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Rapp DE, Zillioux J, Sun F, Jones M, Little M, Mitchell J. Pelvic floor therapy program for the treatment of female urinary incontinence in Belize: a pilot study. Front Glob Womens Health 2024; 5:1325259. [PMID: 38404953 PMCID: PMC10884173 DOI: 10.3389/fgwh.2024.1325259] [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: 10/20/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Urinary incontinence (UI) is highly prevalent in low- and middle-income countries (LMIC). Concurrently, the availability of surgical or conservative UI treatments in LMIC is limited. Methods We conducted a prospective feasibility study of Belize women with UI treated with pelvic floor physical therapy (PFPT) and education (PFE). Patients received individual PFPT/PFE over 2 days, consisting of biofeedback-enhanced PFMT in addition to behavioral, dietary, and general pelvic education. Patient completed a daily 6-month home regimen including 7 PFMT exercises (total 70 repetitions) comprising both endurance and quick flick exercises. Patients also performed comprehensive dietary and behavioral modification activities. Outcomes were assessed at baseline and 6-months, including validated symptom (ICIQ-FLUTS) and QOL (IIQ-7) questionnaires, and strength testing (PERFECT score, perineometry). Results Twenty-eight patients underwent baseline assessment. Four patients were lost to in-person 6-month follow-up, with two of these patients completing subjective assessment only by telephone. The mean (±SD) patient age, BMI, and parity were 50.0 (±10.0) years, 33.2 (±5.8), and 2.8 (±1.5). Provider assessment demonstrated patient comprehension of basic, endurance, and quick flick pelvic floor contractions in 28 (100%), 24 (86%), and 24 (86%) patients, respectively. At 6-month follow-up, significant improvements were seen across multiple validated questionnaire and strength measurement assessments. Median patient-reported improvement level was 7.0 on a 10-point Likert scale. Discussion Study patients demonstrated good understanding of PFMT/PFE and program completion was associated with significant improvements across a variety of subjective incontinence and quality of life outcomes, as well as objective strength testing.
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Affiliation(s)
- David E. Rapp
- Department of Urology, University of Virginia, Charlottesville, VA, United States
- Global Surgical Expedition, Glen Allen, VA, United States
| | - Jacqueline Zillioux
- Department of Urology, University of Virginia, Charlottesville, VA, United States
| | - Fionna Sun
- Department of Urology, University of Virginia, Charlottesville, VA, United States
| | - Marieke Jones
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Michelle Little
- Global Surgical Expedition, Glen Allen, VA, United States
- Women in Motion Physical Therapy, Charlottesville, VA, United States
| | - Jeanice Mitchell
- Global Surgical Expedition, Glen Allen, VA, United States
- Integrity Rehab and Home Health, Killeen, TX, United States
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Dos Santos Sousa AJ, Cordeiro Rodrigues J, Falcão Padilha J, Garcia Godoy A, Menezes Degani A, Danna-Santos A, Driusso P. Effects of health education on women with urinary incontinence: systematic review and meta-analysis. Int Urogynecol J 2024; 35:273-289. [PMID: 38099941 DOI: 10.1007/s00192-023-05693-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 11/06/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the effects of health education (HE) on urinary symptoms and quality of life in women with urinary incontinence (UI). METHODS A systematic review and meta-analysis of trials evaluating HE for women with UI. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. RESULTS The search identified 5,118 articles. Eighteen papers were considered eligible. The interventions investigated included health education (HE), combined intervention, self-management (SM), and structured training (ST). Outcomes included quality of life (QoL), UI frequency, UI severity, impression of improvement, incontinence symptoms, urine leakage, fear of leakage, urgency, and incontinence impact. Compared with the control group there was a significant improvement in the frequency, severity, and impact on the QoL for women with UI (assessed by the total score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ SF); RR = -1.47, 95% CI [-2.07, -0.88]; two trials; low certainty of the evidence). CONCLUSIONS This review shows that HE seems to be beneficial in the treatment of women with UI when compared with control women (no treatment or general health care), improving the frequency, severity, and impact on QoL assessed by the ICIQ SF total score. However, the certainty of this evidence is low.
