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Ledur ÂC, Fontenele MQS, Bueno MEB, Smaili SM, Zamboti CL. Acute Effect of Transcranial Direct Current Stimulation in Pelvic Floor Muscle Function in Young Healthy Women: Initial Findings of a Randomized Controlled Trial. Int Urogynecol J 2024:10.1007/s00192-024-05846-9. [PMID: 38953997 DOI: 10.1007/s00192-024-05846-9] [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: 04/12/2024] [Accepted: 06/07/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Transcranial direct current stimulation (tDCS) can enhance muscle function in healthy individuals. However, it is unknown if tDCS associated with pelvic floor muscle training (PFMT) can improve pelvic floor muscle function (PFMF) in healthy women. The aim of this study was to investigate the acute effect of a single session of tDCS in PFMF compared with sham-tDCS in healthy women. METHODS A double-blind, cross-over, randomized clinical trial was conducted with healthy, nulliparous and sexually active women. PFMF was assessed by bidigital palpation (PERFECT scale) and intravaginal pressure by a manometer (Peritron™). Participants randomly underwent two tDCS sessions (active and sham) 7 days apart. The electrode was positioned equal for both protocols, the anode electrode in the supplementary motor area (M1) and the cathode electrode in the right supraorbital frontal cortex (Fp2). The current was applied for 20 min at 2 mA in active stimulation and for 30 s in sham-tDCS. The tDCS applications were associated with verbal instructions to PFMT in a seated position. After each tDCS session PFMF was reevaluated. RESULTS Twenty young healthy women (aged 23.4 ± 1.7 years; body mass index 21.7 ± 2.2 kg/m2) were included. No difference was observed in power, endurance, and intravaginal pressure of PFMF (p > 0.05). The number of sustained contractions improved from 3.0 (2.0-3.5) to 4.0 (3.0-5.0) after active-tDCS (p = 0.0004) and was superior to sham-tDCS (p = 0.01). CONCLUSION The number of sustained contractions of PFM improved immediately after a single active-tDCS session, with a difference compared with the post-intervention result of sham-tDCS in healthy young women.
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Affiliation(s)
- Ângela C Ledur
- Department of Physiotherapy, State University of Londrina, Robert Koch Avenue 60, Londrina, 86038-350, Brazil
| | - Marta Q S Fontenele
- Department of Physiotherapy, State University of Londrina, Robert Koch Avenue 60, Londrina, 86038-350, Brazil
| | - Maria E B Bueno
- Department of Physiotherapy, State University of Londrina, Robert Koch Avenue 60, Londrina, 86038-350, Brazil
| | - Suhaila M Smaili
- Department of Physiotherapy, State University of Londrina, Robert Koch Avenue 60, Londrina, 86038-350, Brazil
- Neurofunctional Physical Therapy Research Group (GPFIN), Master's and Doctoral degree program in Rehabilitation Sciences, State University of Londrina, Londrina, Paraná, Brazil
| | - Camile L Zamboti
- Department of Physiotherapy, State University of Londrina, Robert Koch Avenue 60, Londrina, 86038-350, Brazil.
- Department of Physiotherapy in School of Science and Technology, Sao Paulo State University (UNESP), 305 Roberto Símonsen Street, Presidente Prudente, SP, 19060-900, Brazil.
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Hall E, Keyser L, McKinney J, Pulliam S, Weinstein M. Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design. JMIR Form Res 2024; 8:e58551. [PMID: 38935967 DOI: 10.2196/58551] [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: 03/18/2024] [Revised: 04/17/2024] [Accepted: 05/30/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women's access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. OBJECTIVE The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. METHODS This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ≥18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. RESULTS Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ≥10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. CONCLUSIONS This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ≥10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes.
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Affiliation(s)
- Evelyn Hall
- Tufts University Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Laura Keyser
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, United States
- Axena Health, Inc., Auburndale, MA, United States
| | - Jessica McKinney
- Axena Health, Inc., Auburndale, MA, United States
- College of Health and Human Services, Andrews University, Berrien Springs, MI, United States
| | - Samantha Pulliam
- Tufts University Medical Center, Tufts University School of Medicine, Boston, MA, United States
- Axena Health, Inc., Auburndale, MA, United States
| | - Milena Weinstein
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Muta M, Takahashi T, Tamai N, Sanada H, Nakagami G. Development of an e-learning program for biofeedback in pelvic floor muscle training for adult women using self-performed ultrasound: An observational study. Jpn J Nurs Sci 2024:e12609. [PMID: 38880980 DOI: 10.1111/jjns.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/04/2024] [Accepted: 04/30/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Pelvic floor muscle training (PFMT) for urinary incontinence (UI) is recommended in combination with biofeedback to visualize pelvic floor muscles. The focus is on non-invasive hand-held ultrasound (US) measurement methods for PFMT, which can be performed at home. Recently, self-performed US measurements in which the patient applies the US to themself have gradually spreading. This study aimed to develop an educational program for the biofeedback method using self-performed US and to evaluate its feasibility. METHODS This study was an observational study. The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) was utilized to create an e-learning program for women aged ≥40 years with UI. Participants self-performed bladder US via e-learning, using a hand-held US device with a convex probe. The primary outcome was the number of times the bladder area was successfully extracted using an existing automatic bladder area extraction system. The secondary outcome was the total score of the technical evaluation of the self-performed US, which was evaluated across three proficiency levels. Descriptive statistics were conducted for participant characteristics, presenting categorical variables as percentages and continuous variables as means ± SD. RESULTS We included 11 participants with a mean age of 56.2 years. Nine participants were able to record US videos, and two were unable to record bladder videos. Regarding the technical evaluation scores, all participants scored ≥80%; four had perfect scores. CONCLUSIONS This study showed that transabdominal self-performed bladder US can be performed in 81.8% of women with UI in their 40-60s by using an e-learning program.
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Affiliation(s)
- Miyako Muta
- Department of Gerontological Nursing / Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Takahashi
- Department of Gerontological Nursing / Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nao Tamai
- Department of Nursing, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Hiromi Sanada
- Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing / Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Pasqualotto L, Driusso P, Dos Reis FJJ, Rodrigues JC, Catai CC, Riccetto C, Jorge CH, Botelho S. Low-Value Practices for Pelvic Floor Dysfunction-Choosing Wisely Recommendations from the Brazilian Association of Physiotherapy in Women's Health: Observational Study. Int Urogynecol J 2024:10.1007/s00192-024-05828-x. [PMID: 38864858 DOI: 10.1007/s00192-024-05828-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The Choosing Wisely campaign is an international initiative that is aimed at promoting a dialog between professionals, helping the population to choose an evidence-based, truly necessary and risk-free care. The aim of the study was to develop the Choosing Wisely Brazil list on Women's Health Physiotherapy in the area of the pelvic floor. METHODS A observational study was carried out between January 2022 and July 2023, proposed by the Brazilian Association of Physiotherapy in Women's Health, and developed by researchers working in the area of the pelvic floor. The development of the list consisted of six stages: a panel of experts, consensus building, national research, a review by the Choosing Wisely Brazil team, preparation of the list, and publication of the recommendations. Descriptive and content analyses were carried out in order to include evidence-based recommendations with over 80% agreement by physiotherapists in Brazil. RESULTS The expert panel was made up of 25 physiotherapists who submitted 63 recommendations. Seven physiotherapists/researchers carried out a critical analysis of the literature and refined the recommendations, resulting in 11 recommendations that were put to a national vote, in which 222 physiotherapists took part. After a review by the Choosing Wisely Brazil team, five recommendations with an average agreement of 88.2% agreement were chosen for publication. CONCLUSIONS The Choosing Wisely Brazil team in Physiotherapy in Women's Health/Pelvic Floor proposed a list of five recommendations that showed a high agreement among Brazilian physiotherapists working in the area.
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Affiliation(s)
- Luísa Pasqualotto
- University of Campinas, School of Medical Sciences, Postgraduate Program in Surgical Science (UNICAMP), Campinas, São Paulo, Brazil
| | - Patricia Driusso
- Women's Health Research Laboratory, Physical Therapy Department (UFSCar), São Carlos, Federal University of São Carlos, São Paulo, Brazil
| | - Felipe José Jandre Dos Reis
- Federal Institute of Rio de Janeiro, Physiotherapy Department (IFRJ), Rio de Janeiro, Brazil
- Department of Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brusselm Pain in Motion Research Group, Brussels, Belgium
| | - Jessica Cordeiro Rodrigues
- Women's Health Research Laboratory, Physical Therapy Department (UFSCar), São Carlos, Federal University of São Carlos, São Paulo, Brazil
| | - Camila Chiazuto Catai
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Cassio Riccetto
- University of Campinas, School of Medical Sciences, Postgraduate Program in Surgical Science (UNICAMP), Campinas, São Paulo, Brazil
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Women's Health Research Laboratory, Physical Therapy Department (UFSCar), São Carlos, Federal University of São Carlos, São Paulo, Brazil
- Federal Institute of Rio de Janeiro, Physiotherapy Department (IFRJ), Rio de Janeiro, Brazil
- Department of Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brusselm Pain in Motion Research Group, Brussels, Belgium
- Federal University of Alfenas, Motor Science Institute, Postgraduate Program in Rehabilitation Sciences (UNIFAL/MG), Alfenas, Minas Gerais, Brazil
| | - Cristine Homsi Jorge
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Simone Botelho
- University of Campinas, School of Medical Sciences, Postgraduate Program in Surgical Science (UNICAMP), Campinas, São Paulo, Brazil.
- Federal University of Alfenas, Motor Science Institute, Postgraduate Program in Rehabilitation Sciences (UNIFAL/MG), Alfenas, Minas Gerais, Brazil.
- UroFisioterapia Laboratory of the Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, UNIFAL/MG, Av. Jovino Fernandes Sales, 2600 Santa Clara, Building C, Room 101-K, Alfenas, MG, 37130-000, Brazil.
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Bø K, Lillegård RH, Skaug KL. Pelvic Floor Muscle Training on Stress Urinary Incontinence in Power- and Weightlifters: a Pilot Study. Int Urogynecol J 2024:10.1007/s00192-024-05801-8. [PMID: 38758455 DOI: 10.1007/s00192-024-05801-8] [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: 01/24/2024] [Accepted: 04/06/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is defined as involuntary leakage of urine on physical effort and is prevalent among power- and weightlifters. However, there is scant knowledge on treatment options for this population. The aim of this pilot study was to evaluate the potential outcomes and feasibility of a pelvic floor muscle training (PFMT) program on SUI in nulliparous female power- and weightlifters. METHODS This was a case-series study, including one weightlifter and two powerlifters aged 21-32 years. The participants conducted 12 weeks of PFMT at home, with weekly follow-up by a physiotherapist. Change in total score of the International Consensus of Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was the primary outcome. Secondary outcome was perceived change assessed by the Patient Global Impression of Improvement (PGI-I) Scale and impact on sport participation. PFM strength, endurance, and resting pressure was measured using vaginal manometry. Feasibility was evaluated as adherence to training and self-efficacy (Self Efficacy Scale for Practicing Pelvic Floor Exercises). RESULTS One athlete reduced their ICIQ-UI-SF score and experienced improvement in symptoms. One athlete reported no change, and one reported a worsening of symptoms. All three participants improved PFM strength and endurance, completed the testing, and 12 weeks of PFMT, but adherence varied between 40 and 80%. Participants reported a lack of time and energy and forgetting to perform the exercises, as reasons for low adherence. CONCLUSION There were varying effects of a 12-week PFMT program on SUI in three strength athletes. The results can create the basis for a future randomized controlled trial.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.
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Hakim S, Santoso BI, Rahardjo HE, Setiati S, Kusumaningsih W, Erwinanto, Prihartono J, Ibrahim N, Indriatmi W. Analyze, design, develop, implement, and evaluate approach to develop a pelvic floor muscle training guidebook to treat stress urinary incontinence in women. Obstet Gynecol Sci 2024; 67:323-334. [PMID: 38479353 PMCID: PMC11099090 DOI: 10.5468/ogs.23212] [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: 08/21/2023] [Revised: 12/09/2023] [Accepted: 02/27/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE Stress urinary incontinence (SUI) is a common problem that affects the quality of life of women worldwide. Pelvic floor muscle training (PFMT) is an effective conservative first-line treatment for SUI. However, low compliance with PFMT is one of the main reasons for therapeutic failure. Indirect supervision using a guidebook may improve PFMT outcomes. To develop a PFMT guidebook using the analyze, design, development, implementation, and evaluation (ADDIE) method. METHODS A guidebook was developed from July 2020 to April 2021 using the ADDIE method. This prospective study used mixed methods, namely qualitative analysis, focus group discussions, and in-depth interviews, and involved various experts from urogynecology, urology, medical rehabilitation, and physiotherapy departments. A pilot study was conducted on patients with SUI to evaluate the effectiveness of the guidebook. RESULTS The ADDIE method was successfully implemented to develop the PFMT guidebook. The formative evaluation of the ADDIE steps mainly focused on the PFMT technique, content clarity, illustration, design, and color choice of the book. After the pilot study, the guidebook significantly improved Incontinence Impact Questionnaire, Short Form, 1-hour pad test, and perineometer scores. However, the pilot study showed no significant improvement in Urogenital Distress Inventory, Short Form scores. CONCLUSION The PFMT guidebook developed using the ADDIE method improved outcomes in patients with SUI.
