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Rai A, Sharma N, Jain SK, Lalwani A, Sharma S. Accuracy and Reliability of Different Approaches for the Assessment of Pelvic Floor Muscle Strength: A Systematic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S856-S861. [PMID: 37694079 PMCID: PMC10485409 DOI: 10.4103/jpbs.jpbs_241_23] [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: 03/12/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 09/12/2023] Open
Abstract
There had been various methods employed for the evaluation of pelvic floor muscle (PFM) strength. The aim of the study was to do a systemic review of these methods for a better understanding of these techniques and to find the best appropriate method. A systemic review of the literature was done using three databases that included: PubMed, Scopus and Web of Science using the keywords "pelvic floor anatomy" and "functional anatomy of pelvic floor muscles" from 1985 to 2022. All the studies involved were analyzed for the methodologies used by the researcher, advantages, disadvantages, and the conclusion of the study. A total of 1,876 studies were found, out of which only 64 met the criteria of inclusion. In these studies, seven methods were used for the determination of PFM strength. These methods included: clinical palpation, perineometer, electromyography, dynamometer, ultrasonography, magnetic resonance imaging, and vaginal cones. The PFM cannot be calculated accurately using any one measuring technique. There is therefore no "gold standard" approach to PFM assessment. However, combining these methods will result in the best outcomes. According to the literature review, the most often employed procedures were digital palpation, perineometry, and Ultrasonography (USG).
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Affiliation(s)
- Alisha Rai
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Nidhi Sharma
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Sanjeev Kumar Jain
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Astha Lalwani
- Department of Obs and Gynae, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Sonika Sharma
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
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2
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El-Sayegh B, Cacciari LP, Primeau FL, Sawan M, Dumoulin C. The state of pelvic floor muscle dynamometry: A scoping review. Neurourol Urodyn 2023; 42:478-499. [PMID: 36478202 DOI: 10.1002/nau.25101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/01/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
AIMS To discuss the advantages and limitation of the different pelvic floor muscle (PFM) dynamometers available, both in research and industry, and to present the extent of variation between them in terms of structure, functioning, psychometric properties, and assessment procedures. METHODS We identified relevant studies from four databases (MEDLINE, Compendex, Web of Science, and Derwent Innovations Index) up to December 2020 using terms related to dynamometry and PFM. In addition, we conducted a hand search of the bibliographies of all relevant reports. Peer-reviewed papers, conference proceedings, patents and user's manuals for commercial dynamometers were included and assessed by two independent reviewers. RESULTS One hundred and one records were included and 23 PFM dynamometers from 15 research groups were identified. From these, 20 were considered as clinical dynamometers (meant for research settings) and three as personal dynamometers (developed by the industry). Overall, significant heterogeneity was found in their structure and functioning, which limits development of normative data for PFM force in women. Further research is needed to assess the psychometric properties of PFM dynamometers and to standardize assessment procedures. CONCLUSION This review points up to the heterogeneity of existing dynamometers and methods of assessing PFM function. It highlights the need to better document their design and assessment protocol methods. Additionally, this review recommends standards for new dynamometers to allow the establishment of normalized data.
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Affiliation(s)
- Batoul El-Sayegh
- Department of Electrical and Computer Engineering, Polytechnique of Montreal, Montreal, Québec, Canada.,Research Center of the Institut Universtaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Licia P Cacciari
- Research Center of the Institut Universtaire de Gériatrie de Montréal, Montréal, Québec, Canada.,School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
| | - Francois L Primeau
- Department of Electrical and Computer Engineering, Polytechnique of Montreal, Montreal, Québec, Canada
| | - Mohamad Sawan
- School of Engineering, Westlake University and Institute of Advanced Study, Westlake Institute for Advanced Study, Hangzhou, China
| | - Chantal Dumoulin
- Research Center of the Institut Universtaire de Gériatrie de Montréal, Montréal, Québec, Canada.,School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
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3
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El-Sayegh B, Dumoulin C, Ali M, Assaf H, De Jong J, Sawan M, Leduc-Primeau F. Portable Dynamometer-Based Measurement of Pelvic Floor Muscle Force. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 11:44-53. [PMID: 36518785 PMCID: PMC9744264 DOI: 10.1109/jtehm.2022.3223258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/29/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In attempts to improve the quality of life of women, continuous projects are sought between rehabilitation intervention and engineering. Using the knowledge of the pelvic floor muscle (PFM) physiology, assessment and training methods are developed to reduce lower urinary tract symptoms such as urinary incontinence. Therefore, this paper covers the design and implementation of a portable vaginal dynamometer. METHODS A PFM probe is designed, 3D printed, assembled, and tested in ten women to assess its acceptability and usability. The feedback from the usability study is used to optimize the PFM probe design. A vaginal dynamometer is developed based on the designed PFM probe, then tested for linearity, repeatability, hysteresis, noise and heat effect, and power consumption. The variability between the different produced PFM probe prototypes is evaluated. RESULTS Force measurements are made using a load cell. Wireless communication is performed through a Bluetooth low energy transceiver v5.0, with a corresponding interface on both computer and smartphone. The device operates at a 3.3V supply and achieves a power consumption of 49.5 mW in operating mode. Two PFM probe sizes are designed to accommodate different vaginal hiatus sizes, based on usability study feedback. The proposed system allows the physiotherapist to wirelessly monitor variation in pelvic floor muscle force during assessment and/or training. DISCUSSION/CONCLUSION The testing results showed that the newly designed system has the potential to measure the PFM function in functional conditions such as the standing position.
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Affiliation(s)
- Batoul El-Sayegh
- Department of Electrical EngineeringPolytechnique Montreal Montreal QC H3T 1J4 Canada
- Research CenterInstitut Universtaire de Gériatrie de Montréal Montréal QC H3W 1W4 Canada
| | - Chantale Dumoulin
- Research CenterInstitut Universtaire de Gériatrie de Montréal Montréal QC H3W 1W4 Canada
- School of Rehabilitation, Faculty of MedicineUniversité de Montréal Montréal QC H3N 1X7 Canada
| | - Mohamed Ali
- Department of Electrical EngineeringPolytechnique Montreal Montreal QC H3T 1J4 Canada
- Department of MicroelectronicsElectronics Research Institute Cairo 12622 Egypt
| | - Hussein Assaf
- Department of Electrical EngineeringPolytechnique Montreal Montreal QC H3T 1J4 Canada
| | | | - Mohamad Sawan
- Department of Electrical EngineeringPolytechnique Montreal Montreal QC H3T 1J4 Canada
- School of EngineeringWestlake University and CenBRAIN Neurotech Center of Excellence, Westlake Institute for Advanced Study Hangzhou 310024 China
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4
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Bélanger C, Dumoulin C, Bergeron S, Mayrand MH, Khalifée S, Waddell G, Dubois MF, Morin M. Pain Characteristics, Fear-avoidance Variables, and Pelvic Floor Function as Predictors of Treatment Response to Physical Therapy in Women With Provoked Vestibulodynia. Clin J Pain 2022; 38:360-367. [PMID: 35258030 DOI: 10.1097/ajp.0000000000001030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to investigate whether pretreatment pain characteristics, psychological variables, and pelvic floor muscle (PFM) function predict the response to physical therapy (PT) in women with provoked vestibulodynia (PVD). MATERIALS AND METHODS One hundred-five women diagnosed with PVD underwent 10 weekly sessions of individual PT comprising education, PFM exercises with biofeedback, manual therapy, and dilators. Treatment outcomes were evaluated at pretreatment, post-treatment, and 6-month follow-up and included pain intensity (numerical rating scale 0 to 10) and sexual function (Female Sexual Function Scale). Multilevel analyses were used to examine the potential predictors of response over time including pain characteristics (PVD subtype, pain duration), psychological variables (fear of pain, pain catastrophizing), and PFM function assessed with a dynamometric speculum (tone, flexibility, and strength). RESULTS PVD subtype and PFM tone were significant predictors of greater treatment response for pain intensity reduction. Secondary PVD (ie, pain developed after a period of pain-free intercourse) and lower PFM tone at baseline were both associated with greater reduction in pain intensity after PT and at follow-up. Among the psychological variables, fear of pain was the only significant predictor of better treatment response when assessed through improvement in sexual function, where higher fear of pain at baseline was associated with greater improvement after PT. DISCUSSION This study identified PVD secondary subtype, lower PFM tone, and higher fear of pain as significant predictors of better treatment response to PT in women with PVD.
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Affiliation(s)
- Clémence Bélanger
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CHUS)
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut Universitaire de gériatrie de Montréal
| | | | - Marie-Hélène Mayrand
- Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Université de Montréal and Research Center of the Centre hospitalier de l'Université de Montréal
| | - Samir Khalifée
- Jewish General Hospital and Royal Victoria Hospital, McGill University Health Center, Montréal, QC, Canada
| | - Guy Waddell
- Department of Obstetrics and Gynecology, CHUS and Université de Sherbrooke
| | | | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CHUS)
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Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama'i MS, Schizas A, Slieker-Ten Hove M, Takahashi S, Voelkl Guevara J. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 2021; 40:1217-1260. [PMID: 33844342 DOI: 10.1002/nau.24658] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The terminology for female and male pelvic floor muscle (PFM) assessment has expanded considerably since the first PFM function and dysfunction standardization of terminology document in 2005. New terms have entered assessment reports, and new investigations to measure PFM function and dysfunction have been developed. An update of this terminology was required to comprehensively document the terms and their definitions, and to describe the assessment method and interpretation of the finding, to standardize assessment procedures and aid diagnostic decision making. METHODS This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) Working Group 16, with contributions from recognized experts in the field and external referees. A logical, sequential, clinically directed assessment framework was created against which the assessment process was mapped. Within categories and subclassifications, each term was assigned a numeric coding. A transparent process of 12 rounds of full working group and external review was undertaken to exhaustively examine each definition, plus additional extensive internal development, with decision making by collective opinion (consensus). RESULTS A Terminology Report for the symptoms, signs, investigations, and diagnoses associated with PFM function and dysfunction, encompassing 185 separate definitions/descriptors, has been developed. It is clinically based with the most common assessment processes defined. Clarity and user-friendliness have been key aims to make it interpretable by clinicians and researchers of different disciplines. CONCLUSION A consensus-based Terminology Report for assessment of PFM function and dysfunction has been produced to aid clinical practice and be a stimulus for research.
