Effects of Biofeedback Combined With Pilates Training on Post-prostatectomy Incontinence

Clinical efficacy of a rehabilitation management protocol for urinary incontinence after robot-assisted laparoscopic prostatectomy

OBJECTIVE

To evaluate the application of a rehabilitation management protocol for urinary incontinence after robot-assisted laparoscopic prostatectomy (RALP).

METHODS

We conducted a retrospective cohort study of 114 patients who underwent RALP between August 2021 and November 2021 as the control group and a prospective analysis of 114 patients who underwent RALP between May 2022 and August 2022 as the experimental group. The rehabilitation management protocol focused on preoperative stage, postoperative care, day of catheter removal, 1 month postoperative, 3 months postoperative, 6 months postoperative, and 12 months or more postoperative.

RESULTS

The 24-h pad test was significantly lower in the experimental group compared with the control group at 2 and 6 months after RALP (both P < 0.01). The scores of the international consultation on incontinence questionnaire-short form (ICIQ-SF) in the experimental group were significantly lower than those in the control group at 1 month after RALP (P < 0.01).The scores of quality of life in the experimental group were significantly higher than those of the control group at 1, 2, and 6 months after RALP (all P < 0.01).The scores of Broome Pelvic Muscle Self-efficacy Scale (BPMSES) were lower than those of the control group at 1, 2, 3, and 6 months after RALP (all P < 0.01).

CONCLUSION

The application of the rehabilitation management protocol had significant beneficial effects on urinary functions and quality of life in patients with prostate cancer after RALP.

Control4Life: A randomized controlled trial protocol examining the feasibility and efficacy of a combined pelvic health rehabilitation and exercise fitness program for individuals undergoing prostatectomy

BACKGROUND

Urinary incontinence (UI), erectile dysfunction and cardiometabolic conditions are common after prostatectomy for prostate cancer (PCa). Although physical activity could improve overall survival and quality of survivorship, fear of UI can restrict participation in exercise. Individuals with PCa could benefit from therapeutic exercise programming to support continence recovery and cardiometabolic health.

AIM

The main objective of this study is to determine the feasibility and the effects of a combined pelvic health rehabilitation and exercise fitness program on UI after prostatectomy. The combined exercise program will be delivered both in-person and virtually.

METHODS

This study follows a modified Zelen, two-arm parallel randomized controlled trial design. A total of 106 individuals with PCa will be recruited before prostatectomy surgery. Participants will be randomized between two groups: one receiving usual care and one receiving a combined exercise fitness and intensive pelvic floor muscle training program. Exercise programming will begin 6-8 weeks after prostatectomy and will last 12 weeks. Outcomes include: the 24-h pad test (primary outcome for UI); physical fitness, metabolic indicators, and patient-reported outcomes on erectile function, self-efficacy, severity of cancer symptoms and quality of life. Important timepoints for assessments include before surgery (T0), after surgery (T1), after intervention (T3) and at one-year after surgery (T4).

CONCLUSION

This study will inform the feasibility of offering comprehensive exercise programming that has the potential to positively impact urinary continence, erectile function and cardiometabolic health of individuals undergoing prostatectomy for prostate cancer.

CLINICALTRIALS REGISTRATION NUMBER

NCT06072911.

Effect of Pilates combined with pelvic floor muscle training on continence of post-prostatectomy incontinence in patients with different body mass index

BACKGROUND

Urinary incontinence symptoms severely affect older people with different body mass index (BMI).To compare the efficacy of the pelvic floor muscle training (PFMT) in patients with post-prostatectomy incontinence with different BMI.

METHODS

Thirty-seven patients with post-prostatectomy incontinence were included. They were divided into group A (BMI ≤ 25,12), group B (26 ≤ BMI ≤ 30,14), and group C (BMI ≥ 31,11) based on difference BMI. Three groups of patients underwent the same Pilates combined with kegel training. Participants were assessed with 1-hour pad test, the number of incontinence episodes, International Consultation on Incontinence Questionnaire and Oxford Grading Scale.

