Yoga para el tratamiento de la incontinencia urinaria en mujeres
Appendices
Appendix 1. Cochrane Incontinence Group Specialised Register search strategy
We used the following strategy to search the Cochrane Incontinence Specialised Register.
(({DESIGN.CCT*} OR {DESIGN.RCT*})
AND ({TOPIC.URINE.INCON*} OR {TOPIC.URINE.OVERACTIVE*} OR {TOPIC.URINE.frequency*} OR {TOPIC.URINE.URGENCY*})
AND {INTVENT.LIFESTYLE.YOGA.} OR {INTVENT.PHYS.YOGA.} OR {INTVENT.PHYS.Exercise.Yoga.} OR {INTVENT.PHYS.RELAXATION.} OR {INTVENT.PSYCH.Relaxation.} OR {INTVENT.PSYCH.MEDITATION.})
(All searches were of the keyword field of Reference Manager 2012.)
Appendix 2. NHS EED search strategies and searches for economic evaluations
NHS EED search strategies for economics evidence, developed by the Centre for Reviews and Dissemination (CRD) to populate NHS EED, are referenced in Section 15.3.1 of the Cochrane Handbook for Systematic Reviews of Interventions (Shemilt 2011), and the most current versions can be found online at www.crd.york.ac.uk/crdweb/searchstrategies.asp.
The original broad searches for economic evaluations were conducted in MEDLINE, Embase and NHS EED on 25 September 2017 by a medical librarian. Further updated searches were run but due to the lack of relevant studies identified by the original broad searches a further updated search run on 22 January 2019 was more focused and included a set of urinary incontinence related terms that were combined with the economic evaluation filters and the set of yoga terms in both MEDLINE and Embase. The search of NHS EED was not updated as this database has not been updated since the original search.
MEDLINE search for NHS EED using OvidSP (developed by CRD)
| 1 | Economics/ |
| 2 | exp "costs and cost analysis"/ |
| 3 | Economics, Dental/ |
| 4 | exp economics, hospital/ |
| 5 | Economics, Medical/ |
| 6 | Economics, Nursing/ |
| 7 | Economics, Pharmaceutical/ |
| 8 | (economic$ or cost or costs or costly or costing or price or prices or pricing or pharmacoeconomic$).ti,ab. |
| 9 | (expenditure$ not energy).ti,ab. |
| 10 | value for money.ti,ab. |
| 11 | budget$.ti,ab. |
| 12 | or/1‐11 |
| 13 | (energy or oxygen) adj cost).ti,ab. |
| 14 | (metabolic adj cost).ti,ab. |
| 15 | ((energy or oxygen) adj expenditure).ti,ab. |
| 16 | or/13‐15 |
| 17 | 12 not 16 |
| 18 | letter.pt. |
| 19 | editorial.pt. |
| 20 | historical article.pt. |
| 21 | or/18‐20 |
| 22 | 17 not 21 |
| 23 | exp animals/ not humans/ |
| 24 | 22 not 23 |
| 25 | bmj.jn. |
| 26 | "cochrane database of systematic reviews".jn. |
| 27 | health technology assessment winchester england.jn. |
| 28 | or/25‐27 |
| 29 | 24 not 28 |
| 30 | limit 29 to yr="2014 ‐Current" |
MEDLINE on OvidSP (1946 to January Week 2 2019) ‐ searched 22 January 2019
1. Economics/
2. exp "costs and cost analysis"/
3. Economics, Dental/
4. exp economics, hospital/
5. Economics, Medical/
6. Economics, Nursing/
7. Economics, Pharmaceutical/
8. (economic$ or cost or costs or costly or costing or price or prices or pricing or pharmacoeconomic$).ti,ab.
9. (expenditure$ not energy).ti,ab.
10. value for money.ti,ab.
11. budget$.ti,ab.
12. or/1‐11
13. ((energy or oxygen) adj cost).ti,ab.
14. (metabolic adj cost).ti,ab.
15. ((energy or oxygen) adj expenditure).ti,ab.
