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Yakit Yeşilyurt S, Ramazanoğlu İ, Tosun G, Özer M, Çeliker Tosun Ö. Does Pelvic Floor Muscle Exercise Change the Hemodynamic Responses of the Inferior Vena Cava in Pregnant Women? A Prospective-Controlled Study. Int Urogynecol J 2024; 35:1653-1662. [PMID: 38963506 DOI: 10.1007/s00192-024-05860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at exploring the immediate impacts of pelvic floor muscle exercises (PFMEs) on various maternal physiological parameters in pregnant women. METHODS The study included a total of 52 women, 26 pregnant (Pregnant group: 28.04±6.01 years; 26.83±3.81 kg/m2) and 26 nonpregnant (Control group: 29.42±5.73 years; 25.41±3.03 kg/m2) individuals. All women received PFME as follows: PFME was performed for 5 min (6-s holding contraction, 10 s of relaxation, 3 rapid PFM contractions). Evaluations were conducted before, immediately after, and 5 min post-exercise, with measurements including inferior vena cava (IVC) diameters and pulsatility index, blood pressure, oxygen saturation, and heart rates. Two-way analysis of variance was performed for group and time comparisons in repeated measurements. RESULTS In both groups, the IVC collapsibility index values were lower 5 min after exercise, although this decrease, although clinically significant, did not reach statistical significance (p = 0.057). Post-exercise systolic blood pressure significantly decreased in both groups, whereas diastolic blood pressure decreased significantly in the pregnant group (p = 0.001, p = 0.023). CONCLUSIONS The study found no statistically significant changes in the collapsibility index of the IVC after PFME but observed a clinically suggestive decrease. The clinical decrease in the collapsibility index can be interpreted as PFME in the supine position increasing venous return. Additionally, PFME was found not to alter maternal and fetal heart rates but contributed to the decrease in maternal systolic and diastolic blood pressure. Our study supports the view that the acute effects of PFME neither induce fetal stress nor pose maternal risks.
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Affiliation(s)
- Seda Yakit Yeşilyurt
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Izmir University of Economics, Izmir, Türkiye.
| | - İrem Ramazanoğlu
- Dokuz Eylül University Institute of Health Sciences Physical Therapy and Rehabilitation Master's Program, Izmir, Türkiye
| | - Gökhan Tosun
- Department of Gynecology and Obstetrics, Health Sciences University Izmir Tepecik Education and Research Hospital, Izmir, Türkiye
| | - Mehmet Özer
- Department of Gynecology and Obstetrics, Health Sciences University Izmir Tepecik Education and Research Hospital, Izmir, Türkiye
| | - Özge Çeliker Tosun
- Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Dokuz Eylül University, Izmir, Türkiye
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Carroll L, Sullivan CO, Doody C, Perrotta C, Fullen BM. Pelvic organ prolapse: Women's experiences of Accessing Care & Recommendations for improvement. BMC Womens Health 2023; 23:672. [PMID: 38114966 PMCID: PMC10729347 DOI: 10.1186/s12905-023-02832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime. Symptoms include pain, bulge, urinary, bowel and sexual symptoms affecting all aspects of a woman's life.Many women with POP symptoms present initially to primary care settings. Research has shown these interactions are often unsatisfactory, with women reporting their health care professional (HCP) trivialized their symptoms or appeared to have poor knowledge about pelvic floor dysfunction (PFD).Aim The aim of this qualitative study was to explore experiences of younger women seeking treatment for POP and their recommendations for improvements.Methods Ethics approval was obtained (LS-21-01-Carroll-Ful). Women with POP were recruited from an online support group (n = 930 members). Inclusion criteria: adult women, diagnosed with POP and aware of their POP stage. Following informed consent, a demographic questionnaire, interview questions and the Central Sensitization Inventory (CSI) were forwarded. Semi-structured zoom audio-recorded interviews were conducted. Thematic analysis was undertaken; transcripts coded, and themes identified.Results Fourteen women aged 32-41, parity 1-3, with POP Grade 1-3 participated. Many women reported HCPs as dismissive or not appreciative of the impact of their condition. Others described interactions with HCPs who they felt listened, understood the impact of their POP, gave simple explanations, a positive prognosis and outlined a realistic treatment plan.Current antenatal education, post-partum care and primary HCP screening for PFD were identified by women as deficient. Many highlighted delays in accessing specialist care for POP. Women made several recommendations for improvements to the current model of care.Conclusions Increased focus on person-centred care, particularly emotional support, information and education may improve younger women's experiences when seeking care for POP.