RESULTS

In the 1-hour pad test, the differences before and after training were statistically significant in all three groups of participants. Group A decreased from 81.83 ± 8.79 to 31.08 ± 5.64 g (P < 0.01). Group B decreased from 80.57 ± 8.87 to 35.85 ± 5.66 g (P < 0.01). Group C decreased from 83.55 ± 10.24 to 40.18 ± 7.01 g (P < 0.01). The number of incontinent episodes in group A decreased from 9.33 ± 1.07 to 3.25 ± 0.62 (P < 0.01). Group B decreased from 8.86 ± 1.09 to 3.79 ± 0.80 (P < 0.01). Group C decreased from 9.27 ± 1.10 to 4.09 ± 0.70 (P < 0.01). The correlation between the three groups of participants and the 1-hour pad test, with an R2 of 0.51. The correlation between the three groups of participants and the number of urinary incontinence episodes with a R2 of 0.43.

CONCLUSIONS

Pelvic floor muscle training can affect the recovery of urinary continence in patients with different BMI. Maintaining a lower BMI can be beneficial for improving urinary control.

TRIAL REGISTRATION

Date of trial registration: November 27, 2023.

Effect of Internet combined with pelvic floor muscle training on postpartum urinary incontinence

INTRODUCTION AND HYPOTHESIS

Urinary incontinence is one of the most common complications associated with parturition or child delivery. The Internet combined with pelvic floor training may be a good way to reduce the spread of the epidemic and treat postpartum incontinence.

METHODS

A total of 38 participants were randomly assigned to Kegel alone (group A = 14), Internet plus Kegel (group B = 12), or Internet plus Pilates (group C = 12). We used the 1-h pad test, the number of episodes of incontinence, the number of pads used, the Oxford Scale, and The International Consultation Incontinence Questionnaire for evaluation.

RESULTS

In the 1-h pad test (g), group A decreased from 40.93 ± 4.66 to 24.00 ± 3.94, group B from 41.75 ± 3.62 to 20.67 ± 3.89, and group C from 40.33 ± 3.89 to 18.67 ± 3.55. In the number of episodes of incontinence, group A decreased from 4.71 ± 1.13 to 2.93 ± 0.62, group B from 4.92 ± 1.16 to 2.42 ± 0.52, and group C from 4.92 ± 1.08 to 2.08 ± 0.52. In the use of urinary pads, group A decreased from 7.14 ± 0.95 to 3.50 ± 0.52, group B from 7.25 ± 0.75 to 3.00 ± 0.95, and group C from 7.42 ± 1.08 to 2.50 ± 0.67. In the Oxford Scale and International Consultation Incontinence Questionnaire Short Form, the difference among the three groups before and after treatment was statistically significant. After 6 weeks of pelvic floor muscle training, most patients achieved grade 3 or higher muscle strength on the Oxford scale.

CONCLUSIONS

The Internet combined with pelvic floor training is a good choice during the current pandemic. Pelvic floor exercises can improve urinary incontinence symptoms.

The added value of devices to pelvic floor muscle training in radical post-prostatectomy stress urinary incontinence: A systematic review with metanalysis

PURPOSE

To investigate the role of pelvic floor devices (e.g., biofeedback, electrical stimulation, magnetic stimulation, or their combination) as adjunctive treatments in pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) after radical prostatectomy.

MATERIALS AND METHODS

A systematic review with meta-analysis. We searched for randomised controlled trials (RCTs) and prospective non-randomised studies investigating the effectiveness of pelvic floor devices as an adjunctive treatment for SUI symptoms assessed with weight pad-test or standardised questionnaires. To assess the risk of bias (RoB) and overall certainty of evidence, the RoB 2.0 or the ROBINS-I, and the GRADE approach were used.

RESULTS

Eleven RCTs met our eligibility criteria. One was at a 'low' RoB, one had 'some concerns', while nine were at a 'high' RoB. Two meta-analyses were conducted to analyse the pooled results of six RCTs included. Specifically, two RCTs reported at week 4 with a 1h pad test a mean difference of 0.64 (95% CI = [-13.09, 14.36]), and four RCTs reported at week 12 with a 24h pad test a mean difference of -47.75 (95% CI = [-104.18, 8.69]). The heterogeneity was high in both analyses (I2 = 80.0%; I2 = 80.6%). The overall level of certainty was very low.