16. or/13‐15
17. 12 not 16
18. letter.pt.
19. editorial.pt.
20. historical article.pt.
21. or/18‐20
22. 17 not 21
23. exp animals/ not humans/
24. 22 not 23
25. (incontinen$ or continen$).tw.
26. exp urinary incontinence/
27. nycturia.tw.
28. ((bladder or detrusor or vesic$) adj5 (instability or stab$ or unstable or irritab$ or hyperreflexia or dys?ynerg$ or dyskinesi$ or irritat$)).tw.
29. (urin$ adj2 (leak$ or urge$ or frequen$)).tw.
30. dribbl$.tw.
31. bladder, neurogenic/
32. ((bladder or detrusor or vesic$) adj2 (hyper$ or overactiv$)).tw.
33. (spinal adj2 bladder$).tw.
34. (bladder$ adj2 (neuropath$ or neurogen$ or neurolog$)).tw.
35. (nervous adj1 (pollakisur$ or pollakiur$)).tw.
36. urinary bladder, overactive/
37. exp enuresis/
38. enure$.tw.
39. bedwet$.tw.
40. bed‐wet$.tw.
41. (bed adj5 wet$).tw.
42. (diurnal adj5 wet$).tw.
43. diurnal‐wet$.tw.
44. ((daytime or day‐time or nighttime or night‐time or nightime) adj5 wet$).tw.
45. (void$ adj2 dysfunct$).tw.
46. ((urin$ or bladder) adj5 sphincter$).tw.
47. (urethra$ adj2 sphincter$).tw.
48. (bladder adj2 neck).tw.
49. (vesic$ adj1 (neck$ or cervi$)).tw.
50. (detrusor adj1 sphincter$).tw.
51. or/25‐50
52. 24 and 51
53. 2014$.ed.
54. 2015$.ed.
55. 2016$.ed.
56. 2017$.ed.
57. 2018$.ed.
58. 2019$.ed.
59. 53 or 54 or 55 or 56 or 57 or 58
60. 52 and 59
61. yoga/
62. yoga.tw.
63. 61 or 62
64. 60 and 63
Embase search for NHS EED using OvidSP (developed by CRD)
| 1 | Health Economics/ |
| 2 | exp Economic Evaluation/ |
| 3 | exp Health Care Cost/ |
| 4 | pharmacoeconomics/ |
| 5 | 1 or 2 or 3 or 4 |
| 6 | (econom$ or cost or costs or costly or costing or price or prices or pricing or parmacoeconomic$).ti,ab. |
| 7 | (expenditure$ not energy).ti,ab. |
| 8 | (value adj2 money).ti,ab. |
| 9 | budget$.ti,ab. |
| 10 | 6 or 7 or 8 or 9 |
| 11 | 5 or 10 |
| 12 | letter.pt. |
| 13 | editorial.pt. |
| 14 | note.pt. |
| 15 | 12 or 13 or 14 |
| 16 | 11 not 15 |
| 17 | (metabolic adj cost).ti,ab. |
| 18 | ((energy or oxygen) adj cost).ti,ab. |
| 19 | ((energy or oxygen) adj expenditure).ti,ab. |
| 20 | 17 or 18 or 19 |
| 21 | 16 not 20 |
| 22 | animal/ |
| 23 | exp animal experiment/ |
| 24 | nonhuman/ |
| 25 | (rat or rats or mouse or mice or hamster or hamsters or animal or animals or dog or dogs or cat or cats or bovine or sheep).ti,ab,sh. |
| 26 | 22 or 23 or 24 or 25 |
| 27 | exp human/ |
| 28 | human experiment/ |
| 29 | 27 or 28 |
| 30 | 26 not (26 and 29) |
| 31 | 21 not 30 |
| 32 | 0959‐8146.is. |
| 33 | (1469‐493X or 1366‐5278).is. |
| 34 | 1756‐1833.en. |
| 35 | 32 or 33 or 34 |
| 36 | 31 not 35 |
| 37 | conference abstract.pt. |
| 38 | 36 not 37 |
| 39 | limit 38 to yr="2014 ‐Current" |
Embase on OvidSP (1974 to 2019 Week 03) was searched on 22 January 2019
