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Chen L, Han Y, Wang L, Zhang H, Zheng Y, Zhang R, Meng G, Zhang YP, Ji D. Conservative Interventions for Urinary Incontinence on Postpartum Women: A Systematic Review and Meta-Analysis. J Midwifery Womens Health 2024. [PMID: 38807257 DOI: 10.1111/jmwh.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/14/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Urinary incontinence (UI) is common in postpartum women and can lead to a reduced quality of life and withdrawal from fitness and exercise activities. Conservative management interventions such as pelvic floor muscle training (PFMT), use of vaginal cones, and biofeedback have been recommended as first-line treatment. We aimed to explore the effects of conservative interventions on UI rate, severity, and incontinence-specific quality of life in postpartum women with UI. METHODS Nine databases were searched from inception to August 2022: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, Wanfang, China National Knowledge Infrastructure, China Biological Medicine, and VIP Journal Integration Platform. Randomized controlled trials examining the effects of conservative interventions on postpartum UI were included. RESULTS Initial searches produced 1839 results, of which 17 studies were eligible. All included studies had a low to moderate risk of bias. Supervised PFMT and use of a vaginal cone were more effective than individual PFMT in decreasing rates of UI (odds ratio, 0.29; 95% CI, 0.14-0.61). Individual PFMT combined with acupuncture (mean difference, -1.91; 95% CI, -2.46 to -1.37) or electroacupuncture and supervised PFMT combined with moxibustion were more effective than individual supervised PFMT alone in improving the severity of symptoms. Furthermore, electrical stimulation and biofeedback combined with acupoint stimulation or core training were more effective than electrical stimulation and biofeedback alone. For improving the incontinence-specific quality of life, supervised PFMT was more efficacious than individual PFMT; electrical stimulation and biofeedback plus core training were more beneficial than electrical stimulation and biofeedback alone. DISCUSSION Supervised PFMT and use of a vaginal cone were more beneficial in decreasing rates of UI compared with individual PFMT. Superior effects in decreasing UI severity may be achieved by combining PFMT or electrical simulation and biofeedback with other therapies. Electrical stimulation and biofeedback plus core training, as well as supervised PFMT, are most effective in improving incontinence-specific quality of life. Further research is required to provide more evidence on the efficacy of these therapies.
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Affiliation(s)
- Lixia Chen
- Medical Emergency Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- Faculty of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory of Microenvironment Regulation and Immunotherapy of Urinary Tumors of Liaoning Province, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ying Han
- School of Nursing, Dalian University, Dalian, China
| | - Liang Wang
- Nursing Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Han Zhang
- Department of Nursing, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yanan Zheng
- Department of Nursing, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Rui Zhang
- School of Nursing, Dalian University, Dalian, China
| | - Ge Meng
- Faculty of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yin-Ping Zhang
- Faculty of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Daihong Ji
- Department of Nursing, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Cao S, Meng L, Lin L, Hu X, Li X. The association between the metabolic score for insulin resistance (METS-IR) index and urinary incontinence in the United States: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. Diabetol Metab Syndr 2023; 15:248. [PMID: 38041100 PMCID: PMC10693039 DOI: 10.1186/s13098-023-01226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The association between insulin resistance and urinary incontinence (UI) has not been investigated widely. The purpose of this study is to assess the relationship between a novel indicator for assessing insulin resistance the metabolic score for insulin resistance (METS-IR) index and urinary incontinence (UI). METHODS This study utilized data from National Health and Nutrition Examination Survey (NHANES) 2001-2018. Weighted multivariable logistic regression models were conducted to explore the association of METS-IR index with three types of UI [stress UI (SUI), urgency UI (UUI), and mixed UI (MUI)]. Smooth curve fitting was utilized to investigate the linear relationship. Subgroup analysis was used to examine the stability of the connection between METS-IR index and UI in different stratifications. RESULTS A total of 17,474 participants were included in this study, of whom 23.76% had SUI, 20.05% had UUI, and 9.59% had MUI. METS-IR index was positively associated with three types of UI with full adjustment [SUI: odds ratio (OR) = 1.023, 95% confidence interval (CI) 1.019-1.027; UUI: OR = 1.015, 95% CI 1.011-1.019; MUI: OR = 1.020, 95% CI 1.016-1.025, all p < 0.001]. After transferring METS-IR index into a categorical variable by quartiles, the positive connection between METS-IR index and UI was still observed in the highest METS-IR group compared to the lowest METS-IR interval (SUI: OR = 2.266, 95% CI 1.947-2.637, p < 0.001; UUI: OR = 1.534, 95% CI 1.344-1.750, p < 0.001; MUI: OR = 2.044, 95% CI 1.707-2.448, p < 0.001). The analysis of smooth curves fitting showed that METS-IR index was positively linearly related to three types of UI. Moreover, the association between METS-IR index and SUI was more significant in females compared to males (p for interaction < 0.05). CONCLUSION An elevated METS-IR index was related to increased risks of three types of UI (SUI, UUI, and MUI) in the United States population. METS-IR index was more significantly connected to SUI in females than males. The association between insulin resistance and UI needs to be explored with more studies.