CONCLUSIONS

In line with our results, we cannot conclude whether pelvic floor devices add any value as adjunctive treatment in the management of SUI after radical prostatectomy. Future studies require more comprehensive and standardised approaches to understand whether these devices are effective.

Non-pharmacological and nonsurgical interventions in male urinary incontinence: A scoping review

AIMS

To describe and synthesize non-pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature.

METHODS

A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three-step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA-ScR Checklist was used to report.

RESULTS

A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 μs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence.

CONCLUSION

The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods.

RELEVANCE TO CLINICAL PRACTICE

Physicians and nurses need to be up to date on the latest evidence-based non-pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences.

Analysis of the effectiveness of the application of pelvic floor rehabilitation exercise and the factors influencing its self-efficacy in postoperative patients with cervical cancer

Objective

To analyze the application effect of pelvic floor rehabilitation exercise in postoperative patients with cervical cancer and the factors influencing their self-efficacy.

Methods

120 postoperative patients with cervical cancer from January 2019 to January 2022 from the Department of Rehabilitation, Aeronautical Industry Flying Hospital, Bayi Orthopaedic Hospital and Southwest Medical University Affiliated Hospital of Traditional Chinese Medicine, and the Department of Obstetrics and Gynecology, Chengdu Seventh People's Hospital, and the Department of Oncology, Sichuan Provincial People's Hospital were selected for the study. They were divided into routine group (n=44, applied routine care) and exercise group (n=76, applied routine care + pelvic floor rehabilitation exercise) according to the different perioperative care programs. The perioperative indicators, bladder function recovery rate and urinary retention incidence, urodynamic indicators, and pelvic floor distress inventory-short form 20 (PFDI-20) scores were compared between the 2 groups. The general data, PFDI-20 scores and broome pelvic muscle self-efficacy scale (BPMSES) scores of patients in the exercise group were investigated and analyzed individually to investigate the factors influencing the self-efficacy of patients with pelvic floor rehabilitation exercise after cervical cancer surgery.

Results

The time of first anal exhaust, urine tube retention and hospitalization after surgery were shorter in the exercise group than in the routine group (P<0.05). The bladder function grade I rate after surgery was more in the exercise group than in the routine group, and the urinary retention incidence was lower than that in the routine group (P<0.05). At 2 weeks after exercise, bladder compliance and bladder detrusor systolic pressure were higher in both groups than before exercise, and they were higher in the exercise group than in the routine group (P<0.05). There was no significant difference in urethral closure pressure within and between the two groups (P>0.05). At 3 months after surgery, the PFDI-20 scores were higher in both groups than before surgery, and the exercise group was lower than the routine group (P<0.05).The BPMSES score for the exercise group was (103.33 ± 9.16). Marital status, residence and PFDI-20 scores were influential factors in the self-efficacy level of patients undergoing pelvic floor rehabilitation exercise after cervical cancer surgery (P<0.05).

Conclusion

Implementing pelvic floor rehabilitation exercise for postoperative patients with cervical cancer can speed up the recovery of pelvic organ function and reduce the occurrence of postoperative urinary retention. Marital status, residence and PFDI-20 scores were influential factors in the self-efficacy level of patients undergoing pelvic floor rehabilitation exercise after cervical cancer surger, medical staff need to incorporate these clinical features to provide targeted nursing interventions to enhance patient compliance with training and improve postoperative survival quality.

Effect of different postures of Pilates combined with Kegel training on pelvic floor muscle strength in post-prostatectomy incontinence

PURPOSE

Urinary incontinence seriously affects the daily ability of older males. This study compared the effect of different postures of Pilates combined with Kegel training on pelvic floor muscle strength in post-prostatectomy incontinence.

METHODS

We included 38 valid samples [group A = 13 (less than 3 months after surgery), group B = 15 (4-6 months after surgery), group C = 10 (more than 6 months after surgery)] and surface electromyography (EMG) was used to record the maximum, and root mean square values of participants in the three groups under four postures.