| 1. | Health Economics/ |
| 2. | exp Economic Evaluation/ |
| 3. | exp Health Care Cost/ |
| 4. | pharmacoeconomics/ |
| 5. | (econom$ or cost or costs or costly or costing or price or prices or pricing or pharmacoeconomic$).ti,ab. |
| 6. | (expenditure$ not energy).ti,ab. |
| 7. | (value adj2 money).ti,ab. |
| 8. | budget$.ti,ab. |
| 9. | or/1‐8 |
| 10. | letter.pt. |
| 11. | editorial.pt. |
| 12. | note.pt. |
| 13. | or/10‐12 |
| 14. | 9 not 13 |
| 15. | (metabolic adj cost).ti,ab. |
| 16. | ((energy or oxygen) adj cost).ti,ab. |
| 17. | ((energy or oxygen) adj expenditure).ti,ab. |
| 18. | 15 or 16 or 17 |
| 19. | 14 not 18 |
| 20. | animal/ |
| 21. | exp animal experiment/ |
| 22. | nonhuman/ |
| 23. | (rat or rats or mouse or mice or hamster or hamsters or animal or animals or dog or dogs or cat or cats or bovine or sheep).ti,ab,sh. |
| 24. | 20 or 21 or 22 or 23 |
| 25. | exp human/ |
| 26. | human experiment/ |
| 27. | 25 or 26 |
| 28. | 24 not (24 and 27) |
| 29. | 19 not 28 |
| 30. | conference abstract.pt. |
| 31. | 29 not 30 |
| 32. | incontinence/ or mixed incontinence/ or stress incontinence/ or urge incontinence/ or urine incontinence/ |
| 33. | continence/ |
| 34. | overactive bladder/ |
| 35. | micturition disorder/ or lower urinary tract symptom/ or pollakisuria/ |
| 36. | urinary dysfunction/ or bladder instability/ or detrusor dyssynergia/ or neurogenic bladder/ or urinary urgency/ or urine extravasation/ |
| 37. | (incontinen$ or continen$).tw. |
| 38. | ((bladder or detrusor or vesic$) adj5 (instab$ or stab$ or unstab* or irritab$ or hyperreflexi$ or dys?ynerg$ or dyskinesi$ or irritat$)).tw. |
| 39. | (urin$ adj2 leak$).tw. |
| 40. | ((bladder or detrusor or vesic$) adj2 (hyper$ or overactiv$)).tw. |
| 41. | (bladder$ adj2 (neuropath$ or neurogen* or neurolog$)).tw. |
| 42. | (nervous adj pollakisur$).tw. |
| 43. | or/32‐42 |
| 44. | 31 and 43 |
| 45. | "2015".yr. |
| 46. | "2016".yr. |
| 47. | "2017".yr. |
| 48. | "2018".yr. |
| 49. | 45 or 46 or 47 or 48 |
| 50. | 44 and 49 |
| 51. | 44 and 49 |
| 52. | limit 51 to (conference abstracts or embase) |
| 53. | yoga/ |
| 54. | yoga.tw. |
| 55. | 53 or 54 |
| 56. | 52 and 55 |
Appendix 3. AMED test search strategy
AMED (Allied and Complementary Medicine): We performed a preliminary test search on AMED on OvidSP (covering 1985 to November 2015) on 30 November 2015 using the broad search strategy below to gauge roughly how many randomised trials there might be in the area of urinary incontinence, overactive bladder, or enuresis. After de‐duplication against the Cochrane Incontinence Group Specialised Register, we did not identify any additional records, therefore we will not search this database for the first version of this Cochrane Review.
