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Frigerio M, Marino G, Barba M, Palmieri S, Ruffolo AF, Degliuomini R, Gallo P, Magoga G, Manodoro S, Vergani P. Prevalence and severity of bowel disorders in the third trimester of pregnancy. AJOG GLOBAL REPORTS 2023; 3:100218. [PMID: 37645654 PMCID: PMC10461240 DOI: 10.1016/j.xagr.2023.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Bowel-related disorders are common conditions associated with pregnancy and are a cause of significant distress and healthcare burden. However, there is a lack of data in the literature about these disorders. OBJECTIVE This study aimed to investigate bowel dysfunctions during the third trimester of pregnancy in a large cohort of women using the validated bowel domain of the Italian version of the Pelvic Floor Questionnaire for Pregnant and Postpartum Women. STUDY DESIGN This was a secondary analysis of a multicenter cross-sectional study conducted in hospitals in Italy and Italian-speaking Switzerland. Women in the third trimester of pregnancy were asked to complete the Italian Pelvic Floor Questionnaire for Pregnant and Postpartum Women. RESULTS During the study period, 927 pregnant women in the third trimester of pregnancy responded to the questionnaire and were included in the analysis. Overall bowel dysfunctions were reported by 29.6% of patients. Constipation was reported by 66.6% of pregnant women, whereas symptoms of obstructed defecation were reported by 49.9% of patients. In contrast, urgency was reported by 41.1% of patients. Incontinence to flatus and incontinence to stool were reported by 45.1% and 2.8% of patients, respectively. Moreover, age >35 years, familiarity with pelvic floor disorders, nicotine abuse, and pelvic floor contraction inability were identified as independent risk factors for at least 1 bowel symptom. CONCLUSION Bowel symptoms are extremely common in the third trimester of pregnancy and can greatly affect a patient's quality of life; therefore, bowel symptoms deserve to be investigated and managed properly. The use of validated questionnaires represents a precious tool to investigate functional symptoms that could be very frequent and disabling in this particular period of life for women.
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Affiliation(s)
- Matteo Frigerio
- ASST Monza, San Gerardo Hospital, Monza, Italy (Dr Frigerio)
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
| | - Giuseppe Marino
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
| | - Marta Barba
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
| | - Stefania Palmieri
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
| | | | | | - Pasquale Gallo
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
- San Giovanni di Dio Hospital, ASL Napoli 2 Nord, Frattamaggiore, Italy (Dr Gallo)
| | - Giulia Magoga
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Italy (Dr Magoga)
| | - Stefano Manodoro
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy (Dr Manodoro)
| | - Patrizia Vergani
- Obstetric Division, Monza and Brianza Mother and Child Foundation, Monza, Italy (Dr Vergani)
| | - Urogynecology-Pelvic Floor Working Group
- ASST Monza, San Gerardo Hospital, Monza, Italy (Dr Frigerio)
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
- San Raffaele University, Milano, Italy (Drs Ruffolo and Degliuomini)
- San Giovanni di Dio Hospital, ASL Napoli 2 Nord, Frattamaggiore, Italy (Dr Gallo)
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Italy (Dr Magoga)
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy (Dr Manodoro)
- Obstetric Division, Monza and Brianza Mother and Child Foundation, Monza, Italy (Dr Vergani)
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Ongenda ION, Mengistu Z, Tincello D, Williams C, Pitchforth E. Opinion: pelvic floor disorders: learning from chronicity & chronic care models. Front Glob Womens Health 2023; 4:1006693. [PMID: 37404229 PMCID: PMC10315837 DOI: 10.3389/fgwh.2023.1006693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Affiliation(s)
- Inès Osenge-Nyoyi Ongenda
- Primary Care Research Group, Department of Health and Community Sciences and Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Zelalem Mengistu
- Obstetrics and Gynecology Department, University of Gondar, Gondar, Ethiopia
| | - Douglas Tincello
- Women's and Children's CBU, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Christopher Williams
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Emma Pitchforth
- Primary Care Research Group, Department of Health and Community Sciences and Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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Öz Yıldırım Ö, Aydın Avci İ, Yıldırım E, Bostancı Y. The effect of the Incontinence Health Belief Development Program on women's urinary incontinence awareness and health beliefs: a randomized controlled trial. Int Urogynecol J 2022:10.1007/s00192-022-05343-x. [PMID: 36129479 DOI: 10.1007/s00192-022-05343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study is aimed at determining the effects of the Incontinence Health Belief Development Program (IHBDP) on the urinary incontinence awareness and health beliefs of women in the pre-menopausal period. METHODS This randomized controlled study was conducted in 160 eligible women. The pre-test and post-test data of the study were collected from experimental and control groups using the Socio-Demographic Characteristics Information Form, the Incontinence Awareness Scale, the Health Belief Scale on Urinary Incontinence and Kegel Exercise, and the Broome Pelvic Muscle Self-Efficacy Scale. The IHBDP was implemented with members of the experimental group for 5 weeks. RESULTS The women in the experimental group showed a significant difference in mean scores at the end of the program on the UI Awareness Scales, the Health Belief Scale on UI, and the Kegel Exercise compared with pre-training scores (p<0.05). In the experimental group, the factor scores and the total score of the Broome Pelvic Muscle Self-Efficacy Scale also increased. Furthermore, a statistically significant total score increase (p<0.05) was observed at the end of the program (79.8±8.8) compared with before the program (35.2±19.6). CONCLUSIONS The training given to the women in the pre-menopausal period based on the Health Belief Model appears highly effective in raising awareness about UI, fostering beliefs about Kegel exercises and increasing pelvic floor muscle self-efficacy.
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Affiliation(s)
- Özge Öz Yıldırım
- Department of Public Health Nursing, Health Sciences Faculty of Ondokuz Mayıs University, Samsun, Turkey.
| | - İlknur Aydın Avci
- Department of Public Health Nursing, Health Sciences Faculty of Ondokuz Mayıs University, Samsun, Turkey
| | | | - Yakup Bostancı
- Medical Faculty, Ondokuz Mayıs University, Samsun, Turkey
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Hutchison D, Ali M, Zillioux J, Ortiz NM, Smith R, Rapp DE. Pelvic Floor Muscle Training in the Management of Female Pelvic Floor Disorders. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vaginal erbium laser for treatment of stress urinary incontinence: optimization of treatment regimen for a sustained long-term effect. Lasers Med Sci 2022; 37:2157-2164. [PMID: 35067817 DOI: 10.1007/s10103-021-03474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Stress urinary incontinence (SUI) is a common health problem that affects roughly 35% of women in the reproductive period. A prospective uncontrolled study was conducted to assess the long-term efficacy and safety of a non-ablative Er:YAG laser treatment of SUI. Forty-three patients participated in the study. All women underwent three sessions of IncontiLase® procedure, and efficacy of laser treatment was assessed by 1-h pad test, 24-h pad test, 3-day voiding diary, and ICIQ-UI SF questionnaire at multiple follow-ups. Statistical analysis was performed using one-way repeated measures ANOVA. Patients were questioned about discomfort during treatment and any adverse events following the laser procedures. All outcome measures showed a significant change over a period of the entire clinical trial. Eighteen-month follow-up revealed a fading of the effect, which was alleviated by single-session maintenance treatments every 6 months. There were no serious adverse events reported during the study. All reported side effects were mild and transient. The application of non-ablative Er:YAG laser for SUI treatment significantly improves the SUI symptoms. High improvement rates and patient satisfaction can be maintained with single-session maintenance treatments performed every 6 months. Long-term safety profile of multiple non-ablative Er:YAG laser treatment is shown. NCT04348994, 16.04.2020, retrospectively registered.
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Cho ST, Kim KH. Pelvic floor muscle exercise and training for coping with urinary incontinence. J Exerc Rehabil 2022; 17:379-387. [PMID: 35036386 PMCID: PMC8743604 DOI: 10.12965/jer.2142666.333] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/30/2021] [Indexed: 12/29/2022] Open
Abstract
The pelvic floor consists of levator ani muscles including puborectalis, pubococcygeus and iliococcygeus muscles, and coccygeus muscles. Pelvic floor muscle exercise (PFME) is defined as exercise to improve pelvic floor muscle strength, power, endurance, relaxation, or a combination of these parameters. PFME strengthens the pelvic floor muscles to provide urethral support to prevent urine leakage and suppress urgency. This exercise has been recommended for urinary incontinence since first described by Kegel. When treating urinary incontinence, particularly stress urinary incontinence, PFME has been recommended as first-line treatment. This article provides clinical application of PFME as a behavioral therapy for urinary incontinence. Clinicians and physical therapist should understand pelvic floor muscle anatomy, evaluation, regimen, and instruct patients how to train the muscles properly.
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Affiliation(s)
- Sung Tae Cho
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Khae Hawn Kim
- Department of Urology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
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Anand A, Khan SM, Khan AA. Stress urinary incontinence in females. Diagnosis and treatment modalities – past, present and the future. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211044583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Stress urinary incontinence (SUI) can be defined as involuntary and unintentional loss of urine through the urethra when vesical pressure exceeds the urethral sphincter pressure during instances of coughing, sneezing or physical exercise. Stress urinary incontinence is the most common form of incontinence in females with an estimated prevalence of 4.5–53% in adult women with urinary incontinence. Yet despite its distressing nature and a negative impact on quality of life, very few women present with their symptoms to a urologist. Materials and methods: A literature search of the MEDLINE, Cochrane Library, Embase, NLH, ClinicalTrials.gov and Google Scholar databases was done up to November 2020, using terms related to SUI, medical therapy, surgical therapy and treatment options. The search terms included female stress urinary incontinence, mid-urethral sling, tension-free vaginal tape and trans obturator tape. The search included original articles, reviews and meta-analyses. Conclusion: Current guidelines for the management of stress urinary incontinence propose a step-ladder pattern, based on treatment invasiveness starting from conservative therapies, then drugs followed by minimally invasive procedures and culminating in invasive surgeries. The surgical approach is to be considered only after conservative therapies fail. The recent advances in the treatment of stress urinary incontinence have brought to light newer modalities and newer technologies that can be utilized which include laser therapy, stem cell therapy, intravesical balloon and others that show a lot of promise. This paper provides an in-depth analysis and reviews the literature on the current modalities and the future prospects of female stress urinary incontinence. Level of evidence: Not applicable for this review article.