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Affiliation(s)
- Shangqi Cao
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Linghao Meng
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Lede Lin
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Xu Hu
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
| | - Xiang Li
- Institute of Urology, Department of Urology, West China Medical School, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
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Yu CY, Yu TY, Chen YW, Lin LF, Peng CW, Chen HC. Core Stabilization Exercise in Prenatal and Postnatal Women With Urinary Incontinence: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Phys Med Rehabil 2023; 102:990-999. [PMID: 37104619 DOI: 10.1097/phm.0000000000002260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the effect size of core stabilization exercise for prenatal and postnatal women through measures of urinary symptoms, voiding function, pelvic floor muscle strength and endurance, quality of life, and pain scores. DESIGN The PubMed, Embase, Cochrane Library, and Scopus databases were searched. Randomized controlled trials were selected and subjected to meta-analysis and risk of bias assessment. RESULTS Ten randomized controlled trials were selected, and 720 participants were included. Ten articles using seven outcomes were analyzed. Relative to the control groups, the core stabilization exercise groups exhibited superior results for urinary symptoms (standardized mean difference = -0.65, 95% confidence interval = -0.97 to 0.33), pelvic floor muscle strength (standardized mean difference = 0.96, 95% confidence interval = 0.53 to 1.39), pelvic floor muscle endurance (standardized mean difference = 0.71, 95% confidence interval = 0.26 to 1.16), quality of life (standardized mean difference = -0.9, 95% confidence interval = -1.23 to 0.58), transverse muscle strength (standardized mean difference = -0.45, 95% confidence interval = -0.9 to -0.01), and voiding function (standardized mean difference = -1.07, 95% confidence interval = -1.87 to 0.28). CONCLUSIONS Core stabilization exercises are safe and beneficial for alleviating urinary symptoms, improving quality of life, strengthening pelvic floor muscles, and improving transverse muscle function in prenatal and postnatal women with urinary incontinence.
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Affiliation(s)
- Chin-Yin Yu
- From the Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (C-YY, Y-WC, L-FL, H-CC); School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (T-YY); Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (Y-WC, H-CC); School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan (L-FL, C-WP); School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan (C-WP); and Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (HC-C)
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Johnson EE, Mamoulakis C, Stoniute A, Omar MI, Sinha S. Conservative interventions for managing urinary incontinence after prostate surgery. Cochrane Database Syst Rev 2023; 4:CD014799. [PMID: 37070660 PMCID: PMC10112049 DOI: 10.1002/14651858.cd014799.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Men may need to undergo prostate surgery to treat prostate cancer or benign prostatic hyperplasia. After these surgeries, men may experience urinary incontinence (UI). Conservative treatments such as pelvic floor muscle training (PFMT), electrical stimulation and lifestyle changes can be undertaken to help manage the symptoms of UI. OBJECTIVES To assess the effects of conservative interventions for managing urinary incontinence after prostate surgery. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearched journals and conference proceedings (searched 22 April 2022). We also searched the reference lists of relevant articles. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of adult men (aged 18 or over) with UI following prostate surgery for treating prostate cancer or LUTS/BPO. We excluded cross-over and cluster-RCTs. We investigated the following key comparisons: PFMT plus biofeedback versus no treatment; sham treatment or verbal/written instructions; combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions; and electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions. DATA COLLECTION AND ANALYSIS We extracted data using a pre-piloted form and assessed risk of bias using the Cochrane risk of bias tool. We used the GRADE approach to assess the certainty of outcomes and comparisons included in the summary of findings tables. We used an adapted version of GRADE to assess certainty in results where there was no single effect measurement available. MAIN RESULTS We identified 25 studies including a total of 3079 participants. Twenty-three studies assessed men who had previously undergone radical prostatectomy or radical retropubic prostatectomy, while only one study assessed men who had undergone transurethral resection of the prostate. One study did not report on previous surgery. Most studies were at high risk of bias for at least one domain. The certainty of evidence assessed using GRADE was mixed. PFMT plus biofeedback versus no treatment, sham treatment or verbal/written instructions Four studies reported on this comparison. PFMT plus biofeedback may result in greater subjective cure of incontinence from 6 to 12 months (1 study; n = 102; low-certainty evidence). However, men undertaking PFMT and biofeedback may be