| Author: | Ali, Mohammed Usman |
| Title: | Repetitive transcranial magnetic stimulation for the treatment of neurogenic overactive bladder in stroke survivors |
| Advisors: | Kannan, Priya (RS) Fong, Kenneth (RS) Kranz, Georg (RS) |
| Degree: | Ph.D. |
| Year: | 2025 |
| Subject: | Neurogenic bladder -- Treatment Bladder -- Diseases -- Treatment Magnetic brain stimulation Cerebrovascular disease -- Patients Hong Kong Polytechnic University -- Dissertations |
| Department: | Department of Rehabilitation Sciences |
| Pages: | xlii, 520 pages : color illustrations |
| Language: | English |
| Abstract: | Background: Neurogenic overactive bladder (OAB) causes significant distress to stroke survivors. Current treatments for neurogenic OAB are invasive, expensive, or lack standardized regimens. Therefore, evaluating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for managing neurogenic OAB among stroke survivors remains crucial. Objectives: To (1) determine the effects of nonsurgical, minimally or non-invasive therapies on urgency urinary incontinence (UUI) in neurogenic OAB, (2) identify psychometrically sound measures for assessing OAB symptoms, (3) identify psychometrically sound measures for evaluating quality of life in neurogenic OAB, (4) investigate the effectiveness of active rTMS compared to sham rTMS in alleviating neurogenic OAB symptoms among stroke survivors, (5) estimate the cost of active and sham rTMS in managing neurogenic OAB symptoms among stroke survivors, (6) explore the experiences of stroke survivors with neurogenic OAB symptoms after rTMS. Methods: A meta-analysis was conducted to determine the effects of non-invasive therapies on UUI symptoms in neurogenic OAB. Two systematic reviews were conducted to identify psychometrically sound measures for evaluating OAB symptoms and quality of life in neurological disorders. A total of 110 stroke survivors with neurogenic OAB symptoms were screened for eligibility; 60 participants were eligible and were randomly assigned to either the active (n = 30) or sham rTMS (n = 30) groups. The active rTMS group received low-frequency rTMS of 1200 pulses per session lasting 20 min thrice weekly. The sham rTMS group received low-frequency stimulation at a 20 % resting motor threshold. The primary (Overactive Bladder Symptom Score [OABSS]) and secondary (Incontinence Quality of Life [I-QOL] and Brief Resilience Scale [BRS]) outcome measures were assessed. The analysis of covariance (ANCOVA) analysis compared changes in the study groups. An estimate of the mean cost per patient was determined for study groups. Thematic analysis was utilised to explore the experiences of participants after active rTMS. Results: The meta-analysis revealed that electrical stimulations (intravaginal and neuromuscular stimulations) are efficacious in decreasing UUI symptoms due to multiple sclerosis and stroke. Among the identified clinical tools for neurogenic OAB symptoms and quality of life, OABSS and I-QOL, respectively, were the most psychometrically sound. The between-group mean difference (MD) of OABSS (effect size [ES]: 0.62) at the primary and secondary endpoints were 1.66 (95% CI = 1.22–2.10, p < 0.001) and 1.81 (95% CI = 1.42–2.20, p < 0.001), respectively. The between-group MD of I-QOL (ES: 0.74) at the primary and secondary endpoints were 16.50 (95% CI = 13.73–19.28, p < 0.001) and 17.48 (95% CI = 14.18–20.79, p < 0.001), respectively. The between-group MD of BRS (ES: 0.10) differed significantly between the active and sham rTMS groups at the primary (MD = 0.12, 95% CI = 0.20–0.22, p = 0.018) and secondary (MD = 0.25, 95% CI = 0.09–0.41, p = 0.002) endpoints. The cost-effectiveness (expressed as the cost-utility) study also identified a lower cost in the active rTMS group compared to the sham rTMS group. The active rTMS participants demonstrated positive experiences following the intervention. Conclusion: Low-frequency rTMS is a promising therapeutic approach for addressing neurogenic OAB symptom severity among stroke survivors. |
| Rights: | All rights reserved |
| Access: | open access |
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