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Affiliation(s)
- Surahman Hakim
- Urogynecology Division, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
- Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Budi Iman Santoso
- Urogynecology Division, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
| | | | - Siti Setiati
- Geriatrics Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
| | | | - Erwinanto
- Urogynecology Division, Department of Obstetrics and Gynecology, Dr. Kariadi Hospital, Semarang,
Indonesia
| | - Joedo Prihartono
- Department of Community Medicine, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
| | - Nurhadi Ibrahim
- Department of Physiology and Biophysics, Faculty of Medicine University of Indonesia, Jakarta,
Indonesia
| | - Wresti Indriatmi
- Dermatology and Venereology, Dr. Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
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Luebke MC, Davidson ERW, Crotty BH, Fergestrom N, O'Connor RC, Schmitt E, Winn AN, Flynn KE, Neuner JM. Referral and Prescription Patterns for Female Patients With Urinary Incontinence. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:489-497. [PMID: 37881958 PMCID: PMC11002977 DOI: 10.1097/spv.0000000000001423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
IMPORTANCE Although behavioral modifications, medications, and other interventions can improve urinary incontinence (UI), many women never receive them. OBJECTIVES To better characterize UI treatment patterns in primary care, we examined prescriptions and referrals to pelvic floor physical therapy (PFPT) and specialist physicians within a large Midwestern academic health system. STUDY DESIGN Electronic health records were queried to identify a cohort of adult female patients receiving a new UI diagnosis during outpatient primary care visits from 2016 to 2020. Urinary incontinence referrals and referral completion were examined for the overall cohort, and medication prescriptions were examined for women with urgency or mixed UI. Logistic regression was used to assess the association of prescriptions and/or referrals with patient demographics, comorbidities, and UI diagnosis dates. RESULTS In the year after primary care UI diagnosis, 37.2% of patients in the overall cohort (n = 4,382) received guideline-concordant care. This included 20.6% of women who were referred for further management: 17.7% to urology/urogynecology and 3.2% to PFPT. Most women who were referred attended an initial appointment. Among those with urgency (n = 2,398) or mixed UI (n = 552), 17.1% were prescribed medication. Women with stress (odds ratio [OR], 3.10; 95% CI, 2.53-3.79) and mixed UI (OR, 6.17; 95% CI, 4.03-9.66) were more likely to be referred for further management, and women diagnosed during the COVID-19 pandemic were less likely to be referred for further care (OR, 0.39; 95% CI, 0.29, 0.48). CONCLUSION Only slightly above 1 in 3 women with a new diagnosis of UI in primary care received guideline-based medications or referrals within 1 year, suggesting missed opportunities for timely care.
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Hao J, Yao Z, Remis A, Huang B, Li Y, Yu X. Pelvic floor muscle training in telerehabilitation: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1753-1764. [PMID: 38340157 DOI: 10.1007/s00404-024-07380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE This systematic review aims to identify, critically appraise, and summarize current evidence regarding the feasibility and efficacy of pelvic floor muscle training in telerehabilitation. METHODS Three bibliographic databases, PubMed, Embase, and Scopus were searched from inception to October 1, 2023. Clinical trials assessing the feasibility and efficacy of pelvic floor muscle training in telerehabilitation were eligible for inclusion. The Physiotherapy Evidence Database scale and National Institutes of Health Study Quality Assessment Tool were used for methodological quality assessment. Study selection, data extraction, and quality assessment were completed by two independent reviewers. Meta-analyses were performed to determine the effects of pelvic floor muscle training in telerehabilitation. RESULTS Five randomized controlled trials and three single cohort clinical trials were included in this review. Four studies were evaluated as good quality, and four as fair. Pelvic floor telerehabilitation was well tolerated and demonstrated good patient compliance and satisfaction. Pooled analysis indicated significant effects of pelvic floor telerehabilitation on the severity of urinary incontinence with a large effect size, pelvic floor muscle strength with a large effect size, and quality of life with a medium effect size. CONCLUSION This systematic review demonstrates that pelvic floor muscle training in telerehabilitation is a feasible and effective approach and highlights its efficacy in patients with urinary incontinence. This review supports the application of pelvic floor muscle training in telerehabilitation and informs further clinical and research endeavors to incorporate digital health technologies in managing pelvic floor dysfunction.
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Affiliation(s)
- Jie Hao
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Zixuan Yao
- Department of Rehabilitation Medicine, Institution of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Science, Beijing, 100051, People's Republic of China.
| | - Andréas Remis
- Health Research Association of Keck Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Biying Huang
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yanfei Li
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Xin Yu
- Department of Rehabilitation Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, People's Republic of China
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Chen C, Zhang J, Zhang H, Li H, Yu J, Pei Y, Fang Y. Effects of different treatment frequencies of electromagnetic stimulation for urinary incontinence in women: study protocol for a randomized controlled trial. Trials 2024; 25:285. [PMID: 38671503 PMCID: PMC11055314 DOI: 10.1186/s13063-024-08103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Urinary incontinence is highly prevalent in women while pelvic floor muscle training is recommended as the first-line therapy. However, the exact treatment regimen is poorly understood. Also, patients with pelvic floor muscle damage may have decreased muscle proprioception and cannot contract their muscles properly. Other conservative treatments including electromagnetic stimulation are suggested by several guidelines. Thus, the present study aims to compare the effectiveness of electromagnetic stimulation combined with pelvic floor muscle training as a conjunct treatment for urinary incontinence and different treatment frequencies will be investigated. METHODS/DESIGN This is a randomized, controlled clinical trial. We will include 165 patients with urinary incontinence from the outpatient center. Participants who meet the inclusion criteria will be randomly allocated to three groups: the pelvic floor muscle training group (active control group), the low-frequency electromagnetic stimulation group (group 1), and the high-frequency electromagnetic stimulation group (group 2). Both group 1 and group 2 will receive ten sessions of electromagnetic stimulation. Group 1 will be treated twice per week for 5 weeks while group 2 will receive 10 days of continuous treatment. The primary outcome is the change in International Consultation on Incontinence Questionnaire-Short Form cores after the ten sessions of the treatment, while the secondary outcomes include a 3-day bladder diary, pelvic floor muscle function, pelvic organ prolapse quantification, and quality of life assessed by SF-12. All the measurements will be assessed at baseline, after the intervention, and after 3 months of follow-up. DISCUSSION The present trial is designed to investigate the effects of a conjunct physiotherapy program for urinary incontinence in women. We hypothesize that this strategy is more effective than pelvic floor muscle training alone, and high-frequency electromagnetic stimulation will be superior to the low-frequency magnetic stimulation group.
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Affiliation(s)
- Chunmei Chen
- Department of Women's Health, School of Medicine, Chengdu Women's and Children's Central Hospital, The Affiliatedffiliatedffiliated Women's and Children's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Zhang
- Department of Women's Health, School of Medicine, Chengdu Women's and Children's Central Hospital, The Affiliatedffiliatedffiliated Women's and Children's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong Zhang
- Department of Women's Health, Jinniu Maternity and Child Health Hospital of Chengdu, Chengdu, China
| | - Haiyan Li
- Jiangsu Department of Science and Technology, Jiangsu Province Pelvic Floor Rehabilitation Engineering Technology Research Center, Zhenjiang, China
| | - Jucheng Yu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yao Pei
- State Key Laboratory of Emerging Infectious Diseases and Centre of Influenza Research, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Jiangsu Department of Science and Technology, Jiangsu Province Pelvic Floor Rehabilitation Engineering Technology Research Center, Zhenjiang, China.
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Park J, Lee K, Lee K. Effect of Fluid and Caffeine Management on Quality of Life in Older Women with Overactive Bladder in Rural Korea: A Pilot Study. J Multidiscip Healthc 2024; 17:1549-1559. [PMID: 38617084 PMCID: PMC11016249 DOI: 10.2147/jmdh.s441256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose This study aimed to investigate the effectiveness of the simplified intervention, consisting of fluid and caffeine management alone in older women with overactive bladder symptoms. Patients and Methods A quasi-experimental pretest-posttest design was used. Rural, community-dwelling older women were recruited at four senior centers in South Korea. Of the 63 participants initially enrolled, 34 met the inclusion criteria. One group (n = 15) used fluid and caffeine management alone (FM), and the other group (n = 12) used a combination of fluid and caffeine management and pelvic floor muscle training (FM+PFMT). Urinary symptom-specific health-related quality of life was measured using the Korean version of KHQ. Sleep quality was measured using the Pittsburgh Sleep Quality Index. After the intervention, participants were assessed 4 and 8 weeks. A linear mixed model was used for the analysis. Results The mean age of the participants was 74.44 ± 5.67 years. Among the nine domains of KHQ, impact on life and physical limitations decreased significantly in both groups, without significant between-group differences. Sleep/energy increased in both groups, and the scores in the FM+PFMT group were significantly improved. The number of micturition episodes per day and the quality of sleep did not differ significantly between the two groups. Conclusion A simplified intervention, consisting of fluid and caffeine management alone can be considered as the first-line intervention to improve health-related quality of life in rural, community-dwelling, older women with overactive bladder symptoms. Healthcare providers should consider providing a relatively simple, but equally effective intervention to maximize the adherence and effectiveness.
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Affiliation(s)
- Jeongok Park
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Kyoungjin Lee
- College of Nursing, Kyungbok University, Gyeonggi-do, South Korea
| | - Kayoung Lee
- College of Nursing, Gachon University, Incheon, South Korea
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Muta M, Takahashi T, Tamai N, Suzuki M, Kawamoto A, Sanada H, Nakagami G. Pelvic floor muscle contraction automatic evaluation algorithm for pelvic floor muscle training biofeedback using self-performed ultrasound. BMC Womens Health 2024; 24:219. [PMID: 38575899 PMCID: PMC10996170 DOI: 10.1186/s12905-024-03041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/21/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Non-invasive biofeedback of pelvic floor muscle training (PFMT) is required for continuous training in home care. Therefore, we considered self-performed ultrasound (US) in adult women with a handheld US device applied to the bladder. However, US images are difficult to read and require assistance when using US at home. In this study, we aimed to develop an algorithm for the automatic evaluation of pelvic floor muscle (PFM) contraction using self-performed bladder US videos to verify whether it is possible to automatically determine PFM contraction from US videos. METHODS Women aged ≥ 20 years were recruited from the outpatient Urology and Gynecology departments of a general hospital or through snowball sampling. The researcher supported the participants in their self-performed bladder US and videos were obtained several times during PFMT. The US videos obtained were used to develop an automatic evaluation algorithm. Supervised machine learning was then performed using expert PFM contraction classifications as ground truth data. Time-series features were generated from the x- and y-coordinate values of the bladder area including the bladder base. The final model was evaluated for accuracy, area under the curve (AUC), recall, precision, and F1. The contribution of each feature variable to the classification ability of the model was estimated. RESULTS The 1144 videos obtained from 56 participants were analyzed. We split the data into training and test sets with 7894 time series features. A light gradient boosting machine model (Light GBM) was selected, and the final model resulted in an accuracy of 0.73, AUC = 0.91, recall = 0.66, precision = 0.73, and F1 = 0.73. Movement of the y-coordinate of the bladder base was shown as the most important. CONCLUSION This study showed that automated classification of PFM contraction from self-performed US videos is possible with high accuracy.