less likely to be objectively cured at from 6 to 12 months (2 studies; n = 269; low-certainty evidence). It is uncertain whether undertaking PFMT and biofeedback has an effect on surface or skin-related adverse events (1 study; n = 205; very low-certainty evidence) or muscle-related adverse events (1 study; n = 205; very low-certainty evidence). Condition-specific quality of life, participant adherence to the intervention and general quality of life were not reported by any study for this comparison. Combinations of conservative treatments versus no treatment, sham treatment or verbal/written instructions Eleven studies assessed this comparison. Combinations of conservative treatments may lead to little difference in the number of men being subjectively cured or improved of incontinence between 6 and 12 months (RR 0.97, 95% CI 0.79 to 1.19; 2 studies; n = 788; low-certainty evidence; in absolute terms: no treatment or sham arm: 307 per 1000 and intervention arm: 297 per 1000). Combinations of conservative treatments probably lead to little difference in condition-specific quality of life (MD -0.28, 95% CI -0.86 to 0.29; 2 studies; n = 788; moderate-certainty evidence) and probably little difference in general quality of life between 6 and 12 months (MD -0.01, 95% CI -0.04 to 0.02; 2 studies; n = 742; moderate-certainty evidence). There is little difference between combinations of conservative treatments and control in terms of objective cure or improvement of incontinence between 6 and 12 months (MD 0.18, 95% CI -0.24 to 0.60; 2 studies; n = 565; high-certainty evidence). However, it is uncertain whether participant adherence to the intervention between 6 and 12 months is increased for those undertaking combinations of conservative treatments (RR 2.08, 95% CI 0.78 to 5.56; 2 studies; n = 763; very low-certainty evidence; in absolute terms: no intervention or sham arm: 172 per 1000 and intervention arm: 358 per 1000). There is probably no difference between combinations and control in terms of the number of men experiencing surface or skin-related adverse events (2 studies; n = 853; moderate-certainty evidence), but it is uncertain whether combinations of treatments lead to more men experiencing muscle-related adverse events (RR 2.92, 95% CI 0.31 to 27.41; 2 studies; n = 136; very low-certainty evidence; in absolute terms: 0 per 1000 for both arms). Electrical or magnetic stimulation versus no treatment, sham treatment or verbal/written instructions We did not identify any studies for this comparison that reported on our key outcomes of interest. AUTHORS' CONCLUSIONS Despite a total of 25 trials, the value of conservative interventions for urinary incontinence following prostate surgery alone, or in combination, remains uncertain. Existing trials are typically small with methodological flaws. These issues are compounded by a lack of standardisation of the PFMT technique and marked variations in protocol concerning combinations of conservative treatments. Adverse events following conservative treatment are often poorly documented and incompletely described. Hence, there is a need for large, high-quality, adequately powered, randomised control trials with robust methodology to address this subject.
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Affiliation(s)
- Eugenie E Johnson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Akvile Stoniute
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
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Díaz-Mohedo E, Odriozola Aguirre I, Molina García E, Infantes-Rosales MA, Hita-Contreras F. Functional Exercise Versus Specific Pelvic Floor Exercise: Observational Pilot Study in Female University Students. Healthcare (Basel) 2023; 11:healthcare11040561. [PMID: 36833095 PMCID: PMC9956231 DOI: 10.3390/healthcare11040561] [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: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES To evaluate the electromyographic (EMG) activity of the pelvic floor musculature (PFM) that takes place when performing the functional movement screen (FMS) exercise, comparing it with the activation in the maximum voluntary contraction of PFM in the supine position (MVC-SP) and standing (MVC-ST). MATERIAL AND METHODS A descriptive, observational study conducted in two phases. In the first study phase, the baseline EMG activity of PFM was measured in the supine position and standing during MVC-SP and MVC-ST and during the execution of the seven exercises that make up the FMS. In the second phase of the study, the baseline EMG activity of PFM was measured in the supine position and standing during MVC-SP and MVC-ST and during the FMS exercise that produced the most EMG in the pilot phase: trunk stability push-up (PU). ANOVA, Friedman's and Pearson's tests were used. RESULTS All FMS exercises performed in the pilot phase showed a value below 100% maximum voluntary contraction (MVC) except PU, which presented an average value of 101.3 μv (SD = 54.5): 112% MVC (SD = 37.6). In the second phase of the study, it was observed that there were no significant differences (p = 0.087) between the three exercises performed: MVC-SP, MVC-ST and PU (39.2 μv (SD = 10.4), 37.5 μv (SD = 10.4) and 40.7 μv (SD = 10.2), respectively). CONCLUSIONS There is no evidence of the existence of significant differences in EMG activation in PFM among the three exercises analysed: MVC-SP, MVC-ST and PU. The results show better EMG values in the functional exercise of PU.