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Affiliation(s)
- Louise Carroll
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland.
- University College Dublin Centre for Translational Pain Research, Dublin, Ireland.
- Tipperary University Hospital, Clonmel, Co. Tipperary, Clonmel, Ireland.
| | - Cliona O' Sullivan
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Catherine Doody
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
- University College Dublin Centre for Translational Pain Research, Dublin, Ireland
| | - Carla Perrotta
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Brona M Fullen
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
- University College Dublin Centre for Translational Pain Research, Dublin, Ireland
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Lucena da Silva M, Andressa Bastos Primo de Sousa Santos T, Wane Carvalho Leite L, Emanoel Chaves da Silva C, Oliveira do Nascimento A, Teixeira Alves A, Driusso P, da Costa Cunha K. The effectiveness of interventions in the prevention of perineal trauma in parturients: A systematic review with meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 283:100-111. [PMID: 36827751 DOI: 10.1016/j.ejogrb.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023]
Abstract
AIM To investigate the effectiveness of interventions to prevent the occurrence of perineal trauma in parturients. METHODS A bibliographic search was carried out in Cochrane Library, MEDLINE via PUBMED, LILACS via Virtual Health Library (VHL), Embase, Scopus, CINAHL, Scielo, Web of Science, and PEDro databases. Randomized clinical trials evaluating the effects of any intervention to prevent perineal trauma during pregnancy and/or childbirth were included. There were no temporal or language restrictions. The risk of bias assessment was performed using the Revised Cochrane Risk-of-bias Tool for Randomized Trials. RESULTS Fifty studies, with a total of 17,221 participants, were included in this meta-analysis. No intervention during childbirth was effective for the prevention of perineal trauma (RR = 1.07, 95% CI [0.98.1.18], p < 0.01, I2 = 83%) when compared to no intervention. However, a lower risk of perineal laceration was verified with techniques performed during pregnancy, when compared to no intervention (RR = 0.81, 95% CI [0.71, 0.93], p = 0.05, I2 = 47%). Among them, highlight the effects of perineal massage in preventing lacerations (RR = 0.69, 95% CI [0.54, 0.87], p < 0.01) when compared to no intervention. CONCLUSIONS The techniques performed during pregnancy, especially perineal massage, are associated with a lower risk of perineal laceration.
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Affiliation(s)
- Marianne Lucena da Silva
- Universidade Federal de Jataí, UFJ - Campus Riachuelo, Rua Riachuelo n° 1530 - Setor - Samuel Grahan, Jataí - GO, 75804-020, Jataí, Goiás, Brazil
| | | | - Lindely Wane Carvalho Leite
- Universidade do Estado do Pará, Avenida Hiléia, s/n° - Agrópolis do Incra - Bairro Amapá CEP: 68502-100, Marabá, Pará, Brazil
| | - Carlos Emanoel Chaves da Silva
- Universidade do Estado do Pará, Avenida Hiléia, s/n° - Agrópolis do Incra - Bairro Amapá CEP: 68502-100, Marabá, Pará, Brazil
| | - Alef Oliveira do Nascimento
- Universidade do Estado do Pará, Avenida Hiléia, s/n° - Agrópolis do Incra - Bairro Amapá CEP: 68502-100, Marabá, Pará, Brazil
| | - Aline Teixeira Alves
- Universidade de Brasília, Universidade de Brasília, Faculdade de Ceilândia, Campus Universitário - Centro Metropolitano, Ceilândia Sul, Brasília-DF. CEP: 72220-275, Brazil.