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Affiliation(s)
- Ajay Anand
- Department of Urology, Government Medical College Jammu, India
| | | | - Azhar Ajaz Khan
- Department of Urology, Indraprastha Apollo Hospital, Delhi, India
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Low Intensity Extracorporeal Shock Wave Therapy as a Novel Treatment for Stress Urinary Incontinence: A Randomized-Controlled Clinical Study. ACTA ACUST UNITED AC 2021; 57:medicina57090947. [PMID: 34577869 PMCID: PMC8470836 DOI: 10.3390/medicina57090947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/24/2021] [Accepted: 09/06/2021] [Indexed: 01/03/2023]
Abstract
Background and Objectives: To evaluate the effects of low intensity extracorporeal shock wave therapy (LiESWT) on stress urinary incontinence (SUI). Materials and Methods: This investigation was a multicenter, single-blind, randomized-controlled trial study. Sixty female SUI patients were randomly assigned to receive LiESWT with 0.25 mJ/mm2 intensity, 3000 pulses, and 3 pulses/s, once weekly for a 4-week (W4) and 8-week (W8) period, or an identical sham LiESWT treatment without energy transmission. The primary endpoint was the changes in urine leakage as measured by a pad test and validated standardized questionnaires, while the secondary endpoint was the changes in a 3-day urinary diary among the baseline (W0), the W4 and W8 of LiESWT, and 1-month (F1), 3-month (F3), and 6-month (F6) follow-up after LiESWT. Results: The results showed that 4 weeks of LiESWT could significantly decrease urine leakage based on the pad test and validated standardized questionnaire scores, as compared to the sham group. Moreover, 8 weeks of LiESWT could significantly reduce urine leakage but increase urine volume and attenuate urgency symptoms, which showed meaningful and persistent improvement at W8, F1, F3, and F6. Furthermore, validated standardized questionnaire scores were significantly improved at W8, F1, F3, and F6 as compared to the baseline (W0). Conclusions: Eight weeks of LiESWT attenuated SUI symptoms upon physical activity, reduced urine leakage, and ameliorated overactive bladder symptoms, which implied that LiESWT significantly improved the quality of life. Our findings suggested that LiESWT could serve as a potentially novel and non-invasive treatment for SUI.
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Nauman K, Stolzle A, Owens L, Frilot CF, Gomelsky A. Impact of preoperative pelvic floor muscle training (pretraining) on urinary storage and emptying symptoms in women undergoing sling surgery. Int Urogynecol J 2021; 33:673-679. [PMID: 34106321 DOI: 10.1007/s00192-021-04870-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Although pelvic floor muscle training (PFMT) is an option for female mixed incontinence (MUI), the role of PFMT prior to midurethral sling (MUS) surgery is not well defined. We hypothesize that preoperative PFMT (pretraining) positively impacts urinary storage and voiding symptoms prior to retropubic MUS. METHODS We carried out an institutional review board-approved, retrospective chart review of women with stress-predominant MUI undergoing a retropubic MUS. Seventy-two women elected for initial PFMT before MUS (group 1). These were age-matched with 72 women who underwent MUS only (group 2). The primary outcome was the change in urinary voiding and storage symptoms (Emptying [E] and Inhibition [I; UUI] subsets of the SEAPI classification). Additional outcomes were stress urinary incontinence (SUI) resolution and change in quality of life (QoL) indices. RESULTS Mean age and follow-up were 49 ± 12 years and 33 ± 12 months respectively. After MUS, SUI resolved in 79.2% and 69.4% in groups 1 and 2 respectively (p > 0.05). In group 1, 18% and 20.8% had improvement/resolution in the E and I subsets prior to MUS. Postoperatively, similar rates of improvement/resolution in the E (25% for both) and I (68% vs 63.9%) subsets were observed in groups 1 and 2 respectively. Postoperative QoL indices were statistically improved in both groups, with no significant difference between groups. CONCLUSIONS Pretraining with PFMT before MUS was associated with preoperative improvement in emptying symptoms and UUI. Although not statistically significant, pretraining was associated with a higher chance of SUI resolution in the long term. If pretraining is beneficial before MUS, the effect appears to be small.
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Affiliation(s)
- Kathryn Nauman
- LSU Health Shreveport School of Medicine, Shreveport, LA, USA
| | - Ann Stolzle
- LSU Health Shreveport School of Medicine, Shreveport, LA, USA
| | - Laura Owens
- Southern Surgical and Medical Specialists, Lafayette, LA, USA
| | - Clifton F Frilot
- School of Allied Health Professions, LSU Health Shreveport, Shreveport, LA, USA
| | - Alex Gomelsky
- Department of Urology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA.
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Paquette J, McDermott CD, Acquaviva B, Faghani N, Lovatsis D. Real-World Effectiveness of Pelvic Floor Muscle Training for Women With Urinary Tract Symptoms and/or Prolapse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1247-1253.e1. [PMID: 34048957 DOI: 10.1016/j.jogc.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the real-world effectiveness of pelvic floor muscle therapy (PFMT) recommendations for patients. METHODS We conducted a cross-sectional study of 70 women who were advised to undergo PFMT after their initial urogynaecology consultation for lower urinary tract symptoms and/or pelvic organ prolapse. About half (51%) of potential participants consented to answer our telephone survey. We calculated the proportion of patients who complied with the recommendation of PFMT, and we subjectively assessed whether these patients found PFMT to be helpful. We also collected demographic data and looked for reasons why patients did not attend PFMT. Chi-square, 2-tailed t, or Fisher exact tests were used to compare differences between patients who attended and those who did not. RESULTS During the 6-month period after their initial consultation, only 28 of 70 women (40%) followed the recommendation to attend PFMT. Sixteen of the 28 women who attended PFMT (57%) reported that they found it helpful. Therefore, the "real-world effectiveness" of the entire study sample was 23%, with only 16 of 70 women benefiting from PFMT. Time constraints (27%) and cost (18%) were the top 2 reasons given for not attending. CONCLUSIONS Despite evidence-based recommendations in favour of PFMT for various pelvic floor disorders, its real-world effectiveness is quite low. A public health commitment to providing access to PFMT would be of significant benefit.
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Affiliation(s)
- Joalee Paquette
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, ON.
| | - Colleen D McDermott
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, ON
| | - Bianca Acquaviva
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, ON
| | - Nelly Faghani
- Physiotherapy - Pelvic Health Solutions, Toronto, ON
| | - Danny Lovatsis
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, ON
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Abstract
OBJECTIVES The efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT). In this study, we investigate the user characteristics and the effectiveness of the same app when freely available, and compare these results with the RCT. DESIGN Prospective cohort study. PARTICIPANTS During a 17-month period, 24 602 non-pregnant, non-postpartum women older than 18 years downloaded the app and responded anonymously to a questionnaire. Of these, 2672 (11%) responded to the 3-month follow-up. INTERVENTION Three months' use of the app Tät, containing information, a pelvic floor muscle training programme and lifestyle advice. MAIN OUTCOME MEASURES Change in symptom severity (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)) and subjective improvement (Patient Global Impression of Improvement (PGI-I)). RESULTS Of the respondents, 88% lived in Sweden and 75% (18 384/24 602) were incontinent with a mean age of 45.5 (SD 14.1) years. The UI types, based on symptoms, were SUI (53%), urgency UI (12%), mixed UI (31%) and undefined (4%). The mean ICIQ-UI SF score was 8.2 (SD 4.0) at baseline. The mean ICIQ-UI SF score reduction at follow-up was 1.31 (95% CI: 1.19 to 1.44) with a larger reduction in those with more severe incontinence at baseline (severe/very severe 3.23 (95% CI: 2.85 to 3.61), moderate 1.41 (95% CI: 1.24 to 1.59) and slight 0.24 (95% CI 0.06 to 0.42). When the results were weighted to match the distribution of severity in the RCT, the ICIQ-UI SF score reduction was 2.2 compared with 3.9 in the RCT. Regarding PGI-I, 65% experienced improvement compared with 92% in the RCT. CONCLUSIONS The app Tät was effective for self-management of UI even in the real world. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.
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Affiliation(s)
- Pontus Rygh
- Department of Public Health and Clinical Medicine, Umeå University Faculty of Medicine, Umea, Sweden
| | - Ina Asklund
- Department of Public Health and Clinical Medicine, Umeå University Faculty of Medicine, Umea, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University Faculty of Medicine, Umea, Sweden
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Kasper-Jędrzejewska M, Jędrzejewski G, Ptaszkowska L, Ptaszkowski K, Schleip R, Halski T. The Rolf Method of Structural Integration and Pelvic Floor Muscle Facilitation: Preliminary Results of a Randomized, Interventional Study. J Clin Med 2020; 9:jcm9123981. [PMID: 33316903 PMCID: PMC7764274 DOI: 10.3390/jcm9123981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
The management of pelvic floor dysfunctions might need to be based on a comprehensive neuro-musculoskeletal therapy such as The Rolf Method of Structural Integration (SI). The aim of the study was to evaluate the pelvic floor muscle (PFM) after the tenth session of SI by using surface electromyography (sEMG). This was a randomized, interventional study. Thirty-three healthy women were randomly assigned to the experimental (SI) or control group. The outcome measures included PFM bioelectrical activity, assessed using sEMG and endovaginal probes. An intervention in the SI group included 60 min of SI once a week, and teaching on how to contract and relax PFMs; in the control group, only the teaching was carried out. In the SI group, a significant difference was found between the PFM sEMG activity during “pre-baseline rest” (p < 0.014) and that during “rest after tonic contraction” (p = 0.021) in the supine position, as were significant increases in “phasic contraction” in the standing position (p = 0.014). In the intergroup comparison, higher PFM sEMG activity after the intervention “phasic contraction” (p = 0.037) and “pre-baseline rest” (p = 0.028) was observed in the SI group. The SI intervention significantly changes some functional bioelectrical activity of PFMs, providing a basis for further research on a new approach to PFM facilitation, particularly in clinical populations.
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Affiliation(s)
- Martyna Kasper-Jędrzejewska
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
- Correspondence:
| | - Grzegorz Jędrzejewski
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
| | - Lucyna Ptaszkowska
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland;
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Georg Brauchle Ring 60/62, 80992 München, Germany;
- Diploma University of Applied Sciences, Am Hegeberg 2, 37242 Bad Sooden-Allendorf, Germany
| | - Tomasz Halski
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
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Corrado B, Giardulli B, Polito F, Aprea S, Lanzano M, Dodaro C. The Impact of Urinary Incontinence on Quality of Life: A Cross-Sectional Study in the Metropolitan City of Naples. Geriatrics (Basel) 2020; 5:E96. [PMID: 33233663 PMCID: PMC7709681 DOI: 10.3390/geriatrics5040096] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022] Open
Abstract
Urinary incontinence is a hygienic and psychosocial problem that often brings people to restrict their social life and to experience depression. The main aim of this study was to evaluate the impact of urinary incontinence on quality of life among residents of the Metropolitan City of Naples, Italy, using a newly designed multidimensional questionnaire. The secondary objective was to find which variables affect the quality of life and symptom severity in these patients. To do so, a sample composed of twenty-eight patients was recruited in a multicentre cross-sectional study. Most of the participants had a mild impairment (60%) concerning social life and self-perception, especially those whose education was above the primary level (p = 0.036) and those who followed a pelvic floor rehabilitation program (p = 0.002). Overflow urinary incontinence was associated with a greater deterioration in the aspirational and occupational domain (p = 0.044). Symptom severity was worse in those who had comorbidities (p = 0.038), who had a high body mass index (p = 0.008) or who used diuretics (p = 0.007). In conclusion, our results suggest that there is a significant impairment of quality of life in patients who have only primary education and who follow a pelvic floor rehabilitation program.