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Affiliation(s)
- Helena Frawley
- School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Beth Shelly
- Beth Shelly Physical Therapy, Moline, Illinois, USA.,Department of Physical Therapy, Saint Ambrose University Davenport, Iowa, USA
| | - Melanie Morin
- School of Rehabilitation Faculty of Medecine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Stéphanie Bernard
- Department of Rehabilitation, Faculté de Médecine, Université Laval, Québec, Quebec, Canada
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Akershus University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Giuseppe Alessandro Digesu
- Academic Department of Obstetrics and Gynaecology, St. Mary's Hospital, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tamara Dickinson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Mohammad S Rahnama'i
- Uniklinik RWTH, University Hospital of Aachen, Aachen, Germany.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Marijke Slieker-Ten Hove
- Department Gynaecology, University of Erasmus, Rotterdam, The Netherlands.,Pelvic Floor Physiotherapy, ProFundum Instituut, Dordrecht, The Netherlands
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Cyr MP, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Morin M. Characterizing Pelvic Floor Muscle Function and Morphometry in Survivors of Gynecological Cancer Who Have Dyspareunia: A Comparative Cross-Sectional Study. Phys Ther 2021; 101:6124113. [PMID: 33522584 DOI: 10.1093/ptj/pzab042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/26/2020] [Accepted: 11/29/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE More than one-half of gynecological cancer survivors are affected by pain during sexual intercourse, also known as dyspareunia. Oncological treatments may result in pelvic floor muscle (PFM) alterations, which are suspected to play a key role in dyspareunia. However, to our knowledge, no study has investigated PFM function and morphometry in this population. The aim of the study was to characterize and compare PFM function and morphometry between gynecological cancer survivors with dyspareunia and asymptomatic women. METHODS Twenty-four gynecological cancer survivors with dyspareunia and 32 women with a history of total hysterectomy but without pelvic pain (asymptomatic women) participated in this comparative cross-sectional study. PFM passive forces (tone), flexibility, stiffness, maximal strength, coordination, and endurance were assessed with an intra-vaginal dynamometric speculum. Bladder neck position, levator plate angle, anorectal angle, and levator hiatal dimensions were measured at rest and on maximal contraction with 3D/4D transperineal ultrasound imaging. RESULTS Compared with asymptomatic women, gynecological cancer survivors showed heightened PFM tone, lower flexibility, higher stiffness, and lower coordination and endurance. At rest, they had a smaller anorectal angle and smaller levator hiatal dimensions, indicating heightened PFM tone. They also presented fewer changes from rest to maximal contraction for anorectal angle and levator hiatal dimensions, suggesting an elevated tone or altered contractile properties. CONCLUSIONS Gynecological cancer survivors with dyspareunia present with altered PFM function and morphometry. This research therefore provides a better understanding of the underlying mechanisms of dyspareunia in cancer survivors. IMPACT Our study confirms alterations in PFM function and morphometry in gynecological cancer survivors with dyspareunia. These findings support the rationale for developing and assessing the efficacy of physical therapy targeting PFM alterations in this population.
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Affiliation(s)
- Marie-Pierre Cyr
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada.,Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Paul Bessette
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.,Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Annick Pina
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Korine Lapointe-Milot
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.,Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada.,Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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7
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Czyrnyj CS, Bérubé MÈ, Lanteigne E, Brennan A, Bader Y, Lomovtsev D, Vandermolen M, Boucher S, Mitri L, McLean L. Design and validation of an automated dual-arm instrumented intravaginal dynamometer. Neurourol Urodyn 2021; 40:604-615. [PMID: 33410542 DOI: 10.1002/nau.24600] [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: 07/29/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 11/11/2022]
Abstract
AIMS (1) To present the design of a novel intravaginal dynamometer (IVD) capable of measuring vaginal closure force on both the anterior and posterior arms, (2) to use bench testing to validate the force, speed of arm opening, and positional accuracy of load measurement along the IVD arms, and (3) to present in vivo force measurements made with this device, comparing forces measured by the anterior and posterior arms. METHODS IVD load measurements were validated against an Instron® Universal Tester, arm opening speeds were validated using video analysis, and position-load accuracy was validated against calibration weights. In vivo IVD data were acquired from female volunteers during passive opening and pelvic floor muscle contraction tasks. Anterior and posterior IVD arm force outcomes were compared. RESULTS Forces measured by the IVD and Instron® exhibited a strong linear relationship with excellent model fit. The speed control system was valid when tested under physiological loading conditions, however smaller antero-posterior opening diameters (25 and 30 mm) exhibited some error. The loading position along the IVD arms had no effect on force outcomes. In vivo data exhibited differences between force outcomes measured at the anterior and posterior aspects of the vagina during active contraction and passive elongation of the pelvic floor muscles. CONCLUSIONS This IVD design demonstrates valid load measurement and speed control during bench testing. Active and passive forces measured are consistent with the literature. With dual instrumented arms, this device allows for further investigation into the source of measured vaginal closure forces.
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Affiliation(s)
- Catriona S Czyrnyj
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Marie-Ève Bérubé
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Eric Lanteigne
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Ana Brennan
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Yousef Bader
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Dmitry Lomovtsev
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Megan Vandermolen
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Samantha Boucher
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Layla Mitri
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
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8
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Cacciari LP, Morin M, Mayrand MH, Tousignant M, Abrahamowicz M, Dumoulin C. Pelvic floor morphometrical and functional changes immediately after pelvic floor muscle training and at 1-year follow-up, in older incontinent women. Neurourol Urodyn 2020; 40:245-255. [PMID: 33075192 DOI: 10.1002/nau.24542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/05/2020] [Indexed: 11/11/2022]
Abstract
AIMS To compare the effects of group-based and individual physiotherapy for stress or mixed urinary incontinence (UI) on pelvic floor morphometry, pelvic floor muscle (PFM) function, and related self-efficacy, immediately after treatment and at 1 year. METHODS This is a planned secondary analysis of the group rehabilitation or individual physiotherapy study, an assessor-blinded, randomized, noninferiority trial. Eligible participants included 362 community-dwelling older women with symptoms of stress/mixed UI. After learning how to contract PFMs, participants completed 12 weeks of PFM training, either individually (one-on-one) or as part of a group (eight women). Pelvic floor transperineal ultrasound volumes (morphometry), PFM intravaginal dynamometric data (function), and self-efficacy in performing PFM exercises were acquired at baseline, posttreatment, and at 1 year. RESULTS Groups were comparable at all time points. Immediately posttreatment, both groups demonstrated significant changes in pelvic floor morphometry during coughs, and in PFM function during contractions and coughs. Participants also reported improved self-efficacy in performing PFM exercises. Results were sustained at 1 year. When participants coughed, pelvic floor structures were better supported (reflected by less caudal movement of the puborectalis sling and a smaller opening of the levator hiatus) in a pattern consistent with the "knack" strategy. Furthermore, both interventions resulted in stronger, faster, more coordinated, and more endurant PFMs. CONCLUSION In older women with stress or mixed UI, both individual and group-based PFM training resulted in comparable improvements in overall PFM function, pelvic floor morphometry during coughs, and related self-efficacy in performing PFM exercises, which were sustained at 1 year.
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Affiliation(s)
- Licia P Cacciari
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Research Center of the Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Hélène Mayrand
- Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Université de Montréal and Research Center of the Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Michel Tousignant
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Research Center of the Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University and Research Institute of the McGill University Health Center, Montreal, Québec, Canada
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
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9
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El-Sayegh B, Dumoulin C, Ali M, Assaf H, Sawan M. A Dynamometer-based Wireless Pelvic Floor Muscle Force Monitoring. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:6127-6130. [PMID: 33019369 DOI: 10.1109/embc44109.2020.9176660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper covers the design and implementation of a proof of concept for a wireless system measuring pelvic floor muscle forces based on a dynamometer. The proposed device is the main component of a novel assessment tool intended for pelvic floor muscle rehabilitation in women suffering from urinary incontinence. The proposed system allows the physiotherapist to wirelessly monitor variation in pelvic floor muscle forces during assessment or training. Wireless communication is provided by a Bluetooth low energy transceiver and a corresponding interface designed for this purpose. Force measurements are sensed with strain gauge precision sensors operated in a Wheatstone bridge configuration. The designed module consumes 14 mW of power in operating mode. System design and experimental results are reported and discussed.