| | - Patrícia Driusso
- Universidade Federal de São Carlos, Rodovia Washington Luís, km 235 - SP-310. São Carlos, CEP 13565-905, São Paulo, Brazil
| | - Katiane da Costa Cunha
- Universidade do Estado do Pará, Avenida Hiléia, s/n° - Agrópolis do Incra - Bairro Amapá CEP: 68502-100, Marabá, Pará, Brazil
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Kuczera A, Opala-Berdzik A, Malá J, Sodowski M, Chmielewska D. Comparison of First Childbirth Characteristics between Elite Judo Athletes and Non-Athletes: The Preliminary Retrospective Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13218. [PMID: 36293804 PMCID: PMC9602800 DOI: 10.3390/ijerph192013218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
It has been speculated that elite athletes are more likely to have obstetric interventions during labor and delivery. So far, the impact of many years of competitive sports participation on childbirth characteristics has not been well-established. This preliminary retrospective case-control study aimed to determine whether the first labors of elite judo competitors required obstetric interventions more frequently and were longer than those of non-athletes. The study comprised 32 parous women: 16 elite judo athletes and 16 non-athletes. Women were included if they had access to the following obstetric data (from their first childbirth hospital discharge reports and/or first child's health record books): induction and augmentation of labor, mode of delivery, the duration of labor and its second stage, episiotomy, perineal tear, and the neonate's Apgar score. Electronic surveys were completed concerning childbirth characteristics, level of "eliteness" (judo athletes), and recreational physical activity (non-athletes). The statistical analysis showed no significant between-group differences in any of the first childbirth outcomes under analysis. The preliminary results indicate elite judo practice before first pregnancy had no negative impact on the rates of labor induction and augmentation, delivery mode, duration of labor, the rates of episiotomy and perineal tear, and the neonate's Apgar score. Due to the small sample size, the conclusions should be considered with caution.
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Affiliation(s)
- Anna Kuczera
- Students Scientific Association on the Analysis of the Influence of Pregnancy on the Musculoskeletal System, Physiotherapy Faculty, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Agnieszka Opala-Berdzik
- Department of Physiotherapy in Internal Diseases, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Jitka Malá
- Physiotherapy Department, Faculty of Physical Education and Sport, Charles University, 121 08 Prague, Czech Republic
| | - Marcin Sodowski
- Gynecology and Obstetrics Ward, City Hospital in Siemianowice Śląskie, 41-100 Siemianowice Slaskie, Poland
| | - Daria Chmielewska
- Electromyography and Pelvic Floor Muscles Laboratory, Department of Physical Medicine, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
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Yetişkin G, Dinç Kaya H. The effect of pelvic floor muscle exercises applied during pregnancy on genito-pelvic pain level in postpartum period. Int Urogynecol J 2022; 33:2791-2799. [PMID: 35678835 DOI: 10.1007/s00192-022-05225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The goal of the study is to determine the effect of pelvic floor muscle exercises on genito-pelvic pain levels during the postpartum period. METHODS The data of the study, which was carried out in a randomized controlled experimental design, were collected in the antenatal policlinic of a public hospital from June-December 2019. There were 60 pregnant women in the experimental and control groups. Pelvic floor muscle exercises were applied to the pregnant women in the experimental group from the 30th week of gestation to the 6th week postpartum. The control group was not given pelvic floor muscle exercise training, and only data collection forms were filled in. During the study, the Descriptive Form, Verbal Category Scale, Pelvic Floor Distress Inventory-20, and Labour and Postpartum Information Form were given to the pregnant women in both groups. RESULTS After pregnant women in the experimental group performed pelvic floor muscle exercises, pain levels were significantly lower than in the control group (p < 0.01). Pelvic Floor Distress Inventory-20 total score and sub-dimension scores of the experimental group were statistically significantly lower than in the control group (p < 0.01). In addition, a statistically significant difference was found (p < 0.01) in the postpartum 72 h findings of the experimental group in which pelvic floor muscle exercises were applied compared to the control group. CONCLUSIONS According to the result of the study, as the gestational weeks progress, the genito-pelvic pain increases. Pelvic floor muscle exercises applied during pregnancy prevent the development and progression of pelvic floor disorders in both the antenatal and postnatal periods. TRIAL REGISTRATION NCT05343520.