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Affiliation(s)
- Ana Jéssica Dos Santos Sousa
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Jéssica Cordeiro Rodrigues
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Juliana Falcão Padilha
- Urogynecological Physiotherapy Laboratory, Department of Physical Therapy, Federal University of Amapá, Macapá, AP, Brazil
| | - Amanda Garcia Godoy
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil
| | - Adriana Menezes Degani
- Laboratory for Advancements in Rehabilitation Sciences, Department of Physical Therapy, Western Michigan University, Kalamazoo, MI, USA
| | - Alessander Danna-Santos
- Laboratory for Advancements in Rehabilitation Sciences, Department of Physical Therapy, Western Michigan University, Kalamazoo, MI, USA
| | - Patricia Driusso
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP, CEP: 13565-905, Brazil.
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Curillo-Aguirre CA, Gea-Izquierdo E. Effectiveness of Pelvic Floor Muscle Training on Quality of Life in Women with Urinary Incontinence: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1004. [PMID: 37374208 PMCID: PMC10301414 DOI: 10.3390/medicina59061004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Urinary incontinence (UI) is a condition that is more common in women than men and has an increasing prevalence with age. It provides a range of psychological and physical burdens that negatively affect the patient's quality of life (QoL). However, the economic burden for the healthcare system is being augmented due to the increasing life expectancy of the population. This article aims to identify the effectiveness of pelvic floor muscle training (PFMT) on the QoL in women with UI. Materials and Methods: A systematic review and meta-analysis were conducted in the PubMed, EMBASE, ProQuest medicine, Cochrane Library, and Google Scholar databases. The terms selected according to components of PICOS were women with urinary incontinence, pelvic floor muscle training, watchful or other types of therapies, quality of life, randomized controlled trials, and interventional or observational studies. The articles included were those published between November 2018 and November 2022. Ten articles were found for the systematic review and eight for the meta-analysis. Results: The QoL moderately increased when PFMT was used on women with UI, the results indicating an overall small effect on the QoL across the controlled studies and a moderate effect on the QoL across the one-group pre-post-studies. Conclusions: Specific QoL domains, such as social activities and general health, also demonstrated benefits from PFMT interventions. This study confirmed the effectiveness of PFMT on the QoL in women with UI, mainly for patients with stress urinary incontinence.
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Affiliation(s)
| | - Enrique Gea-Izquierdo
- Faculty of Medicine, Pontifical Catholic University of Ecuador, Quito 170143, Ecuador
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Le Berre M, Filiatrault J, Reichetzer B, Dumoulin C. Group-Based Pelvic Floor Telerehabilitation to Treat Urinary Incontinence in Older Women: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105791. [PMID: 37239520 DOI: 10.3390/ijerph20105791] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Less than half of women with urinary incontinence (UI) receive treatment, despite the high prevalence and negative impact of UI and the evidence supporting the efficacy of pelvic floor muscle training (PFMT). A non-inferiority randomized controlled trial aiming to support healthcare systems in delivering continence care showed that group-based PFMT was non-inferior and more cost-effective than individual PFMT to treat UI in older women. Recently, the COVID-19 pandemic highlighted the importance of providing online treatment options. Therefore, this pilot study aimed to assess the feasibility of an online group-based PFMT program for UI in older women. Thirty-four older women took part in the program. Feasibility was assessed from both participant and clinician perspectives. One woman dropped out. Participants attended 95.2% of all scheduled sessions, and the majority (32/33, 97.0%) completed their home exercises 4 to 5 times per week. Most women (71.9%) were completely satisfied with the program's effects on their UI symptoms after completion. Only 3 women (9.1%) reported that they would like to receive additional treatment. Physiotherapists reported high acceptability. The fidelity to the original program guidelines was also good. An online group-based PFMT program appears feasible for the treatment of UI in older women, from both participant and clinician perspectives.