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Affiliation(s)
- Bruno Corrado
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (B.C.); (F.P.); (S.A.); (M.L.)
| | - Benedetto Giardulli
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (B.C.); (F.P.); (S.A.); (M.L.)
| | - Francesco Polito
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (B.C.); (F.P.); (S.A.); (M.L.)
| | - Salvatore Aprea
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (B.C.); (F.P.); (S.A.); (M.L.)
| | - Mariangela Lanzano
- Department of Public Health, University Federico II of Naples, 80138 Naples, Italy; (B.C.); (F.P.); (S.A.); (M.L.)
| | - Concetta Dodaro
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80138 Naples, Italy;
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Ahadi T, Raissi GR, Hosseini M, Sajadi S, Ebadi S, Mansoori K. A Randomized Clinical Trial on the Effect of Biofeedback on Pain and Quality of Life of Patients With Chronic Coccydynia. Basic Clin Neurosci 2020; 11:753-763. [PMID: 33850612 PMCID: PMC8019848 DOI: 10.32598/bcn.11.6.1553.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/10/2018] [Accepted: 10/02/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Pelvic floor muscles dysfunction is one of the most important etiologies of coccydynia; therefore, manual therapies have been proposed as the first line of treatment. The purpose of this study was to investigate the effect of biofeedback as a new approach in the treatment of coccydynia. Methods Thirty women were randomized into two groups. Both groups were injected with the corticosteroid. One group received pelvic floor muscle exercises plus biofeedback while the other group only performed exercises. The patient's pain was measured using the Visual Analog Scale (VAS) in the first visit and after 1, 2, and 6 months of follow-up as well as Dallas pain and SF-36 quality of life questionnaires before and 2 months after the treatment. Results Pain had improved significantly after 1, 2, and 6 months in both groups compared to the baseline. However, the amount of change was not different between the groups at any time interval. The results were the same for the Dallas pain scale and SF-36 quality of life questionnaire. Conclusion Adding biofeedback to pelvic floor muscle exercises did not lead to any further improvement in the management of chronic coccydynia. Further studies with larger sample sizes may reveal the effect of biofeedback more clearly.
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Affiliation(s)
- Tannaz Ahadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Raissi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Hosseini
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Sajadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Safoora Ebadi
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Korosh Mansoori
- Neuromusculoskeletal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Bakan AB, Aslan G, Yıldız M. Effects of the Training Given to Older Adults on Urinary Incontinence. AGEING INTERNATIONAL 2020. [DOI: 10.1007/s12126-020-09390-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Xu L, Fu C, Zhang Q, Xiong F, Peng L, Liang Z, Chen L, He C, Wei Q. Efficacy of biofeedback, repetitive transcranial magnetic stimulation and pelvic floor muscle training for female neurogenic bladder dysfunction after spinal cord injury: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e034582. [PMID: 32759239 PMCID: PMC7409967 DOI: 10.1136/bmjopen-2019-034582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/14/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Neurogenic bladder dysfunction is prevalent in female patients with spinal cord injury (SCI), and previous guidelines have recommended pelvic floor muscle training (PFMT) for first-line conservative treatment. However, the actual regimen of PFMT varies widely and the single treatment does not satisfy the need of some patients. Therefore, this study aims to provide a detailed rationale and methodology for comparing the effectiveness of PFMT, biofeedback and repetitive transcranial magnetic stimulation (rTMS) as adjunct treatments for neurogenic bladder dysfunction. METHODS AND ANALYSIS This trial is a single-centre randomised controlled trial for female patients with urinary incontinence (UI) in phase of chronic SCI. Eligible participants will be randomised to one of four arms: (1) PFMT, (2) PFMT with biofeedback, (3) PFMT and rTMS and (4) PFMT with biofeedback and rTMS. There will be 44 participants in each arm and all the subjects will undergo 20 treatment sessions, five times a week for 4 weeks. The outcomes will be evaluated at 4 weeks, 3 months and 6 months after randomisation. The primary outcome is the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, and the secondary outcomes include bladder diary, pelvic floor muscle function and the International Spinal Cord Injury Quality of Life Basic Data Set. ETHICS AND DISSEMINATION The Clinical Research and Biomedical Ethics Committee of the West China Hospital, Sichuan University has approved this trial and the approval number is 2019-885. All participants will be provided written informed consent after verification of the eligibility criteria. The results of this study will be accessible in peer-reviewed publications and be presented at academic conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1900026126).
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Affiliation(s)
- Lin Xu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chenying Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Qing Zhang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Feng Xiong
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Lihong Peng
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Zejun Liang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Li Chen
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chengqi He
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
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A Mobile Application Penyikang Applied in Postpartum Pelvic Floor Dysfunction: A Cross-Sectional Study to Analyze the Factors Influencing Postpartum Pelvic Floor Muscle Strength and Women's Participation in Treatment. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4218371. [PMID: 32775419 PMCID: PMC7407008 DOI: 10.1155/2020/4218371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/27/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022]
Abstract
Objectives Postpartum pelvic floor muscle (PFM) injuries are the result of pregnancy and delivery, which lead to a series of symptoms requiring long-term follow-up. Mobile health platforms are progressively used for monitoring clinical conditions in medical subjects. This survey was a cross-sectional design based on collecting data from an application (Penyikang). We retrospectively analyzed the risk factors for weak postpartum PFM and further analyzed the factors influencing women's participation in the treatment which may help to improve the app's application in the future. Methods We enrolled postpartum women who gave birth at the Women's Hospital, Zhejiang University School of Medicine from August to November 2017; trained them to use the app; and collected the demographic and clinical information. This app requires users to fill questionnaires to assess their knowledge of pelvic floor dysfunction (PFD) and pelvic floor muscle training (PFMT) and experience with PFMT, and each therapy evaluation was restored. The relationship between the knowledge of PFMT/PFD, UI symptoms, and PFM strength was analyzed. Cluster analysis was used to define the degree of participation and identify the factors influencing the patients' participation in intensive therapy and evaluation. Results 1982 postpartum women who enrolled in the app program were defined as weak PFM. Younger maternal age, cesarean section, and without delivery injury were found as the prognostic factors to PFM strength (both type I and type II muscle fibers) (P < 0.05), and higher educational level was also in favor of type II muscle fibers (P < 0.05). Patient-reported UI symptoms were associated with weak PFM strength (P < 0.05); there were no significant differences between knowledge of PFMT or PDF and PFM strength. Finally, patients with a higher degree of participation were more likely to accept the treatment (P < 0.05). Conclusions The mobile app provides a new applicative way to investigate postpartum PFD. The factors influencing women's participation can help us focus on strategies to increase the patients' compliance, and then we will apply the app into more areas to improve the prevention and treatment of postpartum PFD.
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Wessels NJ, Hulshof L, Loohuis AMM, van Gemert-Pijnen L, Jellema P, van der Worp H, Blanker MH. User Experiences and Preferences Regarding an App for the Treatment of Urinary Incontinence in Adult Women: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e17114. [PMID: 32530431 PMCID: PMC7320303 DOI: 10.2196/17114] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/14/2020] [Accepted: 03/05/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although several apps are available to support the treatment of urinary incontinence (UI), little has been reported about the experiences and preferences of their users. OBJECTIVE The objective of this study was to explore the experiences and preferences of women using a mobile app for the treatment of UI and to identify potential improvements to the app. We developed this app for three types of UI: stress UI, urgency UI, and mixed UI. METHODS The participants in this qualitative study were women with self-reported stress UI, urgency UI, or mixed UI who used an app-based treatment to manage their condition for at least six weeks. Following the intervention, semistructured interviews were conducted to explore the participants' experiences and preferences regarding the app. All interviews were audio-recorded, transcribed verbatim, and analyzed separately by two researchers. RESULTS Data saturation was reached after interviewing 9 women (aged 32-68 years) with stress UI (n=1, 11%), urgency UI (n=3, 33%), or mixed UI (n=5, 56%). Accessibility, awareness, usability, and adherence emerged as the main themes. On the one hand, participants appreciated that the app increased their accessibility to care, preserved their privacy, increased their awareness of therapeutic options, was easy to use and useful, and supported treatment adherence. On the other hand, some participants reported that they wanted more contact with a care provider, and others reported that using the app increased their awareness of symptoms. CONCLUSIONS This qualitative study indicates that women appreciate app-based treatment for UI because it can lower barriers to treatment and increase both awareness and adherence to treatment. However, the app does not offer the ability of face-to-face contact and can lead to a greater focus on symptoms.
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Affiliation(s)
- Nienke J Wessels
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Lisa Hulshof
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Anne M M Loohuis
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Lisette van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Petra Jellema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Henk van der Worp
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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ANDAÇ T, CAN GÜRKAN Ö, DEMİRCİ N. Üriner İnkontinansta Kanıt Temelli Tamamlayıcı ve Alternatif Tedaviler. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.605439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Koenig I, Eichelberger P, Luginbuehl H, Kuhn A, Lehmann C, Taeymans J, Radlinger L. Activation patterns of pelvic floor muscles in women with incontinence while running: a randomized controlled trial. Int Urogynecol J 2020; 32:335-343. [PMID: 32472161 DOI: 10.1007/s00192-020-04334-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Running is known to cause urinary leakage in women with stress urinary incontinence (SUI). Task-specific fiber-type recruitment while running can be estimated using wavelets. The aim of this study was to compare the effect of a new physiotherapy program including involuntary, reflexive training with a standard physiotherapy program on pelvic floor muscle (PFM) activation patterns and fiber-type recruitment behavior while running. METHODS In this triple-blinded randomized controlled trial, women with SUI were randomly allocated to the control group (CON), which performed a standard physiotherapy program, or the experimental group (EXP), which received additional involuntary, reflexive training. PFM electromyography (EMG) was recorded during 10 s at three running speeds and analyzed using Morse wavelets. The relative distribution of power (%) over the frequencies from 20 to 200 Hz was extracted and analyzed within six-time intervals of 30 ms. Statistical nonparametric mapping was performed to identify power spectra differences. RESULTS Thirty-nine (CON) and 38 (EXP) women were included. The power spectra showed no statistically significant group differences. The time intervals from 30 ms before to 30 ms after initial contact showed significantly lower intensities than the intervals from 30 to 150 ms after initial contact in the lowest and higher intensities in the highest frequencies for all running speeds and both groups. CONCLUSIONS Power spectra shifts toward higher frequency bands in the pre-initial contact phase could indicate a feed-forward anticipation and a muscle tuning for the expected impact of initial contact event in order to maintain continence.
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Affiliation(s)
- Irene Koenig
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland.
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Patric Eichelberger
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Helena Luginbuehl
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Annette Kuhn
- University Hospital and University of Bern, University Clinic of Gynecology, Bern, Switzerland
| | - Corinne Lehmann
- Department of Physiotherapy, University Hospital Bern, Bern, Switzerland
| | - Jan Taeymans
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lorenz Radlinger
- Bern University of Applied Sciences, Department of Health Professions, Division of Physiotherapy, Murtenstrasse 10, 3008, Bern, Switzerland
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Mazur-Bialy AI, Kołomańska-Bogucka D, Nowakowski C, Tim S. Urinary Incontinence in Women: Modern Methods of Physiotherapy as a Support for Surgical Treatment or Independent Therapy. J Clin Med 2020; 9:E1211. [PMID: 32340194 PMCID: PMC7230757 DOI: 10.3390/jcm9041211] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
Urinary incontinence (UI) is a common health problem affecting quality of life of nearly 420 million people, both women and men. Pelvic floor muscle (PFM) training and other physiotherapy techniques play an important role in non-surgical UI treatment, but their therapeutic effectiveness is limited to slight or moderate severity of UI. Higher UI severity requires surgical procedures with pre- and post-operative physiotherapy. Given that nearly 30%-40% of women without dysfunction and about 70% with pelvic floor dysfunction are unable to perform a correct PFM contraction, therefore, it is particularly important to implement physiotherapeutic techniques aimed at early activation of PFM. Presently, UI physiotherapy focuses primarily on PFM therapy and its proper cooperation with synergistic muscles, the respiratory diaphragm, and correction of improper everyday habits for better pelvic organ support and continence. The purpose of this work is a systematic review showing the possibilities of using physiotherapeutic techniques in the treatment of UI in women with attention to the techniques of PFM activation. Evidence of the effectiveness of well-known (e.g., PFM training, biofeedback, and electrostimulation) and less-known (e.g., magnetostimulation, vibration training) techniques will be presented here regarding the treatment of symptoms of urinary incontinence in women.