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Affiliation(s)
- Miyako Muta
- Department of Gerontological Nursing / Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Toshiaki Takahashi
- Department of Gerontological Nursing / Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Nao Tamai
- Department of Nursing, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, Japan
| | - Motofumi Suzuki
- Department of Urology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, Japan
- Department of Urology, The Kikkoman General Hospital, 100, Miyazaki, Noda-shi, Chiba, Japan
| | - Atsuo Kawamoto
- Division of Ultrasound, Department of Diagnostic Imaging, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, Japan
| | - Hiromi Sanada
- Ishikawa Prefectural Nursing University, 1-1, Gakuendai, Kahoku-shi, Ishikawa, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing / Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
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Carlson K, Andrews M, Bascom A, Baverstock R, Campeau L, Dumoulin C, Labossiere J, Locke J, Nadeau G, Welk B. 2024 Canadian Urological Association guideline: Female stress urinary incontinence. Can Urol Assoc J 2024; 18:83-102. [PMID: 38648655 PMCID: PMC11034962 DOI: 10.5489/cuaj.8751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Kevin Carlson
- Southern Alberta Institute of Urology & Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Matthew Andrews
- Division of Urology, Department of Surgery, Memorial University, St. John’s, NL, Canada
| | | | - Richard Baverstock
- Southern Alberta Institute of Urology & Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | | | - Joe Labossiere
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Geneviève Nadeau
- Division of Urology, Department of Surgery, Université Laval, Quebec, QC, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
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Xu X, Guo P, Xu P, Chen DD, Chen W, Wang H, Jin Y, Wang X, Zhang W, Xie F, Mao M, Zhao R, Feng S. Effectiveness of web-based interventions for women with urinary incontinence: protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e081731. [PMID: 38553066 PMCID: PMC10982709 DOI: 10.1136/bmjopen-2023-081731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Urinary incontinence (UI) is one of the most common chronic diseases among women, which can endanger their physical and mental health and incur a heavy financial burden on both individuals and society. Web-based interventions (WBIs) have been applied to manage women's UI, but their effectiveness has remained inconclusive. This systematic review and meta-analysis aims to explore the effectiveness of WBIs on self-reported symptom severity, condition-specific quality of life, adherence to pelvic floor muscle training (primary outcomes) and other extensive secondary outcomes among women with UI. We also aimed to investigate whether intervention characteristics (format, interactivity and main technology) have impacts on the effectiveness of primary outcomes. METHODS AND ANALYSIS This systematic review protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. 10 electronic databases will be comprehensively searched from their inception to 1 May 2024, along with grey literature searches and manual reviews of relevant reference lists to identify eligible randomised controlled trials. The methodological quality of the included studies will be assessed by two reviewers based on the Cochrane Risk of Bias Tool. Meta-analyses will be conducted via Stata V.12.0. Leave-one-out sensitivity analyses will be performed, and publication bias will be evaluated using funnel plots and Egger's test. Subgroup analyses regarding intervention format, interactivity and main technology will be carried out. ETHICS AND DISSEMINATION No ethics approval is needed for this review since no primary data are to be collected. The results of this review will help develop an optimal WBI for women with UI, thereby providing them with maximum benefits. The findings will be disseminated via a peer-reviewed journal or conference presentation. PROSPERO REGISTRATION NUMBER CRD42023435047.
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Affiliation(s)
- Xuefen Xu
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Pingping Guo
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Ping Xu
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Dan Dan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Weijing Chen
- Department of Obstetrics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongyan Wang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Ying Jin
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaojuan Wang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Fang Xie
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Minna Mao
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Rujia Zhao
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
| | - Suwen Feng
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang, China
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14
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Perrier ET, Aumont L. Pelvic Floor Muscle Training Using the Perifit Device for the Treatment of Urinary Incontinence: A Pragmatic Trial Using Real-World Data. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:250-258. [PMID: 38516650 PMCID: PMC10956527 DOI: 10.1089/whr.2023.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/23/2024]
Abstract
Introduction There is a need for home-based alternatives for women to self-manage urinary incontinence (UI). Using a real-world data approach, the aim of this analysis was to evaluate whether training with the Perifit device was effective in reducing UI symptoms. Materials and Methods A total of 6060 women (45 ± 10 years) with UI who purchased the Perifit device, completed a validated symptoms questionnaire before training (T1) and again at one or several predefined timepoints during training: T2, after completing 40-60 games; T3, after 90-120 games; and/or T4, after 280-300 games. Results UI symptom score decreased progressively from 8.4 ± 4.8 points at T1; to 6.3 ± 4.7 points, 5.5 ± 4.5 points, and 4.6 ± 4.5 points at T2, T3, and T4, respectively (all p < 0.001). The percentage of respondents reporting objective improvement in UI symptoms increased from 71%, to 79%, to 85% at T2, T3, and T4, respectively. Effect size was medium (T2) to large (T3, T4). Higher symptom score at baseline was associated with higher likelihood of improvement. There was no effect of other characteristics including respondent age, menopausal status, time since childbirth, prolapse, or baseline strength on symptom improvement. Conclusions This analysis of responses from over 6000 real-world users suggests that home training with the Perifit may be an effective way to reduce UI symptoms in women of all ages. Given the quality of life, economic, and social burdens of living with UI symptoms, home-based pelvic floor muscle training with the Perifit may be a promising tool to allow women to self-manage UI.
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Affiliation(s)
- Erica T. Perrier
- Department of Research & Development, X6 Innovations, Paris, France
| | - Louise Aumont
- Department of Research & Development, X6 Innovations, Paris, France
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15
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de Araujo CC, Brito LGO, Marques AA, Juliato CRT. Use of a Mobile Application for Pelvic Floor Muscle Training in Women With Urinary Incontinence: a Randomized Control Trial. Int Urogynecol J 2024; 35:589-598. [PMID: 38214718 DOI: 10.1007/s00192-023-05714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at evaluating the impact of a mobile app-guided pelvic floor muscle training (PFMT) program on urinary symptoms and quality of life in women suffering from urinary incontinence. METHODS The study included women with stress urinary incontinence (SUI), who underwent a structured interview and completed validated questionnaires, including the Questionnaire for Urinary Incontinence Diagnosis (QUID), the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), and the Incontinence Quality of Life Questionnaire (I-QOL). These women were randomly assigned to one of two groups: the app group, which received a visual depiction on the expected contraction pattern through a mobile app to support their PFMT exercises, and the control (paper) group. Both groups were instructed to perform PFMT exercises twice daily for 30 days. Data were collected at baseline and at 30, 60, 90, and 120 days after completing the exercises. RESULTS A total of 154 women participated, with 76 in the app group and 78 in the paper group. The mean ages were 61 (± 6.1) and 60.6 (± 6.8) in the app and paper groups respectively (p = 0.644). Both groups showed significant improvements in QUID SUI scores (p < 0.001), overactive bladder (OAB; p < 0.001), ICIQ-SF scores (p < 0.001), and quality-of-life scores (p < 0.001). When comparing the two groups, the app group exhibited a more substantial reduction in OAB (p = 0.017) as assessed by QUID and total (p = 0.042), psychosocial (p = 0.032) and social embarrassment (p = 0.006) I-QOL scores. CONCLUSIONS The study findings suggest that PFMT guided by a mobile app with visual guidance leads to greater improvements in storage symptoms and quality of life than the home-based PFMT guidance.
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Affiliation(s)
- Camila C de Araujo
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Luiz G O Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Andrea A Marques
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil.
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16
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Shah S, Eggers E, Hunter K, Lipetskaia L. Quality of Pelvic Floor Therapy Videos on YouTube: Does Popularity Predict Reliability? UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:233-238. [PMID: 38484236 DOI: 10.1097/spv.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
ABSTRACT This study reviewed instructional videos on YouTube regarding pelvic floor physical therapy and assessed the association between the videos' popularity and the reliability of the videos' content. YouTube was searched using the terms relevant to pelvic floor muscle training. The first 100 videos for each search term were screened, and relevant metrics were collected for those meeting the inclusion criteria. Videos were assessed by 2 independent, trained health care professionals for reliability using the Medical Quality Video Evaluation (MQ-VET) tool, the modified DISCERN tool, the Journal of American Medical Association benchmark criteria, and the Global Quality Score. Popularity was assessed using the Video Power Index (VPI). Higher values for all scoring systems correlated with greater reliability and greater popularity, respectively. Five hundred videos were screened. Two hundred thirty-four videos were duplicates, and 99 did not meet the inclusion criteria. A total of 167 videos were reviewed. The median VPI and MQ-VET score was 201,114.76 (interquartile range, 7,194,020.29) and 48.00 (interquartile range, 12.75), respectively. Spearman's R value was 0.292 (P < 0.001), demonstrating a weak positive correlation between MQ-VET scores and VPI. The interrater reliability of the MQ-VET was good, with an intraclass correlation coefficient of 0.86 (95% confidence interval, 0.71-0.92). In summary, we identified a statistically significant but weak positive correlation between the reliability and popularity of YouTube videos about pelvic floor physical therapy.
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Affiliation(s)
- Shanaya Shah
- From the Cooper Medical School of Rowan University
| | - Erica Eggers
- Department of Obstetrics and Gynecology, Cooper University Healthcare, Camden, NJ
| | - Krystal Hunter
- Cooper Research Institute-Biostatistics Group, Camden, NJ
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Skoura A, Billis E, Papanikolaou DT, Xergia S, Tsarbou C, Tsekoura M, Kortianou E, Maroulis I. Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice. Int Urogynecol J 2024; 35:491-520. [PMID: 38340172 PMCID: PMC11023973 DOI: 10.1007/s00192-024-05727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/29/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research. METHODS For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification. RESULTS Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design. CONCLUSIONS Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.
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Affiliation(s)
- Anastasia Skoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece.
| | - Evdokia Billis
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Dimitra Tania Papanikolaou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Sofia Xergia
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Charis Tsarbou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Maria Tsekoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Building B, Central Campus 26504 Rio, Patras, Achaia, Greece
| | - Eleni Kortianou
- Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Ioannis Maroulis
- Faculty of Medicine, School of Health Sciences, University of Patras, Rio, Patras, Greece
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Lange S, Lange R, Tabibi E, Hitschold T, Müller VI, Naumann G. Comparison of Vaginal Pessaries to Standard Care or Pelvic Floor Muscle Training for Treating Postpartum Urinary Incontinence: a Pragmatic Randomized Controlled Trial. Geburtshilfe Frauenheilkd 2024; 84:246-255. [PMID: 38455997 PMCID: PMC10917606 DOI: 10.1055/a-2243-3784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/10/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction To compare three conservative treatment options, standard care, pelvic floor muscle training (PFMT), and vaginal pessaries, for postpartum urinary incontinence (UI) that are accessible to most patients and practitioners in a generalizable cohort. Materials and Methods A multicenter, open-label, parallel group, pragmatic randomized controlled clinical trial comparing standard care, PFMT, and vaginal cube pessary for postpartum urinary incontinence was conducted in six outpatient clinics. Sample size was based on large treatment effects (Cramers' V > 0.35) with a power of 80% and an alpha of 0.05 for a 3 × 3 contingency table, 44 patients needed to be included in the trial. Outcomes were analyzed according to the intention-to-treat principle. Group comparisons were made using analysis of variance (ANOVA), Kruskal-Wallis, and chi-square test as appropriate. P < 0.05 was considered statistically significant. Results Of the 516 women screened, 111 presented with postpartum UI. Of these, 52 were randomized to one of three treatment groups: standard care (n = 17), pelvic floor muscle training (n = 17), or vaginal cube pessary (n = 18). After 12 weeks of treatment, treatment success, as measured by patient satisfaction, was significantly higher in the vaginal pessary group (77.8%, n = 14/18), compared to the standard care group (41.2%, n = 7/17), and the PFMT (23.5%, n = 4/17; χ 2 2,n = 52 = 14.55; p = 0.006, Cramer-V = 0.374). No adverse events were reported. SUI and MUI accounted for 88.4% of postpartum UI. Conclusion Vaginal pessaries were superior to standard care or PFMT to satisfyingly reduce postpartum UI symptoms. No complications were found.
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Affiliation(s)
- Sören Lange
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Rainer Lange
- DieGyn-Praxis, Alzey/Lampertheim/Mainz/Bad Kreuznach, Germany
- Pelvic floor center Rheinhessen, Klinikum Worms gGmbH, Worms, Germany
| | - Elham Tabibi
- DieGyn-Praxis, Alzey/Lampertheim/Mainz/Bad Kreuznach, Germany
- Department of Obstetrics and Gynecology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Thomas Hitschold
- Pelvic floor center Rheinhessen, Klinikum Worms gGmbH, Worms, Germany
| | - Veronika I. Müller
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine (INM-7), Research Centre Jülich, Jülich, Germany
| | - Gert Naumann
- Department of Obstetrics and Gynecology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Obstetrics and Gynecology, Helios-Klinikum, Erfurt, Germany
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Celenay ST, Balaban M, Kaya DO. Lateral abdominal muscle thickness and contractile function in women with and without stress urinary incontinence. Int Urogynecol J 2024; 35:303-309. [PMID: 37599308 DOI: 10.1007/s00192-023-05636-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) primarily results from the weakness of pelvic floor muscles, working synergistically with the abdominal muscles. The current study aimed to compare thickness and contractile function of lateral abdominal muscles in women with and without SUI. METHODS Thirty-nine women with SUI (SUI group; age: 38.87 ± 8.96 years, body mass index (BMI): 24.03 (5.94) kg/m2) and 42 healthy women (control group; age: 36.21 ± 11.46 years, BMI: 23.90 (5.85) kg/m2) were included. Transverse abdominis (TrA) and internal oblique (IO) muscle thickness at rest and during abdominal drawing-in maneuver (ADIM) were measured with ultrasound imaging in B-mode using a Logiq S7/Expert device and a 9-11 MHz linear transducer. Percentage change in thickness and contractile function of these muscles were also calculated. RESULTS No significant differences in the thickness of TrA and IO muscles at rest and during ADIM between the groups were found (p > 0.05). The percent change in thickness and contractile function of both right and left side TrA muscles and the right side IO muscle were lower in SUI group than control group (p < 0.05). The percentage change in thickness and the contractile function of the left side IO muscle did not change (p > 0.05). CONCLUSION Women with SUI had a smaller percentage change in thickness and contractile function of TrA and IO muscle than women without SUI. However, there was no difference in the morphological features of these muscles between the groups. Considering the lateral abdominal muscle, training may be important for management of SUI.