| 1. | controlled clinical trial.pt. |
| 2. | randomized controlled trial.pt. |
| 3. | randomized controlled trials/ |
| 4. | random allocation/ |
| 5. | double blind method/ |
| 6. | single blind method/ |
| 7. | clinical trial$.pt. |
| 8. | exp clinical trial/ |
| 9. | placebos/ |
| 10. | placebo$.tw. |
| 11. | random$.tw. |
| 12. | research design/ |
| 13. | volunteer$.tw. |
| 14. | (clin$ adj25 trial$).tw. |
| 15. | ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).tw. |
| 16. | factorial.tw. |
| 17. | cross‐over studies/ |
| 18. | crossover.tw. |
| 19. | latin square.tw. |
| 20. | (balance$ adj2 block$).tw. |
| 21. | (animals not humans).sh. |
| 22. | or/1‐20 |
| 23. | 22 not 21 |
| 24. | exp clinical trial/ |
| 25. | (clinical trial or clinical trial phase iii or clinical trialb or clinical trials or comparative studies or comparative study or controlled clinical trial or controlled trial or evaluation studies or multicenter study or multicentre study or randomised controlled trial or randomized controlled trial).pt. |
| 26. | or/1‐20,24‐25 |
| 27. | 26 not 21 |
| 28. | toilet$.tw. |
| 29. | (incontinen$ or continen$).tw. |
| 30. | exp urinary incontinence/ or urination disorders/ |
| 31. | incontinence pads/ |
| 32. | urodynamics/ |
| 33. | urinary sphincter, artificial/ |
| 34. | urodynamic$.tw. |
| 35. | urinary catheterization/ or Urinary Catheters/ |
| 36. | bladder fistula/ or urinary fistula/ or urinary bladder fistula/ |
| 37. | toilet training/ |
| 38. | cutaneous fistula/ |
| 39. | vaginal fistula/ |
| 40. | vesicovaginal fistula/ |
| 41. | "pelvic floor"/ |
| 42. | pelvic floor disorders/ |
| 43. | (pelvi$ adj2 floor).tw. |
| 44. | perineomet$.tw. |
| 45. | interferential.tw. |
| 46. | cystitis, interstitial/ |
| 47. | nycturia.tw. |
| 48. | ((vesic$ or bladder or vagina$) adj5 (support$ or prosthes$)).tw. |
| 49. | (bladder adj6 (train$ or retrain$ or empt$)).tw. |
| 50. | mmk.tw. |
| 51. | marshall marchetti krantz.tw. |
| 52. | burch.tw. |
| 53. | ((bladder or neck or vesic$) adj5 suspen$).tw. |
| 54. | colposuspension$.tw. |
| 55. | guittes.tw. |
| 56. | colporrhaph$.tw. |
| 57. | pereyra.tw. |
| 58. | urethrosuspension$.tw. |
| 59. | cystoplast$.tw. |
| 60. | urethropex$.tw. |
| 61. | lyodura$.tw. |
| 62. | colpoperineoplast$.tw. |
| 63. | urethrocervicopex$.tw. |
| 64. | stamey.tw. |
| 65. | interstitial cystitis.tw. |
| 66. | (fistula$ adj5 (bladder or vesic$ or bladder‐vagina$ or urin$ or vagina$ or uretero‐vagina$ or ureterovagina$ or urogenital or genitourin$)).tw. |
| 67. | raz.tw. |
| 68. | ((urin$ or bladder) adj5 sphincter$).tw. |
