Lower limb muscle strength, balance, mobility and function in older women with urge and mixed urinary incontinence: an observational pilot study Mélanie Le Berre,1,2 Mélanie Morin,3,4 Hélène Corriveau,3,4 Mathieu Hamel,3,4 Sylvie Nadeau,1,5 Johanne Filiatrault,1,2 Chantale Dumoulin1,2 1Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Canada 2School of Rehabilitation, Université de Montréal, Montreal, Canada 3Research Centre on Aging, Université de Sherbrooke, Sherbrooke, Canada 4School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada 5Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada

Background Objectives After the age of 65, up to 1/2 women may experience symptoms of urinary incontinence (UI).1 A positive correlation between falls and urgency UI (UUI) or mixed UI (MUI) has been identified.2,3 Deficits in physical function and motor skills were mentioned as a possible explanation.3,4 This hypothesis could be of particular relevance for physiotherapy.2 However, lower-extremity impairments in older women with UUI/MUI have not been thoroughly investigated. Compare the specific characteristics of lower limb muscle strength, balance, mobility and function in older women with and without UUI or MUI; Explore the association between the severity of the UI symptoms and these characteristics. 1. Milsom et al, 2013; 2. Chiarelli et al, 2019; 3. Foley et al, 2012; 4. Fritel et al, 2013

Methods Design Outcome measures Participants Observational cross-sectional pilot study. UI symptoms severity International Consultation Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) Lower limb muscle strength Biodex dynamometer 30second Sit-to-Stand Balance Single-Leg stance Four Square Step test (FSST) Activities-Specific Balance Confidence (ABC) scale Mobility 10-Meters Walk Test 6-Minutes Walk Test Function Human Activity Profile Questionnaire (HAP) adjusted score SF-12 Physical and Mental Health Summary scores Participants Eligible women were: Aged 65 years and over Living in the community Able to walk safely and independently Either 3 episodes of UI or more per week (UUI/MUI) or no leakage for the last 3 months They were excluded if unable to understand French/English simple instructions or if they had: Medical problems, disabilities or comorbidities that may interfere with the study BMI higher than 35

Results Lower limb muscle strength Balance 30° 60° Flex Ext   With urge/mixed UI No UI Statistical tests Single-leg stance - dominant side (sec) median (min-max) 3.93 (0.85-29.10) 23.99 (2.65-60.00) p < 0.001 Single-leg stance - non-dominant side (sec) 5.74 (1.12-60.00) 17.97 (1.90-60.00)   p < 0.005 Four Square Step Test (score) mean (sd) 8.52 (1.96) 7.86 (1.54) p = 0.22 Activities-Specific Balance Confidence scale 76.03 (19.05) 88.48 (9.26) p = 0.01 Flex Ext

Results Mobility Function Conclusion   With urge/mixed UI No UI Statistical tests 10-Meters Walk Test (m/sec) median (min-max)  1.61 (1.06-2.11) 1.81 (1.16-3.22) p = 0.01 6-Minutes Walk Test (metres) mean (sd) 449.06 (58.29) 463.84 (46.36) p = 0.46   With urge/mixed UI No UI Statistical tests Human Activity Profile Questionnaire (adjusted score) median (min-max) 67 (43-81) 74 (3-82) p = 0.34 SF-12 Physical Health Summary (score) 48.5 (29.0-59.0) 57.0 (44.0-61.0) p = 0.01 Conclusion The results from this pilot study suggest balance and mobility impairments in high-functioning older women with UUI/MUI. More studies are needed to confirm these results.