Responsiveness of Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) after pelvic floor muscle training in women with stress and mixed urinary incontinence

The Effectiveness of Adding Transvaginal Radiofrequency to Pelvic Floor Muscle Training for 6 Weeks in Women with Stress Urinary Incontinence. A Double-Blind Randomised Controlled Trial

INTRODUCTION AND HYPOTHESIS

The objective was to evaluate the clinically beneficial effect of adding transvaginal monopolar non-ablative radiofrequency (RF) to pelvic floor muscle training (PFMT) on leakage severity, quality of life and urinary incontinence-related symptoms in women with stress urinary incontinence (SUI).

METHODS

A double-blind randomised controlled trial was conducted, with a 6-week intervention and a 6-month follow-up. Participants were randomly assigned to the experimental group (PFMT plus RF; n = 18) or the control group (PFMT plus placebo; n = 20). The primary outcome was the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Secondary outcomes included the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), self-efficacy, female sexual function, pelvic floor muscle dynamometry, 1-h pad test and number of SUI episodes per week. Inferential analyses of the data were performed using a two-factor analysis of variance.

RESULTS

Both groups achieved a statistically significant improvement in ICIQ-SF over time. However, the differences observed in the experimental group exceeded the minimal clinically important differences by 4 points (MD = -9.4, 95% CI = -12.6 to -6.3), which was not observed in the control group (MD = -3.9, 95% CI = -6.9 to -1.0). This was maintained at the 6-month follow-up with a significant time*group interaction (p < 0.001, ηp2 = 0.150). There was no time*group interaction in the other variables (p > 0.05). Additionally, a significant difference in favour of the experimental group was observed in the 1-h pad test and episodes of SUI per week (p < 0.05).

CONCLUSIONS

This study highlights the beneficial effects of adding transvaginal RF to PFMT on the severity and amount of leakage, as well as on the quality of life and urinary incontinence-related symptoms in women with moderate SUI. Future trials are needed to assess the effects of this intervention in women with severe SUI.

Cross-Cultural Adaptation and Validation of the Arabic Version of the Prolapse Quality of Life Questionnaire in the United Arab Emirates

BACKGROUND

Given the extensive translation of the Prolapse Quality of Life Questionnaire (P-QoL) into many languages, it is imperative to develop an Arabic version to facilitate the study of pelvic organ health within the Arabian culture.

OBJECTIVE

The aim of this study was to investigate, cross-culturally adapt, and validate the Arabic version of the P-QoL.

STUDY DESIGN

This study involved cross-cultural adaptation and psychometric testing.

METHODS

A total of 90 participants were included in the study. This cross-sectional study was carried out in two phases; during phase I, the P-QoL was translated and adapted from English into Arabic. The Arabic version was psychometrically validated during phase II using the test-retest reliability and internal consistency with Cronbach's alpha coefficient, convergent construct (CC) validity among the four study tools using Spearman's coefficient (r), and discriminative validity using Mann-Whitney test to find the differences between the means of the two samples.

RESULTS

A satisfactory level of semantic, conceptual, idiomatic, and content comparability was reached in the cross-cultural adaptation of the Arabic version of the P-QoL. The internal consistency was high in terms of psychometric validation, with a Cronbach's alpha coefficient of 0.971 for the P-QoL. The test-retest results showed high reliability, with the interclass correlation coefficient (ICC) of the P-QoL determined as 0.987. The convergent construct validity was highly acceptable (moderately strong), reflecting a positive correlation between the Arabic version of the P-QoL and the Australian Pelvic Floor Dysfunction Questionnaire (APFD) (r = 0.68; p < 0.001). Similarly, a significant convergent validity of the Arabic version of the P-QoL and the Visual Analogue Scale (VAS) (r = 0.47; p < 0.001) was observed, as well as a correlation between the APFD and the VAS (r = 0.46; p < 0.001). However, there was no significant correlation between the 12-Item Short-Form Survey (SF-12), the P-QoL, the APFD, and the VAS.

CONCLUSION

Based on the significant correlation found between the Arabic APFD and the VAS, the results reveal good reliability, internal consistency, and construct validity. It is recommended that Arabic-speaking females with pelvic organ prolapse use the Arabic version of the P-QoL. More research is needed to assess the responsiveness of the P-QoL.