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Affiliation(s)
- Agnieszka Irena Mazur-Bialy
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Grzegorzecka 20, 31-531 Krakow, Poland
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Navarro-Brazález B, Prieto-Gómez V, Prieto-Merino D, Sánchez-Sánchez B, McLean L, Torres-Lacomba M. Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial. J Clin Med 2020; 9:E1149. [PMID: 32316686 PMCID: PMC7230910 DOI: 10.3390/jcm9041149] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023] Open
Abstract
Hypopressive exercises have emerged as a conservative treatment option for pelvic floor dysfunction (PFD). The aim of this study was to compare the effects of an eight-week hypopressive exercise program to those of an individualized pelvic floor muscle (PFM) training (PFMT) program, and to a combination of both immediately after treatment and at follow-up assessments at 3, 6 and 12 months later. The study was a prospective, single-centre, assessor-blinded, randomised controlled trial. Ninety-four women with PFD were assigned to PFMT (n = 32), hypopressive exercises (n = 31) or both (n = 31). All programs included the same educational component, and instruction about lifestyle interventions and the knack manoeuvre. Primary outcomes were the Pelvic Floor Distress Inventory Short Form (PFDI-20); the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7); PFM strength (manometry and dynamometry) and pelvic floor basal tone (dynamometry). There were no statistically significant differences between groups at baseline, nor after the intervention. Overall, women reduced their symptoms (24.41-30.5 on the PFDI-20); improved their quality of life (14.78-21.49 on the PFIQ-7), improved their PFM strength (8.61-9.32 cmH2O on manometry; 106.2-247.7 g on dynamometry), and increased their pelvic floor basal tone (1.8-22.9 g on dynamometry). These data suggest that individual PFMT, hypopressive exercises and a combination of both interventions significantly reduce PFD symptoms, enhance quality of life, and improve PFM strength and basal tone in women with PFD, both in the short and longer term.
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Affiliation(s)
- Beatriz Navarro-Brazález
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
| | - Virginia Prieto-Gómez
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
| | - David Prieto-Merino
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
- Applied statistical methods in Medical Research Group, Catholic University of Murcia (UCAM), 30107 Murcia, Spain
| | - Beatriz Sánchez-Sánchez
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
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Oliveira MCE, Bezerra LO, Melo Ângelo PH, de Oliveira MC, Silva-Filho E, Ribeiro TS, Pegado R, Micussi MTABC. Game therapy a new approach to treat women facing mixed urinary incontinence: A study protocol. Neurourol Urodyn 2020; 39:1592-1600. [PMID: 32243660 DOI: 10.1002/nau.24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/22/2020] [Indexed: 12/20/2022]
Abstract
AIMS To describe a pelvic floor muscle training (PFMT) isolated and associated with game therapy (PFMT + GT) for women facing mixed urinary incontinence (MUI) during climacteric period. METHODS To standardize a randomized controlled clinical trial intervention, a protocol was created, in an attempt to decrease women's symptomatology generated by MUI, through pelvic floor and abdomino-loin-pelvic muscles strength, and endurance. This study protocol will be composed of 32 volunteers, divided into two groups of 16. They will perform PFMT isolated or PFMT + GT, twice a week during 8 weeks. Interventions will last 40 minutes and will be divided into warming (5 minutes), training (30 minutes), and 5 minutes will be composed of resting time between exercises (1 minute each). Isolated PFMT sessions will be performed through four modalities of exercises: diaphragmatic, bridge, abdominal (plank), and pelvic mobility. PFMT + GT training will be carried out by using Wii Fit Plus games, such as Lotus Focus, Penguin Slide, Basic Step, and Hula Hoop from Wii equipment. Assessments will occur before, after, and 1 month after interventions. Vaginal manometry, 1-hour Pad Test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Intervention (PGI) will be used to evaluate the sample. CONCLUSIONS It is expected greater increase on pelvic floor muscle (PFM) strength, endurance, vaginal pressure for PFMT + GG. Moreover, it is supposed that PFMT + GT volunteers present better treatment adherence due to games motivational inclusion.
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Affiliation(s)
| | - Livia Oliveira Bezerra
- Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Maiara Costa de Oliveira
- Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Edson Silva-Filho
- Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Tatiana Souza Ribeiro
- Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Development of a wireless accelerometer-based Intravaginal device to detect pelvic floor motion for evaluation of pelvic floor dysfunction. Biomed Microdevices 2020; 22:26. [PMID: 32185505 PMCID: PMC7078143 DOI: 10.1007/s10544-020-00479-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Urinary incontinence (UI) is experienced by an estimated 51% of women in the U.S. and often results from impaired function or weakening of the pelvic floor muscles. Pelvic floor muscle training (PFMT) is a frontline nonsurgical treatment, yet a number of symptomatic individuals cannot accurately perform a pelvic floor muscle contraction with simple verbal or written instruction. Long-term adherence to PFMT regimens is often a barrier to resolution of symptoms. Various biofeedback tools have been utilized to aid correct pelvic floor muscle performance and adherence. One novel device, the leva® Pelvic Digital Health System, utilizes an intravaginal probe embedded with MEMS accelerometer sensors that allow real-time visualization of the shape and motion of the vagina during PFMT. Early positive results with this device prompted design of a wearable version. The purpose of this study was to design a wearable, wireless clinical research device to optimize MEMS accelerometer sensor placement to detect maximal movement during a pelvic floor muscle exercise (PFME) and to test the form factor for retention and user acceptability. The device comprised a ring designed to sit at the fornix with an extension following the length of the vagina. This paper presents design components and results from clinical testing of 10 subjects. It was determined that a ring form factor alone, similar to other vaginal rings (pessaries, estrogen rings) provided less accurate visual information about PFME performance. By contrast, we determined that a ring with an extension allowed for device retention and improved real-time detection of vaginal shape and motion during PFMT.
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Electromyography of pelvic floor muscles with true differential versus faux differential electrode configuration. Int Urogynecol J 2020; 31:2051-2059. [PMID: 32067059 DOI: 10.1007/s00192-020-04225-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In pelvic floor muscle (PFM) electromyography (EMG) two different bipolar configurations are applied: "true differential" configuration (TD) measures neuromuscular activity with two ipsilateral electrodes, whereas "faux differential" configuration (FD) has two electrodes placed on each side of the PFMs. The aim of the study was to determine possible differences and the relationship between both configurations. METHODS A secondary data analysis of 28 continent (CON) and 22 stress urinary incontinent (SUI) women was performed. Surface EMG was measured using a vaginal probe during maximal voluntary (MVC) and fast voluntary (FVC) contractions. TD and FD were explored with amplitude- and time-related EMG parameters, cross-correlation coefficients (R(0)) and statistical parametric mapping (SPM). RESULTS Of a total of 62 comparisons of EMG parameters of MVC and FVC, only one comparison showed significant differences between the two configurations (CON group, FVC4peak TD versus FD, p = 0.015). R(0) were high in both groups for all MVC and FVC variables (R(0) ≥ 0.989). SPM detected 3 out of 28 comparisons with short (0.124-0.404 s) significant supra-threshold clusters (p < 0.025). CONCLUSIONS The findings suggest that TD and FD might measure neuromuscular activity almost the same. Very high cross-correlation coefficients and a very limited number of significant results from EMG parameters, as well as SPM, suggest that in the measured sample the choice of TD or FD might remain practically irrelevant. To gain further insight into the scientific and clinical relevance of choosing either of the electrode configurations, the comparisons should be re-evaluated on a sample with more severe incontinence symptoms.
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Magaldi FM, Moreno M, Magaldi CM, Cafarchio EM, Aronsson P, Sato MA, Maifrino LBM. Resistance Exercise Evokes Changes on Urinary Bladder Function and Morphology in Hypoestrogen Rats. Front Physiol 2020; 10:1605. [PMID: 32063862 PMCID: PMC7000622 DOI: 10.3389/fphys.2019.01605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/23/2019] [Indexed: 12/21/2022] Open
Abstract
Serum levels of estrogen decrease at climacterium and directly interfere with the urogenital tract. Urinary bladder (UB) is responsive to hormonal changes, especially estrogen. Resistance exercise elicits benefits on severe chronic diseases. Nevertheless, it is still unclear whether the resistance exercise directly affects the UB in ovariectomized (OVx) rats. This study focused on investigating the effects of resistance exercise on UB function and morphology in OVx and control rats. Adult female Wistar rats (∼250-300 g, 14-16 weeks old) [control (n = 20) and OVx (n = 20)] were divided in the following groups: sedentary (SED), and trained over 1 week (acute), 3 weeks (intermediate), and 10 weeks (chronic). Training was carried out in a ladder, with six bouts in alternate days with 75% of body weight load attached to the tail of the animal. Afterward, the animals were isoflurane anesthetized for evaluation of intravesical pressure (IP) changes upon topical administration of acetylcholine (Ach) and noradrenaline (NE) on the UB. At the end of the experiment, the UB was harvested for histological analysis and stained with hematoxylin-eosin and picrosirius red. Ach increased the IP in both OVx and control rats, whereas NE decreased the IP. However, the acute and intermediate groups showed attenuated responses to Ach and NE, while the chronic groups recovered the responses to Ach and NE close to those observed in SED groups. Acute and intermediate groups also showed decreased thickness of the muscular layer, with a reversal of the process with chronic training. In the OVx groups, the acute training reduced the thickness of the smooth muscle and mucosal layers, whereas chronic training increased it. Urothelium thickness decreased in the OVx SED and acute groups. Collagen type I fibers (CI-F) reduced in OVx SED acute and intermediate groups, while collagen type III fibers (CIII-F) increased in the OVx acute group. In the mucosal layer, the volume density of CFs reduced in OVx rats compared to control groups and chronic training resulted in their recovery. Our data suggest that chronic resistance exercise for 10 weeks reversed the functional and morphological changes caused by hypoestrogenism.