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Affiliation(s)
- Mélanie Le Berre
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC H3N 1X7, Canada
- Research Center, the Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, QC H3W 1W4, Canada
| | - Johanne Filiatrault
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC H3N 1X7, Canada
- Research Center, the Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, QC H3W 1W4, Canada
| | - Barbara Reichetzer
- Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC H2X 0C1, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Institut Universitaire de Gériatrie de Montréal (IUGM), Montreal, QC H3W 1W5, Canada
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC H3N 1X7, Canada
- Research Center, the Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, QC H3W 1W4, Canada
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Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:S1-S19. [PMID: 36548636 DOI: 10.1097/spv.0000000000001272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications. OBJECTIVES The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment. STUDY DESIGN The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference. Experts from multidisciplinary fields examined cognitive function, higher neural control of the OAB patient, risk factors for cognitive impairment in older patients, cognitive effects of antimuscarinic medications for OAB treatment, OAB phenotyping, conservative and advanced OAB therapies, and the need for a multidisciplinary approach to person-centered treatment. Translational topics included the blood-brain barrier, purine metabolome, mechanotransduction, and gene therapy for OAB targets. RESULTS Research surrounding OAB treatment efficacy in cognitively impaired individuals is limited. Short- and long-term outcomes regarding antimuscarinic effects on cognition are mixed; however, greater anticholinergic burden and duration of use influence risk. Oxybutynin is most consistently associated with negative cognitive effects in short-term, prospective studies. Although data are limited, beta-adrenergic agonists do not appear to confer the same cognitive risk. CONCLUSIONS The 2021 SOS summary report provides a comprehensive review of the fundamental, translational, and clinical research on OAB with emphasis on cognitive impairment risks to antimuscarinic medications. Duration of use and antimuscarinic type, specifically oxybutynin when examining OAB treatments, appears to have the most cognitive impact; however, conclusions are limited by the primarily cognitively intact population studied. Given current evidence, it appears prudent to minimize anticholinergic burden by emphasizing nonantimuscarinic therapeutic regimens in the older population and/or those with cognitive impairment.
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Alouini S, Memic S, Couillandre A. Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback or Electrostimulation in Women: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052789. [PMID: 35270480 PMCID: PMC8910078 DOI: 10.3390/ijerph19052789] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/18/2022]
Abstract
To determine the effectiveness of pelvic floor muscle training (PFMT) with or without biofeedback or electrostimulation in reducing urinary incontinence and pelvic floor muscle con-traction in non-pregnant women with urinary incontinence. Methods: The following electronic databases were searched: PubMed, Cochrane Central, ClinicalTrials.gov, EU Clinical Trials Register, and sources from NICE, FDA, EMA, and SMC (articles only in English, 2000–2021). Search terms were: urinary incontinence, pelvic floor muscle training or exercises, biofeedback, electrostimulation. We used the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for this systematic review. Relevant articles were selected, data were extracted, and quality was assessed. Data were extracted in predesigned form, followed by narrative synthesis. Results: Following the search, 15 RCTs were retrieved using the strict inclusion and exclusion criteria, assessing 2441 non-pregnant women with urinary incontinence. Of the 15 studies, 7 were low risk, 5 were medium risk, and 3 were high-risk studies. Of the 2441 patients, 970 were in PFMT, 69 were in extracorporeal magnetic innervation (ExMi) or with PFMT + BF, 30 were in electrostimulation (ES), 21 were in whole body vibration training (WBVT), 23 were in pelvic floor muscle + abdominal muscle therapy (PFM + AMT), 326 were in PFMT + biofeedback, 93 were in vaginal cones (VC), 362 were in PFMT + education, 318 were in education, and 229 were in control groups. The most often measures employed were pad tests, bladder diary, and questionnaire on the quality of life. Stress, urge and mixed urinary incontinence were studied. In all RCT, PFMT significantly reduced urinary incontinence, essentially SIU and MUI, when compared with the control group before and after treatment. Overall, out of 997 PFMT or PFMT + education patients, 504 patients (50.5%) showed improvement in urinary incontinence, and 218 became continent (21.8%) (negative pad test). In total, 62% of patients significantly reduced their urinary incontinence or cured it and improved their pelvic floor muscle contraction. All other physiotherapist techniques also significantly reduced urinary leakages, e.g., vaginal cones, biofeedback, ExMI, and WBVT when compared with the control group. There were no significant differences between these methods in reducing the severity of urinary incontinence. Conclusion: PFMT alone or with bio-feedback or electrostimulation was effective in reducing urinary incontinence and improving pelvic floor muscle contraction. PFMT when compared with other interventions such as bio-feedback, VC, and WBVT did not show significant differences but was superior to the control group. RCT studies with similar parameters used for measuring the outcomes need to be included.
