluid consumption . RESULTS The main effect of self-monitoring on grams of urine loss was significant . After adjusting for baseline urine loss , time in the intervention or in wait list group , age , hormone status , and race the self- monitoring group lost an average of 13.3 g less urine and had improved 26.1 points in quality of life compared to the wait list group . The effect of self-monitoring on episodes of urine loss was not significant in the total sample but was more effective for women who had 9 or more episodes of urine loss , were 65 years or older , and were premenopausal or taking hormone replacement therapy . Participants 
    Output:
    
This review found that the existing evidence was insufficient to make any strong recommendations about the best approach to pelvic floor muscle training .
We suggest that women are offered reasonably frequent appointments during the training period , because the few data consistently showed that women receiving regular ( e.g. weekly ) supervision were more likely to report improvement than women doing pelvic floor muscle training with little or no supervision