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Affiliation(s)
- Fernanda M Magaldi
- Laboratório de Análise Morfoquantitativa e Imunoistoquímica, Universidade São Judas Tadeu, São Paulo, Brazil
| | - Monise Moreno
- Laboratório de Análise Morfoquantitativa e Imunoistoquímica, Universidade São Judas Tadeu, São Paulo, Brazil
| | - Cristiane M Magaldi
- Laboratório de Análise Morfoquantitativa e Imunoistoquímica, Universidade São Judas Tadeu, São Paulo, Brazil
| | - Eduardo M Cafarchio
- Deptartamento Morfologia e Fisiologia, Faculdade de Medicina do ABC, Centro Universitário Saude ABC, Santo André, Brazil
| | - Patrik Aronsson
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monica A Sato
- Deptartamento Morfologia e Fisiologia, Faculdade de Medicina do ABC, Centro Universitário Saude ABC, Santo André, Brazil
| | - Laura B M Maifrino
- Laboratório de Análise Morfoquantitativa e Imunoistoquímica, Universidade São Judas Tadeu, São Paulo, Brazil
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Grant A, Currie S. Qualitative exploration of the acceptability of a postnatal pelvic floor muscle training intervention to prevent urinary incontinence. BMC Womens Health 2020; 20:9. [PMID: 31952500 PMCID: PMC6967084 DOI: 10.1186/s12905-019-0878-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/30/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Childbirth is a major risk factor for urinary incontinence (UI). As a result, pelvic floor muscle training (PFMT) is commonly recommended during and after pregnancy to prevent the onset of UI. PFMT is often classed as a physical activity (PA) behaviour, hence PA guidelines for postnatal women encourage PFMT alongside aerobic activities. However, postnatal lifestyle interventions tend to overlook PFMT which can be detrimental to women's health and future health risks, including urinary incontinence. This study aimed to explore perceptions and acceptability of a postnatal physical activity and PFMT intervention with postnatal women in Scotland. METHODS We recruited women who had given birth within the last 5 years by displaying posters in health centres and community centres in Stirling and through Facebook. Data was gathered via online and face-to-face focus groups, that were audio recorded and transcribed verbatim. Analytic themes were initially organised under related concepts derived from the topic guide and thematic analysis conducted. Subsequent analysis was by the Framework technique. RESULTS A total of seven online and face-to-face focus group discussions with 31 women identified there was a clear intention behaviour gap for engagement in PA, with both psychological and logistical barriers identified such as motivation and childcare. This was distinct from PFMT where there was a feeling of helplessness around not knowing how to perform a correct PFMT contraction subsequently resulting in women not adhering to PFMT guidance. Women felt there was no accessible PFMT advice available through the NHS. Some participants had received PFMT advice after childbirth and spoke of the Squeezee app being useful in adhering to a PFMT regimen but they did require additional teaching on how to do correct contractions. There was need for clarity and practical support for PFMT in the postnatal period with an approved intervention incorporating an accessible app being suggested by participants. CONCLUSIONS Women would like to be trained on postnatal PFMT but face barriers to accessing adequate information and education on how to do a PFMT contraction. An intervention combining PFMT training and an app would be the most useful for their needs and circumstances.
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Affiliation(s)
- Aileen Grant
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, AB14 7QG UK
| | - Sinead Currie
- Psychology, Faculty of Natural Sciences, University of Stirling, Scotland, FK9 4LA UK
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Vrolijks RO, Notenboom-Nas FJM, de Boer D, Schouten T, Timmerman A, Zijlstra A, Witte LPW, Knol-de Vries GE, Blanker MH. Exploring pelvic floor muscle activity in men with lower urinary tract symptoms. Neurourol Urodyn 2020; 39:732-737. [PMID: 31899809 PMCID: PMC7027460 DOI: 10.1002/nau.24267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/17/2019] [Indexed: 11/12/2022]
Abstract
Aim We aimed to explore the utility of the Multiple Array Probe Leiden (MAPLe) device to assess pelvic floor muscle activity in men with lower urinary tract symptoms (LUTS). Methods This was an observational cohort study performed at the urology outpatient department of a large teaching hospital in the Netherlands between April and October 2018. We recruited male patients referred for the assessment of LUTS, without a history of prostate surgery, if they had an International Prostate Symptom Score greater than or equal to 8. The MAPLe device was then used to assess the puborectalis, pubococcygeus, iliococcygeus, urogenital diaphragm, and the internal and external anal sphincters during three tasks: a rest period (1 minute), five maximum voluntary contractions (held for 3 seconds each), and three maximal endurance contractions (held for 15 seconds each). Results In total, 57 patients were included, 5 of which had diabetes mellitus. Muscle activity at rest was significantly lower than during either contraction task and did not differ between the muscle groups. By contrast, the external anal sphincter had significantly less activity than any other muscle group during the endurance task, and the internal anal sphincter and puborectalis had significantly less activity during the maximum voluntary contraction task. No association was found between pelvic floor muscle activity and LUTS severity during any task. Conclusion Pelvic floor muscle activity and LUTS severity appear to be unrelated, but this does not completely exclude the possibility of muscle involvement in the development or experience of symptoms. Further research is needed.
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Affiliation(s)
- Ruben O Vrolijks
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Françoise J M Notenboom-Nas
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Deborah de Boer
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Tamara Schouten
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Alice Timmerman
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Aylene Zijlstra
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Grietje E Knol-de Vries
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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García-Sánchez E, Ávila-Gandía V, López-Román J, Martínez-Rodríguez A, Rubio-Arias JÁ. What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4358. [PMID: 31717291 PMCID: PMC6887794 DOI: 10.3390/ijerph16224358] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022]
Abstract
Pelvic floor muscle training is commonly used for urine loss. However, research studies have not determined which training load is the most effective for women with stress urinary incontinence (SUI). Moreover, none of the previous reviews or studies have described the total effectiveness of pelvic floor muscle training (PFMT) with an objective test such as the pad test. The objectives were to analyze the effectiveness of pelvic floor muscle training in women with SUI and to determine which training load produces the greatest adaptations for decreasing urine loss. The search was conducted in three databases (PubMed, Web of Science and Cochrane), for randomized controlled trials (RCTs) that evaluated the effects of PFMT. Studies were included if they met the following criteria: participants were women; were older than 18; had SUI; were treated with PFMT; and the assessments of the effects were measured with a pad test. Finally, 10 articles (293 women) analyzed the pad test in women with SUI who performed PFMT. The meta-analysis showed that PFMT, independent of the protocol used in the study, resulted in decreased urine loss in women suffering from SUI. However, for large effects, the program should last 6-12 weeks, with >3 sessions/week and a length of session <45 min.
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Affiliation(s)
- Esther García-Sánchez
- Department of Exercise Physiology, Universidad Católica de Murcia, 30107 Murcia, Spain; (E.G.-S.); (V.Á.-G.); (J.L.-R.)
- Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, 30003 Murcia, Spain
- Health Sciences PhD program, Universidad Católica de Murcia, 30107 Murcia, Spain
| | - Vicente Ávila-Gandía
- Department of Exercise Physiology, Universidad Católica de Murcia, 30107 Murcia, Spain; (E.G.-S.); (V.Á.-G.); (J.L.-R.)
| | - Javier López-Román
- Department of Exercise Physiology, Universidad Católica de Murcia, 30107 Murcia, Spain; (E.G.-S.); (V.Á.-G.); (J.L.-R.)
- Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, 30003 Murcia, Spain
| | - Alejandro Martínez-Rodríguez
- Department of Analytical Chemistry, Nutrition and Food Science, Faculty of Science, Alicante University, 03690 Alicante, Spain;
| | - Jacobo Á. Rubio-Arias
- Faculty of Sports, UCAM, Universidad Católica de Murcia, 30107 Murcia, Spain
- Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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Pelvic floor muscles after birth: Do unstable shoes have an effect on pelvic floor activity and can this be measured reliably? – A feasibility study / Der Beckenboden nach der Geburt: Verändern instabile Schuhe die Aktivität und kann diese reliabel gemessen werden? – Eine Machbarkeitsstudie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2019. [DOI: 10.2478/ijhp-2019-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
Women often suffer from urinary incontinence after childbirth. Pelvic floor muscle training is an evidenced-based intervention to prevent urinary incontinence and improve its symptoms
Aim
The primary purpose of this study was to determine if there is a change in the activation of the pelvic floor muscles with different extrinsic parameters (barefoot versus unstable shoe). Second, we wanted to define variables that can be measured reliably and correlated with pelvic floor activity.
Methods
Data of 15 women who were 8 weeks to 6 months postpartum were analyzed. Two conditions (“barefoot” and “kyBoot”) were tested, with each participant performing three different tasks: walking, standing with an active pelvic floor, and standing with a passive pelvic floor. Three-dimensional kinematics of the body were recorded. Activity of the abdominal, back, and gluteal muscles was measured using surface electromyography (EMG). The activity of the pelvic floor was recorded using a vaginal electrode. Maximum pelvic floor activity was compared for each condition, and correlations among pelvic floor activity, kinematic variables, and skeletal muscle activity were determined.
Results
The maximum activity of the pelvic floor while walking was significantly higher when participants were barefoot than when they were wearing kyBoot shoes. For the standing trials, no significant differences between the conditions were detected. No surrogate marker was found to measure the pelvic floor activity.
Conclusion
With regard to the pelvic floor musculature, no recommendation is possible in favor of or against wearing unstable shoes. Technical developments are necessary to provide solutions to reliably measure the pelvic floor activity.
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Pandey D, Maturi C, Dhakar BPS, Jain G, Kyalakond K. Interventions and Quality of Life in Stress Urinary Incontinence. Gynecol Minim Invasive Ther 2019; 8:106-112. [PMID: 31544020 PMCID: PMC6743231 DOI: 10.4103/gmit.gmit_72_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 05/02/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: Stress urinary incontinence (SUI), though is more prevalent than many chronic diseases, has remained largely underreported and underdiagnosed condition. We aimed to find the improvement in the quality of life (QoL) of women with SUI after individual interventions, namely mid-urethral sling (MUS), pelvic floor muscle training (PFMT), and no treatment/control group, as primary treatment modalities. Materials and Methods: This was a prospective interventional case–control study conducted at a university teaching hospital, over a period of 2 years. Parous women with at least one vaginal delivery, attending the gynecology outpatient department, were encouraged to fill the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Those with SUI were divided into three arms (MUS, PFMT, and no treatment/control group), according to the informed decision for choice of management. Baseline QoL was documented for all with King's Health Questionnaire. QoL was again recorded after 3 months of the start of treatment and was compared with the baseline. Results: In our study cohort, the prevalence of SUI was 15.2%, with a consultation rate of only 30.7%. MUS surgery improves QoL significantly in women with SUI, followed by PFMT. We found 100% symptomatic relief, high rate of improvement in QoL with minimal easy to manage complications, in the surgical intervention arm. PFMT, though has a positive impact on QoL, requires continuous motivation, as 22% discontinued. Without treatment, QoL in SUI patients remained more or less the same. Conclusion: The help-seeking behavior (consultation rate) for SUI is poor. MUS (surgical arm) had 100% symptom relief in 3-month follow-up. MUS showed the best results in terms of QoL improvement, followed by PFMT in SUI in our study. It is important not only to educate women about the problem but also to encourage them to seek treatment and indicate that it is a treatable condition.
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Affiliation(s)
- Deeksha Pandey
- Department of Obstetrics and Gynecology, Kasturba Medical College, MAHE, Manipal, Karnataka, India
| | - Chaitanya Maturi
- Department of Obstetrics and Gynecology, Kasturba Medical College, MAHE, Manipal, Karnataka, India
| | | | - Gazal Jain
- Department of Obstetrics and Gynecology, Kasturba Medical College, MAHE, Manipal, Karnataka, India
| | - Keerti Kyalakond
- Department of Obstetrics and Gynecology, Kasturba Medical College, MAHE, Manipal, Karnataka, India
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Abstract
There have been several recent developments in surgical treatments for male and female incontinence. This article reviews the current options for treatments of urge and stress incontinence in men and women. Treatments for urge incontinence discussed include intradetrusor onabotulinum toxin A, sacral neuromodulation and percutaneous tibial nerve stimulation. For stress incontinence, suburethral mesh, bulking agents, autologous slings, colposuspension, male slings and artificial urinary sphincters are assessed.