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Błudnicka M, Piernicka M, Kortas J, Bojar D, Duda-Biernacka B, Szumilewicz A. The influence of one-time biofeedback electromyography session on the firing order in the pelvic floor muscle contraction in pregnant woman–A randomized controlled trial. Front Hum Neurosci 2022; 16:944792. [PMID: 36248694 PMCID: PMC9559232 DOI: 10.3389/fnhum.2022.944792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022] Open
Abstract
Many women are initially unable to contract the pelvic floor muscles (PFMs) properly, activating other muscle groups before, or instead of, PFM. Numerous authors have proved that biofeedback can be an ideal tool supporting learning of the PFM contraction. However, there is currently a lack of scientific data on how many biofeedback sessions are necessary in this educational process. In this study we aimed at assessing the effects of one-time electromyography (EMG) biofeedback session on the order in which PFM are activated (so called firing order) during conscious contractions in relation to selected synergistic muscles in pregnant, continent women. A randomized controlled trial was conducted in 90 healthy nulliparous women with uncomplicated pregnancies and without diagnosed urinary incontinence. We divided the participants into a biofeedback group (50) and a control group (40). They were, respectively: 30 ± 4 and 30 ± 4 years old, at their 23 ± 5 or 25 ± 7 week of gestation and presented 23 ± 5 or 24 ± 5 kg/m2 BMI value (M + SD). Surface EMG with vaginal probes has been used to assess the PFM firing order in selected tasks: in five 3-s maximal contractions (quick flicks), five 10-s contractions, and in a 60-s contraction (static hold). We used the 1–5 scale, where “1” meant the best score, awarded when PFM was activated first in order. The most important finding of our study is that a single EMG biofeedback substantially improved the PFM contractions in pregnant women. First, when applying one-time biofeedback session, more women maintained correct technique or improved it in the second assessment, compared to the control group (73 vs. 65%). Secondly, using the quantitative and qualitative analysis with the Chi-square McNamara B/C test, in the biofeedback group we observed a statistically significant improvement of PFM firing order in four tasks: in the first quick flicks (p = 0.016), third quick flicks (p = 0.027), fifth quick flicks (p = 0.008), and in the first 10-s contractions (p = 0.046). In the control group we observed better outcome only in one motor task: in the fourth 10-s contraction (p = 0.009). Given the positive effects of a single session of EMG biofeedback on the firing order in the PFM contractions, it should be recommended for pregnant women without urinary incontinence to teach them how to perform PFM exercises correctly.
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Affiliation(s)
- Monika Błudnicka
- Department of Clinical Physiotherapy and Professional Practices, Gdansk University of Physical Education and Sport, Gdańsk, Poland
- *Correspondence: Monika Błudnicka, ;
| | - Magdalena Piernicka
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Jakub Kortas
- Department of Health and Life Sciences, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Damian Bojar
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Barbara Duda-Biernacka
- Department of Health and Life Sciences, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Anna Szumilewicz
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
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Ding DC, Li PC. Stem-cell therapy in stress urinary incontinence: A review. Tzu Chi Med J 2022. [DOI: 10.4103/tcmj.tcmj_145_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Al-Shenqiti AM, Ragab WM, Rostum EH, Emara HA, Khaled OA. Effects of behavioural therapy versus interferential current on bladder dysfunction in multiple sclerosis patients; a randomised clinical study. J Taibah Univ Med Sci 2021; 16:812-818. [PMID: 34899124 PMCID: PMC8626809 DOI: 10.1016/j.jtumed.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives This study examines the effect of behavioural therapy (biofeedback) and interferential current on bladder dysfunction in multiple sclerosis patients. Methods Fifty patients with secondary progressive type multiple sclerosis (SPMS) suffering from bladder dysfunction were divided equally into two groups randomly. Group A (GA) received behavioural therapy (biofeedback training), while Group B (GB) received interferential current training. Both groups were assessed by urodynamics for detrusor pressure and maximum flow rate before and after eight weeks of behavioural therapy and interferential training. Results Both groups, GA and GB, showed significant increase in the detrusor pressure and maximum flow rate after eight weeks of training. There was no significant difference between both methods. However, GA showed more improvement by close observation. Conclusions Both behavioural therapy and interferential current training effectively managed bladder dysfunction in patients with SPMS, with more evident effects in behavioural therapy patients by close observation.
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Affiliation(s)
- Abdullah M Al-Shenqiti
- Department of Physical Therapy, Faculty of Medical Rehabilitation, Taibah University, Almadinah Almunawwarah, KSA
| | - Walaa M Ragab
- Department of Neurology, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Esraa H Rostum
- Department of Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Hatem A Emara
- Department of Physical Therapy for Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Osama A Khaled
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Li Q, Zhang X. Effects of yoga on the intervention of levator ani hiatus in postpartum women: a prospective study. J Phys Ther Sci 2021; 33:862-869. [PMID: 34776624 PMCID: PMC8575480 DOI: 10.1589/jpts.33.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to explore the application value of yoga intervention in
early postpartum recovery of the levator ani muscle hiatus (LAH) area. [Participants and
Methods] Females in natural labor from May 2020 to November 2020 in the Third People’s
Hospital of Sun Yat-sen University Ultrasound Research Center were prospectively included
for a pelvic ultrasound examination. The control group received no intervention. The
experimental group received 60-min yoga once a week from week 1 to week 12 postpartum. A
pelvic ultrasound examination was performed on the week 6 and week 12 postpartum. The LAH
area was measured at rest, during contraction and Valsalva maneuver. [Results] A total of
128 participants who met the inclusion criteria were selected and randomly assigned to the
control group (n=66) and the experimental group (n=62)
in pre and post intervention design. No significant differences were found in age, parity,
body mass index, and fetal weight between the control and experimental groups. Further, no
significant difference was observed in the LAH area between the control and experimental
groups at rest, during contraction and Valsalva maneuver on the week 6 postpartum.