| 69. | ((bladder or detrusor or vesic$) adj5 (instability or stab$ or unstable or irritab$ or hyperreflexia or dys?ynerg$ or dyskinesi$ or irritat$)).tw. |
| 70. | (void$ adj5 (prompt$ or diar$)).tw. |
| 71. | urethral syndrome.tw. |
| 72. | (urethra$ adj2 sphincter$).tw. |
| 73. | (bladder adj2 neck).tw. |
| 74. | (urin$ adj2 (leak$ or urge$ or frequen$)).tw. |
| 75. | urinary fistula/ |
| 76. | dribbl$.tw. |
| 77. | diaper$.tw. |
| 78. | bladder, neurogenic/ or bladder neurogenic/ or bladder disease/ |
| 79. | (bladder adj1 ulcer$).tw. |
| 80. | (hunner? adj1 ulcer$).tw. |
| 81. | (vesic$ adj1 (neck$ or cervi$)).tw. |
| 82. | cystostomy.tw. |
| 83. | cystostomy/ |
| 84. | vesicostom$.tw. |
| 85. | cystostom$.tw. |
| 86. | colporraph$.tw. |
| 87. | (fistula$ adj1 (urethra$ or colovesic$ or cystocol$ or cystovagina$ or vagino$)).tw. |
| 88. | (sling$ adj1 procedure$).tw. |
| 89. | (pelvi$ adj5 rehab$).tw. |
| 90. | ((bladder or detrusor or vesic$) adj2 (hyper$ or overactiv$)).tw. |
| 91. | (urin$ adj2 extravasat$).tw. |
| 92. | ((urin$ or bladder or urethra$) adj1 (prosthes$ or endoprosthes$)).tw. |
| 93. | (detrusor adj1 sphincter$).tw. |
| 94. | (spinal adj2 bladder$).tw. |
| 95. | (bladder$ adj2 (neuropath$ or neurogen$ or neurolog$)).tw. |
| 96. | bodyworn$.tw. |
| 97. | underpad$.tw. |
| 98. | (nervous adj1 (pollakisur$ or pollakiur$)).tw. |
| 99. | urinary bladder, overactive/ |
| 100. | or/28‐99 |
| 101. | *prostate/ |
| 102. | *prostatectomy/ |
| 103. | *prostatic hyperplasia/ |
| 104. | *prostatic neoplasm/ |
| 105. | *prostatic neoplasms/ |
| 106. | *bladder neoplasms/ |
| 107. | *prostatitis/ |
| 108. | *prostatic diseases/ |
| 109. | or/101‐108 |
| 110. | 100 not 109 |
| 111. | 27 and 110 |
| 112. | exp enuresis/ |
| 113. | enure$.tw. |
| 114. | bedwet$.tw. |
| 115. | bed‐wet$.tw. |
| 116. | (bed adj5 wet$).tw. |
| 117. | (diurnal adj5 wet$).tw. |
| 118. | diurnal‐wet$.tw. |
| 119. | ((daytime or day‐time or nighttime or night‐time or nightime) adj5 wet$).tw. |
| 120. | urotherap*.tw. |
| 121. | (void$ adj2 dysfunct$).tw. |
| 122. | or/112‐121 |
| 123. | 27 and 122 |
Appendix 4. CINAHL preliminary search strategy
CINAHL (Cumulative Index to Nursing and Allied Health Literature): We tested the following search strategy in CINAHL (on EBSCOhost) on 2 December 2015 (covering December 1981 to the most recent entry date 1 December 2015). After de‐duplication against the Cochrane Incontinence Group Specialised Register, we did not retrieve any additional records, therefore we will not search CINAHL for this Cochrane Review.