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Affiliation(s)
- Alison Downey
- Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - Richard D Inman
- Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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Dufour S, Fedorkow D, Kun J, Deng SX, Fang Q. Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study. JMIR Mhealth Uhealth 2019; 7:e12587. [PMID: 31298221 PMCID: PMC6657451 DOI: 10.2196/12587] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 04/27/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background The postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry. Objective The aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women. Methods A 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne’s interpretive description approach. Results A total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77%), a cumbersome initiation process (n=8, 61%), and discomfort from the device (n=8, 61%) were reasons impeding intervention acceptability. Most participants (n=17, 74%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants. Conclusions Our pilot study demonstrated the potential for mHealth solution–enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth solutions that may be of value if acceptability and feasibility issues can be overcome. Trial Registration ClinicalTrials.gov NCT02865954; https://clinicaltrials.gov/ct2/show/NCT02865954
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Affiliation(s)
- Sinéad Dufour
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Donna Fedorkow
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Jessica Kun
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | | | - Qiyin Fang
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.,Department of Engineering Physics, McMaster University, Hamilton, ON, Canada
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Pérez DC, Chao CW, Jiménez LL, Fernández IM, de la Llave Rincón AI. Pelvic floor muscle training adapted for urinary incontinence in multiple sclerosis: a randomized clinical trial. Int Urogynecol J 2019; 31:267-275. [DOI: 10.1007/s00192-019-03993-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/20/2019] [Indexed: 12/22/2022]
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Effect of intravaginal vibratory versus electric stimulation on the pelvic floor muscles: A randomized clinical trial. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100022. [PMID: 31403114 PMCID: PMC6687376 DOI: 10.1016/j.eurox.2019.100022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/19/2019] [Accepted: 04/16/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction According to the International Urogynecological Association and International Continence Society people with normal pelvic floor muscle function should have the ability to voluntarily and involuntarily contract and relax these muscles. However, many women are unaware of their pelvic floor, and it is estimated that about 30–50% do not know how to actively contract these muscles. Within this context, therapeutic strategies to improve pelvic floor muscle strength and function are particularly relevant. Aims To compare the use of an intravaginal vibratory stimulus (IVVS) versus intravaginal electrical stimulation (IVES) on pelvic floor muscle functionality in women with pelvic floor dysfunctions who cannot voluntarily contract these muscles. Materials and methods Randomized clinical trial performed at a tertiary care hospital from June 2016 to September 2017. The sample comprised adult women with pelvic floor dysfunction who were unable to contract their pelvic floor muscles voluntarily. Women with latex allergy or other allergies in the pelvic region, vaginal or urinary tract infection, gynecological cancer, significant pain on palpation, or pelvic floor training over the preceding 6 months were excluded. After baseline assessment, women that met the inclusion criteria were randomized to receive once-weekly 20-minute sessions of IVVS or IVES for 6 weeks. Results Twenty-one women were randomly assigned to each group; 18 completed the IVVS and 17 completed the IVES protocols. The IVVS group presented a significant increase in PFM strength in relation to the IVES group (p = 0.026). There was a significant interaction between time and type of intervention for the same variable (p = 0.008) in the IVVS group. Conclusion Both techniques were beneficial, but IVVS was significantly superior to IVES in improving pevic floor muscle strength. Additional studies are warranted to consolidate the utility of IVVS as a treatment modality for pelvic floor dysfunction.
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Dufour S, Hondronicols A, Flanigan K. Enhancing Pelvic Health: Optimizing the Services Provided by Primary Health Care Teams in Ontario by Integrating Physiotherapists. Physiother Can 2019; 71:168-175. [PMID: 31040512 DOI: 10.3138/ptc.2017-81.pc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this review was threefold: (1) to outline the current landscape of service provision for two common pelvic floor disorders, urinary incontinence (UI) and pelvic organ prolapse (POP); (2) to describe common pelvic floor dysfunctions (UI and POP) and the associated evidence-based, conservative care; and (3) to present the potential to integrate physiotherapists into inter-professional primary health care teams to optimize the provision of care for these disorders. Method: A literature review was undertaken and a case study was developed to describe evidence-informed conservative care for pelvic floor dysfunctions. Results: A variety of models exist to treat pelvic floor disorders. Physiotherapists and nurses are key care providers, and their scope and care provision overlaps. In Ontario specifically, both nurses and physiotherapists with additional postgraduate training in pelvic floor disorders are integrated into primary health care, but only to a very limited degree, and they are arguably well positioned to leverage their skills in their respective scopes of practice to optimize the provision of pelvic health care. Conclusions: Physiotherapists and nurses are shown to be key providers of effective, conservative care to promote pelvic health. There is an opportunity to integrate these types of provider into primary care organizations in Ontario; this collaborative care could translate into improved outcomes for patients and the health care system at large.
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Affiliation(s)
- Sinéad Dufour
- School of Rehabilitation Science.,Faculty of Health Sciences, Department of Family Medicine, McMaster University.,The World of My Baby, Milton, Ont
| | - Amy Hondronicols
- School of Rehabilitation Science.,Hamilton Family Health Team, Hamilton, Ont
| | - Kathryn Flanigan
- Faculty of Health Sciences, Department of Family Medicine, McMaster University
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Cacciari LP, Dumoulin C, Hay-Smith EJ. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a cochrane systematic review abridged republication. Braz J Phys Ther 2019; 23:93-107. [PMID: 30704907 PMCID: PMC6428911 DOI: 10.1016/j.bjpt.2019.01.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pelvic floor muscle training is the most commonly used physical therapy treatment for women with urinary incontinence. OBJECTIVES To assess the effects of Pelvic floor muscle training for women with urinary incontinence in comparison to a control treatment and to summarize relevant economic findings. METHODS Cochrane Incontinence Group Specialized Register (February 12, 2018). SELECTION CRITERIA Randomized or quasi-randomized trials in women with stress, urgency or mixed urinary incontinence (symptoms, signs, or urodynamic). DATA COLLECTION AND ANALYSIS Trials were independently assessed by at least two reviewers authors and subgrouped by urinary incontinence type. Quality of evidence was assessed by adopting the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS The review included thirty-one trials involving 1817 women from 14 countries. Overall, trials were small to moderate size, and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration. Based on data available, we can be confident that Pelvic floor muscle training can cure or improve symptoms of stress and all other types of urinary incontinence. It may reduce the number of leakage episodes and the quantity of leakage, while improving reported symptoms and quality of life. Women were more satisfied with Pelvic floor muscle training, while those in control groups were more likely to seek further treatment. Long-term effectiveness and cost-effectiveness of Pelvic floor muscle training needs to be further researched. CONCLUSIONS The addition of ten new trials did not change the essential findings of the earlier review, suggesting that Pelvic floor muscle training could be included in first-line conservative management of women with urinary incontinence.
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Affiliation(s)
- Licia P Cacciari
- Faculty of Medicine, University of Montréal, Research Center of the Institut Universitaire de Gériatrie, Montreal, QC, Canada
| | - Chantale Dumoulin
- Faculty of Medicine, University of Montréal, Research Center of the Institut Universitaire de Gériatrie, Montreal, QC, Canada; Canadian Research Chair in Urogynecological Health and Aging, Montreal, QC, Canada.
| | - E Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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Grant A, Dean S, Hay-Smith J, Hagen S, McClurg D, Taylor A, Kovandzic M, Bugge C. Effectiveness and cost-effectiveness randomised controlled trial of basic versus biofeedback-mediated intensive pelvic floor muscle training for female stress or mixed urinary incontinence: protocol for the OPAL (optimising pelvic floor exercises to achieve long-term benefits) trial mixed methods longitudinal qualitative case study and process evaluation. BMJ Open 2019; 9:e024152. [PMID: 30782894 PMCID: PMC6411251 DOI: 10.1136/bmjopen-2018-024152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Female urinary incontinence (UI) is common affecting up to 45% of women. Pelvic floor muscle training (PFMT) is the first-line treatment but there is uncertainty whether intensive PFMT is better than basic PFMT for long-term symptomatic improvement. It is also unclear which factors influence women's ability to perform PFMT long term and whether this has impacts on long-term outcomes. OPAL (optimising PFMT to achieve long-term benefits) trial examines the effectiveness and cost-effectiveness of basic PFMT versus biofeedback-mediated PFMT and this evaluation explores women's experiences of treatment and the factors which influence effectiveness. This will provide data aiding interpretation of the trial findings; make recommendations for optimising the treatment protocol; support implementation in practice; and address gaps in the literature around long-term adherence to PFMT for women with stress or mixed UI. METHODS AND ANALYSIS This evaluation comprises a longitudinal qualitative case study and process evaluation (PE). The case study aims to explore women's experiences of treatment and adherence and the PE will explore factors influencing intervention effectiveness. The case study has a two-tailed design and will recruit 40 women, 20 from each trial group; they will be interviewed four times over 2 years. Process data will be collected from women through questionnaires at four time-points, from health professionals through checklists and interviews and by sampling 100 audio recordings of appointments. Qualitative analysis will use case study methodology (qualitative study) and the framework technique (PE) and will interrogate for similarities and differences between the trial groups regarding barriers and facilitators to adherence. Process data analyses will examine fidelity, engagement and mediating factors using descriptive and interpretative statistics. ETHICS AND DISSEMINATION Approval from West of Scotland Research Ethics Committee 4 (16/LO/0990). Findings will be published in journals, disseminated at conferences and through the final report. TRIAL REGISTRATION NUMBER ISRCTN57746448.
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Affiliation(s)
- Aileen Grant
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Sarah Dean
- South West Peninsula Collaboration for Leadership in Applied Research in Health Care (PenCLAHRC), University of Exeter, Exeter, UK
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Suzanne Hagen
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Doreen McClurg
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anne Taylor
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Marija Kovandzic
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Firet L, de Bree C, Verhoeks CM, Teunissen DAM, Lagro-Janssen ALM. Mixed feelings: general practitioners' attitudes towards eHealth for stress urinary incontinence - a qualitative study. BMC FAMILY PRACTICE 2019; 20:21. [PMID: 30684962 PMCID: PMC6347743 DOI: 10.1186/s12875-019-0907-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/15/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is the most prevalent subtype of urinary incontinence and is a bothering condition in women. Only a minority of those with SUI consult a general practitioner (GP). EHealth with pelvic floor muscle training (PFMT) is effective in reducing incontinence symptoms and might increase access to care. The role of the GP regarding such an eHealth intervention is unknown. The aim of the study is to gain insight into the attitudes towards a PFMT internet-based, eHealth, intervention for SUI. METHODS A qualitative study was conducted. Data were collected through semi-structured interviews among purposively sampled GPs. Audio records were fully transcribed, and analysed thematically. RESULTS Thirteen GPs were interviewed, nine females and four males. Three themes emerged: appraisal of eHealth as a welcome new tool, mixed feelings about a supportive role, and eHealth is no cure-all. GPs welcomed eHealth for SUI as matching their preferences for PFMT and having advantages for patients. With eHealth as stand-alone therapy GPs were concerned about the lack of feedback, and the loss of motivation to adhere to the intervention. Therefore, GPs considered personal support important. The GP's decision to recommend eHealth was strongly influenced by a woman's motivation and her age. GPs' treatment preferences for elderly are different from those for young women with SUI; both PFMT and eHealth are perceived less suitable for older women. CONCLUSION EHealth with PFMT fits into the GPs' routine practice of SUI and adds value to it. Although there is evidence that eHealth as a stand-alone intervention is effective, GPs consider personal support important to supplement the perceived shortcomings. Probably GPs are not aware of, or convinced of the existing evidence. Training should address this issue and should also focus on common misunderstandings about regular care for women with SUI, such as the idea that PFMT is not suitable for the elderly. Improving GPs' knowledge that eHealth can be a stand-alone therapy for SUI facilitates the implementation in daily care.