However, the LAH area in experimental group significantly reduced at rest, during
contraction and Valsalva maneuver on the week 12 postpartum. The differences of LAH area
(date week 6 minus date week 12) in the control group at rest, during contraction and
Valsalva maneuver were 0.12 ± 3.12 cm2, 0.80 ± 2.29 cm2, and 0.80 ±
4.22 cm2, while in the control these were 1.95 ± 3.41 cm2, 1.39 ±
1.91 cm2, and 3.81 ± 5.49 cm2, respectively. Compared with control
group, the differences of LAH area significantly increased in experimental group at rest
and during Valsalva maneuver. [Conclusion] Yoga intervention can help in the recovery of
LAH.
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Affiliation(s)
- Qunfeng Li
- Macau University of Science and Technology, Faculty of Medicine, China.,Guangdong Vocational College of Science and Technology, China
| | - Xinling Zhang
- Third Affiliated Hospital of Sun Yat-sen University: No. 600, Tianhe Road, Tianhe District, Guangzhou 510630, China
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Effects of a One-Time Biofeedback EMG Session on Neuromuscular Activity of the Pelvic Floor Muscles in Pregnant Women. NEUROPHYSIOLOGY+ 2021. [DOI: 10.1007/s11062-021-09902-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wilk I, Rajkowska-Rabon E, Sobiech M, Kołodyńska G, Nowak B, Doroszkiewicz W, Andrzejewski W, Kassolik K. Therapeutic massage in women with stress urinary incontinence: a pilot study. MEDICAL SCIENCE PULSE 2021. [DOI: 10.5604/01.3001.0015.0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Stress incontinence affects 25–60% of women of all ages and causes constant discomfort, significantly
lowering quality of life. The most common causes of urinary incontinence are weakened sphincter
muscles or bladder failure.
Aim of the study: The aim of this study was to assess the effectiveness of therapeutic massage therapy for
stress urinary incontinence and to determine whether therapeutic massage can restore the normal function
of the bladder sphincters.
Material and methods: The study involved eleven women with a diagnosis of primary stress urinary incontinence,
aged 50–79 years. The women attended therapeutic massage sessions twice a week for four weeks.
A sanitary pad test was performed before starting and immediately after ending the therapy to verify its effectiveness.
Results: In eight women, the amount of urine that leaked decreased after therapy. This result was statistically
significant (p = 0.02). In three cases, urine leakage was reduced to zero.
Conclusions: Therapeutic massage, acting locally, improves the function of the bladder sphincters, their
flexibility and the ability to contract and relax. Massage eliminates or significantly reduces the symptoms of
stress urinary incontinence.
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Affiliation(s)
- Iwona Wilk
- Department of Physiotherapy, University School of Physical Education in Wroclaw, Poland; 2. University School of Physical Education in Wroclaw, Poland
| | - Elżbieta Rajkowska-Rabon
- Department of Physiotherapy, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | - Marta Sobiech
- Department of Physiotherapy, University School of Physical Education in Wroclaw, Poland
| | - Gabriela Kołodyńska
- Department of Physiotherapy, University School of Physical Education in Wroclaw, Poland
| | | | | | - Waldemar Andrzejewski
- Department of Physiotherapy, University School of Physical Education in Wroclaw, Poland
| | - Krzysztof Kassolik
- Department of Physiotherapy, University School of Physical Education in Wroclaw, Poland
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Effectiveness of physiotherapy for lower urinary tract symptoms in postpartum women: systematic review and meta-analysis. Int Urogynecol J 2021; 33:507-521. [PMID: 34302516 DOI: 10.1007/s00192-021-04939-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The efficacy of physiotherapy for postpartum lower urinary tract symptoms (LUTS) has attracted considerable research interest. In the current study we evaluated the efficacy and safety of pelvic floor muscle training (PFMT) combined with biofeedback (BF), electrical stimulation (ES) therapy, or both for postpartum LUTS. METHODS PUBMED, EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science and Technique Journals Database, and Wanfang databases were searched from inception to December 2020. Eligible randomized controlled trials on postpartum LUTS comparing PFMT plus BF, ES, or both with PFMT alone were included. The Cochrane handbook was used to evaluate the quality of the studies. RESULTS Seventeen studies were included. The results of the meta-analysis showed that PFMT plus ES with or without BF was more effective than PFMT alone. Patients receiving PFMT plus ES and BF achieved greater improvement than controls receiving PFMT alone in incontinence quality of life scores (mean difference: 15.33, 95% confidence interval [CI]: 11.70-18.97, P < 0.00001), pelvic floor muscle strength (risk ratio: 2.29, 95% CI: 1.53-3.43, P < 0.0001), and urodynamic parameters (maximum urethral closure pressure, abdominal leak point pressure, and maximum urinary flow rate), and 1-h urine leakage (standardized mean difference: -0.70, 95% CI: -1.23 to -0.17, P = 0.010) also decreased. CONCLUSIONS PFMT plus ES with or without BF exhibited better efficacy and safety for early postpartum LUTS than PFMT alone.