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10
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Czyrnyj CS, Bérubé M, Brooks K, Varette K, McLean L. Reliability and validity of a mobile home pelvic floor muscle trainer: The Elvie Trainer. Neurourol Urodyn 2020; 39:1717-1731. [DOI: 10.1002/nau.24439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/04/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Catriona S. Czyrnyj
- Department of Mechanical EngineeringUniversity of OttawaOttawa Ontario Canada
| | - Marie‐Ève Bérubé
- School of Rehabilitation SciencesUniversity of OttawaOttawa Ontario Canada
| | - Kaylee Brooks
- School of Rehabilitation SciencesUniversity of OttawaOttawa Ontario Canada
| | - Kevin Varette
- School of Rehabilitation TherapyQueen's UniversityKingston Ontario Canada
| | - Linda McLean
- School of Rehabilitation SciencesUniversity of OttawaOttawa Ontario Canada
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11
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Grinberg K, Sela Y, Nissanholtz-Gannot R. New Insights about Chronic Pelvic Pain Syndrome (CPPS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3005. [PMID: 32357440 PMCID: PMC7246747 DOI: 10.3390/ijerph17093005] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. The aim of this article was to present new insight about CPPS in order to raise awareness of nursing and medical staff in the identification and diagnosis of the syndrome and to promote an appropriate treatment for each woman who suffers from CPPS. METHODS A literature review about the factors associated with CPPS and therapeutic interventions for CPPS was conducted. RESULTS CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. CONCLUSIONS The therapeutic interventions in CPPS cases should, consequently, follow a multidisciplinary approach.
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Affiliation(s)
- Keren Grinberg
- Department of Nursing, Faculty of Social and Community Science, Ruppin Academic Center, 40250 Emek-Hefer, Israel
| | - Yael Sela
- Department of Nursing, Faculty of Social and Community Science, Ruppin Academic Center, 40250 Emek-Hefer, Israel
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Mercier J, Morin M, Tang A, Reichetzer B, Lemieux MC, Samir K, Zaki D, Gougeon F, Dumoulin C. Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause. Climacteric 2020; 23:468-473. [PMID: 32105155 DOI: 10.1080/13697137.2020.1724942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: This study aims to investigate the mechanism of action of pelvic floor muscle training (PFMT) for the improvement of the signs and symptoms of genitourinary syndrome of menopause (GSM) in postmenopausal women with GSM and urinary incontinence (UI).Methods: Twenty-nine women were included in the secondary analysis of a single-arm feasibility study. Using color Doppler ultrasound, the peak systolic velocity, time-averaged maximum velocity, and pulsatility index of the internal pudendal and dorsal clitoral arteries were measured at rest and after a pelvic floor muscle (PFM) contraction task. PFM function was assessed by dynamometry, and vulvovaginal tissue elasticity was measured using the Vaginal Atrophy Index.Results: PFMT significantly improved blood flow parameters in both arteries (p < 0.05) and significantly increased the speed of PFM relaxation after a contraction (p = 0.003). After the intervention, a marginally significant decrease in PFM tone was observed, as well as an increase in PFM strength (p = 0.060 and p = 0.051, respectively). Finally, improvements in skin elasticity and introitus width were observed as measured by the Vaginal Atrophy Index (p < 0.007).Conclusion: Our findings suggest that PFMT improves blood flow in vulvovaginal tissues, PFM relaxation capacity, and vulvovaginal tissue elasticity in postmenopausal women with GSM and UI.
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Affiliation(s)
- J Mercier
- Centre de recherche, Institut universitaire de gériatrie de Montréal, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - M Morin
- Centre de recherche, Centre hospitalier universitaire de Sherbrooke, School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - A Tang
- Department of Radiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - B Reichetzer
- Department of Obstetrics and Gynecology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - M-C Lemieux
- Department of Obstetrics and Gynecology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - K Samir
- Department of Obstetrics and Gynecology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - D Zaki
- Department of Obstetrics and Gynecology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - F Gougeon
- Department of Pathology and Cell Biology, Université de Montréal, Montreal, QC, Canada
| | - C Dumoulin
- Centre de recherche, Institut universitaire de gériatrie de Montréal, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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Cacciari LP, Amorim AC, Pássaro AC, Dumoulin C, Sacco ICN. Intravaginal pressure profile of continent and incontinent women. J Biomech 2019; 99:109572. [PMID: 31931973 DOI: 10.1016/j.jbiomech.2019.109572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/26/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
A well-functioning pelvic floor muscle plays an important role in maintaining urinary continence. The aim of this study was to describe and compare the intravaginal pressure profile using a multisensor device along the vaginal length in women with and without urinary incontinence (UI), while performing pelvic floor muscle tasks. Fifty-four adult pre-menopausal women (31 continent and 23 incontinent) participated in this cross-sectional observational cohort study. The intravaginal pressure profile was assessed at rest, during maximum and sustained pelvic floor muscle contractions, using the Pliance® multisensor device. Between-group comparisons were performed considering the overall pressure and the pressure profile of 10-subregions along the vaginal length. In the overall pressure assessment, women with UI presented lower pressures at rest, similar pressures during maximum contraction and lower capacity to maintain pressure during sustained contraction compared to those in the continent group. The pressure profile assessment showed between-group differences that were consistent throughout tasks, with the incontinent group presenting lower pressures than the continent group, specifically in the mid-vaginal length, around 3-4 cm from the vaginal opening. We observed consistent deficits in pressure generation in incontinent compared to continent women, precisely in the region of the pelvic floor muscles. With this protocol and novel instrument, we obtained a reliable and consistent intravaginal pressure profile of continent and incontinent women. This approach could assist clinicians in the assessment of pelvic floor muscle function and foster a better understanding of the urinary incontinence mechanism.
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Affiliation(s)
- Licia P Cacciari
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada.
| | - Amanda C Amorim
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Anice C Pássaro
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Chantal Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
| | - Isabel C N Sacco
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Anumba DOC, Gillespie S, Jha S, Abdi S, Kruger J, Taberner A, Nielsen PMF, Li X. Postnatal pelvic floor muscle stiffness measured by vaginal elastometry in women with obstetric anal sphincter injury: a pilot study. Int Urogynecol J 2019; 31:567-575. [PMID: 31802165 PMCID: PMC7093346 DOI: 10.1007/s00192-019-04136-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis Vaginal childbirth is associated with pelvic floor muscle (PFM) damage in a third of women. The biomechanics prediction, detection and management of PFM damage remain poorly understood. We sought in this pilot study to determine whether quantifying PFM stiffness postnatally by vaginal elastometry, in women attending a perineal trauma clinic (PTC) within 6 months of obstetric anal sphincter injury, correlates with their antecedent labour characteristics, pelvic floor muscle damage, or urinary/bowel/sexual symptoms, to inform future definitive prospective studies. Methods In this pilot study, we measured postnatal PFM stiffness by vaginal elastometry in 54 women. A subset of participants (n = 14) underwent magnetic resonance imaging (MRI) to define any levator ani (LA) muscle defects from vaginal childbirth. We investigated the association of PFM stiffness with demographics, labour and delivery characteristics, clinical features and MRI evidence of LA damage. Results Raised maternal BMI was associated with reduced pelvic floor stiffness (r = −0.4; p < 0.01). Higher stiffness values were associated with forceps delivery for delayed second stage of labour (n = 14) vs non-forceps vaginal delivery (n = 40; 630 ± 40 N/m vs 500 ± 30 N/m; p < 0.05), and a non-significant trend towards longer duration of the second stage of labour. Women with urinary, bowel or sexual symptoms (n = 37) demonstrated higher pelvic floor stiffness values than those without (570 ± 30 N/m vs 450 ± 40 N/m; p < 0.05). Conclusions A history of delayed second stage of labour and forceps delivery was associated with higher PFM stiffness values in the postnatal period. Whether high pelvic muscle stiffness antenatally is a risk factor for instrumental vaginal delivery and LA avulsion is unknown.
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Affiliation(s)
- Dilly O C Anumba
- Academic Unit of Reproductive and Developmental Medicine, Faculty of Medicine Dentistry and Health, The University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK. .,Insigneo Institute for in silico Medicine, The University of Sheffield, Sheffield, UK.
| | - Siobhán Gillespie
- Academic Unit of Reproductive and Developmental Medicine, Faculty of Medicine Dentistry and Health, The University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK
| | - Swati Jha
- Academic Unit of Reproductive and Developmental Medicine, Faculty of Medicine Dentistry and Health, The University of Sheffield, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK
| | - Shahram Abdi
- Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jenny Kruger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Andrew Taberner
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Poul M F Nielsen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Xinshan Li
- Insigneo Institute for in silico Medicine, The University of Sheffield, Sheffield, UK.,Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
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Niederauer S, Cottle B, Sheng X, Ashton-Miller J, Delancey J, Hitchcock R. Subsequent Use of a Pressure Sensor to Record Intra-Abdominal Pressure After Maximum Vaginal Closure Force in a Clinical Trial. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2019; 8:2500208. [PMID: 31966934 PMCID: PMC6964966 DOI: 10.1109/jtehm.2019.2952245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/01/2019] [Accepted: 10/17/2019] [Indexed: 11/13/2022]
Abstract
Pelvic floor disorders are caused by weakening or damage to the tissues lining the bottom of the abdominal cavity. These disorders affect nearly 1 in every 4 women in the United States and symptoms that drastically diminish a patient’s quality of life. Vaginal closure force is a good measure of pelvic health, but current vaginal dynamometers were not designed for the rigors of hospital reprocessing, often failing due to sensor degradation through repeated sterilization processes. In order to obtain measurements of vaginal closure force in a large study, we designed a vaginal dynamometer that utilizes a removable intra-abdominal sensor already in production for the study. The sensor’s existing data acquisition system was modified to transmit to a tablet allowing the user to view data in real-time. The new speculum design allowed a single sensor to measure vaginal closure force before being used to collect intra-abdominal pressure data in the same study visit. The measurements taken with the new speculum were similar to measurements taken with a previously reported vaginal dynamometer.