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Affiliation(s)
- Lotte Firet
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands.
| | - Chrissy de Bree
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Carmen M Verhoeks
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Doreth A M Teunissen
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
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Hödl M, Halfens RJG, Lohrmann C. Effectiveness of conservative urinary incontinence management among female nursing home residents-A cluster RCT. Arch Gerontol Geriatr 2019; 81:245-251. [PMID: 30684769 DOI: 10.1016/j.archger.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/03/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Guideline-compliant conservative management of urinary incontinence (UI) is the first step of the initial management for UI and is recommended for long-term care in older persons. Recent studies have focused on the effects of guideline-compliant UI management. However, most of these studies were tested in another setting than nursing homes and were not focused on conservative management. AIMS To measure the effectiveness of 29 evidence-based nursing recommendations regarding the conservative management of UI in Austrian nursing homes. METHODS The study is a cluster randomized intervention trial with institution as the unit of randomization. Twelve nursing homes in two Austrian provinces (Styria, Carinthia) were randomly allocated to the intervention group (IG) and control group (CG). Data were collected from participating residents over a three-month period. The intervention consisted of the implementation of recommendations for the conservative management of UI among female nursing home residents. The primary outcome variable was the daily UI experienced by the participating residents. RESULTS Residents in the (IG n = 216) had a lower risk (OR = 0.14, p = 0.02) of experiencing daily UI and were less likely to receive absorbent products (OR = 0.01, p = 0.01) than residents in the CG (n = 165). Residents in the IG (OR = 5.16, p = 0.00) were five times more likely to receive recommended interventions (e.g., bladder training) than residents in the CG. CONCLUSION Introducing guideline-compliant management into nursing practice can increase the likelihood of evidence-based interventions for the conservative management of UI. The intervention in this study targeted on nurses/nurse managers and can be recommended for the nursing home setting.
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Affiliation(s)
- Manuela Hödl
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4/3, 8010 Graz, Austria.
| | - Ruud J G Halfens
- Maastricht University, Department of Health Services Research, CAPHRI, Care and Public Health Research Institute, Duboisdomein 30, 6229 GT Maastricht, the Netherlands.
| | - Christa Lohrmann
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4/3, 8010 Graz, Austria.
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Vaz CT, Sampaio RF, Saltiel F, Figueiredo EM. Effectiveness of pelvic floor muscle training and bladder training for women with urinary incontinence in primary care: a pragmatic controlled trial. Braz J Phys Ther 2019; 23:116-124. [PMID: 30704906 DOI: 10.1016/j.bjpt.2019.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Although the efficacy of pelvic floor muscle training (PFMT) and bladder training are well established, there is a paucity of patient centered models using these interventions to treat women with UI at primary level of health assistance in Brazil. OBJECTIVE To investigate the effectiveness of a physical therapy intervention to treat women with UI in primary health centers. METHODS Pragmatic non-randomized controlled trial in which women with UI from the community participated in a supervised physical therapy program consisting of bladder training plus 12 weeks of PFMT, performed either at home or in the health center. Outcome measures were amount and frequency of urine loss measured by the 24-h pad-test and the 24-h voiding diary; secondary outcome was the impact of UI on quality of life measured by the ICIQ-SF. Outcomes were measured at baseline, at the 6th and 12th weeks of the intervention and 1 month after discharge. RESULTS Interventions reduced the amount (pad-test, p=0.004; d=0.13, 95% CI=-0.23 to 0.49) and frequency of urine loss (voiding diary, p=0.003; d=0.51, 95%CI=0.14 to 0.87), and the impact of UI on quality of life (ICIQ-SF, p<0.001; d=1.26, 95%CI=0.87 to 1.66) over time, with positive effects from the 6th week up to 1 month for both intervention setting (home and health center), and no differences between them. CONCLUSION Interventions were effective, can be implemented in primary health centers favoring the treatment of a greater number of women who do not have access to specialized physical therapy. TRIAL REGISTRATION RBR-8tww4y.
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Affiliation(s)
- Camila Teixeira Vaz
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Physical Therapy Department, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, MG, Brazil
| | - Rosana Ferreira Sampaio
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Fernanda Saltiel
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Faculdade de Ciências Médicas de Minas Gerais (FCMMG) Belo Horizonte, MG, Brazil
| | - Elyonara Mello Figueiredo
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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Muhammad J, Muhamad R, Husain NRN, Daud N. Pelvic Floor Muscle Exercise Education and Factors Associated with Implementation among Antenatal Women in Hospital Universiti Sains Malaysia. Korean J Fam Med 2019; 40:45-52. [PMID: 30613064 PMCID: PMC6351794 DOI: 10.4082/kjfm.17.0136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/28/2018] [Indexed: 11/25/2022] Open
Abstract
Background Pelvic floor muscle exercise is effective for pelvic floor muscle dysfunction. Despite the high prevalence of pelvic floor muscle dysfunction in women in the community, pelvic floor muscle exercise recognition is low in Malaysian society; thus, this intervention is not frequently used . This study assessed the knowledge of, attitudes towards, and use of pelvic floor muscle exercise among antenatal women before and after educational classes. The study also determined factors associated with exercise practice. Methods An interventional study was conducted in 121 antenatal women selected through systematic random sampling between June and December 2010. Baseline knowledge of, attitude towards, and practice of pelvic floor muscle exercise were assessed using self-administered validated questionnaires at first visit and at 2 months post-partum. All participants attended two exercise education classes on their next two visits before delivery. A paired t-test and multivariate analysis were used for data evaluation. Results The mean pre-intervention scores for knowledge, attitudes, and practice were 24.98, 24.25, and 3.51, respectively, with statistically significant mean score increments after intervention (P<0.001). The mean differences were 4.67 (95% confidence interval [CI], 3.86–5.49), 3.77 (95% CI, 3.05–4.50) and 3.45 (95% CI, 2.90–4.00) for knowledge, attitudes, and practice, respectively. Lack of baseline information on pelvic floor muscle exercise was significantly associated with practice change following an educational class. Conclusion Education is effective in improving knowledge of, attitude towards, and practice of pelvic floor muscle exercise. There is a need for greater effort to increase exercise awareness in our community, especially during antenatal class.
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Affiliation(s)
- Juliawati Muhammad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Rosediani Muhamad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nik Rosmawati Nik Husain
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Norwati Daud
- Department of Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
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Expectations regarding eHealth among women with stress urinary incontinence. Int Urogynecol J 2018; 30:1955-1963. [PMID: 30594948 PMCID: PMC6834728 DOI: 10.1007/s00192-018-3849-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/03/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is a common condition with a major impact on quality of life (QoL). Various factors prevent women from seeking help. However, eHealth (Internet-based therapy) with pelvic floor muscle training (PFMT) is an effective and satisfying intervention for these women. We hypothesize that women with symptoms after regular therapy will profit from eHealth. This study explores the expectations regarding an eHealth intervention among women who still suffer from SUI despite treatment. METHODS A qualitative study with semistructured interviews was conducted using a grounded theory approach. The study included women with SUI who had ever sought help for their condition. RESULTS Thirteen women were interviewed, most whom had experience with PFMT and still suffered from moderate-to-severe incontinence. Two themes emerged from data analysis: the need to meet, and eHealth as a tool to bridge obstacles. Women greatly emphasized that a healthcare professional, preferably one they know, should be available with eHealth. Several women indicated that the absence of personal contact caused lack of trust in success. However, several women were willing to use eHealth because its anonymity and flexibility could overcome obstacles in regular care. CONCLUSIONS eHealth based on PFMT is currently not a preferable treatment modality for women who still suffer from SUI despite treatment. eHealth cannot act as a substitute for their positive experience with personal contact. Some women are willing to use eHealth because of its advantages over regular care. Future experiences with eHealth might enable women with SUI to trust digital care.
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Cotterill N, Sullivan A, Norton C, Wilkins A, Weir I, Kilonzo M, Drake MJ. Conservative interventions for urinary or faecal incontinence, or both, in adults with multiple sclerosis. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikki Cotterill
- North Bristol NHS Trust; Bristol Urological Institute; Southmead Hospital Bristol UK BS10 5NB
- CLAHRC West; The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; 9th Floor, Whitefriars Lewins Mead Bristol UK BS1 2NT
- University of the West of England; Centre for Health and Clinical Research, Faculty of Health and Applied Sciences; Blackberry Hill Bristol UK BS16 1DD
| | - Amanda Sullivan
- North Bristol NHS Trust; Department of Physiotherapy; Southmead Hospital, Southmead Road Bristol UK BS10 5NB
| | - Christine Norton
- King's College London; Adult Nursing, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care; 57 Waterloo Road London UK SE1 8WA
| | - Alastair Wilkins
- North Bristol NHS Trust; Bristol and Avon Multiple Sclerosis Unit/Clinical Neurosciences; Southmead Hospital, Southmead Road Bristol UK BS10 5NB
| | - Iain Weir
- University of West of England; Department of Engineering, Design and Mathematics; Coldharbour Lane Bristol UK BS16 1QY
| | - Mary Kilonzo
- University of Aberdeen; Health Economics Research Unit; Aberdeen UK AB25 2ZD
| | - Marcus J Drake
- University of Bristol; School of Clinical Sciences; Bristol UK BS10 5NB
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Dos Santos RER, Vaz CT. Conhecimento de profissionais da atenção primária à saúde sobre a abordagem terapêutica na incontinência urinária feminina. HU REVISTA 2018. [DOI: 10.34019/1982-8047.2017.v43.2837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A incontinência urinária é considerada um importante problema de saúde que afeta milhões de mulheres em todas as idades. O presente estudo teve como objetivo verificar o conhecimento dos profissionais que trabalham na Atenção Primária à Saúde, na Estratégia Saúde da Família, no município de Governador Valadares, Minas Gerais, sobre a abordagem terapêutica na Incontinência Urinária feminina. Tratou-se de um estudo transversal descritivo, realizado no Município de Governador Valadares. A amostra constituiu-se por todos os médicos e enfermeiros, que atuavam nas 59 equipes de Saúde da Família do município. Utilizou-se da aplicação de um questionário elaborado pelos pesquisadores para levantar informações a respeito da formação acadêmica e dados demográficos dos profissionais; conhecimento sobre a IU feminina e abordagens terapêuticas. A análise descritiva foi avaliada com medidas de tendência central, dispersão e frequência. Participaram do estudo 76 indivíduos, sendo 74% do sexo feminino. Foi identificado que 58% dos profissionais selecionaram a opção do tratamento fisioterapêutico como intervenção de primeira escolha para o tratamento da IU feminina; e que 51% acreditavam que as mulheres com tal condição de saúde não precisam ser encaminhadas necessariamente para o nível secundário de atenção. Por outro lado, na questão discursiva, na qual os profissionais deveriam discorrer a respeito da sua abordagem terapêutica em mulheres com IU, apenas 24% dos profissionais relataram que fariam o direcionamento das mulheres para o atendimento fisioterapêutico. A análise conjunta dos dados permitiu concluir que os profissionais participantes do estudo se mostraram instruídos com relação ao contexto geral da IU feminina, no entanto, tal conhecimento não reflete a realidade da prática clínica, evidenciando uma divergência de saberes. Aponta com isso, a necessidade da educação continuada, para que seja possível concretizar o que é recomendado em diretrizes internacionais.