| # | Query |
| S44 | S31 AND S43 |
| S43 | S32 OR S33 OR S34 OR S35 OR S36 OR S37 OR S38 OR S39 OR S40 OR S41 OR S42 |
| S42 | TX pranayama |
| S41 | TX kundalini |
| S40 | TX qigong |
| S39 | TX relax* |
| S38 | TX meditat* |
| S37 | TX yogic |
| S36 | TX yoga |
| S35 | (MH "Qigong") |
| S34 | (MH "Relaxation") OR (MH "Muscle Relaxation") |
| S33 | (MH "Relaxation Techniques") OR (MH "Meditation") |
| S32 | (MH "Yoga+") |
| S31 | S23 AND S30 |
| S30 | S24 OR S25 OR S26 OR S27 OR S28 OR S29 |
| S29 | TI overactiv* N3 bladder* OR AB overactiv* N3 bladder* |
| S28 | TI urin* N3 leak* OR AB urin* N3 leak* |
| S27 | TI ( incontinen* OR continen* ) OR AB ( incontinen* OR continen* ) |
| S26 | MH incontinence |
| S25 | MH overactive bladder |
| S24 | MH Urinary incontinence+ |
| S23 | S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15 or S16 or S17 or S18 or S19 or S20 or S21 or S22 |
| S22 | TI ( singl* N25 blind* OR singl* N25 mask* OR doubl* N25 blind* or doubl* N25 mask* OR trebl* N25 blind* OR trebl* N25 mask*OR tripl* N25 blind* OR tripl* N25 mask* ) or AB ( singl* N25 blind* OR singl* N25 mask* OR doubl* N25 blind* or doubl* N25 mask* OR trebl* N25 blind* OR trebl* N25 mask*OR tripl* N25 blind* OR tripl* N25 mask* ) |
| S21 | (MH "Comparative Studies") |
| S20 | (MH "Clinical Research+") |
| S19 | (MH "Static Group Comparison") |
| S18 | (MH "Quantitative Studies") |
| S17 | (MH "Crossover Design") or (MH "Solomon Four‐Group Design") |
| S16 | (MH "Factorial Design") |
| S15 | (MH "Community Trials") |
| S14 | (MH "Random Sample") |
| S13 | TI balance* N2 block* or AB balance* N2 block* |
| S12 | TI "latin square" or AB "latin square" |
| S11 | TI factorial or AB factorial |
| S10 | TI clin* N25 trial* or AB clin* N25 trial* |
| S9 | (MH "Study Design") |
| S8 | (AB random*) OR (TI random*) |
| S7 | (AB placebo*) OR (TI placebo*) |
| S6 | (MH "Placebos") |
| S5 | PT Clinical Trial OR (PT "randomized controlled trial") |
| S4 | (MH "Clinical Trials+") |
| S3 | MH (random assignment) OR (crossover design) |
| S2 | cross‐over |
| S1 | crossover |
Appendix 5. IndMED preliminary strategy
IndMED: We performed a preliminary search of IndMED (www.indmed.nic.in/) on 2 December 2015 using the following terms in Advanced Strategy, applying no limits, and using the default setting to search in: Any Where.
yoga OR yogic OR meditation OR relaxation OR kundalini OR pranayama
AND
incontinent OR incontinence OR continent OR incontinence
PRISMA study flow diagram.
Study flow diagram for economics studies.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Yoga versus no specific active intervention, Outcome 1 Number of women who report cure or improvement of urinary incontinence (at short term ‐ 6 weeks).
Comparison 1 Yoga versus no specific active intervention, Outcome 2 Urinary incontinence condition‐ or symptom‐specific quality of life (at short term ‐ 6 weeks).
Comparison 1 Yoga versus no specific active intervention, Outcome 3 Adjusted analysis for condition‐ or symptom‐specific quality of life at short term (6 weeks).
Comparison 1 Yoga versus no specific active intervention, Outcome 4 Number of micturitions (daily) (at short term ‐ 6 weeks).
Comparison 1 Yoga versus no specific active intervention, Outcome 5 Adjusted analysis for number of micturitions at short term (6 weeks).
Comparison 1 Yoga versus no specific active intervention, Outcome 6 Number of episodes of incontinence (daily) (at short term ‐ 6 weeks).
Comparison 1 Yoga versus no specific active intervention, Outcome 7 Adjusted analysis for number of incontinence episodes at short term (6 weeks).
Comparison 1 Yoga versus no specific active intervention, Outcome 8 Bothersomeness of symptoms (at short term ‐ 6 weeks).
Comparison 1 Yoga versus no specific active intervention, Outcome 9 Adjusted analysis for bothersomeness of symptoms at short term (6 weeks).
Comparison 1 Yoga versus no specific active intervention, Outcome 10 Adverse effects (at short term ‐ 6 weeks).
Comparison 2 Yoga versus an active intervention, Outcome 1 Number of women who report cure or improvement of urinary incontinence (at short term ‐ 8 weeks).