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Affiliation(s)
- Stefan Niederauer
- 1Department of BioengineeringThe University of UtahSalt Lake CityUT84112USA
| | - Brian Cottle
- 1Department of BioengineeringThe University of UtahSalt Lake CityUT84112USA
| | - Xiaoming Sheng
- 2Department of PediatricsSchool of MedicineThe University of UtahSalt Lake CityUT84112USA
| | - James Ashton-Miller
- 3Department of Mechanical EngineeringUniversity of MichiganAnn ArborMI48109USA
| | - John Delancey
- 4Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMI48109USA
| | - Robert Hitchcock
- 1Department of BioengineeringThe University of UtahSalt Lake CityUT84112USA
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Cacciari LP, Kruger J, Goodman J, Budgett D, Dumoulin C. Reliability and validity of intravaginal pressure measurements with a new intravaginal pressure device: The FemFit®. Neurourol Urodyn 2019; 39:253-260. [PMID: 31588623 DOI: 10.1002/nau.24179] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/23/2019] [Indexed: 11/06/2022]
Abstract
AIMS To test the reliability and validity of intravaginal pressure measurements acquired during pelvic floor muscle (PFM) tasks in different body positions using the FemFit®, a new intravaginal pressure device. METHODS Twenty healthy adult women participated in this study. Two assessment sessions were conducted. Intravaginal pressure measurements using the FemFit® were repeated during PFM contraction and straining maneuvers while lying and standing. Maximal intravaginal pressures were collated and compared within and between sessions. They were also correlated to maximal force measurements obtained by dynamometry and vaginal digital palpation. Test-retest reliability was assessed using intraclass correlation coefficient, standard error of measurement and Bland-Altman plots. The validity of the pressure measurements was assessed using Pearson's correlation (dynamometry) and Spearman's rho (palpation). RESULTS This test-retest study indicate excellent reliability for PFM contraction and straining maneuver both in lying and standing, within and between sessions. For the straining maneuver while standing, increased variability was suggested by a wider limit of agreement on Bland-Altman plots (spanning 31.3 to 43.3mm Hg). A significant moderate to strong correlation was found when comparing measurements of PFM contraction using the FemFit® and the dynamometer or the palpation (Pearson's coefficient = 0.72, P = .006; Spearman's rho = 0.68, P = .005, respectively). CONCLUSION Our research findings suggest that intravaginal pressures can be reliably measured during PFM contraction and straining manoeuver while lying and standing, using the FemFit® device, both within and between sessions. A moderate to strong correlation between the FemFit® pressure and the force measurements obtained by dynamometry or palpation reinforce the validity of measurements.
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Affiliation(s)
- Licia P Cacciari
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut universitaire de gériatrie de Montréal, Montréal, Quebec, Canada
| | - Jennifer Kruger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jonathan Goodman
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - David Budgett
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Chantal Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Center of the Institut universitaire de gériatrie de Montréal, Montréal, Quebec, Canada
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Jia X, Rana N, Crouss T, Whitmore KE. Gynecological associated disorders and management. Int J Urol 2019; 26 Suppl 1:46-51. [PMID: 31144734 DOI: 10.1111/iju.13974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic pelvic pain syndrome is complex and involves multiple organ systems. The gynecological aspects of chronic pelvic pain syndrome can be divided into four different areas: intra-abdominal, vaginal, pelvic floor muscles and sexual pain. This article provides an overview of gynecological evaluation in patients with chronic pelvic pain and reviews the most common gynecological diagnoses and their management. METHODS An extensive review of the literature including guidelines from the International Continence Society, the European Association of Urology, and the International Association for the Study of Pain was performed. RESULTS Gynecological evaluation of patients with chronic pelvic pain begins with a thorough history and physical examination. Laboratory tests, imaging studies and diagnostic procedures can be used as adjuncts to make a diagnosis. Treatment modalities include physical therapy, medications, trigger points injections, and surgery. CONCLUSION Common gynecological diagnoses of chronic pelvic pain include endometriosis, adenomyosis, vulvodynia, high tone pelvic floor dysfunction, and genitopelvic pain/penetration disorder. Gynecology is one of the many systems that can be associated with chronic pelvic pain. Managing patients with chronic pelvic pain requires a multimodal and multidisciplinary approach.
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Affiliation(s)
- Xibei Jia
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Neha Rana
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Tess Crouss
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Kristene E Whitmore
- Division of Female Pelvic Medicine and Reconstructive surgery and Urology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Lemos AQ, Brasil CA, Valverde D, Ferreira JDS, Lordêlo P, Sá KN. The pilates method in the function of pelvic floor muscles: Systematic review and meta-analysis. J Bodyw Mov Ther 2019; 23:270-277. [PMID: 31103107 DOI: 10.1016/j.jbmt.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/14/2017] [Accepted: 02/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Many Pilates instructors believe that the method can produce significant improvement in the resistance of pelvic floor muscles, but it is known that about 49% of women who can contract this muscle do not perform an adequate contraction and cannot increase urethral closure pressure. OBJECTIVES To evaluate the response of the Pilates method in the function of the pelvic floor muscles, compared to the control group, in healthy women. SEARCH METHODS The following databases were searched from October to December 2016: PUBMED, SCIELO, LILACS, MEDLINE, WEB OF SCIENCE and CINAHL via PERIÓDICOS CAPES, without restriction of language and year of publication. SELECTION CRITERIA Randomized (RCTs), quasi-randomized, and non-randomized clinical trials assessing the effectiveness of the Pilates method for the fuction of pelvic floor muscles in healthy women were included. DATA COLLECTION AND ANALYSIS Two reviewers independently selected the studies, assessed the risk of bias and performed the data extraction. Primary outcomes were the method of evaluation of strength, function, coordination, and symmetry of contraction of the pelvic floor muscles. RESULTS 4434 articles were identified and 2 articles were selected to compose this review and the meta-analysis. No between-group difference was demonstrated for the pelvic floor muscle function as measured by perineometry (p = 0.32). CONCLUSIONS No evidence showed a modification of the function of pelvic floor muscles in healthy women practicing the Pilates method.
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Affiliation(s)
- Amanda Queiroz Lemos
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Metropolitan Union for the Development of Education and Culture (UNIME), Lauro de Freitas, Bahia, Brazil.
| | - Cristina Aires Brasil
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Metropolitan Union for the Development of Education and Culture (UNIME), Lauro de Freitas, Bahia, Brazil
| | - Danielle Valverde
- Bahiana School of Medicine and Public Health, Center for Attention to the Pelvic Floor, Salvador, Bahia, Brazil
| | - Janine Dos Santos Ferreira
- Bahiana School of Medicine and Public Health, Center for Attention to the Pelvic Floor, Salvador, Bahia, Brazil
| | - Patrícia Lordêlo
- Postgraduate Program at the Bahiana School of Medicine and Public Health, Center for Attention to the Pelvic Floor, Salvador, Bahia, Brazil
| | - Katia Nunes Sá
- Postgraduate Program at the Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
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Billecocq S, Bo K, Dumoulin C, Aigon A, Amarenco G, Bakker E, Cornillet-Bernard M, Crétinon S, Deffieux X, Lartigues G, Loobuick M, Steenstrup B, de Tayrac R. [An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and non-pharmacological management of female pelvic floor dysfunction]. Prog Urol 2019; 29:183-208. [PMID: 30803873 DOI: 10.1016/j.purol.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/30/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There has been an increasing need for the terminology for the conservative management of female pelvic floor dysfunction to be collated in a clinically-based consensus report. METHODS This report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology and nursing were invited to comment on the paper. RESULTS A terminology report for the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically-based with the most common symptoms, signs, assessments, diagnoses and treatments defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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Affiliation(s)
- S Billecocq
- Maternité Notre-Dame-de-Bon-Secours, groupe hospitalier Paris-Saint-Joseph, 75014 Paris, France.
| | - K Bo
- Department of sports medecine, Norwegian school of sports sciences, PO Box Ulleval Stadion, 0806 Oslo, Norvège
| | - C Dumoulin
- Programme de physiothérapie, faculté de médecine, université de Montréal, Montréal, Canada
| | - A Aigon
- Cabinet kinésithérapie libéral, 44000 Nantes, France
| | - G Amarenco
- Service de neuro-urologie et exploration périnéale, hôpital Tenon, 75020 Paris, France
| | - E Bakker
- HEL de Vinci, Parnasse-ISEI, 1200 Bruxelles, Belgique
| | | | - S Crétinon
- Hôpital Foch, école de sages-femmes, 92150 Suresnes, France
| | - X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, 92140 Clamart, France
| | | | - M Loobuick
- Cabinet kinésithérapie libéral, 75017 Paris, France
| | - B Steenstrup
- Service d'urologie, CHU de Rouen Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - R de Tayrac
- Service de gynécologie-obstétrique, CHRU Caremeau, place du Pr-R.-Debré, 30029 Nîmes cedex 9, France
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Saltiel F, Miranda-Gazzola APG, Vitória RO, Figueiredo EM. Terminology of Pelvic Floor Muscle Function in Women With and Without Urinary Incontinence: A Systematic Review. Phys Ther 2018; 98:876-890. [PMID: 30010919 DOI: 10.1093/ptj/pzy084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/08/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pelvic floor muscle function (PFMF) is a target of the physical therapist intervention for women with urinary incontinence (UI). However, possible variations in PFMF terminology might hamper communication among researchers and health care professionals in Women's Health. OBJECTIVE The objective of this study was to investigate the terminology of PFMF regarding clear terms, conceptual definitions, and operational definitions. DATA SOURCES Data sources include PUBMED, CINAHL, LILACS, and SCIELO. STUDY SELECTION Observational studies investigating any PFMF in women with or without UI, published in English, Spanish, or Portuguese from 2005 through 2017, were considered. DATA EXTRACTION The risk of bias was assessed by a questionnaire on the quality of observational studies. Data on terminology were extracted as terms, conceptual definitions, and operational definitions of PFMF and were synthesized according to key words, key ideas, and key operationalization, respectively. Consistencies and variations were identified for the most frequently investigated PFMF. DATA SYNTHESIS Sixty-four studies were included, and a low risk of bias was identified. All studies presented terms and operational definitions of PFMF, but only 29.7% presented conceptual definitions of those terms. One hundred ninety-six different terms referred to PFMF. According to similarities in terminology, 161 PFMF terms could be grouped under 26 terms; the other 35 were left ungrouped. Therefore, a total of 61 different PFMF terms were identified in the literature. LIMITATIONS A limitation in the study was that only observational studies were included. CONCLUSIONS A large variation in PFMF terminology was identified, precluding data gathering and meta-analysis. The lack of use of standardized terminology delays the progress of scientific knowledge and evidence-based practice dissemination. Efforts toward creating a collaborative, consensual terminology based on a sound framework are necessary.