RESULTS

There were significant differences in the maximum and mean values among the three groups. In group A, the mean values were 13.04 ± 1.56, 16.98 ± 1.76, 41.58 ± 4.17, and 24.53 ± 2.45 (P < 0.01), respectively. In group B, the mean values were 13.85 ± 1.55, 18.63 ± 1.44, 45.87 ± 3.31, and 28.63 ± 2.02 (P < 0.01), respectively. In group C, the mean values were 14.80 ± 1.32, 19.59 ± 1.55, 47.85 ± 5.05, and 30.11 ± 2.26 (P < 0.01), respectively. The mean and peak values of surface EMG in the three groups correlated with the four basic movements. R² values were 0.76 and 0.85, 0.77 and 0.88, 0.77 and 0.91, respectively.

CONCLUSIONS

Pilates with Kegel training was superior to Kegel training alone in unit recruitment ability of the pelvic floor muscles. Pilates training in different positions is recommended according to the patient's condition.

Efficacy of Pilates in Functional Body Composition: A Systematic Review

The aim of this review was to collect and systematize results of studies from the last 5 years concerning the influence of the Pilates method (PM) on functional body composition (FBC). Methods: The criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used in this review. We conducted research in three scientific databases: (i) Web of Science Core Collection, (ii) SCOPUS, and (iii) search directory of the library catalog of the Faculty of Sport and Physical Education of the University of Coimbra—EBSCO Discovery Services. We found 334 articles, covering the period between 1 January 2017 and 31 December 2021. After the selection process, we found 33 eligible articles. Results: The main results seem to point to a tendency to get a better body weight and body fat percentage (BFP), hip circumference (HC), waist, and skinfolds from the chest, abdomen, triceps, and supra-iliac in mostly female samples. Available evidence indicates that, in body composition (BC) and FBC, Pilates practice tends to be effective in reducing obesity as a multifactorial condition. Conclusions: It is concluded that there is a marked trend in the benefits of Pilates in FBC, which is in line with other systematic reviews at the BC level (which includes body weight (BW) and body mass index (BMI)) and in the reduction of the percentage of fat mass (FM). It is also concluded that there is a vast lack of studies on the male population, preventing further scientific development in this area. The limitations of this systematic review can be overcome with studies that bring together multidisciplinary aspects of FBC, better designed and methodologically more robust, which will allow more reliable analyses for the implementation of the Pilates method in terms of FBC. In addition, further studies with a male sample or mixed samples (men vs. women) could confirm the trend of no gender differences in the benefits of Pilates practice.

College English Reading Teaching Integrating Production Oriented Approach from the Perspective of Artificial Intelligence

The objectives are to solve many problems in traditional English reading teaching, such as the passive acceptance of students' learning situation, the rigid teaching mode of teachers and the difficulty in taking into account the individual needs of each student, and the forced averaging of students' English learning ability and level. Firstly, a detection method of English reading level based on the Backpropagation neural network (BPNN) is designed. Secondly, the teaching process and specific teaching plan are designed with the Production Oriented Approach (POA). Finally, the detection method of English reading level is verified by simulation experiments, and the effect of the teaching method integrating POA is analyzed. The results show that (1) when the learning rate is 0.26 and the training time is 1000 times, the mean square error (MSE) of the model is the smallest. (2) The results of the practical experiment indicate that the number of people who sign up for the college English proficiency test, the number of actual exams, and the pass rate of the test in the experimental group using the teaching method are higher than those in the control group. Moreover, the number of people in the experimental group increased more than that in the control group after the experiment. There is no significant difference in the test results of the two groups before the experiment, and the average test scores of the experimental group are obviously higher than those of the control group after the experiment. The p value of the two groups of results is less than 0.05 in the t-test, indicating that there is a significant difference in the English reading level between the two groups after the experiment. Simultaneously, the difference between the results of class A before and after the experiment is larger than that of class B, showing that the teaching method integrating POA is more effective for students with higher English levels. Therefore, compared with the traditional teaching method, the teaching mode integrating POA is more effective in improving the English reading level of college students. It aims to transform POA theory into practice and provide a great reference for college English reading teaching.