Comparison 2 Yoga versus an active intervention, Outcome 2 Number of women who report cure or improvement of urinary incontinence (at intermediate term ‐ 6 months).
Comparison 2 Yoga versus an active intervention, Outcome 3 Number of women who report cure or improvement of urinary incontinence (at long term ‐ 1 year).
| Yoga compared with wait‐list for urinary incontinence in women | ||||||
| Patient or population: women with either stress‐predominant or urge‐predominant urinary incontinence Settings: community Intervention: yoga Comparison: wait‐list | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No. of participants | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Wait‐list | Yoga | |||||
| Number of women who report they are cured (they no longer experience urinary incontinence) | ‐ | ‐ | ‐ | ‐ | ‐ | The study did not report this outcome. |
| Number of women who report cure or improvement of urinary incontinence at short term (six weeks) | 111 per 1000 | 703 per 1000 | RR 6.33 (1.44 to 27.88) | 18 | ⊕⊝⊝⊝ | Number of women who reported satisfaction with change in urine leakage. |
| Urinary incontinence condition‐ or symptom‐specific quality of life at short term (6 weeks) Measured by Incontinence Impact Questionnaire Short Form (IIQ‐7) (lower = better) | The mean change in the control group was a decrease of 31 units. | The mean change in the intervention group was 1.74 units higher (33.02 units lower to 36.50 units higher). | Not applicable | 18 | ⊕⊝⊝⊝ | |
| Number of micturitions (daily) at short term (6 weeks) | The mean change in the control group was a decrease of 0.13 micturitions. | The mean change in the intervention group was | Not applicable | 18 | ⊕⊝⊝⊝ | |
| Number of episodes of incontinence (daily) at short term (6 weeks) | The mean change in the control group was a decrease of 0.27 episodes. | The mean change in the intervention group was | Not applicable | 18 | ⊕⊝⊝⊝ | |
| Bothersomeness of symptoms at short term (6 weeks) Measured by Urogenital Distress Inventory 6 (UDI‐6) (lower = better) | The mean change in the control group was a decrease of 0.1 units. | The mean change in the intervention group was 0.90 units lower (0.34 to 1.46 lower). | Not applicable | 18 | ⊕⊝⊝⊝ | |
| Adverse effects at short term (6 weeks) | 222 per 1000 | 222 per 1000 | RD 0% (‐38% to 38%) | 18 | ⊕⊝⊝⊝ | 2 women in each group reported an adverse effect. However, there were 7 adverse effects overall and the distribution of adverse effects between groups is not reported. None of the adverse effects were considered to be potentially related to the study and none were serious. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Downgraded two levels for risk of bias because there was no blinding of participants or providers (risk of performance bias), and outcome was self assessed and self recorded by participants (risk of detection bias). | ||||||
| Yoga compared with mindfulness‐based stress reduction (MBSR) for urinary incontinence in women | ||||||
| Patient or population: women with urge‐predominant urinary incontinence Settings: community Intervention: yoga Comparison: mindfulness‐based stress reduction (MBSR) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No. of participants | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| MBSR | Yoga | |||||
| Number of women who report they are cured (they no longer experience urinary incontinence) | ‐ | ‐ | ‐ | ‐ | ‐ | The study did not report this outcome. |
| Number of women who report cure or improvement of urinary incontinence at short term (8 weeks) | 461 per 1000 | 42 per 1000 | RR 0.09 (0.01 to 1.43) | 24 | ⊕⊝⊝⊝ | |