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Affiliation(s)
- Fernanda Saltiel
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Women's Health Specialist, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Elyonara M Figueiredo
- Physical Therapy Department, Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Av. Antonio Carolos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901 Brazil
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Fear-avoidance and Pelvic Floor Muscle Function are Associated With Pain Intensity in Women With Vulvodynia. Clin J Pain 2018. [DOI: 10.1097/ajp.0000000000000604] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fontaine F, Dumoulin C, Bergeron S, Mayrand MH, Khalifé S, Wadell G, Morin M. Pelvic Floor Muscle Morphometry and Function in Women With Primary and Secondary Provoked Vestibulodynia. J Sex Med 2018; 15:1149-1157. [DOI: 10.1016/j.jsxm.2018.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
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Dos Reis Nagano RC, Biasotto-Gonzalez DA, da Costa GL, Amorim KM, Fumagalli MA, Amorim CF, Politti F. Test-retest reliability of the different dynamometric variables used to evaluate pelvic floor musculature during the menstrual cycle. Neurourol Urodyn 2018; 37:2606-2613. [PMID: 29664139 DOI: 10.1002/nau.23595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/20/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the reliability of different dynamometric variables of the pelvic floor muscles (PFM) in healthy women during different periods of menstrual cycle. MATERIALS AND METHODS Vaginal dynamometric equipment was developed by the authors and its reproducibility was tested. The PFM contractions of 20 healthy women were collected by two independent examiners over three consecutive weeks, always on the same day, with a seven-day interval between readings, starting from the first day after the end of the menstrual period. For the measurements, the branch of the dynamometer was positioned first on the sagittal plane and then on the frontal plane. Baseline, peak time, maximum PFM strength, impulse contraction, and average contraction force were calculated. Reproducibility was tested using the intra-class correlation coefficient (ICC) and standard error of measurement. Repeated-measures ANOVA was used to compare the data from different days. RESULTS For intra-day and inter-day reliability between examiners, all the parameters collected on the sagittal plane presented good and excellent reproducibility (ICC2,1 = 0.60 to 0.98), whereas reproducibility on the frontal plane was respectively poor and excellent (ICC2,1 = 0.23 to 0.97). The ANOVA revealed significant differences between sessions only for the impulse of contraction for the sagittal (P = 0.005) and frontal (P = 0.03) planes. CONCLUSIONS Time and contraction force parameters of the PFM are not influenced by hormonal alterations that occur during the menstrual cycle. The impulse of contraction was the only variable to demonstrate a significant difference between the first and second week of the data collection protocol. The baseline, maximum strength value, impulse of contraction, and average contraction force variables presented good to excellent reproducibility and can be safely used as a method of PFM evaluation.
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Affiliation(s)
- Reny C Dos Reis Nagano
- Universidade Nove de Julho, Postgraduate Program in Rehabilitation Sciences, Physical Therapy Departament, São Paulo, Brazil
| | - Daniela A Biasotto-Gonzalez
- Universidade Nove de Julho, Postgraduate Program in Rehabilitation Sciences, Physical Therapy Departament, São Paulo, Brazil
| | | | - Karina M Amorim
- Universidade Nove de Julho, Postgraduate Program in Rehabilitation Sciences, Physical Therapy Departament, São Paulo, Brazil
| | - Marco A Fumagalli
- Faculdade das Américas, Department of Mechanical Engineering, São Paulo, Brazil
| | - César F Amorim
- Universidade Cidade de São Paulo, Postgraduate Program in Rehabilitation Sciences, Physical Therapy Departament, São Paulo, Brazil
| | - Fabiano Politti
- Universidade Nove de Julho, Postgraduate Program in Rehabilitation Sciences, Physical Therapy Departament, São Paulo, Brazil
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Bérubé MÈ, Czyrnyj CS, McLean L. An automated intravaginal dynamometer: Reliability metrics and the impact of testing protocol on active and passive forces measured from the pelvic floor muscles. Neurourol Urodyn 2018; 37:1875-1888. [PMID: 29635776 DOI: 10.1002/nau.23575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/07/2017] [Indexed: 12/28/2022]
Abstract
AIMS (1) To determine the reliability of an automated dynamometer designed to assess pelvic floor muscle (PFM) strength and resistance to passive elongation. (2) To evaluate the impact of PFM length and rate of tissue elongation on dynamometric outcomes. METHODS At each of two sessions, twenty nulliparous women performed three maximum voluntary contractions (MVC) of their PFMs with the dynamometer set to two different anteroposterior (AP) diameters (25 mm, 35 mm). Next, with PFMs relaxed, the arms of the dynamometer opened three times to 40 mm at two speeds (25 mm/s, 50 mm/s). Outcomes included baseline force, peak force, relative peak force, rate of force development (RFD), stiffness and stress relaxation. Repeated-measures ANOVAs were used to test trial, day, and task effects (α = 0.05), and intra-class correlation coefficients (ICCs) were computed. RESULTS Forces measured on MVC were higher with the larger AP diameter, and passive resistance was higher for the faster rate of tissue elongation. The between-trial reliability of all outcomes was excellent (0.82 < ICC < 0.98) for all measures except for peak force during the passive elongation task (0.56 < ICC < 0.93). Between-day reliability was good to excellent for active and passive RFD (0.75 < ICC < 0.93), stiffness (ICC = 0.77) and relative peak force (0.71 < ICC < 0.87); absolute force (0.11 < ICC < 0.85) and stress relaxation responses (0.19 < ICC < 0.98) tended to be less reliable. CONCLUSIONS The reliability of the dynamometer is adequate for both clinical and research applications. Relative forces were more reliable than absolute forces. Dimensions and rate of tissue elongation should be controlled and reported with all pelvic floor muscle assessments as these parameters impact outcomes.
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Affiliation(s)
- Marie-Ève Bérubé
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Catriona S Czyrnyj
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
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25
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An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Int Urogynecol J 2018; 29:647-666. [DOI: 10.1007/s00192-018-3603-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 01/13/2023]
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26
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Rogers RG, Pauls RN, Thakar R, Morin M, Kuhn A, Petri E, Fatton B, Whitmore K, Kinsberg S, Lee J. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Neurourol Urodyn 2018; 37:1220-1240. [PMID: 29441607 DOI: 10.1002/nau.23508] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022]
Abstract
AIMS The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report. METHODS This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction. RESULTS A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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Affiliation(s)
| | | | - Ranee Thakar
- Croydon University Hospital Croydon, London, United Kingdom
| | | | - Annette Kuhn
- University Teaching Hospital Berne (Inselspital), Bern, Switzerland
| | | | - Brigitte Fatton
- University Hospital Nîmes, Nimes, Languedoc-Roussillon, France
| | | | | | - Joseph Lee
- University of New South Wales, St Vincents Hospital, Sydney, New South Wales, Australia
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Dumoulin C, Morin M, Mayrand MH, Tousignant M, Abrahamowicz M. Group physiotherapy compared to individual physiotherapy to treat urinary incontinence in aging women: study protocol for a randomized controlled trial. Trials 2017; 18:544. [PMID: 29145873 PMCID: PMC5689182 DOI: 10.1186/s13063-017-2261-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/17/2017] [Indexed: 11/23/2022] Open
Abstract
Background Urinary incontinence (UI), one of the most prevalent health concerns confronting women aged over 60 years, affects up to 55% of older community-dwelling women—20–25% with severe symptoms. Clinical practice guidelines recommend individualized pelvic floor muscle training (PFMT) as a first-line treatment for stress or mixed UI in women, although lack of human and financial resources limits delivery of this first-line treatment. Preliminary data suggest that group-based treatments may provide the answer. To date, no adequately powered trials have evaluated the effectiveness or cost-effectiveness of group compared to individual PFMT for UI in older women. Given demographic projections, high prevalence of UI in older women, costly barriers, and group PFMT promising results, there is a clear need to rigorously compare the short- and long-term effectiveness and cost-effectiveness of group vs individual PFMT. Methods/Design The study is designed as a non-inferiority randomized controlled trial, conducted in two facilities (Montreal and Sherbrooke) in the Canadian province of Quebec. Participants include 364 ambulatory, community-dwelling women, aged 60 years and older, with stress or mixed UI. Randomly assigned participants will follow a 12-week PFMT, either in one-on-one sessions or as part of a group, under the supervision of a physiotherapist. Blinded assessments at baseline, immediately post intervention, and at one year will include the seven-day bladder diary, the 24-h pad test, symptoms and quality of life questionnaires, adherence and self-efficacy questionnaire, pelvic floor muscle function, and cost assessments. Primary analysis will test our main hypothesis that group-based treatment is not inferior to individualized treatment with respect to the primary outcome: relative (%) reduction in the number of leakages. Discussion Should this study find that a group-based approach is not less effective than individual PFMT, and more cost-effective, this trial will impact positively continence-care accessibility and warrant a change in clinical practice. Trial registration ClinicalTrials.gov, NCT02039830. Registered on 12 December 2013; Study protocol version 2; 21 November 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2261-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Research Centre of the Institut Universitaire de Gériatrie de Montréal, 4565 Queen Mary M-5816, Montreal, QC, H3W 1W5, Canada.
| | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Marie-Hélène Mayrand
- Department of Obstetrics and Gynecology and Social and Preventive Medicine, Université de Montréal and Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Michel Tousignant
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center on Aging, Sherbrooke, QC, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
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High spatial resolution pressure distribution of the vaginal canal in Pompoir practitioners: A biomechanical approach for assessing the pelvic floor. Clin Biomech (Bristol, Avon) 2017; 47:53-60. [PMID: 28600995 DOI: 10.1016/j.clinbiomech.2017.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 05/23/2017] [Accepted: 05/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pompoir is a technique poorly studied in the literature that claims to improve pelvic floor strength and coordination. This study aims to investigate the pelvic floor muscles' coordination throughout the vaginal canal among Pompoir practitioners and non-practitioners by describing a high resolution map of pressure distribution. METHODS This cross-sectional, study included 40 healthy women in two groups: control and Pompoir. While these women performed both sustained and "waveform" pelvic floor muscle contractions, the spatiotemporal pressure distribution in their vaginal canals was evaluated by a non-deformable probe fully instrumented with a 10×10 matrix of capacitive transducers. FINDINGS Pompoir group was able to sustain the pressure levels achieved for a longer period (40% longer, moderate effect, P=0.04). During the "waveform" contraction task, Pompoir group achieved lower, earlier peak pressures (moderate effect, P=0.05) and decreased rates of contraction (small effect, P=0.04) and relaxation (large effect, P=0.01). During both tasks, Pompoir group had smaller relative contributions by the mid-region and the anteroposterior planes and greater contributions by the caudal and cranial regions and the latero-lateral planes. INTERPRETATION Results suggest that specific coordination training of the pelvic floor muscles alters the pressure distribution profile, promoting a more-symmetric distribution of pressure throughout the vaginal canal. Therefore, this study suggests that pelvic floor muscles can be trained to a degree beyond strengthening by focusing on coordination, which results in changes in symmetry of the spatiotemporal pressure distribution in the vaginal canal.
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Kruger JA, Budgett SC, Wong V, Nielsen PM, Nash MP, Smalldridge J, Hayward LM, Tian TY, Taberner AJ. Characterizing levator-ani muscle stiffness pre- and post-childbirth in European and Polynesian women in New Zealand: a pilot study. Acta Obstet Gynecol Scand 2017; 96:1234-1242. [DOI: 10.1111/aogs.13186] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 06/18/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Jennifer A. Kruger
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | | | - Vivien Wong
- Sydney Medical School Nepean; University of Sydney; Sydney Australia
| | - Poul M.F. Nielsen
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - Martyn P. Nash
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - Jackie Smalldridge
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - Lynsey M. Hayward
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - Tania Y. Tian
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - Andrew J. Taberner
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
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Bernard S, Moffet H, Plante M, Ouellet MP, Leblond J, Dumoulin C. Pelvic-Floor Properties in Women Reporting Urinary Incontinence After Surgery and Radiotherapy for Endometrial Cancer. Phys Ther 2017; 97:438-448. [PMID: 28201796 DOI: 10.1093/ptj/pzx012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Endometrial cancer is the fourth most prevalent cancer in Canadian women. Radiotherapy (RT) is frequently recommended as an adjuvant treatment. There is a high prevalence (>80%) of urinary incontinence (UI) after RT. It is plausible that UI is associated, at least in part, with alterations of the pelvic-floor muscles (PFM). OBJECTIVE The aim of this exploratory study was to compare the PFM functional properties of women reporting UI after hysterectomy and RT for endometrial cancer with those of women with a history of hysterectomy but without UI. DESIGN A descriptive cross-sectional study was conducted. Eleven women were recruited for the affected group, and 18 were recruited for the comparison group. METHODS Urogenital and bowel functions were assessed using International Consultation on Incontinence Questionnaires, and PFM properties were evaluated using a Montreal dynamometer. Nonparametric tests were used for comparison of personal characteristics, functional status, and muscle properties. A correspondence analysis detailed the association between UI severity and PFM properties. RESULTS Maximal opening of dynamometer branches, maximal vaginal length, PFM maximum force and rate of force development in a strength test, and number of rapid contractions during a speed test were reduced in the affected group. No significant difference was found for the endurance test. The severity of UI was found to correspond to the rate of force development and the number of rapid contractions in a speed test, endurance, age, and vaginal length. LIMITATIONS The results are limited to the population studied. The small sample size limited the strength of the conclusions. CONCLUSIONS Some evidence of alterations in PFM properties were found in women with UI after hysterectomy and RT for endometrial cancer. These alterations appeared to be associated with UI, suggesting a possible role for rehabilitation.
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Cyr MP, Kruger J, Wong V, Dumoulin C, Girard I, Morin M. Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period. Am J Obstet Gynecol 2017; 216:274.e1-274.e8. [PMID: 27939329 DOI: 10.1016/j.ajog.2016.11.1049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/16/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pelvic floor muscles are subject to considerable stretching during vaginal birth. In 13-36% of women, stretching results in avulsion injury whereby the puborectalis muscle disconnects from its insertion points on the pubis bone. Until now, few studies have investigated the effect of this lesion on pelvic floor muscles in the early postpartum period. OBJECTIVE The primary aim of this study was to compare pelvic floor muscle morphometry and function in primiparous women with and without puborectalis avulsion in the early postpartum period. Our secondary objective was to compare the 2 groups for pelvic floor disorders and impact on quality of life. STUDY DESIGN In all, 52 primiparous women diagnosed with (n = 22) or without (n = 30) puborectalis avulsion injury were assessed at 3 months postpartum. Pelvic floor muscle morphometry was evaluated with 3-/4-dimensional transperineal ultrasound at rest, maximal contraction, and Valsalva maneuver. Different parameters were measured in the midsagittal and axial planes: bladder neck position, levator plate angle, anorectal angle, and levator hiatus dimensions. The dynamometric speculum was used to assess pelvic floor muscle function including: passive properties (passive forces and stiffness) during dynamic stretches, maximal strength, speed of contraction, and endurance. Pelvic floor disorder-related symptoms (eg, urinary incontinence, vaginal and bowel symptoms) and impact on quality of life were evaluated with the International Consultation on Incontinence Questionnaire and the Pelvic Floor Impact Questionnaire-Short Form. Pelvic Organ Prolapse Quantification was also assessed. RESULTS In comparison to women without avulsion, women with avulsion presented an enlarged hiatus area at rest, maximal contraction, and Valsalva maneuver (P ≤ .013) and all other ultrasound parameters were found to be significantly altered during maximal contraction (P ≤ .014). They showed lower passive forces at maximal and 20-mm vaginal apertures as well as lower stiffness at 20-mm aperture (P ≤ .048). Significantly lower strength, speed of contraction, and endurance were also found in women with avulsion (P ≤ .005). They also presented more urinary incontinence symptoms (P = .040) whereas vaginal and bowel symptoms were found to be similar in the 2 groups. Pelvic Organ Prolapse Quantification revealed greater anterior compartment descent in women with avulsion (P ≤ .010). The impact of pelvic floor disorders on quality of life was found to be significantly higher in women with avulsion (P = .038). CONCLUSION This study confirms that pelvic floor muscle morphometry and function are impaired in primiparous women with puborectalis avulsion in the early postpartum period. Moreover, it highlights specific muscle parameters that are altered such as passive properties, strength, speed of contraction, and endurance.
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An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J 2016; 28:191-213. [PMID: 27921161 DOI: 10.1007/s00192-016-3123-4] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/02/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report. METHODS This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper. RESULTS A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research.