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Bag Soytas R, Soytas M, Danacioglu YO, Citgez S, Yavuzer H, Can G, Onal B, Doventas A. Relationship between the types of urinary incontinence, handgrip strength, and pelvic floor muscle strength in adult women. Neurourol Urodyn 2021; 40:1532-1538. [PMID: 34004030 DOI: 10.1002/nau.24699] [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: 02/25/2021] [Revised: 04/22/2021] [Accepted: 04/30/2021] [Indexed: 12/20/2022]
Abstract
AIM To investigate the relationship between handgrip strength with types of urinary incontinence (UI) and pelvic floor muscle strength (PFMS) in women. METHODS Ninety-two women, who presented to the geriatric and urology outpatient clinics complaining of UI between July 2019 and February 2020 and had indicated to undergo urodynamic assessment after basic neurourological evaluation, were included in this cross-sectional study. The presence and types of UI were identified by clinical examination and urodynamic studies. Demographic parameters, anthropometric data, comorbidities and medications were recorded. The International Consultation on Incontinence Questionnaire-Short Form was applied. Handgrip strength (HGS) was measured by a hand dynamometer. The PFMS was subjectively assessed via vaginal digital palpation and measured quantitatively by the vaginal probe of the perineometer. RESULTS Thirty-eight urodynamic stress, 28 detrusor overactivity, 26 urodynamic mixed UI patients were reported. Perineometer measurements were significantly lower in the urodynamic stress UI group compared to the other two groups (p = 0.020). There was no relationship between the types of urinary incontinence and HGS. However, a positive correlation was found between PFMS and HGS (p = 0.045, r = 0.298). CONCLUSION The positive correlation between HGS and PFMS indicates that low HGS may be a marker for PFMS weakness. Furthermore, the association between sarcopenia and UI may be explained by this condition.
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Affiliation(s)
- Rabia Bag Soytas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mustafa Soytas
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Yavuz O Danacioglu
- Department of Urology, Istanbul Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Sinharib Citgez
- Department Of Urology, Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gunay Can
- Department of Public Health, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Bulent Onal
- Department Of Urology, Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Alper Doventas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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14
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Johnson E, Mamoulakis C, Omar MI, Sinha S. Conservative interventions for managing urinary incontinence after prostate surgery. Hippokratia 2021. [DOI: 10.1002/14651858.cd014799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eugenie Johnson
- Population Health Sciences Institute; Newcastle University; Newcastle upon Tyne UK
| | - Charalampos Mamoulakis
- Department of Urology; University General Hospital of Heraklion, University of Crete Medical School; Heraklion, Crete Greece
| | - Muhammad Imran Omar
- Guidelines Office; European Association of Urology; Arnhem Netherlands
- Academic Urology Unit; University of Aberdeen; Aberdeen UK
| | - Sanjay Sinha
- Department of Urology; Apollo Hospital; Hyderabad India
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Wu TF, Huang LH, Lai YF, Chen GD, Ng SC. Early postpartum biofeedback assisted pelvic floor muscle training in primiparous women with second degree perineal laceration: Effect on sexual function and lower urinary tract symptoms. Taiwan J Obstet Gynecol 2021; 60:78-83. [PMID: 33495013 DOI: 10.1016/j.tjog.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To evaluate the short-term effect of routine early postpartum electromyographic biofeedback assisted pelvic floor muscle training on sexual function and lower urinary tract symptoms. MATERIALS AND METHODS From December 2016 to November 2017, primiparous women with vaginal delivery, who experienced non-extended second-degree perineal laceration were invited to participate. Seventy-five participants were assigned into a pelvic floor muscle training (PFMT) group or control group. Women in the PFMT group received supervised biofeedback-assisted pelvic floor muscle training at the 1st week and 4th week postpartum. Exercises were performed at home with the same protocol until 6 weeks postpartum. The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Urinary Distress Inventory short form questionnaire (UDI-6) were used to evaluate sexual function and lower urinary tract symptoms respectively at immediate postpartum, 6 weeks, 3 months, and 6 months postpartum. RESULTS Forty-five women (23 in PFMT group,22 in control group) completed all questionnaires at 6 months postpartum. For overall sexual function and the three sexual functional domains, no statistically significant difference was found in PISQ scores from baseline to 6 weeks, 3 months, and 6 months postpartum between the PFMT and control groups. For postpartum lower urinary tract symptoms, all symptoms gradually improved over time for both groups without a statistically significant difference between groups. CONCLUSION Our study showed that supervised biofeedback-assisted pelvic floor muscle training started routinely at one week postpartum did not provide additional improvement in postpartum sexual function and lower urinary tract symptoms.
