METHODS AND MATERIALS: SCIENTIFIC/CLINICAL SIGNIFICANCE: DO PHYSICAL THERAPY INTERVENTIONS AFFECT FUNCTIONAL INCONTINENCE AND QUALITY OF LIFE IN PEOPLE WITH MULTIPLE SCLEROSIS? AN EVIDENCE-BASED REVIEW V Block, PT, M Rivera, PT, DPTSc, M Melnick, PT, PhD and D D Allen, PT, PhD. Department of Physical Therapy and Rehabilitation Science, University of San Francisco California/ San Francisco State University, USA. PURPOSE/HYPOTHESIS: Multiple sclerosis (MS) presents with many debilitating symptoms, including urinary incontinence (UI), which physical therapy (PT) may address. UI is prevalent but consensus is lacking regarding effectiveness of non-surgical or pharmaceutical interventions. A meta-analysis of long-term, conservative treatment options may supply this deficiency. Our purpose was to analyze the current evidence for effectiveness of PT to decrease UI and improve quality of life (QoL) in persons with MS. Figure 1: Forest Plot Showing The Combined Effects for Between Sub-groups of Quality of Life and Incontinence variables RESULTS: Six studies met the inclusion criteria. Between-group analysis (figure 1) revealed statistically significant differences in incontinence episodes and both measures of QoL, though failed to reach significance for functional control mechanisms. Incontinence leakage episodes and QoL participation improved within groups. CONCLUSIONS: Meta-analysis indicates support for PT for minimizing incontinence compared to pre-treatment, and affecting incontinence and measures of QoL in persons with MS more than control groups. Limitations include heterogeneity regarding the duration and type of PT intervention, and were applied in different types of MS. Treatment protocols vary, lacking a definitive technique. Further research may reveal the most effective combination and variety of PT interventions for persons with MS, and could help solidify the benefits of non-pharmaceutical or surgical interventions for this population. METHODS AND MATERIALS: An electronic search conducted through 11.26.2013, included search terms: incontinence, bladder dysfunction, urinary incontinence, Multiple Sclerosis, MS, physical therapy, physiotherapy, therapy and rehabilitation. Criteria for inclusion: diagnosis of MS, intervention involved PT focusing on UI or bladder dysfunction, outcomes assessed QoL and/or UI, and at least a 4/10 (PEDro scale) or a 2b level of evidence. Outcomes were combined across studies and effect sizes are depicted in forest plots. No date limits were used. Figure 2: Forest Plot Showing The Combined Effects for Within Sub-groups of Quality of Life and Incontinence variables Statistically significant Not statistically significant PRISMA DIAGRAM SHOWING SEARCH TIMELINE SCIENTIFIC/CLINICAL SIGNIFICANCE: Persons with MS have a high risk of UI and conventional medications have side effects that promote low adherence and therefore the problem persists. PT interventions can be an effective, safe first line treatment option to improve UI and participation QoL. For all the outcomes, a lower value corresponds to either a reduction in incontinence (for example: number of leakages per 24 hours) or an increase in Quality of Life. REFERENCES: DeSeze M, Raibaut P, Gallien P, et al. Transcutaneous Posterior Tibial Nerve Stimulation For Treatment Of Overactive Bladder Syndrome In Multiple Sclerosis: A Multicenter Prospective Study. Neurourol Urodyn. 2011;30:306–11. Khan F, Pallant JF, Pallant JI, Brand C, Kilpatrick TJ. A randomised controlled trial: outcomes of bladder rehabilitation in persons with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2010 Sep;81(9):1033-8. Lúcio AC, Perissinoto MC, Natalin RA, Prudente A, Damasceno BP, D'ancona CA. A comparative study of pelvic floor muscle training in women with multiple sclerosis: its impact on lower urinary tract symptoms and quality of life. Clinics (Sao Paulo). 2011;66(9):1563-8. McClurg D, Ashe RG, Marshall K, Lowe-Strong AS. Comparison of pelvic floor muscle training, electromyography biofeedback, and neuromuscular electrical stimulation for bladder dysfunction in people with multiple sclerosis: a randomized pilot study. Neurourol Urodyn. 2006;25(4):337-48. McClurg D, Ashe R.G and Lowe-Strong A.S. Neuromuscular Electrical Stimulation and the Treatment of Lower Urinary Tract Dysfunction in Multiple Sclerosis - A double blind, Placebo Controlled, Randomised Clinical Trial. Neurourol Urodyn. 2008;27(3):231-7. Vahtera T, Haaranen M, Viramo-Koskela AL, Ruutiainen J. Pelvic floor rehabilitation is effective in patients with multiple sclerosis. Clin Rehabil. 1997 Aug;11(3):211-9.