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Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, Bortolini M, Dumoulin C, Gomes M, McClurg D, Meijlink J, Shelly E, Trabuco E, Walker C, Wells A. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn 2016; 36:221-244. [DOI: 10.1002/nau.23107] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/02/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Kari Bo
- Department of Sports Medicine; Norwegian School of Sport Sciences; PO Box 4014, Ullevål Stadion, 0806 Oslo Norway
| | | | | | | | | | - Bary Berghmans
- Maastricht University Medical Centre; Maastricht Netherlands
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Pelvic floor muscle strength in primigravidae and non-pregnant nulliparous women: a comparative study. Int Urogynecol J 2016; 28:131-137. [DOI: 10.1007/s00192-016-3088-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
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35
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Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy: a case study. Menopause 2016; 23:816-20. [DOI: 10.1097/gme.0000000000000620] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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36
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Morin M, Dumoulin C, Bergeron S, Mayrand MH, Khalifé S, Waddell G, Dubois MF. Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods. Contemp Clin Trials 2016; 46:52-59. [DOI: 10.1016/j.cct.2015.11.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/10/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
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Romero-Cullerés G, Peña-Pitarch E, Jané-Feixas C, Arnau A, Montesinos J, Abenoza-Guardiola M. Intra-rater reliability and diagnostic accuracy of a new vaginal dynamometer to measure pelvic floor muscle strength in women with urinary incontinence. Neurourol Urodyn 2015; 36:333-337. [DOI: 10.1002/nau.22924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/16/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Georgia Romero-Cullerés
- Physical Medicine and Rehabilitation; Althaia Xarxa Assistencial Universitària de Manresa; Manresa Barcelona Spain
| | - Esteban Peña-Pitarch
- Escola Politècnica Superior d'Enginyeria de Manresa (EPSEM); Universitat Politècnica de Catalunya; Manresa Barcelona Spain
| | - Celia Jané-Feixas
- Physical Medicine and Rehabilitation; Althaia Xarxa Assistencial Universitària de Manresa; Manresa Barcelona Spain
| | - Anna Arnau
- Clinical Research Unit; Althaia Xarxa Assistencial Universitària de Manresa; Manresa Barcelona Spain
| | - Jesus Montesinos
- Clinical Research Unit; Althaia Xarxa Assistencial Universitària de Manresa; Manresa Barcelona Spain
| | - Montserrat Abenoza-Guardiola
- Physical Medicine and Rehabilitation; Althaia Xarxa Assistencial Universitària de Manresa; Manresa Barcelona Spain
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Martinho NM, Marques J, Silva VR, Silva SLA, Carvalho LC, Botelho S. Intra and inter-rater reliability study of pelvic floor muscle dynamometric measurements. Braz J Phys Ther 2015; 19:97-104. [PMID: 25993624 PMCID: PMC4481829 DOI: 10.1590/bjpt-rbf.2014.0083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/27/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE: The aim of this study was to evaluate the intra and inter-rater reliability of
pelvic floor muscle (PFM) dynamometric measurements for maximum and average
strengths, as well as endurance. METHOD: A convenience sample of 18 nulliparous women, without any urogynecological
complaints, aged between 19 and 31 (mean age of 25.4±3.9) participated in this
study. They were evaluated using a pelvic floor dynamometer based on load cell
technology. The dynamometric evaluations were repeated in three successive
sessions: two on the same day with a rest period of 30 minutes between them, and
the third on the following day. All participants were evaluated twice in each
session; first by examiner 1 followed by examiner 2. The vaginal dynamometry data
were analyzed using three parameters: maximum strength, average strength, and
endurance. The Intraclass Correlation Coefficient (ICC) was applied to estimate
the PFM dynamometric measurement reliability, considering a good level as being
above 0.75. RESULTS: The intra and inter-raters' analyses showed good reliability for maximum strength
(ICCintra-rater1=0.96, ICCintra-rater2=0.95, and
ICCinter-rater=0.96), average strength
(ICCintra-rater1=0.96, ICCintra-rater2=0.94, and
ICCinter-rater=0.97), and endurance
(ICCintra-rater1=0.88, ICCintra-rater2=0.86, and
ICCinter-rater=0.92) dynamometric measurements. CONCLUSIONS: The PFM dynamometric measurements showed good intra- and inter-rater reliability
for maximum strength, average strength and endurance, which demonstrates that this
is a reliable device that can be used in clinical practice.
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Affiliation(s)
- Natalia M Martinho
- Escola de Enfermagem, Universidade Federal de Alfenas, Alfenas, MG, Brazil
| | - Joseane Marques
- Escola de Enfermagem, Universidade Federal de Alfenas, Alfenas, MG, Brazil
| | - Valéria R Silva
- Escola de Enfermagem, Universidade Federal de Alfenas, Alfenas, MG, Brazil
| | - Silvia L A Silva
- Escola de Enfermagem, Universidade Federal de Alfenas, Alfenas, MG, Brazil
| | | | - Simone Botelho
- Escola de Enfermagem, Universidade Federal de Alfenas, Alfenas, MG, Brazil
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Corsini-Munt S, Bergeron S, Rosen NO, Steben M, Mayrand MH, Delisle I, McDuff P, Aerts L, Santerre-Baillargeon M. A comparison of cognitive-behavioral couple therapy and lidocaine in the treatment of provoked vestibulodynia: study protocol for a randomized clinical trial. Trials 2014; 15:506. [PMID: 25540035 PMCID: PMC4307632 DOI: 10.1186/1745-6215-15-506] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/26/2014] [Indexed: 01/23/2023] Open
Abstract
Background Provoked vestibulodynia (PVD), a frequent form of chronic genital pain, is associated with decreased sexual function for afflicted women, as well as impoverished sexual satisfaction for women and their partners. Pain and sexuality outcomes for couples with PVD are influenced by interpersonal factors, such as pain catastrophizing, partner responses to pain, ambivalence over emotional expression, attachment style and perceived relationship and sexual intimacy. Despite recommendations in the literature to include the partner in cognitive-behavioral therapy targeted at improving pain and sexuality outcomes, no randomized clinical trial has tested the efficacy of this type of intervention and compared it to a first-line medical intervention. Methods This bi-center, randomized clinical trial is designed to examine the efficacy of cognitive-behavioral couple therapy compared to topical lidocaine. It is conducted across two Canadian university-hospital centers. Eligible women diagnosed with PVD and their partners are randomized to one of the two interventions. Evaluations are conducted using structured interviews and validated self-report measures at three time points: Pre-treatment (T1: prior to randomization), post-treatment (T2), and 6-month follow-up (T3). The primary outcome is the change in reported pain during intercourse between T1 and T2. Secondary outcomes focus on whether there are significant differences between the two treatments at T2 and T3 on (a) the multidimensional aspects of women’s pain and (b) women and partners’ sexuality (sexual function and satisfaction), psychological adjustment (anxiety, depression, catastrophizing, self-efficacy, and quality of life), relationship factors (partner responses and dyadic adjustment) and self-reported improvement and treatment satisfaction. In order to detect an effect size as small as 0.32 for secondary outcomes, a sample of 170 couples is being recruited (27% dropout expected). A clinically significant decrease in pain is defined as a 30% reduction. Discussion The randomized clinical trial design is the most appropriate to examine the efficacy of cognitive-behavioral couple therapy, a recently developed and pilot-tested psychosocial intervention for couples coping with PVD, in comparison to a frequent first-line treatment option, topical lidocaine. Findings from this study will provide important information about empirically supported treatment options for PVD, and inform future treatment development and research for this patient population. Trial registration Clinicaltrials.gov NCT01935063; registration date: 27 August 27 2013.
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Affiliation(s)
- Serena Corsini-Munt
- Department of Psychology, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montréal H3T 1J4, Canada.
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Ashton-Miller JA, Zielinski R, DeLancey JOL, Miller JM. Validity and reliability of an instrumented speculum designed to minimize the effect of intra-abdominal pressure on the measurement of pelvic floor muscle strength. Clin Biomech (Bristol, Avon) 2014; 29:1146-50. [PMID: 25307868 PMCID: PMC4372800 DOI: 10.1016/j.clinbiomech.2014.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Measurements of pelvic floor muscle strength are contaminated by crosstalk from intra-abdominal pressure. We tested an improved instrumented speculum designed to minimize this crosstalk. The hypotheses were that the speculum yields: 1) maximum vaginal closure forces unrelated to intra-abdominal pressure, 2) discriminatory validity between women with strong vs. weak pelvic floor muscles, and 3) acceptable test-retest reliability. METHODS Maximum voluntary vaginal closure force was measured in 40 incontinent women (20-77 years) on two visits spaced one month apart. At the baseline visit, intra-abdominal pressure was also estimated via intra-vesical catheterization during the vaginal closure force measurement. Subjective estimate of pelvic floor muscle strength was also assessed using digital palpation by a skilled examiner to determine group placement as "strong" (n=31) or "weak" (n=9). FINDINGS Vaginal closure force was not significantly correlated with intra-abdominal pressure (r=-.26, P=.109). The groups with subjectively scored strong and weak pelvic floor muscles differed significantly by mean [SD] maximum vaginal closure force (3.8 [1.7] vs. 1.9 [0.8] N respectively, P<.01.) Across both time points the mean vaginal closure force was 3.42 [1.67] N with a range of .68 to 9.05 N. Mean Visit 1 and Visit 2 vaginal closure force scores did not differ (3.41 [1.8] and 3.42 [1.6] N, respectively). The vaginal closure force repeatability coefficient was 3.1N. INTERPRETATION The improved speculum measured maximum vaginal closure force without evidence of crosstalk from intra-abdominal pressure, while retaining acceptable discriminant validity and repeatability.
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Affiliation(s)
- James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan College of Engineering, Ann Arbor, MI, United States.
| | - Ruth Zielinski
- University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - John O L DeLancey
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, MI, United States
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Mittal RK, Sheean G, Padda BS, Rajasekaran MR. Length tension function of puborectalis muscle: implications for the treatment of fecal incontinence and pelvic floor disorders. J Neurogastroenterol Motil 2014; 20:539-46. [PMID: 25273124 PMCID: PMC4204420 DOI: 10.5056/jnm14033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/AIMS External anal sphincter (EAS) and puborectalis muscle (PRM) play important role in anal continence function. Based on length-tension measurement, we recently reported that the human EAS muscle operates at short sarcomere length under phys-iological conditions. Goal of our study was to determine if PRM also operates at the short sarcomere length. METHODS Length-tension relationship of the PRM muscle was studied in vivo in 10 healthy nullipara women. Length was altered by vagi-nal distension using custom-designed probes of 5, 10, 15, 20, 25 and 30 mm diameters as well as by distending a poly-ethylene bag with different volumes of water. Probes were equipped with a reverse perfuse sleeve sensor to measure vaginal pressure (surrogate of PRM tension). PRM electromyogram (EMG) was recorded using wire electrodes. Three-dimensional ultra-sound images were obtained to determine effect of vaginal distension on PRM length. RESULTS Ultrasound images demonstrate distension volume dependent increase in PRM length. Rest and squeeze pressures of vaginal bag increased with the increase in bag volume. Similarly, the change in vaginal pressure, which represents the PRM contraction increased with the increase in the probe size. Increase in probe size was not associated with an increase in EMG activity (a marker of neural drive) of the PRM. CONCLUSIONS Probe size dependent increase in PRM contraction pressure, in the presence of constant EMG (neural input) proves that the hu-man PRM operates at short sarcomere length. Surgically adjusting the PRM length may represent a novel strategy to improve treat anal continence and possibly other pelvic floor disorders.(J Neurogastroenterol Motil 2014;20:539-546).