Digital Care Program for Urinary Incontinence in Females: A Large-Scale, Prospective, Cohort Study

Female urinary incontinence (UI) is highly prevalent in the US (>60%). Pelvic floor muscle training (PFMT) represents first-line care for UI; however, access and adherence challenges urge new care delivery models. This prospective cohort study investigates the feasibility and safety of a remote digital care program (DCP) combining education and PFMT with real-time biofeedback with an average duration of 10 weeks. The primary outcome was the change in the Urinary Impact Questionnaire-short form (UIQ-7) from baseline to program-end, calculated through latent growth curve analysis (LGCA). Secondary outcomes included the impact of pelvic conditions (PFIQ-7), depression (PHQ-9), anxiety (GAD-7), productivity impairment (WPAI), intention to seek additional healthcare, engagement, and satisfaction. Of the 326 participants who started the program, 264 (81.0%) completed the intervention. Significant improvement on UIQ-7 (8.8, 95%CI 4.7; 12.9, p < 0.001) was observed, corresponding to a response rate of 57.3%, together with improvements in all other outcomes and high satisfaction (8.9/10, SD 1.8). This study shows the feasibility and safety of a completely remote DCP with biofeedback managed asynchronously by a physical therapist to reduce UI-related symptoms in a real-world setting. Together, these findings may advocate for the exploration of this care delivery option to escalate access to proper and timely UI care.

Women with functional constipation have a worse ability to relax their pelvic floor muscle: A cross sectional study

INTRODUCTION

Functional intestinal constipation (FIC) has a high prevalence worldwide. It is higher in adult and elderly women, and in those with alterations in the pelvic floor muscle (PFM) structure and function.

OBJECTIVE

The primary aim of this study was to characterize PFM function, including tone, of women with and without FIC. The secondary aim was to assess and compare the general and symptom-related quality of life (QoL) between participants with and without FIC and its correlation with the assessed PFM function.

METHODS

This was a cross-sectional observational study, the outcomes were assessed using vaginal palpation, vaginal manometry and validated questionnaires: the Pelvic Floor Impact Questionnaire Short Form 7 (PFIQ-7), the Pelvic Floor Distress inventory (PFDI-20), and the Short-Form Health Survey (SF-36). This study included 60 women, 30 with FIC and 30 without FIC. The mean age of women with FIC was 48.2 years (standard deviation [SD] 12.22) and 51 years (SD 13.47) for those without FIC. Both groups were overweight. There was a significant difference between groups in the bowel domain of the PFIQ-7 (p = 0.016) and in the anal dysfunction domain of the PFDI-20 (p < 0.001), being higher in those women with FIC. Women with FIC presented a significantly worse ability to voluntarily relax their PFM (38.3%) than those without FIC (11.7%; p = 0.008). participants without FIC presented higher values of maximum voluntary contraction (MVC) assessed by vaginal manometry compared to participants without FIC (p = 0.008). PFM tone was not different between groups.

CONCLUSION

Women with FIC have more difficulty in relaxing their PFM and lower MVC values than women without FIC. FIC negatively impacts women's symptom-related QoL. The main contribution of this study was to reavel the difficulty of the participants with FIC to relax their PFM. This finding is important to guide clinical decision making for an adequate treatment program direct to women with FIC.

Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the Vulvovaginal Symptoms Questionnaire

OBJECTIVE

The aims of this study were to perform a cross-cultural adaptation of the Vulvovaginal Symptoms Questionnaire (VSQ) into Brazilian Portuguese (VSQ-Br) and evaluate its measurement properties (structural validity, construct validity, internal consistency, and reliability).

METHODS

Cross-cultural adaptation was conducted through the translation, synthesis, and back-translation of the VSQ-Br. Subsequently, 314 women completed the Pelvic Floor Impact Questionnaire, Pelvic Floor Disorders Inventory, Medical Outcomes Study 36-Item Short-Form Health Survey, and VSQ-Br. Seven to 10 days later, participants completed the VSQ-Br for the second time. Data were submitted for confirmatory factor analysis. Cronbach α was used to verify internal consistency, and construct validity was assessed using Pearson correlation coefficient ( r ). Reliability was calculated using the intraclass correlation coefficient.

RESULTS

Confirmatory factor analysis showed that the questions were grouped into four domains (symptoms, emotions, life impact, and sexual impact). The model showed good fit (>0.95). The Cronbach α in this study was 0.85, reflecting adequate internal consistency. Adequate reliability was confirmed, with an intraclass correlation coefficient total score of 0.80. The VSQ-Br had a weak correlation with the pelvic domain of the Pelvic Floor Disorders Inventory, the pelvic organ prolapse domain of the Pelvic Floor Impact Questionnaire, and pain, vitality, and the social aspect domains of the Medical Outcomes Study 36-Item Short-Form Health Survey.

CONCLUSIONS

The VSQ-Br was validated and had acceptable measurement properties for assessing vulvovaginal symptoms in Brazilian women.