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Affiliation(s)
- Ting-Feng Wu
- Department of Obstetrics and Gynecology, Lee Women's Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, Veterans General Hospital, Taichung, Taiwan
| | - Li-Hua Huang
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Fen Lai
- Department of Physical Therapy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Gin-Den Chen
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Soo-Cheen Ng
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Use of bioactive extracellular matrix fragments as a urethral bulking agent to treat stress urinary incontinence. Acta Biomater 2020; 117:156-166. [PMID: 33035698 DOI: 10.1016/j.actbio.2020.09.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 12/25/2022]
Abstract
Injection of urethral bulking agents is a low-risk, minimally invasive surgical procedure to treat stress urinary incontinence (SUI). In this study, we developed a promising injectable bulking agent comprising extracellular matrix fragments of adipose-derived stem cell sheets (ADSC ECM) and investigated its effectiveness in urethral bulking therapy. The structural integrity and proteins of ADSC sheet ECM were well retained in decellularized ADSC ECM fragments. To locate transplanted ADSC ECM fragments, they were labeled with ultrasmall super-paramagnetic iron oxide nanoparticles, which enabled in vivo monitoring after implantation in a SUI rat model for up to 4 weeks. When ADSC ECM fragments were injected into the rat urethra, they became fully integrated with the surrounding tissue within 1 week. Four weeks after transplantation, host cells had regenerated within the ADSC ECM fragment injection area. Moreover, new smooth muscle tissue had formed around the ADSC ECM fragments, as confirmed by positive staining of myosin. These results indicate that injection of ECM fragments may be a promising minimally invasive approach for treating SUI.
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Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol 2020; 31:485-493. [PMID: 31609735 DOI: 10.1097/gco.0000000000000584] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To describe the principles of pelvic floor physical therapy (PFPT), review the evidence for PFPT as a treatment for pelvic floor dysfunction, and summarize the current recommendations for PFPT as a first-line conservative treatment option for pelvic floor disorders. RECENT FINDINGS Pelvic floor dysfunction can cause voiding and defecation problems, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain. PFPT is a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction. Based on the available evidence, PFPT with or without supplemental modalities can improve or cure symptoms of urinary incontinence, POP, fecal incontinence, peripartum and postpartum pelvic floor dysfunction, and hypertonic pelvic floor disorders, including pelvic floor myofascial pain, dyspareunia, vaginismus, and vulvodynia. Currently, there is conflicting evidence regarding the effectiveness of perioperative PFPT before or after POP and urinary incontinence surgery. SUMMARY PFPT has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders. Standards of PFPT treatment protocols, however, vary widely and larger well designed trials are recommended to show long-term effectiveness.
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Xu L, Fu C, Zhang Q, Xiong F, Peng L, Liang Z, Chen L, He C, Wei Q. Efficacy of biofeedback, repetitive transcranial magnetic stimulation and pelvic floor muscle training for female neurogenic bladder dysfunction after spinal cord injury: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e034582. [PMID: 32759239 PMCID: PMC7409967 DOI: 10.1136/bmjopen-2019-034582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/14/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Neurogenic bladder dysfunction is prevalent in female patients with spinal cord injury (SCI), and previous guidelines have recommended pelvic floor muscle training (PFMT) for first-line conservative treatment. However, the actual regimen of PFMT varies widely and the single treatment does not satisfy the need of some patients. Therefore, this study aims to provide a detailed rationale and methodology for comparing the effectiveness of PFMT, biofeedback and repetitive transcranial magnetic stimulation (rTMS) as adjunct treatments for neurogenic bladder dysfunction. METHODS AND ANALYSIS This trial is a single-centre randomised controlled trial for female patients with urinary incontinence (UI) in phase of chronic SCI. Eligible participants will be randomised to one of four arms: (1) PFMT, (2) PFMT with biofeedback, (3) PFMT and rTMS and (4) PFMT with biofeedback and rTMS. There will be 44 participants in each arm and all the subjects will undergo 20 treatment sessions, five times a week for 4 weeks. The outcomes will be evaluated at 4 weeks, 3 months and 6 months after randomisation. The primary outcome is the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, and the secondary outcomes include bladder diary, pelvic floor muscle function and the International Spinal Cord Injury Quality of Life Basic Data Set. ETHICS AND DISSEMINATION The Clinical Research and Biomedical Ethics Committee of the West China Hospital, Sichuan University has approved this trial and the approval number is 2019-885. All participants will be provided written informed consent after verification of the eligibility criteria. The results of this study will be accessible in peer-reviewed publications and be presented at academic conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1900026126).