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Affiliation(s)
- Seyda Toprak Celenay
- Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | - Mehtap Balaban
- Faculty of Medicine, Department of Radiology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Derya Ozer Kaya
- Health Sciences Faculty, Department of Physiotherapy Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey
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Chen KY, Jones MK, Zillioux JM, Rapp DE. Pilot Study of a Novel Online Comprehensive Pelvic Floor Program for Urinary Incontinence in Women. Int Urogynecol J 2024; 35:415-421. [PMID: 38175280 DOI: 10.1007/s00192-023-05695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) is common in women and has a vast impact on quality of life (QOL), financial health, and work disability. Robust evidence demonstrates the efficacy of comprehensive conservative therapy (pelvic floor muscle training [PFMT], and behavioral and dietary modification) in the treatment of UI. However, numerous barriers impede access to this care, including limited specialized therapists, financial barriers, and scheduling obstacles. To address these barriers, we developed a novel comprehensive online pelvic floor program (oPFP). METHODS We performed a prospective study assessing continence and QOL outcomes in women with stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed urinary incontinence (MUI) treated with oPFP between May 2019 and November 2022. Outcomes were assessed at baseline and following completion of the 2-month program using the validated International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms, Urgency Perception Scale (UPS), Incontinence Impact Questionnaire (IIQ-7) questionnaires, and 24-h bladder diary. Data were analyzed using linear, Poisson mixed models, or generalized estimating equations. RESULTS Twenty-eight women (2 SUI, 3 UUI, 23 MUI) were enrolled and 19 (2 SUI, 2 UUI, 15 MUI) completed the study. Following oPFP, participants showed significantly improved SUI domain scores (3.04 ± 0.19 vs 1.81 ± 0.23, p < 0.001), UPS reason score (2.52 ± 0.18 vs 2.05 ± 0.14, p = 0.003), IIQ-7 sum scores (5.16 ± 0.88 vs 3.07 ± 0.70, p = 0.038), and daily incontinence episodes (2.96 ± 0.60 vs 1.06 ± 0.29, p < 0.001). Mean patient-reported improvement was 5.4 ± 2.5 (ten-point Likert scale). Of respondents, 89% reported program satisfaction, ease of use, and would recommend the program to others. CONCLUSION The oPFP results in significant improvements to a variety of UI and QOL measures. This program provides an important UI treatment option and gives women greater access to effective conservative therapy.
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Affiliation(s)
- Katherina Y Chen
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Marieke K Jones
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | - David E Rapp
- Department of Urology, University of Virginia, Charlottesville, VA, USA
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Chu L, Jin X, Wu S, Tong X, Li H, Chen X. Effect of Pelvic Floor Muscle Training With Smartphone Reminders on Women in the Postpartum Period: A Randomized Controlled Trial. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:138-146. [PMID: 37556387 DOI: 10.1097/spv.0000000000001401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
IMPORTANCE Standard postpartum pelvic floor muscle training (PFMT) can effectively reduce the incidence of pelvic floor dysfunction diseases. OBJECTIVE This study aimed to evaluate the adherence of PFMT with smartphone application reminders on women in the postpartum period. STUDY DESIGN We conducted a randomized controlled trial. This single-center randomized (1:1) controlled study included primiparous women admitted to Tongji Hospital between March 2022 and June 2022 (ChiCTR2200059157). Every puerpera was given pelvic floor muscle (PFM) assessment and PFMT guidance at 6 weeks after delivery. After randomization, women in the intervention group received daily training reminders from the smartphone application WeChat. Adherence to PFMT, a symptom of stress urinary incontinence, and PFM characteristics were measured 3 months later. RESULTS A total of 148 participants were included in the final analysis (76 in the intervention group and 72 in the control group). The adherence rate of daily PFMT was higher in the intervention group than in the control group (53.9% vs 20.8%, P = 0.00) at 3-month follow-up. In addition, participants in the intervention group showed higher peak surface electromyography of PFMs (39.8 ± 6.2 vs 37.5 ± 5.9 μV, P = 0.03) and longer PFM endurance (8.1 ± 2.0 vs 7.3 ± 2.0 seconds, P = 0.01) than in the control group, whereas there was no difference between the 2 groups in International Consultation on Incontinence Questionnaire-Short Form ( P = 0.60) and the Patient Global Impression of Improvement scores ( P = 1.00). CONCLUSIONS Smartphone application-based PFMT could increase adherence and improves electromyography of PFMs in the short term but did not affect stress urinary incontinence symptoms in women in the postpartum period.
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Affiliation(s)
| | - Xia Jin
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Siyu Wu
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Xiaowen Tong
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Huaifang Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Xinliang Chen
- From the Department of Gynecology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University
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22
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Nguyen TTB, Hsu YY, Sari YP. The Effect of Pelvic Floor Muscle Training on Health-Related Quality of Life in Postmenopausal Women With Genitourinary Syndrome: A Systematic Review and Meta-Analysis. J Nurs Res 2024; 32:e316. [PMID: 38271065 DOI: 10.1097/jnr.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Genitourinary syndrome is commonly reported in postmenopausal women. Kegel's exercise is a noninvasive therapy that improves pelvic floor muscle parameters. However, the effect of Kegel's exercise on health-related quality of life (HRQoL) in postmenopausal women with genitourinary syndrome has not been synthesized or shown. PURPOSE This study was designed to systematically review and analyze the previous literature to determine whether Kegel's exercise enhances HRQoL in postmenopausal women with genitourinary syndrome of menopause. METHODS A systematic review and meta-analysis of randomized controlled trials was conducted, and six databases were searched, including Embase, MEDLINE, Cochrane, CINAHL, Web of Science, and Scopus, from their dates of inception to November 2021. Eligible studies evaluated the effects of Kegel's exercise on HRQoL in postmenopausal women with urinary, sexual, or genital symptoms. Review Manager software was used to perform the meta-analysis using a random-effects model. Chi-square and I2 tests were used to evaluate heterogeneity among the studies. Meta-analysis was performed based on the symptoms (i.e., urinary, sexual, and genital) identified in the quality-of-life questionnaires. RESULTS This systematic review covered five studies with 268 participants. The research appraisal found most of these studies had a low risk of bias. The intervention periods ranged from 4 to 12 weeks. Compared with non-Kegel's exercise or regular activity, Kegel's exercise was found to significantly improve HRQoL-related urinary symptoms (three studies, standardized mean difference = -0.95, 95% CI [-1.35, -0.54], I2 = 0%). However, the effect of this exercise on HRQoL-related sexual symptoms did not differ from non-Kegel's exercise or regular activity (two studies, standardized mean difference = 1.11, 95% CI [-0.25, 2.47], I2 = 94%). None of the covered studies examined the effect of Kegel's exercise on HRQoL-related genital symptoms. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Kegel's exercise is an effective intervention for improving HRQoL-related urinary symptoms in postmenopausal women. However, there remains insufficient evidence to assess the effectiveness of Kegel's exercise on HRQoL-related genital symptoms in this population. The results support using Kegel's exercise as a useful intervention to manage urinary symptoms in postmenopausal women.
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Affiliation(s)
- Tram Thi Bich Nguyen
- MS, RN, Doctoral Student, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan; and Lecturer, Medical Simulation Center, Duy Tan University, Vietnam
| | - Yu-Yun Hsu
- PhD, RN, FAAN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Yanti Puspita Sari
- MSN, RN, Doctoral Candidate, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan; and Assistant Professor, Maternity and Child Health Nursing Department, Faculty of Nursing, Universitas Andalas, Padang, West Sumatra, Indonesia
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23
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Sassani JC, Giugale LE, Lavelle ES, Shepherd JP. Cost-Utility Analysis of Midurethral Sling Timing Among Women Undergoing Prolapse Surgery. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:65-72. [PMID: 37493280 DOI: 10.1097/spv.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE There are no guidelines regarding the ideal timing of midurethral sling (MUS) placement following prolapse repair. OBJECTIVE The objective of this study was to estimate the cost-utility of concomitant MUS versus staged MUS among women undergoing apical suspension surgery for pelvic organ prolapse. STUDY DESIGN Cost-utility modeling using a decision analysis tree compared concomitant MUS with staged MUS over a 1-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER). Six scenarios were modeled to estimate cost-utilities for women with preoperative overt, occult, or no stress urinary incontinence (SUI) who underwent either minimally invasive sacrocolpopexy or vaginal native tissue apical suspension. Possible complications of de novo overactive bladder, urinary retention requiring sling lysis, mesh exposure, and persistent SUI were included. Costs from a third-party payer perspective were derived from Medicare 2022 reimbursements. One-way sensitivity analyses were performed. RESULTS Among women without preoperative SUI, staged MUS was the dominant strategy for both surgical routes with higher utility and lower costs. For women with either occult or overt SUI undergoing sacrocolpopexy or vaginal repair, concomitant MUS was cost-effective (ICER = $21,114-$96,536 per quality-adjusted life-year). Therefore, concomitant MUS is preferred for patients with preoperative SUI as higher costs were offset by higher effectiveness. One-way sensitivity analyses demonstrated that ICERs were most affected by probability of cure following MUS. CONCLUSIONS A staged MUS procedure is the dominant strategy for women undergoing apical prolapse repair without preoperative SUI. In women with either overt or occult SUI, the ICER was below the willingness-to-pay threshold of $100,000 per quality-adjusted life-year, suggesting that concomitant MUS surgery is cost-effective.
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Affiliation(s)
| | - Lauren E Giugale
- Division of Urogynecology, Magee-Women's Hospital, University of Pittsburgh, Pittsburgh, PA
| | | | - Jonathan P Shepherd
- Division of Urogynecology, University of Connecticut Health Center, Farmington, CT
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24
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Wenming C, Xiaoman D, Ling G, Yun L, Xiyan G. Acupuncture combined with pelvic floor rehabilitation training for postpartum stress urinary incontinence: protocol for a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1296751. [PMID: 38126072 PMCID: PMC10730657 DOI: 10.3389/fmed.2023.1296751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction The purpose of this study is to systematically evaluate the efficacy and safety of acupuncture combined with pelvic floor rehabilitation training in the treatment of postpartum stress urinary incontinence, and to promote the further promotion and application of acupuncture in the field of rehabilitation. Methods and analysis Randomized controlled trials (RCTs) of acupuncture combined with pelvic floor rehabilitation in the treatment of postpartum stress urinary incontinence will be searched in PubMed, Web of Science (WOS), Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang (WF), and VIP databases. The clinical trial Registry (ClinicalTrials.gov and Chinese clinical trial Registry) will also be searched. The search period is limited to July 1, 2023, and the language limit of this systematic review is Chinese and English. The primary outcome is clinical effective rate. International Consultation on Incontinence Questionnaire-Short Form (ICI-Q-SF), 1-h pad test, pelvic floor muscle potential value, incidence of adverse events are secondary outcomes. A meta-analysis will be performed using RevMan 5.4 statistical software. If feasible, subgroup analysis and sensitivity analysis will be performed to address potential causes of inconsistency and heterogeneity. The risk of bias will be assessed using the approach recommended by Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence will be assessed using GRADE. This Protocol has been developed in accordance with the guideline of Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015. Discussion Acupuncture combined with pelvic floor rehabilitation training can effectively promote the rehabilitation of postpartum stress urinary incontinence patients, and provide a reference for the clinical application of integrated Chinese and Western medicine treatment in the field of rehabilitation. Systematic review registration PROSPERO CRD42023455801.
