***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: CONTEXT Pelvic floor electrical stimulation ( PFES ) has been shown to be effective for stress incontinence . However , its role in a multicomponent behavioral training program has not been defined . OBJECTIVE To determine if PFES increases efficacy of behavioral training for community-dwelling women with stress incontinence . DESIGN AND SETTING Prospect i ve r and omized controlled trial conducted from October 1 , 1995 , through May 1 , 2001 , at a university-based outpatient continence clinic in the United States . PATIENTS Volunteer sample of 200 ambulatory , nondemented , community-dwelling women aged 40 to 78 years with stress or mixed incontinence with stress as the predominant pattern ; stratified by race , type of incontinence ( stress only vs mixed ) , and severity ( frequency of episodes ) . INTERVENTIONS Patients were r and omly assigned to 8 weeks ( 4 visits ) of behavioral training , 8 weeks ( 4 visits ) of the behavioral training plus home PFES , or 8 weeks of self-administered behavioral treatment using a self-help booklet ( control condition ) . MAIN OUTCOME MEASURES Primary outcome was percentage reduction in the number of incontinent episodes as documented in bladder diaries . Secondary outcomes were patient satisfaction and changes in quality of life . RESULTS Intention-to-treat analysis showed that incontinence was reduced a mean of 68.6 % with behavioral training , 71.9 % with behavioral training plus PFES , and 52.5 % with the self-help booklet ( P = .005 ) . In comparison with the self-help booklet , behavioral training ( P = .02 ) and behavioral training plus PFES ( P = .002 ) were significantly more effective , but they were not significantly different from each other ( P = .60 ) . The PFES group had significantly better patient self-perception of outcome ( P<.001 ) and satisfaction with progress ( P = .02 ) . Significant improvements were seen across all 3 groups on the Incontinence Impact Question naire but with no between-group differences . CONCLUSIONS Treatment with PFES did not increase effectiveness of a comprehensive behavioral program for women with stress incontinence . A self-help booklet reduced incontinence and improved quality of life but not as much as the clinic-based programs In a prospect i ve r and omized study the efficiacy of physical therapy in female stress incontinence could be verified . The greatest success rate was achieved by medical gymnastics , whereas the perineal electrical stimulation should be used as supporting measure like a biofeedback mechanism because of its low effective intensity . Despite of the good therapeutic success ( 51.5 % ) with lasting effects no objective criteria to the use of physical therapy in female stress incontinence were found The objectives of this paper were to assess the quality of life of community-living women with urinary incontinence according to age , symptom group , amount of leakage , and duration , by use of the Sickness Impact Profile ( SIP ) .  Thirty-six women aged between 40 and 60 years and 40 women aged 70 years or more were r and omly selected from the clients attending an incontinence clinic and interviewed using the SIP question naire . Urge and stress incontinence subgroups were defined by means of a symptom question naire . Total , psychosocial , and physical dysfunctions were moderate ( 8 % , 7 % , and 8 % respectively ) in general , but major differences were found when age and symptom groups were analysed . Urge symptoms were associated with more impairment than symptoms of stress incontinence . The elderly women with symptoms of stress incontinence were relatively little affected , while their younger counterparts were severely affected , especially in the categories of emotional behavior and recreation and pastimes . We conclude that urinary incontinence in women adversely affects quality of life to a significant degree ; the extent depends on the nature of incontinence and the age of the person The purpose of this study was to explore changes in psychological distress associated with behavioral treatment and drug treatment for urge incontinence in community-dwelling older women . Participants were 197 ambulatory , nondemented women ( aged 55 years or older ) with persistent urge urinary incontinence . Participants were patients in a r and omized clinical trial comparing biofeedback-assisted behavioral treatment , drug treatment with oxybutynin chloride , and a placebo-control condition .  Psychological distress was measured before and after treatment using the Hopkins Symptom Checklist ( SCL-90-R ) . Multivariate and univariate analyses of variance showed that the two treatment groups and the control group had similar significant improvements on the nine subscales and the global severity index . Analysis of individual SCL-90-R subscale scores revealed trends suggesting that behavioral treatment tended to produce the largest improvements . The reductions of distress were not correlated consistently with reduction of incontinence . The results of this study showed that psychological distress was significantly reduced after treatment , regardless of the type of treatment 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 PURPOSE To compare the effectiveness of pelvic floor exercises , electrical stimulation , vaginal cones , and no active treatment in women with urodynamic stress urinary incontinence . PATIENTS AND METHODS One hundred eighteen subjects were r and omly selected to recieve pelvic floor exercises ( n=31 ) , ES ( n=30 ) , vaginal cones ( n=27 ) , or no