| Urinary incontinence condition‐ or symptom‐specific quality of life at short term (8 weeks) Measured by the Overactive Bladder Health‐Related Quality of Life (OAB‐HRQL) scale (higher per cent improvement = better) | ‐ | ‐ | ‐ | ‐ | ⊕⊝⊝⊝ | The study reported medians and IQR, therefore we could not extract data for meta‐analysis. The authors reported that the median per cent improvement at 8 weeks was 8.70 (IQR 1.75 to 20.59) in the yoga group (n = 11) and 29.27 (IQR 8.11 to 93.33) in the MBSR group (n = 13) (reported P value = 0.03). |
| Number of micturitions (daily) | ‐ | ‐ | ‐ | ‐ | ‐ | The study did not report this outcome. |
| Number of episodes of incontinence (daily) at short term (8 weeks) | ‐ | ‐ | ‐ | ‐ | ⊕⊝⊝⊝ | The study reported medians and IQR, therefore we could not extract data for meta‐analysis. The authors reported that the median per cent improvement at 8 weeks was ‐33.33 (IQR ‐50.00 to 16.67) in the yoga group (n = 11) and ‐60 (IQR ‐88.89 to ‐50.00) in the MBSR group (n = 13) (reported P value = 0.03). |
| Bothersomeness of symptoms at short term (6 weeks) Measured by the Overactive Bladder Symptom and Quality of Life‐Short Form (OABq‐SF) (lower = better) | ‐ | ‐ | ‐ | ‐ | ⊕⊝⊝⊝ | The study reported medians and IQR, therefore we could not extract data for meta‐analysis. The authors reported that the median per cent change at 8 weeks was ‐25.0 (IQR ‐35 to 20) in the yoga group (n = 11) and ‐55.6 (IQR ‐50 to ‐87) in the MBSR group (n = 13) (reported P value = 0.005). |
| Adverse effects | ‐ | ‐ | ‐ | ‐ | ‐ | The study did not report on adverse effects. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Downgraded two levels for risk of bias because there was no blinding of participants or providers (risk of performance bias), and there was a high percentage of loss to follow‐up that was unbalanced across study arms (risk of attrition bias). | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of women who report cure or improvement of urinary incontinence (at short term ‐ 6 weeks) Show forest plot | 1 | 18 | Risk Ratio (M‐H, Fixed, 95% CI) | 6.33 [1.44, 27.88] |
| 2 Urinary incontinence condition‐ or symptom‐specific quality of life (at short term ‐ 6 weeks) Show forest plot | 1 | 18 | Mean Difference (IV, Fixed, 95% CI) | 1.74 [‐33.02, 36.50] |
| 3 Adjusted analysis for condition‐ or symptom‐specific quality of life at short term (6 weeks) Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | ‐27.7 [‐66.80, 11.40] | |
| 4 Number of micturitions (daily) (at short term ‐ 6 weeks) Show forest plot | 1 | 18 | Mean Difference (IV, Fixed, 95% CI) | ‐0.77 [‐2.13, 0.59] |
| 5 Adjusted analysis for number of micturitions at short term (6 weeks) Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | ‐0.12 [‐1.73, 1.49] | |
| 6 Number of episodes of incontinence (daily) (at short term ‐ 6 weeks) Show forest plot | 1 | 18 | Mean Difference (IV, Fixed, 95% CI) | ‐1.57 [‐2.83, ‐0.31] |
| 7 Adjusted analysis for number of incontinence episodes at short term (6 weeks) Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | ‐1.4 [‐2.79, ‐0.01] | |
| 8 Bothersomeness of symptoms (at short term ‐ 6 weeks) Show forest plot | 1 | 18 | Mean Difference (IV, Fixed, 95% CI) | ‐0.90 [‐1.46, ‐0.34] |
| 9 Adjusted analysis for bothersomeness of symptoms at short term (6 weeks) Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | ‐0.9 [‐1.40, ‐0.40] | |
| 10 Adverse effects (at short term ‐ 6 weeks) Show forest plot | 1 | 18 | Risk Difference (M‐H, Fixed, 95% CI) | 0.0 [‐0.38, 0.38] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of women who report cure or improvement of urinary incontinence (at short term ‐ 8 weeks) Show forest plot | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.09 [0.01, 1.43] |
| 2 Number of women who report cure or improvement of urinary incontinence (at intermediate term ‐ 6 months) Show forest plot | 1 | 20 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.03, 1.42] |
| 3 Number of women who report cure or improvement of urinary incontinence (at long term ‐ 1 year) Show forest plot | 1 | 21 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.22 [0.03, 1.53] |
