• Roberta Leopoldino de Andrade, Kari Bø, Flavia Ignácio Antonio, Patricia Driusso, Elaine Cristine Lemes Mateus-Vasconcelos, Salvador Ramos, Monica Pitanguy Julio, and FerreiraCristine Homsi JorgeCHJHealth Science Department, University of São Paulo, Ribeirão Preto, Brazil..
• Health Science Department, University of São Paulo, Ribeirão Preto, Brazil.
• J Physiother. 2018 Apr 1; 64 (2): 91-96.

QuestionDoes an educational program with instructions for performing 'the Knack' improve voluntary contraction of the pelvic floor muscles, reduce reports of urinary incontinence, improve sexual function, and promote women's knowledge of the pelvic floor muscles?DesignRandomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessors.ParticipantsNinety-nine women from the local community.InterventionThe experimental group (n=50) received one lecture per week for 4 weeks, and instructions for performing 'the Knack'. The control group (n=49) received no intervention.Outcome MeasuresThe primary outcome was maximum voluntary contraction of the pelvic floor muscles measured using manometry. Secondary outcomes were: ability to contract the pelvic floor muscles measured using vaginal palpation; severity of urinary incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scored from 0 to 21; self-reported sexual function; and knowledge related to the pelvic floor. Outcomes were measured at baseline and after 4 weeks.ResultsThe intervention did not significantly improve: maximum voluntary contraction (MD 2.7 cmH2O higher in the experimental group, 95% CI -0.5 to 5.9); ability to contract the pelvic floor muscles (RR 2.18, 95% CI 0.49 to 9.65); or self-reported severity of urinary incontinence (MD 1 point greater reduction in the experimental group, 95% CI -3 to 1). Sexual function did not significantly differ between groups, but very few of the women engaged in sexual activity during the study period. The educational program did, however, significantly increase women's knowledge related to the location, functions and dysfunctions of the pelvic floor muscles, and treatment options.ConclusionEducation and teaching women to perform 'the Knack' had no significant effect on voluntary contraction of the pelvic floor muscles, urinary incontinence or sexual function, but it promoted women's knowledge about the pelvic floor.Trial RegistrationBrazilian Registry of Clinical Trials, RBR-95sxqv. [de Andrade RL, Bø K, Antonio FI, Driusso P, Mateus-Vasconcelos ECL, Ramos S, Julio MP, Ferreira CHJ (2018) An education program about pelvic floor muscles improved women's knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial. Journal of Physiotherapy 64: 91-96].Copyright © 2018 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

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