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Affiliation(s)
- Ravinder K Mittal
- Pelvic Floor Function and Diseases Group, Division of Gastroenterology, University of California, San Diego, CA, USA
| | - Geoff Sheean
- Pelvic Floor Function and Diseases Group, Department of Neurology, University of California, San Diego, CA, USA
| | - Bikram S Padda
- Pelvic Floor Function and Diseases Group, Division of Gastroenterology, University of California, San Diego, CA, USA
| | - Mahadevan R Rajasekaran
- Pelvic Floor Function and Diseases Group, Division of Gastroenterology, University of California, San Diego, CA, USA
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Kruger JA, Nielsen PM, Budgett SC, Taberner AJ. An automated hand-held elastometer for quantifying the passive stiffness of the levator ani muscle in women. Neurourol Urodyn 2013; 34:133-8. [DOI: 10.1002/nau.22537] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/25/2013] [Indexed: 12/28/2022]
Affiliation(s)
- Jennifer A. Kruger
- Auckland Bioengineering Institute; The University of Auckland; Auckland New Zealand
| | - Poul M.F. Nielsen
- Department of Engineering Science; Auckland Bioengineering Institute; The University of Auckland; Auckland New Zealand
| | | | - Andrew J. Taberner
- Department of Engineering Science; Auckland Bioengineering Institute; The University of Auckland; Auckland New Zealand
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Dumoulin C, Martin C, Elliott V, Bourbonnais D, Morin M, Lemieux MC, Gauthier R. Randomized controlled trial of physiotherapy for postpartum stress incontinence: 7-year follow-up. Neurourol Urodyn 2013; 32:449-54. [DOI: 10.1002/nau.22330] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 09/12/2012] [Indexed: 11/11/2022]
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Kim EY, Kim SY, Oh DW. Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training. Clin Rehabil 2011; 26:132-41. [DOI: 10.1177/0269215511411498] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To investigate the effect of supervised and unsupervised pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence and to compare the outcomes. Design: Randomized, single-blind controlled study. Setting: Outpatient rehabilitation hospital. Subjects: Eighteen subjects with postpartum urinary incontinence. Interventions: Subjects were randomized to either a supervised training group with verbal instruction from a physiotherapist, or an unsupervised training group after undergoing a supervised demonstration session. Main measures: Bristol Female Lower Urinary Tract Symptom questionnaire (urinary symptoms and quality of life) and vaginal function test (maximal vaginal squeeze pressure and holding time) using a perineometer. Results: The change values for urinary symptoms (−27.22 ± 6.20 versus −18.22 ± 5.49), quality of life (−5.33 ± 2.96 versus −1.78 ± 3.93), total score (−32.56 ± 8.17 versus −20.00 ± 6.67), maximal vaginal squeeze pressure (18.96 ± 9.08 versus 2.67 ± 3.64 mmHg), and holding time (11.32 ± 3.17 versus 5.72 ± 2.29 seconds) were more improved in the supervised group than in the unsupervised group ( P < 0.05). In the supervised group, significant differences were found for all variables between pre- and post-test values ( P < 0.01), whereas the unsupervised group showed significant differences for urinary symptom score, total score and holding time between the pre- and post-test results ( P < 0.05). Conclusions: These findings suggest that exercising the pelvic floor muscles by utilizing trunk stabilization under physiotherapist supervision may be beneficial for the management of postpartum urinary incontinence.
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Affiliation(s)
- Eun-Young Kim
- Department of Physical Therapy, The Graduate School, Daejeon University, Dong-gu, Daejeon, Republic of Korea
| | - Suhn-Yeop Kim
- Department of Physical Therapy, College of Health and Sport Science, Daejeon University, Dong-gu, Daejeon, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health and Sport Science, Daejeon University, Dong-gu, Daejeon, Republic of Korea
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Reliability of Bidirectional and Variable-Opening Equipment for the Measurement of Pelvic Floor Muscle Strength. PM R 2011; 3:21-6. [DOI: 10.1016/j.pmrj.2010.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 10/21/2010] [Accepted: 10/27/2010] [Indexed: 11/17/2022]
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Ferreira CHJ, Barbosa PB, de Oliveira Souza F, Antônio FI, Franco MM, Bø K. Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometer. Physiotherapy 2010; 97:132-8. [PMID: 21497247 DOI: 10.1016/j.physio.2010.06.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Accepted: 06/28/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the inter-rater reliability of the modified Oxford Grading Scale and the Peritron manometer. DESIGN All participants were evaluated twice, first by one examiner and 30 days later by a second examiner. Measurements of vaginal squeeze pressure were compared with the results from the palpation test. PARTICIPANTS Nineteen women with a mean age of 23.7 years (range 21 to 28 years). RESULTS Inter-rater reliability for vaginal palpation was fair (κ=0.33, 95% confidence interval 0.09 to 0.57). Using the Peritron manometer, the difference between examiners was less than 10cmH(2)O in 11 of the 19 (58%) cases. The palpation test did not differentiate between weak, moderate, good and strong muscle contractions. This study found fair inter-rater reliability for the modified Oxford Grading Scale and moderate inter-rater reliability for the Peritron manometer. CONCLUSIONS The inter-rater reliability of vaginal squeeze pressure measurement using the Peritron manometer is acceptable and can be used in re-evaluations performed by different examiners in clinical practice. However, for research purposes, the ideal situation would be for a single examiner to assess and re-assess the subject. Vaginal palpation is important in the clinical assessment of correctness of a pelvic floor muscle contraction, but this study does not support the use of the modified Oxford Grading Scale as a reliable and valid method to measure and differentiate pelvic floor muscle strength.
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Affiliation(s)
- Cristine Homsi Jorge Ferreira
- Faculty of Medicine of Ribeirão Preto, Department of Biomechanics, Medicine and Rehabilitation of Locomotor System, Course of Physiotherapy, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, 14049-900, Ribeirão Preto, SP, Brazil.
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Morin M, Gravel D, Bourbonnais D, Dumoulin C, Ouellet S, Pilon JF. Application of a new method in the study of pelvic floor muscle passive properties in continent women. J Electromyogr Kinesiol 2010; 20:795-803. [DOI: 10.1016/j.jelekin.2009.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 10/07/2009] [Accepted: 10/07/2009] [Indexed: 11/26/2022] Open
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Raizada V, Bhargava V, Jung SA, Karstens A, Pretorius D, Krysl P, Mittal RK. Dynamic assessment of the vaginal high-pressure zone using high-definition manometery, 3-dimensional ultrasound, and magnetic resonance imaging of the pelvic floor muscles. Am J Obstet Gynecol 2010; 203:172.e1-8. [PMID: 20462564 DOI: 10.1016/j.ajog.2010.02.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 12/14/2009] [Accepted: 02/10/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We used a novel technique, high-definition manometry (HDM) that utilizes 256 tactile sensitive microtransducers to define the characteristics of vaginal high-pressure zone. STUDY DESIGN Sixteen nullipara asymptomatic women were studied using HDM, transperineal 2-dimensional dynamic ultrasound and dynamic magnetic resonance (MR) imaging. RESULTS Vaginal high-pressure zone revealed higher contact pressures in anterior and posterior directions compared with lateral directions, both at rest and squeeze. At rest, anterior pressure cluster is located 10 mm cephalad to posterior pressure cluster; with squeeze the latter moves in the cranial direction by 7 mm. Ultrasound and MR images revealed that the anorectal angle moves cephalad and ventrally during squeeze. Cephalad movement of posterior pressure cluster during squeeze is similar to the cranial movement of anorectal angle. CONCLUSION We propose that the vaginal high-pressure zone represents the constrictor function and cranial movement of the posterior pressure cluster represents the elevator function of pelvic floor. HDM may be used to measure the constrictor and elevator functions of pelvic floor muscles.
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Affiliation(s)
- Varuna Raizada
- Pelvic Floor Function and Disease Group, Division of Gastroenterology, University of California, San Diego, San Diego, CA, USA
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Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux MC. Predictors of Success for Physiotherapy Treatment in Women With Persistent Postpartum Stress Urinary Incontinence. Arch Phys Med Rehabil 2010; 91:1059-63. [DOI: 10.1016/j.apmr.2010.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 02/24/2010] [Accepted: 03/02/2010] [Indexed: 11/16/2022]
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Measurement of pelvic floor muscular strength with the Colpexin pull test: a comparative study. Int Urogynecol J 2010; 21:1011-7. [PMID: 20306174 DOI: 10.1007/s00192-010-1130-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to compare the Colpexin pull test (CPT) with the Oxford muscle grading scale (OMGS) in assessing pelvic floor muscle strength. METHODS In phase 1, 15 asymptomatic women underwent OMGS and CPT using three different spheres to select the ideal size. CPT values as well as patient/examiner comfort and ease of CPT performance were recorded. In phase 2, 30 women with stress urinary incontinence underwent CPT and OMGS by two examiners during two separate sessions. Statistical analysis was performed. RESULTS In phase 1, the 36-mm sphere was selected based on resting (p < 0.001), contraction CPT (p < 0.001), patient ease (p = 0.018), patient comfort (p = 0.004), and examiner comfort (p < 0.001). In phase 2, there was good intra-rater and inter-rater agreement in maximum CPT. Both tests were positively correlated (r = 0.50, p < 0.001). CONCLUSION CPT is an objective measure of pelvic floor strength and provides consistent, reproducible results.
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