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Affiliation(s)
- Chu Wenming
- College of Acupuncture and Tuina, Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Deng Xiaoman
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Gao Ling
- College of Acupuncture and Tuina, Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Li Yun
- College of Acupuncture and Tuina, Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
| | - Gao Xiyan
- College of Acupuncture and Tuina, Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
- Department of Acupuncture, The Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
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25
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Villeda-Hernandez M, Baker BC, Romero C, Rossiter JM, Dicker MPM, Faul CFJ. Chemically Driven Oscillating Soft Pneumatic Actuation. Soft Robot 2023; 10:1159-1170. [PMID: 37384917 DOI: 10.1089/soro.2022.0168] [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: 07/01/2023] Open
Abstract
Pneumatic actuators are widely studied in soft robotics as they are facile, low cost, scalable, and robust and exhibit compliance similar to many systems found in nature. The challenge is to harness high energy density chemical and biochemical reactions that can generate sufficient pneumatic pressure to actuate soft systems in a controlled and ecologically compatible manner. This investigation evaluates the potential of chemical reactions as both positive and negative pressure sources for use in soft robotic pneumatic actuators. Considering the pneumatic actuation demands, the chemical mechanisms of the pressure sources, and the safety of the system, several gas evolution/consumption reactions are evaluated and compared. Furthermore, the novel coupling of both gas evolution and gas consumption reactions is discussed and evaluated for the design of oscillating systems, driven by the complementary evolution and consumption of carbon dioxide. Control over the speed of gas generation and consumption is achieved by adjusting the initial ratios of feed materials. Coupling the appropriate reactions with pneumatic soft-matter actuators has delivered autonomous cyclic actuation. The reversibility of these systems is demonstrated in a range of displacement experiments, and practical application is shown through a soft gripper that can move, pick up, and let go of objects. Our approach presents a significant step toward more autonomous, versatile soft robots driven by chemo-pneumatic actuators.
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Affiliation(s)
- Marcos Villeda-Hernandez
- School of Chemistry, University of Bristol, Bristol, United Kingdom
- School of Civil, Aerospace and Mechanical Engineering, University of Bristol, Bristol, United Kingdom
- Bristol Centre of Functional Nanomaterials, University of Bristol, Bristol, United Kingdom
| | - Benjamin C Baker
- School of Chemistry, University of Bristol, Bristol, United Kingdom
| | - Christian Romero
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
- Bristol Robotics Laboratory, University of Bristol, Bristol, United Kingdom
| | - Jonathan M Rossiter
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
- Bristol Robotics Laboratory, University of Bristol, Bristol, United Kingdom
| | - Michael P M Dicker
- School of Civil, Aerospace and Mechanical Engineering, University of Bristol, Bristol, United Kingdom
| | - Charl F J Faul
- School of Chemistry, University of Bristol, Bristol, United Kingdom
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26
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Sonel Tur B, Evcik D. Are conservative interventions effective for treating urinary incontinence in women? A Cochrane Review summary with commentary. Turk J Phys Med Rehabil 2023; 69:541-544. [PMID: 38766581 PMCID: PMC11099863 DOI: 10.5606/tftrd.2023.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 05/22/2024] Open
Affiliation(s)
- Birkan Sonel Tur
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Deniz Evcik
- Department of Physical Medicine and Rehabilitation, Ankara Güven Hospital, Ankara, Türkiye
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27
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Dakic JG, Hay-Smith EJC, Lin KY, Cook JL, Frawley HC. Women's preferences for pelvic floor screening in sport and exercise: a mixed-methods study integrating survey and interview data in Australian women. Br J Sports Med 2023; 57:1539-1549. [PMID: 37648412 DOI: 10.1136/bjsports-2023-107017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES One in two women experiencing pelvic floor (PF) symptoms stop playing sport or exercising. The study examines the perspective of women with PF symptoms to inform acceptable screening practices within sport and exercise settings. METHODS Explanatory, sequential, mixed-methods design. Phase 1: survey of 18-65 years, symptomatic, Australian women (n=4556). Phase 2: semistructured interviews with a subset of survey participants (n=23). Integration occurred through connection of phases (study design, sampling) and joint display of data. RESULTS Findings are represented in three threads: (1) 'women (not) telling'; a majority of women had told no-one within a sport or exercise setting about their PF symptoms due to shame/embarrassment, lack of pelvic health knowledge and not wanting to initiate the conversation, (2) 'asking women (screening for PF symptoms)'; women endorsed including PF symptom questions within existing sport and exercise screening practices but only when conducted in a respectful and considered manner and (3) 'creating safety'; professionals can assist women to disclose by demonstrating expertise, trustworthiness and competency. If health and exercise professionals are provided with appropriate training, they could raise pelvic health awareness and promote a supportive and safe sport and exercise culture. CONCLUSION Women with PF symptoms support health and exercise professionals initiating conversations about PF health to normalise the topic, and include PF symptoms among other pre-exercise screening questions. However, women should be informed on the relevance and potential benefits of PF screening prior to commencing. Safe screening practices require building trust by providing information, gaining consent, displaying comfort and genuine interest, and being knowledgeable within one's scope of practice to the provision of advice, exercise modifications and referral as appropriate.
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Affiliation(s)
- Jodie G Dakic
- Department of Physiotherapy, Monash University, Clayton, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kuan-Yin Lin
- Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
| | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Helena C Frawley
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Allied Health Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Allied Health Research, Mercy Hospital for Women, Melbourne, Victoria, Australia
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28
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Höder A, Stenbeck J, Fernando M, Lange E. Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth - a systematic review. BMC Womens Health 2023; 23:618. [PMID: 37980530 PMCID: PMC10657595 DOI: 10.1186/s12905-023-02765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Childbirth is one of the biggest risk factors for incontinence. Urinary and anal incontinence can cause pain and social limitations that affect social life, cohabitation, and work. There is currently no up-to-date literature study on the effect of pelvic floor muscle training with feedback from a physiotherapist, which involves verbal instructions based on vaginal and anal digital palpation, compared to treatment without feedback (e.g., recommendations for pelvic floor muscle training). AIM The objective of this systematic review was to examine the scientific evidence regarding the impact of pelvic floor muscle training (PFMT) with feedback from a physiotherapist and/or biofeedback on urinary and anal incontinence in women during the first six months following vaginal delivery, compared to treatment without feedback. METHODS The literature search was conducted in the databases PubMed, Cochrane, and CINAHL. In addition, a manual search was conducted. The search terms consisted of MeSH terms and synonyms in the respective search block including population, intervention, and study design, as well as the terms pelvic floor and postpartum. An evaluation of each included study was conducted for methodological quality, evidence value, and clinical relevance. RESULTS Eight studies were included, three of which showed a significant difference between groups, in favor of the intervention group that received pelvic floor muscle training with feedback from a physiotherapist and/or biofeedback. Due to the varying results and insufficient quality for the majority of the studies, the scientific basis was considered insufficient. CONCLUSION The scientific evidence for pelvic floor muscle training with feedback from a physiotherapist or biofeedback on postpartum urinary and anal incontinence compared to treatment without feedback is considered insufficient. Further research on the subject is needed. The study is registered in PROSPERO CRD42022361296.
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Affiliation(s)
- Amanda Höder
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefin Stenbeck
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Elvira Lange
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Department of General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Sweden. Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
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29
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Chinthakanan O, Saraluck A, Kijmanawat A, Aimjirakul K, Wattanayingcharoenchai R, Manonai J. Comparison of Low-Energy Radiofrequency Thermal Vaginal Therapy with Sham Treatment for Stress Urinary Incontinence in Postmenopausal Women: A Randomized Controlled Trial. Int J Womens Health 2023; 15:1779-1790. [PMID: 38020937 PMCID: PMC10657547 DOI: 10.2147/ijwh.s431233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction and Hypothesis Low-energy radiofrequency (RF) thermal vaginal therapy for vaginal laxity and the genitourinary syndrome of menopause denatures collagen fibrils in the endopelvic fascia; fiber tightening during healing may stabilize the urethra and bladder neck, thereby resolving female stress urinary incontinence (SUI), especially in postmenopausal women. This study compared RF vaginal therapy with sham treatment for mild to moderate SUI. Methods This double-blinded, randomized controlled trial, conducted at a tertiary center from September 2018 to April 2021, recruited postmenopausal women with mild to moderate degree of SUI who had never undergone surgery, energy-based therapy, or vaginal estrogen treatment. The intervention group received vaginal RF laser treatment; the sham group did not. The primary outcome was the 1-hour pad-weight test (PWT) result. Secondary outcomes were Incontinence Quality of Life (I-QOL), Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Patient Global Impression of Improvement (PGI-I), percentage of improvement among all participants, and adverse events. Data were analyzed using STATA 17.0. Results Forty-nine participants randomized to RF (n = 23) and sham (n = 26) groups were eligible for analysis. PWT decreased during follow-up in the RF group but remained stable in the sham group; PWT did not significantly differ between groups. The 1-year post-treatment success rate was higher in the RF group (69.6%) than in the sham group (38.5%). At 1 year post-treatment, there were no statistically significant differences in any secondary outcomes. Conclusion Low-energy RF vaginal therapy is an alternative treatment for mild to moderate SUI in postmenopausal women without serious adverse events. Larger randomized controlled trials should be conducted.
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Affiliation(s)
- Orawee Chinthakanan
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Apisith Saraluck
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Athasit Kijmanawat
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Komkrit Aimjirakul
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rujira Wattanayingcharoenchai
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jittima Manonai
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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30
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Tsikopoulos I, Lazarou L, Tzelves L, Sakalis V, Papathanasiou C, Samarinas M. The effect of pelvic floor muscle training on urodynamic parameters in women with stress urinary incontinence. Cent European J Urol 2023; 76:315-321. [PMID: 38230312 PMCID: PMC10789280 DOI: 10.5173/ceju.2023.148] [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: 07/16/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction Pelvic floor muscle training (PFMT) is suggested for women with stress urinary incontinence (SUI). The aim of our study is to examine the effectiveness of PFMT on urodynamic (UDS) parameters. Material and methods This is a prospective observational study enrolling women with SUI. Pelvic surgery, prolapse, body mass index >30, and cognitive disability were exclusion criteria. Patients had baseline UDS, then PFMT only (Group A) or PFMT plus biofeedback (BFD) (Group B) for 6 months and UDS 3 months after treatment. The primary investigated parameters were the number of pads used per day and Valsalva leak point pressure (VLPP). Results Forty-six women completed the study, 22 in Group A and 24 in Group B. At baseline, all patients documented SUI with 3 median pads used per day. Urodynamic SUI was documented with a median Valsalva leak point pressure (mVLPP) of 45 cmH2O. At the re-evaluation, 12 women (26.1%) had SUI in BDs with median number pads per day of 1, which was statistically different to baseline (p = 0.02). Urodynamic SUI was reported in 8 (17.4%) women with a mVLPP of 88 cmH2O.Six patients were from Group A and 6 from Group B. In Group A, the median number of pads per day was 1, and urodynamic SUI was found in 3 women. In Group B, the median number of pads per day was 1, and urodynamic SUI was found in 5 women. Thirty-four women (73.9%) were dry - 16 (47.1%) from Group A and 18 (52.9%) from Group B. Conclusions PFMT improves urodynamic parameters among women with SUI.
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Affiliation(s)
| | - Lazaros Lazarou
- 2 Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Lazaros Tzelves
- Department of Urology, University College of London Hospitals (UCLH), London, United Kingdom
| | - Vasileios Sakalis
- Department of Urology, Hippokrateion General Hospital of Thessaloniki, Thessaloniki, Greece
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31
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Metcalfe D, Hoeritzauer I, Angus M, Novak A, Hutton M, Woodfield J. Diagnosis of cauda equina syndrome in the emergency department. Emerg Med J 2023; 40:787-793. [PMID: 37669831 DOI: 10.1136/emermed-2023-213151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
Cauda equina syndrome (CES) is a spinal emergency that can be challenging to identify from among the many patients presenting to EDs with low back and/or radicular leg pain. This article presents a practical guide to the assessment and early management of patients with suspected CES as well as an up-to-date review of the most important studies in this area that should inform clinical practice in the ED.