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Association of baseline severity of lower urinary tract symptoms with the success conservative therapy for urinary incontinence in women. Int Urogynecol J 2018; 30:705-710. [PMID: 30306193 DOI: 10.1007/s00192-018-3778-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To identify the association between the symptom severity and outcome of conservative management for OAB, SUI and MUI. Conservative treatments are recommended for overactive bladder (OAB), stress urinary incontinence (SUI) and mixed incontinence (MUI). It is unclear whether disease severity affects treatment outcome. METHODS Patients receiving conservative management were reviewed. Disease-specific questionnaires (OAB-q SF, ICIQ-UI SF) and bladder diaries recorded baseline symptoms. Success was defined by Patient Global Impression of Improvement questionnaire (PGI-I) response of "very much better" or "much better". Non-parametric statistical tests and logistic regression were used. RESULTS In 50 OAB patients success was associated with lower symptom severity [30 (0-80) vs. 80 (23-100), p = 0.0001], fewer urgency episodes [4 (0-12) vs. 6 (0-11), p = 0.032] and lower ICIQ-UI SF [5.5 (0-20) vs. 15 (0-21), p = 0.002], but higher QoL [67 (20-101) vs. 24 (6-58), p = 0.0001]. In 50 MUI patients, variables were fewer urgency episodes [3 (0-10) vs. 6 (0-16), p = 0.004] and lower ICIQ-UI [11 (1-18) vs. 15 (5-21), p = 0.03]. In 40 SUI patients, variables were fewer incontinence episodes [1 (0-4) vs. 2 (0-5), p = 0.05] and lower ICIQ-UI [11 (6-16) vs. 13.5 (11-19), p = 0.003]. Multiple regression confirmed OAB-q QoL [odds ratio (OR) 1.10 (95% confidence intervals 1.04, 1.1)] for OAB, urgency episodes [OR 0.74 (0.56, 0.98)] and ICIQ-UI [OR 0.83 (0.71, 0.98] for MUI and ICIQ-UI [OR 0.57 (0.40, 0.83)] for SUI. CONCLUSIONS Milder baseline disease severity was associated with successful outcome. There is potential for triage at initial assessment to second-line interventions for women unlikely to achieve success.
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Dumoulin C, Cacciari LP, Hay‐Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018; 10:CD005654. [PMID: 30288727 PMCID: PMC6516955 DOI: 10.1002/14651858.cd005654.pub4] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI).This is an update of a Cochrane Review first published in 2001 and last updated in 2014. OBJECTIVES To assess the effects of PFMT for women with urinary incontinence (UI) in comparison to no treatment, placebo or sham treatments, or other inactive control treatments; and summarise the findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register (searched 12 February 2018), which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings, and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in women with SUI, UUI or MUI (based on symptoms, signs or urodynamics). One arm of the trial included PFMT. Another arm was a no treatment, placebo, sham or other inactive control treatment arm. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials for eligibility and risk of bias. We extracted and cross-checked data. A third review author resolved disagreements. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. We subgrouped trials by diagnosis of UI. We undertook formal meta-analysis when appropriate. MAIN RESULTS The review included 31 trials (10 of which were new for this update) involving 1817 women from 14 countries. Overall, trials were of small-to-moderate size, with follow-ups generally less than 12 months and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration, study populations and outcome measures. There was only one study of women with MUI and only one study with UUI alone, with no data on cure, cure or improvement, or number of episodes of UI for these subgroups.Symptomatic cure of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were eight times more likely to report cure (56% versus 6%; risk ratio (RR) 8.38, 95% confidence interval (CI) 3.68 to 19.07; 4 trials, 165 women; high-quality evidence). For women with any type of UI, PFMT groups were five times more likely to report cure (35% versus 6%; RR 5.34, 95% CI 2.78 to 10.26; 3 trials, 290 women; moderate-quality evidence).Symptomatic cure or improvement of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were six times more likely to report cure or improvement (74% versus 11%; RR 6.33, 95% CI 3.88 to 10.33; 3 trials, 242 women; moderate-quality evidence). For women with any type of UI, PFMT groups were two times more likely to report cure or improvement than women in the control groups (67% versus 29%; RR 2.39, 95% CI 1.64 to 3.47; 2 trials, 166 women; moderate-quality evidence).UI-specific symptoms and quality of life (QoL) at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT group were more likely to report significant improvement in UI symptoms (7 trials, 376 women; moderate-quality evidence), and to report significant improvement in UI QoL (6 trials, 348 women; low-quality evidence). For any type of UI, women in the PFMT group were more likely to report significant improvement in UI symptoms (1 trial, 121 women; moderate-quality evidence) and to report significant improvement in UI QoL (4 trials, 258 women; moderate-quality evidence). Finally, for women with mixed UI treated with PFMT, there was one small trial (12 women) reporting better QoL.Leakage episodes in 24 hours at the end of treatment: PFMT reduced leakage episodes by one in women with SUI (mean difference (MD) 1.23 lower, 95% CI 1.78 lower to 0.68 lower; 7 trials, 432 women; moderate-quality evidence) and in women with all types of UI (MD 1.00 lower, 95% CI 1.37 lower to 0.64 lower; 4 trials, 349 women; moderate-quality evidence).Leakage on short clinic-based pad tests at the end of treatment: women with SUI in the PFMT groups lost significantly less urine in short (up to one hour) pad tests. The comparison showed considerable heterogeneity but the findings still favoured PFMT when using a random-effects model (MD 9.71 g lower, 95% CI 18.92 lower to 0.50 lower; 4 trials, 185 women; moderate-quality evidence). For women with all types of UI, PFMT groups also reported less urine loss on short pad tests than controls (MD 3.72 g lower, 95% CI 5.46 lower to 1.98 lower; 2 trials, 146 women; moderate-quality evidence).Women in the PFMT group were also more satisfied with treatment and their sexual outcomes were better. Adverse events were rare and, in the two trials that did report any, they were minor. The findings of the review were largely supported by the 'Summary of findings' tables, but most of the evidence was downgraded to moderate on methodological grounds. The exception was 'participant-perceived cure' in women with SUI, which was rated as high quality. AUTHORS' CONCLUSIONS Based on the data available, we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI. It may reduce the number of leakage episodes, the quantity of leakage on the short pad tests in the clinic and symptoms on UI-specific symptom questionnaires. The authors of the one economic evaluation identified for the Brief Economic Commentary reported that the cost-effectiveness of PFMT looks promising. The findings of the review suggest that PFMT could be included in first-line conservative management programmes for women with UI. The long-term effectiveness and cost-effectiveness of PFMT needs to be further researched.
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Affiliation(s)
- Chantale Dumoulin
- University of MontrealSchool of Rehabilitation, Faculty of MedicineC.P.6128 Succ. Centre‐villeMontrealQCCanadaH3C 3J7
| | - Licia P Cacciari
- University of MontrealSchool of Rehabilitation, Faculty of MedicineC.P.6128 Succ. Centre‐villeMontrealQCCanadaH3C 3J7
| | - E Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineWellingtonNew Zealand
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O'Reilly N, Nelson HD, Conry JM, Frost J, Gregory KD, Kendig SM, Phipps M, Salganicoff A, Ramos D, Zahn C, Qaseem A. Screening for Urinary Incontinence in Women: A Recommendation From the Women's Preventive Services Initiative. Ann Intern Med 2018; 169:320-328. [PMID: 30105360 DOI: 10.7326/m18-0595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION Recommendation on screening for urinary incontinence in women by the Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient representatives. The WPSI's recommendations are intended to guide clinical practice and coverage of services for the Health Resources and Services Administration and other stakeholders. The target audience for this recommendation includes all clinicians providing preventive health care for women, particularly in primary care settings. This recommendation applies to women of all ages, as well as adolescents. METHODS The WPSI developed this recommendation after evaluating evidence regarding the benefits and harms of screening for urinary incontinence in women. The evaluation included a systematic review of the accuracy of screening instruments and the benefits and harms of treatments. Indirect evidence was used to link screening and health outcomes in the chain of evidence that might support screening in the absence of direct evidence. The WPSI also considered the effect of screening on symptom progression and avoidance of costly and complex treatments, as well as implementation factors. RECOMMENDATION The WPSI recommends screening women for urinary incontinence annually. Screening ideally should assess whether women experience urinary incontinence and whether it affects their activities and quality of life. The WPSI recommends referring women for further evaluation and treatment if indicated.
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Affiliation(s)
- Nancy O'Reilly
- American College of Obstetricians and Gynecologists, Washington, DC (N.O., J.M.C., C.Z.)
| | - Heidi D Nelson
- Oregon Health & Science University, Portland, Oregon (H.D.N.)
| | - Jeanne M Conry
- American College of Obstetricians and Gynecologists, Washington, DC (N.O., J.M.C., C.Z.)
| | - Jennifer Frost
- American Academy of Family Physicians, Leawood, Kansas (J.F.)
| | | | - Susan M Kendig
- National Association of Nurse Practitioners in Women's Health, Washington, DC (S.M.K.)
| | - Maureen Phipps
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island (M.P.)
| | | | - Diana Ramos
- California Department of Public Health, Sacramento, California (D.R.)
| | - Christopher Zahn
- American College of Obstetricians and Gynecologists, Washington, DC (N.O., J.M.C., C.Z.)
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q.)
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Amin K, Lucioni A. Stress Urinary Incontinence Management in the Patient With Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Casteleijn FM, Zwolsman SE, Kowalik CR, Roovers JPPWR. Patients' perspectives on urethral bulk injection therapy and mid-urethral sling surgery for stress urinary incontinence. Int Urogynecol J 2018; 29:1249-1257. [PMID: 29675556 PMCID: PMC6132683 DOI: 10.1007/s00192-018-3644-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/23/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to identify all treatment decision factors that determined the preference for peri-urethral bulk injection therapy (PBI) or mid-urethral sling (MUS) surgery in patients with primary stress urinary incontinence (SUI). Second, we explored what patients expect from treatment for SUI and whether patients would consider PBI as a primary treatment option. METHODS In a qualitative design, 20 semi-structured, face-to-face interviews were conducted in women with primary SUI. Exclusion criteria were: previous PBI or MUS surgery; predominating urgency. Interviews were guided by three open-ended questions and a topic list. PBI treatment and MUS surgery were described in detail, and the efficacy was stated as 70% and 90%, respectively. Data saturation was reached when no new treatment decision factors were identified in three consecutive interviews. Interviews were audiotaped and fully transcribed. Thematic analysis by a coding process was done independently by two researchers. RESULTS Sixteen procedural, personal, professional, social and external treatment decision factors were identified. Regarding expectations about treatment for SUI, women believed 'becoming dry' was wishful thinking. The majority of patients accepted a small degree of persistent urinary incontinence after treatment. Regardless of their treatment preference, patients indicated that women should be informed about PBI as a primary treatment option. CONCLUSION Patients with primary SUI are open to PBI as an alternative treatment option even with lower cure rates compared with MUS surgery performed under general or spinal anesthesia. Patients indicated that women with primary SUI seeking treatment should be informed about PBI as a treatment option.
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Affiliation(s)
- Fenne M Casteleijn
- Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Sandra E Zwolsman
- Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Claudia R Kowalik
- Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jan-Paul P W R Roovers
- Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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