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Affiliation(s)
| | - Hüsniye Dinç Kaya
- Faculty of Health Sciences Department of Midwifery, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Hübner M, Rothe C, Plappert C, Baeßler K. Aspects of Pelvic Floor Protection in Spontaneous Delivery - a Review. Geburtshilfe Frauenheilkd 2022; 82:400-409. [PMID: 35392067 PMCID: PMC8983111 DOI: 10.1055/a-1515-2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
The necessity of increasingly addressing aspects of pelvic floor protection, i.e., prevention of the most frequent female pelvic floor disorders, such as urinary incontinence, faecal incontinence and pelvic organ prolapse, is the result of the steadily improving understanding of the association of pregnancy and delivery with the prevalence of these disorders. About a quarter of all women experience one or more such symptoms during their life. Apart from age and weight, pregnancies and births play an important part. While initial discussion of pelvic floor protection often focused very rapidly on the mode of delivery and elective caesarean section as a possible protective intervention, it has become apparent in the last few decades how varied and wide-ranging the options are that can be used to protect against pelvic floor disorders. The mode of delivery as such is "only" one element among numerous other considerations and has diminished markedly in importance. Interprofessionality and interdisciplinarity undoubtedly represent an important development as resulting recommendations must always be incorporated in an overall context that considers mother and child at the same time. Considering the pelvic floor only certainly does not make sense. This review article will analyze in greater detail important pre-, intra- and postpartum aspects that in their entirety can provide insight into the various aspects of pelvic floor protection. The authors regard the following article as an additional basis for discussion on achieving a sustained reduction in the incidence and prevalence of female pelvic floor disorders.
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Affiliation(s)
- Markus Hübner
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- Medizinische Fakultät der Universität Tübingen, Tübingen, Germany
| | | | - Claudia Plappert
- Institut für Gesundheitswissenschaften, Abt. Hebammenwissenschaft, Universität Tübingen, Tübingen, Germany
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Jaffar A, Mohd-Sidik S, Foo CN, Admodisastro N, Abdul Salam SN, Ismail ND. Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study. JMIR Hum Factors 2022; 9:e30989. [PMID: 35113025 PMCID: PMC8855292 DOI: 10.2196/30989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but their effectiveness in pregnant women was limited. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. OBJECTIVE This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. METHODS We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. RESULTS A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design-11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. CONCLUSIONS The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study.
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Affiliation(s)
- Aida Jaffar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.,Primary Care Unit, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Wilayah Persekutuan, Malaysia
| | - Sherina Mohd-Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Chai Nien Foo
- Department of Population Medicine, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Novia Admodisastro
- Software Engineering & Information System Department, Faculty of Computer Science & Information Technology, Universiti Putra Malaysia, Selangor, Malaysia
| | - Sobihatun Nur Abdul Salam
- School of Multimedia Technology and Communication, College of Arts and Sciences, Universiti Utara Malaysia, Kedah, Malaysia
| | - Noor Diana Ismail
- Klinik Kesihatan Bt 9 Cheras, Ministry of Health, Selangor, Malaysia
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Barger MK. Current Resources for Evidence-Based Practice, July/August 2021. J Midwifery Womens Health 2021; 66:540-547. [PMID: 34338411 DOI: 10.1111/jmwh.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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Woodley SJ, Hay-Smith EJC. Narrative review of pelvic floor muscle training for childbearing women-why, when, what, and how. Int Urogynecol J 2021; 32:1977-1988. [PMID: 33950309 DOI: 10.1007/s00192-021-04804-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) is prevalent during pregnancy and postpartum. UI in pregnancy strongly predicts UI postpartum and later in life. UI reduces women's wellbeing and quality of life and presents a significant burden to healthcare resource. METHODS A narrative review summarizing quantitative and qualitative evidence about pelvic floor muscle training (PFMT) for prevention and treatment of UI for childbearing women. RESULTS There are clinically important reductions in the risk of developing UI in pregnancy and after delivery for pregnant women who start PFMT during pregnancy, and PFMT offers additional benefits preventing prolapse and improving sexual function. If women develop UI during pregnancy or postpartum then PFMT is an appropriate first-line treatment. For novice exercisers, a programme comprising eight contractions, with 8-s holds, three times a day, 3 days a week, for at least 3 months is a reasonable minimum and 'generic' prescription. All women need clear accurate verbal instruction in how to do PFMT. Incontinent women, and women who cannot do a correct contraction, require referral for pelvic floor rehabilitation. Behavioural support from maternity care providers (MCPs)-increasing women's opportunity, capability, and motivation for PFMT-is as important as the exercise prescription. CONCLUSION PFMT is effective to prevent and treat UI in childbearing women. All pregnant and postpartum women, at every contact with a MCP, should be asked if they are continent. Continent women need exercise prescription and behavioural support to do PFMT to prevent UI. Incontinent women require appropriate referral for diagnosis or treatment.
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Affiliation(s)
- Stephanie J Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.
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