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Affiliation(s)
- Souhail Alouini
- Center Hospitalier Regional d’Orléans, Departement of Gynecologic Surgery, 14 Avenue de L’hôpital, 45100 Orleans, France
- EUKCVL, Université d’Orléans, 45100 Orleans, France; (S.M.); (A.C.)
- Correspondence:
| | - Sejla Memic
- EUKCVL, Université d’Orléans, 45100 Orleans, France; (S.M.); (A.C.)
| | - Annabelle Couillandre
- EUKCVL, Université d’Orléans, 45100 Orleans, France; (S.M.); (A.C.)
- Laboratoire CIAMS, Université Paris—Sud, EA 4532, 91400 Orsay, France
- Laboratoire en Neurosciences, Physiologie et Psychologie, LINP2, Université Paris Nanterre, 92001 Nanterre, France
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Ege S. [Urinary Continence and Mobility - two sides of the same coin]. Dtsch Med Wochenschr 2021; 146:959-965. [PMID: 34344030 DOI: 10.1055/a-1405-3828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Urinary incontinence and gait disorders are common health related problems that occur especially in old age. Therefore they are called geriatric syndromes. Do they develop independently or is there an association? Do improvements of urinary incontinence result in reduced gait disorders and vice versa? It seems, that there is an interrelation between urinary incontinence and gait disorders. And further, both syndroms seem to interact closely and can be influenced by improvements of each other. Knowing and recognizing the interaction of micturition and physical performance is essential to working towards prevention of UI and to improving quality of treatment and quality of life.
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Khan Z, Cheong YF, Miedema SS, Naved RT, Yount KM. Women's experiences of economic coercion and depressive symptoms in Matlab, Bangladesh. SSM Popul Health 2020; 12:100641. [PMID: 33304983 PMCID: PMC7714676 DOI: 10.1016/j.ssmph.2020.100641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/20/2022] Open
Abstract
Prior studies of the association between intimate partner violence (IPV) and depressive symptoms have typically excluded economic coercion (EC), a prevalent form of IPV worldwide. Here, we used structural equation models (SEM) to estimate the association of EC with depressive symptoms, with and without adjustment for physical/psychological/sexual IPV, among women in rural Matlab, Bangladesh. Data were collected from cross-sectional surveys with married women 15-49 years, conducted between November 2018 and January 2019. Prior-week depressive symptoms were measured using the 10-item Centre for Epidemiologic Studies Depression short-form. Lifetime EC was assessed using a bi-dimensional, 36-item scale developed in Matlab. Lifetime physical/sexual/psychological IPV was assessed using the 20-item WHO Domestic Violence module. Covariates were age, age at marriage, and schooling; partner's schooling; and household wealth. Among 929 women, lifetime experience of EC ranged from 41.9% (control over access to work, schooling, and training) to 50.0% (control over use/maintenance of economic resources), while any lifetime physical/psychological/sexual IPV was 89.5%. Coercion involving the use and maintenance of economic resources had a significant, adjusted association with depressive symptoms (standardized coefficient = 0.491, p<0.001, R2=0.221). The standardized association of any physical/psychological/sexual IPV with depressive symptoms, adjusted for covariates and cluster sampling, was 0.346 (p <0.001, R2=0.143). When further adjusted for the two measures of EC, the association was attenuated and non-significant (0.049, p = 0.817). These findings suggest that EC is prevalent, significantly associated with depressive symptoms, and attenuates the association of other forms of IPV with depressive symptoms. Addressing EC with other forms of IPV may be necessary to reduce depressive symptoms in exposed women.