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Affiliation(s)
- David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Michelle Angus
- Complex Spinal Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Alex Novak
- Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mike Hutton
- Exeter Spinal Surgery Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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32
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Randazzo G, Reitano G, Carletti F, Iafrate M, Betto G, Novara G, Dal Moro F, Zattoni F. Urology: a trip into metaverse. World J Urol 2023; 41:2647-2657. [PMID: 37552265 PMCID: PMC10582132 DOI: 10.1007/s00345-023-04560-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE Metaverse is becoming an alternative world in which technology and virtual experiences are mixed with real life, and it holds the promise of changing our way of living. Healthcare is already changing thanks to Metaverse and its numerous applications. In particular, Urology and urologic patients can benefit in many ways from Metaverse. METHODS A non-systematic literature review identified recently published studies dealing with Metaverse. The database used for this review was PubMed, and the identified studies served as the base for a narrative analysis of the literature that explored the use of Metaverse in Urology. RESULTS Virtual consultations can enhance access to care and reduce distance and costs, and pain management and rehabilitation can find an incredible support in virtual reality, reducing anxiety and stress and improving adherence to therapy. Metaverse has the biggest potential in urologic surgery, where it can revolutionize both surgery planning, with 3D modeling and virtual surgeries, and intraoperatively, with augmented reality and artificial intelligence. Med Schools can implement Metaverse in anatomy and surgery lectures, providing an immersive environment for learning, and residents can use this platform for learning in a safe space at their own pace. However, there are also potential challenges and ethical concerns associated with the use of the metaverse in healthcare. CONCLUSIONS This paper provides an overview of the concept of the metaverse, its potential applications, challenges, and opportunities, and discusses the implications of its development in Urology.
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Affiliation(s)
- Gianmarco Randazzo
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Giuseppe Reitano
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Filippo Carletti
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Massimo Iafrate
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Giovanni Betto
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Giacomo Novara
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Fabrizio Dal Moro
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Fabio Zattoni
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
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Brennen R, Soh SE, Denehy L, Lin KY, Jobling T, McNally OM, Hyde S, Kruger J, Frawley H. Pelvic floor muscle training delivered via telehealth to treat urinary and/or faecal incontinence after gynaecological cancer surgery: a single cohort feasibility study. Support Care Cancer 2023; 31:589. [PMID: 37740820 PMCID: PMC10517895 DOI: 10.1007/s00520-023-08050-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE To assess the feasibility and clinical outcomes of telehealth-delivered pelvic floor muscle training (PFMT) for urinary incontinence (UI) and/or faecal incontinence (FI) after gynaecological cancer surgery. METHODS In this pre-post cohort clinical trial, patients with incontinence after gynaecological cancer surgery underwent a 12-week physiotherapist-supervised telehealth-delivered PFMT program. The intervention involved seven videoconference sessions with real-time feedback from an intra-vaginal biofeedback device and a daily home PFMT program. Feasibility outcomes included recruitment, retention, engagement and adherence rates. Clinical outcomes were assessed at baseline, immediately post-intervention and a 3-month post-intervention using International Consultation on Incontinence questionnaires for UI (ICIQ-UI-SF) and Bowel function (ICIQ-B) and the intra-vaginal biofeedback device. Means and 95%CIs for all time points were analysed using bootstrapping methods. RESULTS Of the 63 eligible patients, 39 (62%) consented to the study. Three participants did not complete baseline assessment and were not enrolled in the trial. Of the 36 participants who were enrolled, 32 (89%) received the intervention. Retention was 89% (n=32/36). The majority of participants (n=30, 94%) demonstrated high engagement, attending at least six videoconference sessions. Adherence to the daily PFMT program was moderate, with 24 participants (75%) completing five-to-seven PFMT sessions per week during the intervention. All clinical outcomes improved immediately post-intervention; however, the magnitude of these improvements was small. CONCLUSION Telehealth-delivered PFMT may be feasible to treat incontinence after gynaecological cancer surgery. TRIAL REGISTRATION ClinicalTrials.gov Identifier: ACTRN12621000880842).
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Affiliation(s)
- Robyn Brennen
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia.
- Monash Health, Cheltenham, VIC, 3192, Australia.
| | - Sze-Ee Soh
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, 3199, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Linda Denehy
- School of Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
- The Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Kuan Yin Lin
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei City, 100, Taiwan
| | | | - Orla M McNally
- The Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- The Royal Women's Hospital, Parkville, VIC, 3010, Australia
- The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Simon Hyde
- The University of Melbourne, Parkville, VIC, 3010, Australia
- Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Jenny Kruger
- Auckland Bioengineering Group, University of Auckland, Auckland, New Zealand
| | - Helena Frawley
- School of Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
- The Royal Women's Hospital, Parkville, VIC, 3010, Australia
- Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
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Saus‐Ortega C, Sierra‐Garcia E, Martínez‐Sabater A, Chover‐Sierra E, Ballestar‐Tarín ML. Effect of pelvic floor muscle training on female sexual function: A systematic review protocol and meta-analysis. Nurs Open 2023; 10:5790-5796. [PMID: 37232024 PMCID: PMC10416017 DOI: 10.1002/nop2.1826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/24/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
AIM To recognize, appraise and summarize the research evidence that has explored the results of pelvic floor muscle training on female sexual function. DESIGN Systematic review and possible meta-analysis. METHODOLOGY Between September and October 2022, the Cochrane Library, CINAHL, MEDLINE, EMBASE, PsycINFO and Scopus electronic databases will be searched. We will include RCT's in English, Spanish and Portuguese that investigate the results of pelvic floor muscle training on female sexual function. The data will be extracted by two researchers independently. Risk of bias will be measured from the Cochrane Risk of Bias Tool. The meta-analysis of the results will be performed using Comprehensive Meta-Analysis Version 2. RESULTS This systematic review and possible meta-analysis will contribute significantly to the promotion of pelvic floor health and women's sexual function and to strengthen clinical practice and define other areas of study.
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Affiliation(s)
- Carlos Saus‐Ortega
- Nursing School La FeAdscript Centre to the University of ValenciaValenciaSpain
- Research Group GREIACCHealth Research Institute La FeValenciaSpain
| | | | - Antonio Martínez‐Sabater
- Nursing Care and Education Research Group (GRIECE), GIUV2019‐456, Nursing DepartmentUniversitat de ValenciaValenciaSpain
- Care Research Group (INCLIVA), Hospital Clínico Universitario de ValenciaValenciaSpain
| | - Elena Chover‐Sierra
- Nursing Care and Education Research Group (GRIECE), GIUV2019‐456, Nursing DepartmentUniversitat de ValenciaValenciaSpain
- Internal MedicineConsorci Hospital General Universitari de ValenciaValenciaSpain
| | - María Luisa Ballestar‐Tarín
- Nursing Care and Education Research Group (GRIECE), GIUV2019‐456, Nursing DepartmentUniversitat de ValenciaValenciaSpain
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Ghaderi F, Kharaji G, Hajebrahimi S, Pashazadeh F, Berghmans B, Salehi Pourmehr H. Physiotherapy in Patients with Stress Urinary Incontinence: A Systematic Review and Meta-analysis. UROLOGY RESEARCH & PRACTICE 2023; 49:293-306. [PMID: 37877877 PMCID: PMC10646808 DOI: 10.5152/tud.2023.23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/04/2023] [Indexed: 10/26/2023]
Abstract
Physiotherapy is the most commonly used treatment for stress urinary incontinence including pelvic floor muscle training, biofeedback, and electrical stimulation. This systematic review evaluated the effects of physiotherapy in patients with stress urinary incontinence compared with no treatment, placebo, sham, surgery, or other inactive control treatments. MEDLINE (via PubMed), The Cochrane Library (CENTRAL), Embase, Scopus, Web of Science, PEDro, and Trip Database were explored using applicable vocabularies for all English and Persian language investigations released from inception to January 2021. On one side, trials including physiotherapy of pelvic floor muscle training, biofeedback, and electrical stimulation and on the other, either no treatment, placebo, sham, surgery, or other inactive control treatments were included. Studies were assessed for appropriateness and methodological excellence. Two authors extracted data. Disagreements were resolved by a third opinion. Data were processed as described in the Joanna Briggs Institute Handbook. Twenty-nine trials with 2601 participants were found, but only 16 were included because of data heterogeneity. The results showed that physiotherapy interventions are better than no treatment in terms of urine leakage, but no difference was found for urinary incontinence severity. Also, physiotherapy showed favorable results over comparison groups for International Consultation on Incontinence Questionnaire, pad test, pelvic floor muscle function, and improvement outcomes. This systematic review supports the widespread use of pelvic physiotherapy as the first-line treatment for adult patients with stress urinary incontinence.
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Affiliation(s)
- Fariba Ghaderi
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghazal Kharaji
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Faculty of Medicine, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Faculty of Medicine, Tabriz, Iran
| | - Bary Berghmans
- Pelvic Care Unit Maastricht, CAPHRI, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Hanieh Salehi Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Liu L, Chen B, Si X, Hou W, Fan Q, Li X, Li J, Ming S, Yin P, Chen Y. Optimized electroacupuncture treatment for female stress urinary incontinence: study protocol for a multi-center randomized controlled trial. Front Psychiatry 2023; 14:1228131. [PMID: 37663593 PMCID: PMC10470623 DOI: 10.3389/fpsyt.2023.1228131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Stress urinary incontinence (SUI) is a common condition that can severely affect women's life quality. Electroacupuncture (EA) has been proved to be an optional treatment for SUI, but the tolerance of EA becomes a factor affecting efficiency, which should not be ignored and needs to be solved urgently. The purpose of this study is to find out whether the use of alternating acupoints combination can solve this problem or not and provide an optimization of EA treatment for female SUI. Methods This multi-center randomized controlled trial will enroll 360 patients with SUI. They will be randomly assigned to one of the three groups-sacral acupoints group (sacral group), abdominal acupoints group (abdominal group), or alternating acupoints group (alternating group)-at a 1:1:1 ratio. The patients will receive 18 sessions of EA treatment and will be followed up for 48 weeks after the treatment. The primary outcome measure of the study is the change of urine leakage at week 6. The secondary outcomes include the incontinence episode frequency (IEF), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), severity of SUI, patient self-evaluation of therapeutic effects, weekly usage of urine pads, ultrasonography of pelvic floor, specialty therapies for SUI, evaluation of discomfort during EA treatment, patient acceptability evaluation and adverse events related to intervention. Discussion This trial is specifically designed to offer an optimized EA treatment for female SUI, aiming to enhance their quality of life.Clinical trial registration: ClinicalTrials.gov, identifier ID:NCT05635669.
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Affiliation(s)
- Lumin Liu
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bingli Chen
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaohui Si
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenguang Hou
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Fan
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu Li
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Juanjuan Li
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuren Ming
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ping Yin
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuelai Chen
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Tavahomi M, Dadgoo M, Vasaghi-Gharamaleki B, Talebian S, Emami M, Shanbehzadeh S. Lateral abdominal muscle thickness during breathing maneuvers in women with and without stress urinary incontinence. Int Urogynecol J 2023; 34:1939-1946. [PMID: 36811632 PMCID: PMC9944775 DOI: 10.1007/s00192-023-05458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/30/2022] [Indexed: 02/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) patients predominantly experience involuntary leakage during respiratory functions that induce a rapid increase in intra-abdominal pressure (IAP) such as coughing and sneezing. The abdominal muscles have an important role in the forced expiration and modulation of IAP. We hypothesized that SUI patients have different thickness changes in the abdominal muscles compared to healthy individuals during breathing maneuvers. METHODS This case-control study was conducted on 17 adult women with SUI and 20 continent women. Muscle thickness changes were measured by ultrasonography at the end of deep inspiration and expiration, and the expiratory phase of voluntary coughing for external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) muscles. The percent thickness changes of muscles were used and analyzed with a two-way mixed ANOVA test and post-hoc pairwise comparison at a confidence level of 95% (p < 0.05). RESULTS The percent thickness changes of TrA muscle were significantly lower in SUI patients at deep expiration (p < 0.001, Cohen's d = 2.055) and coughing (p < 0.001, Cohen's d=1.691). While, percent thickness changes for EO (p = 0.004, Cohen's d=0.996) and IO thickness (p < 0.001, Cohen's d=1.784) were greater at deep expiration and deep inspiration, respectively. CONCLUSIONS The percent thickness changes of abdominal muscles differed between women with and without SUI during breathing maneuvers. The present study provided information regarding the altered function of abdominal muscles during breathing maneuvers; therefore, it is important to consider the respiratory role of abdominal muscles for the rehabilitation of SUI patients.
