Core Massage and Exercise in Pediatric LUTD

Pediatric lower urinary tract dysfunction (LUTD) is a common and multifactorial health problem. A holistic perspective is required in treatment. Therefore, the aim of our study is to demonstrate the additional effects of massage therapy and exercise training for the abdomino-lumbopelvic area in children with LUTD compared to standard urotherapy and pelvic floor biofeedback therapy in a randomized controlled design. At the beginning of our study, sample size was estimated using the G Power 3.1.9.7 program. To detect a clinically significant difference of 30% between the groups (80% improvement in the research arm and 50% in the control arm) with 80% power and an alpha level of 0.05 based on a one-sided hypothesis, the minimum sample size was determined to be 42 participants, with 21 allocated to each group. The study will include 42 volunteer children aged 7-15 years with symptoms associated with functional LUTD, accompanied by their parents. Children will be randomly assigned to 2 separate groups according to an online computer generated, gender stratified block randomization list. Group 1 will receive core-based massage and exercise training in addition to standard urotherapy and pelvic floor EMG biofeedback therapy. Group 2 will receive only standard urotherapy and pelvic floor EMG biofeedback therapy. The treatments will be applied 2 days a week for 6 weeks. Children will be evaluated at the beginning of the study and at the end of the treatment (6th week). The primary outcome measure is the "Dysfunctional Voiding and Incontinence Score". Secondary outcome measures are 3-day voiding and defecation diaries data, uroflowmetry parameters, residual urine volume after voiding by pelvic ultrasound and physical fitness parameters. SPSS program will be used for data analysis. In the comparison of numerical data between 2 independent groups, "Independent Groups T Test" will be used when parametric assumptions are met and "Mann-Whitney U test" will be used when parametric assumptions are not met. In the analysis of change within the dependent group, "Significance Test of the Difference Between Two Pairs" will be used when parametric assumptions are met and "Wilcoxon Test" will be used when parametric assumptions are not met. In the examination of the change in outcome measurements over time, the effect of the treatments in both groups on the dependent variables in all evaluations (In-group factor, Time; pre-treatment and post-treatment) will be tested with "Repeated Measures of Anova" using Treatment Group*Time (2*2) factors. Type-1 error level for statistical significance will be based on 5%.

Inclusion criteria

• Children between the ages of 7 and 15
• Presence of symptoms of functional lower urinary tract dysfunction
• Do not have a condition (such as autism, ADHD-Attention Deficit and Hyperactivity Disorder) that would prevent cooperation with the assessments and interventions in the study
• Consented to participate in the study by their parents

Exclusion criteria

• Symptomatic urinary tract infection,
• A neurological disease,
• Neurogenic bladder/bowel diagnosis,
• Monosymptomatic enuresis,
• Anatomical anomaly that may affect bladder/bowel function,
• Fecal incontinence,
• Disruption of skin integrity or open wound at the massage site and
• An orthopedic problem that would prevent them from performing the exercises in the study