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Affiliation(s)
- Lin Xu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chenying Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Qing Zhang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Feng Xiong
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Lihong Peng
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Zejun Liang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Li Chen
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chengqi He
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
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Campbell KG, Batt ME, Drummond A. A feasibility study of the physiotherapy management of urinary incontinence in athletic women: trial protocol for the POsITIve study. Pilot Feasibility Stud 2020; 6:103. [PMID: 32695435 PMCID: PMC7366300 DOI: 10.1186/s40814-020-00638-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
Background Urinary incontinence (UI) affects up to 40% of adult women within the UK, and pelvic floor muscle training can be effective as a treatment. The prevalence of UI is higher in athletic women than in their sedentary counterparts, but there is little research into reasons for this or into treatment within this population. The aim of this study is to investigate the feasibility of conducting a future randomised controlled trial of physiotherapeutic management of UI in athletic women. Methods This is a mixed methods study with three distinct but related phases. Phase 1: Semi-structured interviews with health care professionals in the community will explore current management practices of UI in women and particularly in female athletes in order to inform the control arm of a future study. It will also establish community health care professionals’ understanding of pelvic health physiotherapy. Phase 2: Athletic and regularly exercising women recruited directly from gyms and sports clubs will undergo a course of physiotherapy to manage UI. This will establish study recruitment, eligibility, consent, attendance, attrition, and data completion rates. It will provide information regarding appropriate clinical venues and outcome measures to use for this patient group. Phase 3: Semi-structured interviews with purposefully selected participants from phase 2 will investigate participant satisfaction with recruitment procedures, the intervention, outcome measures and the venues. Further, we will collect data regarding the use of a smartphone ‘app’ for adherence and monitoring of home exercises and participants’ beliefs around randomisation in a future study. We will explore the impact of UI on life and sport in more detail. Discussion This study will establish the ease and acceptability of recruiting athletic women directly from gyms and sports clubs and identify attrition rates. It will also explore the acceptability of the intervention, clinical venues and outcome measures. Data collected will be used to inform a future randomised controlled trial. Trial registration NCT03986411 (clinicaltrials.gov). Registered on 14 June 2019
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Affiliation(s)
- K Gillian Campbell
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, NG7 2HA UK
| | - Mark E Batt
- Centre for Sports Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, NG7 2HA UK
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Brennan L, Dorronzoro Zubiete E, Caulfield B. Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2019; 20:E181. [PMID: 31905653 PMCID: PMC6982782 DOI: 10.3390/s20010181] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 01/23/2023]
Abstract
Digital biofeedback systems (DBSs) are used in physical rehabilitation to improve outcomes by engaging and educating patients and have the potential to support patients while doing targeted exercises during home rehabilitation. The components of feedback (mode, content, frequency and timing) can influence motor learning and engagement in various ways. The feedback design used in DBSs for targeted exercise home rehabilitation, as well as the evidence underpinning the feedback and how it is evaluated, is not clearly known. To explore these concepts, we conducted a scoping review where an electronic search of PUBMED, PEDro and ACM digital libraries was conducted from January 2000 to July 2019. The main inclusion criteria included DBSs for targeted exercises, in a home rehabilitation setting, which have been tested on a clinical population. Nineteen papers were reviewed, detailing thirteen different DBSs. Feedback was mainly visual, concurrent and descriptive, frequently providing knowledge of results. Three systems provided clear rationale for the use of feedback. Four studies conducted specific evaluations of the feedback, and seven studies evaluated feedback in a less detailed or indirect manner. Future studies should describe in detail the feedback design in DBSs and consider a robust evaluation of the feedback element of the intervention to determine its efficacy.
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Affiliation(s)
- Louise Brennan
- Physiotherapy department, Beacon Hospital, Bracken Road, Sandyford Industrial Estate, Dublin 18, Ireland
- Insight Centre for Data Analytics, O’Brien Science Centre, University College Dublin, Dublin 4, Ireland;
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | | | - Brian Caulfield
- Insight Centre for Data Analytics, O’Brien Science Centre, University College Dublin, Dublin 4, Ireland;
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
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Bovbjerg ML. Current Resources for Evidence-Based Practice, November 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:693-704. [PMID: 31629697 DOI: 10.1016/j.jogn.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A review of new resources to support the provision of evidence-based care for women and infants.
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Dufour S, Fedorkow D, Kun J, Deng SX, Fang Q. Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study. JMIR Mhealth Uhealth 2019; 7:e12587. [PMID: 31298221 PMCID: PMC6657451 DOI: 10.2196/12587] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 04/27/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background The postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry. Objective The aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women. Methods A 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne’s interpretive description approach. Results A total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77%), a cumbersome initiation process (n=8, 61%), and discomfort from the device (n=8, 61%) were reasons impeding intervention acceptability. Most participants (n=17, 74%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants. Conclusions Our pilot study demonstrated the potential for mHealth solution–enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth solutions that may be of value if acceptability and feasibility issues can be overcome. Trial Registration ClinicalTrials.gov NCT02865954; https://clinicaltrials.gov/ct2/show/NCT02865954
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Affiliation(s)
- Sinéad Dufour
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Donna Fedorkow
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Jessica Kun
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | | | - Qiyin Fang
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.,Department of Engineering Physics, McMaster University, Hamilton, ON, Canada
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