treatment ( untreated control ) ( n=30 ) . Women were evaluated before and after completion of six months of treatment by the pad test , quality of life question naire ( I-QOL ) , urodynamic test , voiding diary , and subjective response . RESULTS In the objective evaluation , we observed a statistically significant reduction in the pad test ( p=0.003 ) , in the number of stress urinary episodes ( p<0.001 ) , and a significant improvement in the quality of life ( p<0.001 ) in subjects who used pelvic floor exercises , electrical stimulation , and vaginal cones compared to the control group . No significant difference was found between groups in the urodynamic parameters . In the subjective evaluation , 58 % , 55 % , and 54 % of women who had used pelvic floor exercises , electrical stimulation , and vaginal cones , respectively , reported being satisfied after treatment . In the control group , only 21 % patients were satisfied with the treatment . CONCLUSION Based on this study , pelvic floor exercises , electrical stimulation , and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence OBJECTIVES To assess whether urinary incontinence ( UI ) and its severity are associated with poor self-rated health in a national sample of community-living older adults and whether this relationship persists after controlling for confounding attributable to functional status , comorbidity , and demographic factors . DESIGN A cross-sectional analysis using multivariate logistic regression . SETTING Subjects were from the 1990 - 1991 National Survey of Self-Care and Aging ( N = 3485 ) , a r and om sampling in geographic clusters of community-dwelling Medicare beneficiaries 65 years of age or older in the contiguous United States . MEASURES The responses to an interviewer-administered question naire regarding urinary incontinence , Basic Activities of Daily Living ( BADL ) , Instrumental Activities of Daily Living ( IADL ) , Mobility Activities of Daily Living ( MADL )  , age , gender , place of residence , race , education , need for proxy response to the survey , and number of medical conditions . RESULTS Unadjusted analysis showed the presence of urinary incontinence to be associated with poor self-rated health ( OR 2.7 , 2.1 - 3.3 ) . With gender , number of comorbid conditions , race , IADL impairment , and interaction terms of incontinence/race and incontinence/IADL in the final model , UI was associated with poor self-rated health in certain subgroups . White subjects with no IADL impairment and mild-moderate incontinence had an OR of 2.0 ( 95 % CI 1.5 - 2.9 ) and those with severe incontinence had an OR of 4.5 ( 95 % CI 2.4 - 8.4 ) of rating their health as poor , whereas those with no IADL impairment and no incontinence were the referent group . For those with a lot of difficulty performing one or more IADL activity , the association of UI and poor self-rated health was weak . For non-white subjects , there was no association , or a very weak association , of UI and poor self-rated health . CONCLUSION In this national sample , urinary incontinence was independently and positively associated with poor self-rated health after adjustment for age , comorbidity , and frailty for most community-dwelling older adults . This association between UI and poor self-rated health was weaker and statistically insignificant when IADL impairment was present or in non-white subjects . Further research is indicated to better underst and the impact of urinary incontinence in specific cultural setting 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 Background Urinary incontinence affects approximately 5 % ( 800.000 ) of the Dutch population . Guidelines recommend pelvic floor muscle/bladder training for most patients . Unfortunately , general practitioners use this training only incidentally , but prescribe incontinence pads . Over 50 % of patients get such pads , costing € 160 million each year . Due to ageing of the population a further increase of expenses is expected . Several national reports recommend to involve nurse specialists to support general practitioners and improve patient care . The main objective of our study is to investigate the effectiveness and cost-effectiveness of involving nurse specialists in primary care for urinary incontinence . This paper describes the study protocol . Methods / Design In a pragmatic prospect i ve multi centre two-armed r and omized controlled trial in the Netherl and s  the availability and involvement for the general practitioners of a nurse specialist will be compared with usual care .  All consecutive patients consulting their general practitioner within 1 year for urinary incontinence and patients already diagnosed with urinary incontinence are eligible . Included patients will be followed for 12 months . Primary outcome is severity of urinary incontinence ( measured with the International Consultation on Incontinence Question naire Short Form ( ICIQ-UI SF ) ) . Based on ICIQ-UI SF outcome data the number of patients needed to include is 350 . For the economic evaluation quality of life and costs will be measured alongside the clinical trial . For the longer term extrapolation of the economic evaluation a Markov modelling approach will be 
    Output:
    
Women who did PFMT were more likely to report they were cured or improved than women who did not .
There were too few data to draw conclusions about effects on other outcomes such as condition specific quality of life .
Overall , the review provides some support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress , urge , or mixed , urinary incontinence .