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Affiliation(s)
- Mahnaz Tavahomi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mehdi Dadgoo
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Behnoosh Vasaghi-Gharamaleki
- Rehabilitation Research Center, Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Emami
- Department of Urology, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sanaz Shanbehzadeh
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Guérin S, Khene ZE, Peyronnet B, Bensalah K, Zimmern PE. Google searches for stress urinary incontinence treatment options: a worldwide trend analysis in the synthetic mesh controversy era. World J Urol 2023; 41:2217-2223. [PMID: 37358599 DOI: 10.1007/s00345-023-04474-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023] Open
Abstract
PURPOSE To analyze trends in worldwide public interest in the treatment options for stress urinary incontinence around the latest FDA 2019 ban on vaginal mesh for prolapse. METHODS We used the web-based tool Google Trends to analyse online searches related to the following terms: 'pelvic floor muscle exercises', 'continence pessary', 'pubovaginal slings', 'Burch colposuspension', 'midurethral slings', 'injectable bulking agents'. Data were expressed as relative search volume on a scale of 0-100. Comparisons of annual relative search volume and average annual percentage change, were analyzed to assess loss or gain of interest. Finally, we assessed the impact of the last FDA alert. RESULTS The mean annual relative search volume for midurethral slings was 20% in 2006 and significantly decreased until 8% in 2022 (p < 0.01). A regular decrease interest was recorded for autologous surgeries but a regain of interest for pubovaginal slings was registered since 2020 (+ 2.8%; p < 0.01). Conversely, a steep interest was noted for injectable bulking agents (average annual percentage change: + 4.4%; p < 0.01) and conservative therapies (p < 0.01). When trends were compared before and after the FDA 2019 alert, a lower research volume was found for midurethral slings, while a higher research volume was observed all others treatments (all p < 0.05). CONCLUSION The online public researches about midurethral slings have considerably decreased following warnings on the use of transvaginal mesh. There seems to be a growing interest in conservative measures, bulking agents, and recently pubovaginal slings.
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Affiliation(s)
- Sonia Guérin
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
- Department of Obstetrics, Gynecology and Human Reproduction, Rennes University Hospital, 16 Boulevard de Bulgarie, Rennes, France
| | - Zine-Eddine Khene
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
- Department of Urology, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, 2 Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
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Gerritse MB, de Swart E, de Vries M, Kluivers KB. Identifying Womens' Needs in Making a Treatment Decision for Stress Urinary Incontinence: A Qualitative Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:358-366. [PMID: 37476608 PMCID: PMC10354721 DOI: 10.1089/whr.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/22/2023]
Abstract
Background Choosing a treatment option for female stress urinary incontinence (SUI) is a preference-sensitive decision. Nowadays, shared decision making (SDM) is the preferred way of decision making. SDM considers the needs patients have regarding the decision-making process. The aim of this study was to identify decisional needs of women who are making a treatment decision for SUI. Materials and Methods Semistructured interviews were planned with women who had been seeking treatment for SUI. Patients were recruited in two teaching hospitals in the Netherlands. Interviewers used a topic list based on the Ottawa decision support framework. The interviews were transcribed and coded. Themes and subthemes of factors relating to the treatment decision-making process were identified and described. Results We interviewed a total of 16 women. Four major themes of SUI patients' needs were identified: information on disorder and treatment, SDM, personalized health care, and consideration for social context. Within these themes, specific needs varied between individuals. In addition to the provision of objective information, other important identified needs were subjective, such as acknowledgment of symptoms and feeling understood by a physician. It was important for patients that they had a sufficient amount of time to make their decision. Conclusions To ensure a good quality treatment decision in female SUI, several topics need to be addressed in an SDM process. The themes of decisional needs identified in this study can help improve the decision-making process.
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Affiliation(s)
- Maria B.E. Gerritse
- Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Obstetrics and Gynecology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Ellis de Swart
- Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke de Vries
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands
| | - Kirsten B. Kluivers
- Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
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Fu Y, Jackson C, Nelson A, Iles-Smith H, McGowan L. Exploring support, experiences and needs of older women and health professionals to inform a self-management package for urinary incontinence: a qualitative study. BMJ Open 2023; 13:e071831. [PMID: 37400236 DOI: 10.1136/bmjopen-2023-071831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES Many women attempt to manage urinary incontinence (UI) independently with variable success while health professionals may be unaware of their needs. This study aimed to (1) understand older women's experiences of UI, their self-management strategies and support needs; (2) explore health professionals' experiences of supporting women and providing relevant services and (3) combine their experiences contribute to development of a theory-based and evidence-based self-management package for UI. DESIGN Qualitative semi-structured interviews were conducted with 11 older women with UI and 11 specialist health professionals. Data were analysed independently using the framework approach, then synthesised in a triangulation matrix to identify implications for content and delivery of the self-management package. SETTING Community centres, community continence clinic and urogynaecology centre of a local teaching hospital in northern England. PARTICIPANTS Women aged 55 years and over who self-reported symptoms of UI and health professionals delivering UI services. RESULTS Three overarching themes emerged. Older women see UI as a 'fact of life' but many struggle with it: women typically considered UI as part of ageing yet expressed annoyance, distress, embarrassment and had made significant lifestyle changes. Access to information and limited high-quality professional support: health professionals provided specialist UI care and information. Yet less than half of women accessed specialist services, those who had, highly valued these services. 'Trial and error' with different self-management strategies: women had tried or were using different strategies (continence pads, pelvic floor exercises, bladder management and training, fluid management and medication), with mixed success. Health professionals provided evidence-based, personalised support and motivation. CONCLUSIONS Findings informed the content of the self-management package that focused on providing facts, acknowledging challenges of living with/self-managing UI, sharing others' experiences, using motivational strategies and self-management tools. Delivery preferences were independent use by women or working through the package with a health professional.
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Affiliation(s)
- Yu Fu
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Andrea Nelson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Salford, UK
- Corporate Nursing, Northern Care Alliance NHS Group, Salford, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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Tabbakha NE, Bahillo A, Jimenez-Martin A, Garcia-Dominguez JJ, Torralba-de-Lago E, Torres-Lacomba M, Navarro-Brazalez B. A Customized System to Test Pelvic Floor Muscles Contraction: A Proof of Concept. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38083113 DOI: 10.1109/embc40787.2023.10340448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Studies show that there is a high prevalence of pelvic floor dysfunctions which negatively affect the quality of life of people who suffer from them. The few sensory mechanisms that pelvic floor muscles have to inform the brain of their situation can make it difficult to perform voluntary contractions or identify risk factors. Currently, there is no consensus to improve this proprioception. This work introduces the development of a novel intravaginal device that is connected to a mobile data acquisition system and able to discern the correct contraction of the pelvic floor muscles versus contraction of adjacent muscles or abdominal thrust efforts. A cross-sectional pilot clinical study has been carried out to validate this end with healthy adult nulliparous woman with good pelvic floor muscles contraction capability in supine position.Clinical relevance- The proposed system allows a personalized and real-time assessment of the contractile capability of the pelvic floor muscles (PFM), distinguishing between muscular plans (deep/superficial PFM), between sides (right/left PFM), and between pressures from the PFM and intra-abdominal muscles (IAP). The development of an intravaginal device which is able to simultaneously measure all these features is an important advancement in this field since it can provide information in real time on the contraction capability of all the PFM as well as on the influence of the IAP during different PFM exercises.
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Takacs P, Pákozdy K, Koroknai E, Erdődi B, Krasznai Z, Kozma B. A randomized controlled pilot trial to assess the effectiveness of a specially formulated food supplement and pelvic floor muscle training in women with stress-predominant urinary incontinence. BMC Womens Health 2023; 23:321. [PMID: 37340306 DOI: 10.1186/s12905-023-02476-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: 10/18/2022] [Accepted: 06/10/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is the first-line treatment approach for stress urinary incontinence. Creatine and leucine have been shown to improve muscle function. Our aim was to assess the effectiveness of a food supplement and PFMT in women with stress-predominant urinary incontinence. METHODS Women with stress-predominant urinary incontinence were randomized in 1:1 ratio to receive daily oral supplementation for six weeks with either a food supplement (treatment group) or placebo (control group). Both groups were instructed to perform standardized daily PFMT. The primary outcome was the Urogenital Distress Inventory Short Form (UDI-6) score. Secondary outcomes were the Incontinence Impact Questionnaire (IIQ-7) score, Patient's Global Impression of Severity (PGI-S), and Biomechanical Integrity score (BI-score) measured by Vaginal Tactile Imager. To have a power of 80% and a significance level of 5% to detect a decrease of 16 points in the UDI-6 score, a sample size of 32 was needed, with 16 patients in each arm of our trial. RESULTS Sixteen women in the control group and sixteen in the treatment group completed the trial. Between-group analysis revealed no significant differences between the control and treatment group except for mean change (delta) in vaginal squeeze pressure [(cmH2O, mean ± SD), 5 ± 12 vs. 15 ± 15, P = 0.04] and mean change (delta) in PGI-S score [(mean ± SD), -0.2 ± 0.9 vs. -0.8 ± 0.8, P = 0.04]. Within-group analysis showed that UDI-6 and IIQ-7 scores improved significantly from baseline to six weeks in the treatment group but not in the control group [UDI-6 score (mean ± SD) 45 ± 21 vs. 29 ± 21, P = 0.02; 43 ± 18 vs. 33 ± 26, P = 0.22] [IIQ-7 score (mean ± SD) 50 ± 30 vs. 30 ± 21, P = 0.01; 48 ± 23 vs.40 ± 28, P = 0.36]. PGI-S scores only improved in the treatment group from baseline to six weeks after treatment [PGI-S score (mean ± SD) 3.1 ± 0.8 vs. 2.3 ± 0.8, P = 0.0001]. BI-score, on average, improved significantly in the treatment and control group as well [SD unit, mean, from - 1.06 to -0.58, P = 0.001; from - 0.66 to -0.42, P = 0.04]. CONCLUSIONS Women with stress-predominant urinary incontinence receiving a specially formulated supplement in addition to daily PFMT for six weeks had significantly improved urinary symptoms (decrease in UDI-6 score and IIQ-7) and BI-score compared to their baseline. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05358769. 27/04/2022.
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Affiliation(s)
- Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 526, Norfolk, VG, 23507-2007, USA
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Krisztina Pákozdy
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Erzsébet Koroknai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Balázs Erdődi
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Zoárd Krasznai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Bence Kozma
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary.
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Kamalı S, Özengin N, Topçuoğlu MA. The effect of e-pelvic floor muscle training on symptoms in women with stress urinary incontinence: a randomized controlled trial. Women Health 2023:1-11. [PMID: 37315962 DOI: 10.1080/03630242.2023.2223729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
The aim of this study was to investigate how e-pelvic floor muscle training (e-PFMT) affected urinary incontinence (UI) symptoms and quality of life (QoL) in women with stress urinary incontinence (SUI). Fifty-five women with SUI symptoms were randomly assigned to the intervention (n = 27) or the control (n = 28) group. Both groups were given lifestyle advice about SUI. The intervention group performed e-PFMT three days a week, one day via videoconference, and was supervised by a physiotherapist for eight weeks. UI symptoms were assessed by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), the Incontinence Severity Index (ISI), the Urinary Distress Inventory-6 (UDI-6), and QoL was assessed by the King's Health Questionnaire (KHQ) before and after intervention. After intervention, the Patient Global Impression of Improvement (PGI-I) scale was used to assess improvement, and the Visual Analogue Scale (VAS) was used to assess adherence. While the intervention group's ICIQ-UI SF, ISI, and UDI-6 scores improved (p < .001), there was no change in the control group (p > .05). Except for personal relationship limitations, all KHQ scores improved in the intervention group. The control group's role limitations and sleep/energy disturbances scores worsened. ICIQ-UI SF (p = .004), ISI (p < .001), and UDI-6 (p < .001) scores of the intervention group were improved compared to the control group. PGI-I and adherence were found to be higher in the intervention group compared to the control group. e-PFMT performed via videoconference to women with SUI, was found to be effective in improving UI symptoms and QoL as compared to lifestyle instructions only.