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Affiliation(s)
- Zara Khan
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Yuk F Cheong
- Department of Psychology, Emory University, 36 Eagle Row, Suite 270, Atlanta, GA, 30322, USA
| | - Stephanie S Miedema
- Department of Sociology, Emory University, 1555 Dickey Drive, Tarbutton Hall Room 225, Atlanta, 30322, Georgia
| | - Ruchira T Naved
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box 128, Dhaka, 1000, Bangladesh
| | - Kathryn M Yount
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
- Department of Sociology, Emory University, 1555 Dickey Drive, Tarbutton Hall Room 225, Atlanta, 30322, Georgia
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Pelvic Floor Muscle Training for Older Women with Urinary Incontinence. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Haque R, Kabir F, Naher K, Cherry N, MacDonald D, Wagg A, Chowdhury Z. Promoting and maintaining urinary continence: Follow-up from a cluster-randomized trial of elderly village women in Bangladesh. Neurourol Urodyn 2020; 39:1152-1161. [PMID: 32162727 DOI: 10.1002/nau.24334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/02/2020] [Indexed: 11/09/2022]
Abstract
AIMS Pelvic floor and mobility exercises were shown to be effective in managing incontinence in a cluster-randomized trial (CRT) of village women aged 60 to 75 years in Bangladesh. The present analysis examines continence 12 months after the CRT and exercise program implementation with village paramedics as preceptors. METHODS Women from nine villages in the exercise arm of the CRT were followed-up 12 months after the 6-month intervention. They provided information about exercise since the CRT and a 3-day continence record (3DCR). Posttrial, a further 6-month exercise intervention led by village paramedics was initiated in 20 villages. Women completed the two-item Sandvik severity questionnaire before and after the intervention. Paramedics kept a record of each woman's attendance at the 48 exercise sessions RESULTS: A total of 130 of 150 women from the CRT completed the 12-month follow-up; 61.5% were dry on the 3DCR at follow-up. Total continence was related to the continuation of exercises carried out in the home and absence of urinary tract infection at follow-up. Those exercising at follow-up had an odds ratio (OR) of 3.49 (95% confidence interval [CI], 1.86-6.58) of being continent at follow-up. Higher end-of-CRT body mass index was associated with greater follow-up leakage. In the 20-village roll-out, with 316 incontinent women, improvement in both severity and total continence on the Sandvik questionnaire were related to a total number of sessions attended (OR = 1.09; 95% CI, 1.05-1.13). At roll-out, 38.6% achieved continence, comparable to 43.0% in the CRT using physiotherapy preceptors CONCLUSIONS: Group exercise classes led by paramedics resulted in a marked improvement in continence but maintenance requires exercise postintervention.
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Affiliation(s)
- Rezaul Haque
- Gonoshasthaya Kendra, Savar, Bangladesh.,Department of Social Medicine, Gono Bishwabidyalay University, Savar, Bangladesh
| | | | - Kamrun Naher
- Department of Physiotherapy, Gono Bishwabidyalay University, Savar, Bangladesh
| | - Nicola Cherry
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dianna MacDonald
- Department of Obstetrics and Gynaecology, Lois Hole Hospital for Women, Edmonton, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
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Hay-Smith EJC. Pelvic floor muscle training in lower-income settings. LANCET GLOBAL HEALTH 2019; 7:e823-e824. [PMID: 31200879 DOI: 10.1016/s2214-109x(19)30234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 11/18/2022]
Affiliation(s)
- E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, PO Box 7343, Wellington South 6242, New Zealand.
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