Identification of Factors Related to UI in Patients With MS and EMG Assessment of PFM Activity

Primary outcomes

1. Expanded disability status scale (EDSS)

   Time frame: Single assessment at enrollment

   The Expanded disability status scale (EDSS) will be assessed disability and progression in PwMS, with scores from 0 (normal neurological exam) to 10 (death from MS). Higher scores indicate greater disability.

2. Neurogenic Bladder Symptom Score (NBSS)

   Time frame: Single assessment at enrollment

   Storage, voiding, and complication symptoms of neurogenic bladder will be assessed with the Neurogenic Bladder Symptom Score (NBSS), a 24-item questionnaire covering incontinence, storage and voiding, and outcomes.

3. International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF)

   Time frame: Single assessment at enrollment

   The frequency and amount of leakage will be assessed using a six-item scale, and urinary incontinence will be categorised into four groups: mild (1-5), moderate (6-12), severe (13-18) and very severe.

4. Incontinence Impact Questionnaire (IIQ-7)

   Time frame: Single assessment at enrollment

   Urinary symptoms' impact on daily activities was assessed with the Incontinence Impact Questionnaire (IIQ-7). The 7-item Likert scale has a score range of 0-21, with higher scores reflecting an increased negative impact of incontinence on social functioning, quality of life, and physical activity.

5. Pelvic Floor Muscle Activity

   Time frame: Single assessment at enrollment

   An electromyography (EMG) device with surface electrodes will be used to assess pelvic floor muscle (PFM) activity. Patients received training beforehand, and measurements were taken noninvasively with two electrodes around the perineum and vagina and one on the inner thigh in women.

6. International Physical Activity Questionnaire (IPAQ)

   Time frame: Single assessment at enrollment

   The International Physical Activity Questionnaire (IPAQ) assesses the frequency and duration of vigorous, moderate, and walking-like activities over a week. The values are multiplied by factors of 8, 4, and 3.3 Metabolic Equivalent of Tasks, respectively, to help measure overall physical activity. The minimum score for the IPAQ is 0, while there is no theoretically determined maximum score. Higher scores are associated with the individual engaging in a higher level of physical activity.

7. Fatigue severity scale (FSS)

   Time frame: Single assessment at enrollment

   Fatigue severity scale (FSS) assesses fatigue severity in MS with nine items rated on a 7-point Likert scale. The mean score, adapted to Turkish society, indicates pathological fatigue if it is 4 or higher.