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Affiliation(s)
- Sena Kamalı
- Institute of Graduate Studies, Department of Neuroscience, Ondokuz Mayıs University, Samsun, Turkey
| | - Nuriye Özengin
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Abant İ̇zzet Baysal University, Bolu, Turkey
| | - Mehmet Ata Topçuoğlu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Abant İ̇zzet Baysal University, Bolu, Turkey
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Mendes PCS, Fretta TB, Camargo MFC, Driusso P, Homsi Jorge C. Effect of pelvic floor muscle training on reports of urinary incontinence in obese women undergoing a low-calorie diet before bariatric surgery - protocol of a randomized controlled trial. Trials 2023; 24:376. [PMID: 37277833 DOI: 10.1186/s13063-023-07347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/03/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Obesity represents a growing threat to health with multiple negative impacts including urinary incontinence. Pelvic floor muscle training (PFMT) is the first line of treatment for urinary incontinence. Both surgical and conservative weight loss results in improvement of urinary incontinence reports in obese women and we hypothesize that a low-calorie diet in combination with PFMT would result in additional beneficial effects to urinary symptoms in women with UI compared would with weight loss alone. OBJECTIVE To assess the effect of a low-calorie diet plus PFMT protocol in obese women's urinary incontinence reports. METHODS This is a protocol for a randomized controlled trial that will include obese women reporting UI and being able to contract their pelvic floor muscles. The participants will be randomly allocated in two groups: group 1 will participate in a 12-week protocol of low-calorie diet delivered by a multi-professional team at a tertiary hospital; group II will receive the same low-calorie diet protocol during 12 weeks and will additionally participate in 6 group sessions of supervised PFMT delivered by a physiotherapist. The primary outcome of the study is self-reported UI, and severity and impact of UI on women's quality of life will be assessed by the ICIQ-SF score. The secondary outcomes will be adherence to the protocols assessed using a home diary, pelvic floor muscle function assessed by bidigital vaginal palpation and the modified Oxford grading scale, and women's self-perception of their PFM contraction using a questionnaire. Satisfaction with treatments will be assessed using a visual analog scale. The statistical analysis will be performed by intention to treat and multivariate analysis of mixed effects will be used to compare outcomes. The complier average causal effects (CACE) method will be used to assess adherence. There is an urgent need for a high-quality RCT to investigate if the association of a low-calorie diet and PFMT can provide a larger effect in the improvement of urinary incontinence reports in women with obesity. TRIAL REGISTRATION Clinical Trials NCT04159467. Registered on 08/28/2021.
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Affiliation(s)
- Pauliana C S Mendes
- Department of Health Sciences, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Tatiana B Fretta
- Department of Health Sciences, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Cristine Homsi Jorge
- University of São Paulo, Ribeirão Preto Medical School, Graduation Program in Rehabilitation and Functional Performance, Avenida Bandeirantes 3900, Monte Alegre, SP, 14.049-900, Ribeirão Preto, Brazil.
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Hall EF, Biller DH, Buss JL, Ferzandi T, Halder GE, Muffly TM, Nickel KB, Nihira M, Olsen MA, Wallace SL, Lowder JL. Medium-Term Outcomes of Conservative and Surgical Treatments for Stress Urinary Incontinence: A Medicare Claims Analysis: Developed by the AUGS Payment Reform Committee. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:536-544. [PMID: 37235803 PMCID: PMC10468831 DOI: 10.1097/spv.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older. METHODS This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment. RESULTS Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons). CONCLUSIONS In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings.
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Affiliation(s)
- Evelyn F Hall
- From the Department of Obstetrics and Gynecology, Tufts University, Boston, MA
| | - Daniel H Biller
- Division of Urogynecology, Department of OBGYN, Vanderbilt University Medical College, Nashville, TN
| | - Joanna L Buss
- Institute for Informatics, Washington University School of Medicine, St Louis, MO
| | - Tanaz Ferzandi
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine at University of Southern California, Los Angeles, CA
| | - Gabriela E Halder
- Division of Urogynecology, Department of OBGYN, University of Texas Medical Branch, Galveston, TX
| | - Tyler M Muffly
- Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, CO
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Internal Medicine, Washington University in St Louis, St Louis, MO
| | - Mikio Nihira
- KPC Healthcare, UC Riverside School of Medicine, Riverside, CA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Internal Medicine, Washington University in St Louis, St Louis, MO
| | - Shannon L Wallace
- Division of Urogynecology, Subspecialty Care for Women's Health, Cleveland Clinic, Cleveland, OH
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO
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Wang Y, Liu L, Chen Q, Gao K, Wang H, Xu N, Chen Y, Wong DWC, Lam WK. Modified lumbo-pelvic exercise to alleviate mild stress urinary incontinence in middle-aged females. Sci Rep 2023; 13:7142. [PMID: 37130891 PMCID: PMC10153777 DOI: 10.1038/s41598-023-34417-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/29/2023] [Indexed: 05/04/2023] Open
Abstract
Urinary incontinence is one of the common clinical problems of females passing middle age. Traditional pelvic floor muscle training to alleviate urinary incontinence is too dull and unpleasant. Therefore, we were motivated to purpose a modified lumbo-pelvic exercise training incorporating simplified dancing components with pelvic floor muscle training. The objective of this study was to evaluate the 16-week modified lumbo-pelvic exercise program that incorporated dance and abdominal drawing-in maneuvers. Middle-aged females were randomly assigned into the experimental (n = 13) and control (n = 11) groups. Compared to the control group, the exercise group significantly reduced body fat, visceral fat index, waistline, waist-hip ratio, perceived incontinence score, frequency of urine leakage, and pad testing index (p < 0.05). In addition, there were significant improvements in pelvic floor function, vital capacity, and muscle activity of the right rectus abdominis (p < 0.05). This indicated that the modified lumbo-pelvic exercise program can promote benefits of physical training and alleviate urinary incontinence in middle-aged females.
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Affiliation(s)
- Yi Wang
- Department of Physical Education, Renmin University of China, Beijing, China
- Sports and Social Development Research Center, Renmin University of China, Beijing, China
| | - Liangchao Liu
- Physical Education Department, University of International Business and Economics, Beijing, China
| | - Qi Chen
- Physical Education Department, University of International Business and Economics, Beijing, China
| | - Kuiting Gao
- School of Physical Education, Shandong University of Technology, Shandong, China.
| | - Hongchu Wang
- School of Mathematical Sciences, South China Normal University, Guangzhou, China
| | - Naxin Xu
- Sport Science School, Beijing Sport University, Beijing, China
| | - Yinru Chen
- College of Education, Beijing Sport University, Beijing, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong, China.
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Moossdorff-Steinhauser HFA, Houkes I, Berghmans BCM, Spaanderman MEA, Bols EMJ. Experiences of Peri-partum Urinary Incontinence from a Women's and Health Care Perspective: A Qualitative Study. Matern Child Health J 2023:10.1007/s10995-023-03631-6. [PMID: 36988797 DOI: 10.1007/s10995-023-03631-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Urinary incontinence (UI) is highly prevalent peri-partum. To gain more understanding regarding the gap between the prevalence of UI and actual help seeking behaviour of peri-partum women, this study aims to understand, (1) how peri-partum women experience UI and which factors influence these experiences and (2) the perspective of health care professionals on UI during pregnancy, and the first year after childbirth. METHODS A qualitative approach was used, using semi-structured interviews with adult pregnant and up to 1 year post-partum women and a focus group with health care professionals (HCP's) involved in the care of pregnant and post-partum women. Thematic analysis was used to analyse the data. RESULTS Six pregnant and seven post-partum women were included. Nearly all of these women expressed to be not, or only slightly bothered by their UI and accept it as a result of pregnancy and/or delivery. They were surprised because they were unaware that UI could be a problem. None of the HCP's routinely asked about the presence of UI during pregnancy. At the post-natal check at 6 weeks post-partum, UI is still not a standard question for the majority of the gynecologists and registrars in contrast to the midwives. CONCLUSIONS FOR PRACTICE The interviewed women with UI during pregnancy and the first year after childbirth were surprised but hardly bothered by their UI and accept it as part of being pregnant or as a result of the delivery. HCP's do not routinely discuss UI during pregnancy or post-partum.
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Affiliation(s)
| | - Inge Houkes
- School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Bary C M Berghmans
- Pelvic Care Center Maastricht, CAPHRI, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | | | - Esther M J Bols
- School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Farrell D, Moran J, Zat Z, Miller PW, Knibbs L, Papanikolopoulos P, Prattos T, McGowan I, McLaughlin D, Barron I, Mattheß C, Kiernan MD. Group early intervention eye movement desensitization and reprocessing therapy as a video-conference psychotherapy with frontline/emergency workers in response to the COVID-19 pandemic in the treatment of post-traumatic stress disorder and moral injury—An RCT study. Front Psychol 2023; 14:1129912. [PMID: 37063579 PMCID: PMC10100089 DOI: 10.3389/fpsyg.2023.1129912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/22/2023] [Indexed: 04/01/2023] Open
Abstract
ObjectiveFrontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol—GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 4x2h sessions over 1-week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery.MethodsThe study’s design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre—treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences – International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study.ResultsResults highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) (t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) (t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study’s findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic.ConclusionThe NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions.Clinical Trial Registration:Clinicaltrials.gov, ISRCTN16933691.
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Affiliation(s)
- Derek Farrell
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
- School of Nursing and Midwifery, Queen’s University, Belfast, Northern Ireland, United Kingdom
- *Correspondence: Derek Farrell,
| | - Johnny Moran
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Zeynep Zat
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Paul W. Miller
- School of Nursing, Magee Campus, Ulster University, Northern Ireland, United Kingdom
| | - Lorraine Knibbs
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Penny Papanikolopoulos
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Tessa Prattos
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Iain McGowan
- School of Nursing and Midwifery, Queen’s University, Belfast, Northern Ireland, United Kingdom
| | - Derek McLaughlin
- School of Nursing and Midwifery, Queen’s University, Belfast, Northern Ireland, United Kingdom
| | - Ian Barron
- Centre for International Education, College of Education, University of Massachusetts, Amherst, MA, United States
| | - Cordula Mattheß
- Department for Violence Prevention, Trauma and Criminology (VPTC), School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Matthew D. Kiernan
- Northern Hub for Veteran and Military Families’ Research, Northumbria University, Newcastle upon Tyne, United Kingdom
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Tennfjord MK, Kassie BA, Gashaw ZM, Asaye MM, Muche HA, Fenta TT, Chala KN, Mæland KS. Pelvic Floor Disorders and Pelvic Floor Muscle Exercise: A Survey on Knowledge, Attitude, and Practice among Pregnant Women in Northwest Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4201. [PMID: 36901212 PMCID: PMC10001623 DOI: 10.3390/ijerph20054201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
The purpose of the study was to investigate 1: overall knowledge of pelvic organ prolapse (POP) and urinary incontinence (UI) as well as knowledge, attitudes, and practice of pelvic floor muscle exercise (PFME); and 2: the association of these factors with parity in pregnant women in Gondar, Ethiopia. A facility-based cross-sectional study was performed in the Central Gondar zone, northwest Ethiopia between February and April 2021. The associations between parity and knowledge of POP and UI, and knowledge, attitude, and practice towards PFME were estimated using logistics regression models and presented as crude and adjusted odds ratios with 95% confidence intervals. Nulliparous women were used as the reference. Adjustments were made for maternal age, antenatal care visits, and level of education. The study sample comprised 502 pregnant women: 133 nulliparous, and 369 multiparous. We found no association between parity and knowledge of POP, UI, or knowledge, attitude, and practice toward PFME. The sum score indicated poor knowledge about both POP, UI, and PFME in the study population, and poor attitude and practice of PFME. Despite a high attendance in antenatal care services, knowledge, attitude, and practice were poor, indicating a need for quality improvement of the services.
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Affiliation(s)
| | - Belayneh Ayanaw Kassie
- Department of Women’s and Family Health, College of Medicine and Health Science, School of Midwifery, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Zelalem Mengistu Gashaw
- Department of Gynecology and Obstetrics, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Mengstu Melkamu Asaye
- Department of Women’s and Family Health, College of Medicine and Health Science, School of Midwifery, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Haymanot Alem Muche
- Department of Clinical Midwifery, College of Medicine and Health Science, School of Midwifery, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Tibebu Tadesse Fenta
- University of Gondar Comprehensive Specialized Hospital, Gondar P.O. Box 196, Ethiopia
| | - Kalkidan Nigussie Chala
- Department of Physiotherapy, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Karolina S. Mæland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063 Bergen, Norway
- Faculty of Health Sciences, SHARE-Center for Resilience in Healthcare, University of Stavanger, 4036 Stavanger, Norway
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Tanaka JRV, Sousa KHJF, Alves PJP, Guerra MJJ, Gonçalves PDB. Educational Technology on Urinary Incontinence during Pregnancy: Development and Validation of an Online Course for the Brazilian Population. AQUICHAN 2023. [DOI: 10.5294/aqui.2023.23.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Objective: To describe the development and validation process of an online course on urinary incontinence during pregnancy in Brazil. Materials and methods: This methodological study followed an online course’s literature search, development, and validation steps. A total of 22 specialists participated in the validation step, and the content validity index (CVI) was used. Fifty-one Physical Therapy students (target audience) also participated in the Suitability Assessment of Materials. Results: The synthesis reached in the integrative review provided the basis for the course’s theoretical content, which was regarded as suitable by the specialists regarding its content, language, presentation, stimulation/motivation, and cultural adequacy (CVI = 0.99). The target audience considered the course organized, easily understandable, engaging, and motivational, with a positive response index ranging from 84.3 % to 100 %. Conclusions: The Brazilian version of the online course was considered sufficiently adequate in content and interface quality by both specialists and the target audience.
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