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Barbosa-Silva J, Sato TDO, Homsi Jorge C, Armijo-Olivo S, Driusso P. What are the cut-off points for vaginal manometry to differentiate women with a weak from those with a strong pelvic floor muscle contraction?: Vaginal manometry to classify a pelvic floor muscle contraction. Braz J Phys Ther 2023; 27:100572. [PMID: 38043160 PMCID: PMC10703600 DOI: 10.1016/j.bjpt.2023.100572] [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] [Received: 05/25/2022] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Vaginal manometry is regarded as an objective method to assess pelvic floor muscles (PFM) function and can measure several variables during contraction. OBJECTIVE To determine which variables could differentiate women with/without a weak/strong PFM contraction and determine their cut-off points. METHODS This is a diagnostic accuracy study performed on 156 women with a mean age of 40.4 (SD, 15.9) years. The reference test was vaginal palpation and the index test was vaginal manometry (Peritron™ manometer). Variables were pressure at rest, pressure achieved with maximal voluntary contraction (MVC), MVC average, duration, gradient, and area under the curve (AUCm). The Receiver Operating Curve (AUC/ROC) and logistic regression were used to analyze the data and obtain cut-off points. RESULTS Excellent ability to discriminate women with a weak/strong PFM contraction was found for MVC average (cut-off: 28.93 cmH2O), MVC (cut-off: 38.61 cmH2O), and the AUCm (cut-off: 1011.93 cm²*s). The gradient variable had good discrimination ability (AUC/ROC=0.81; cut-off: 28.68 cmH2O/s). The MVC average assessed by manometry, menopausal status, and the presence of stress urinary incontinence (SUI) were associated with a weak/strong PFM contraction in the multivariate analysis; however, the most parsimonious model to discriminate weak/strong PFM contraction included only the MVC average (AUC/ROC = 0.95; sensitivity: 0.87; specificity: 0.91). CONCLUSION These results suggest which manometry variables are appropriate to assess and classify PFM function in females. These could be used to help physical therapists to make clinic decisions about the management of female PFM.
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Affiliation(s)
- Jordana Barbosa-Silva
- Women's Health Research Laboratory, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil; Faculty of Business and Social Sciences, University of Applied Sciences - Hochschule Osnabrück, Osnabrück, Germany.
| | - Tatiana de Oliveira Sato
- Preventive Physical Therapy and Ergonomics Laboratory, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Cristine Homsi Jorge
- Pelvic Floor Muscle Function Laboratory, Health Science Departament, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Susan Armijo-Olivo
- Faculty of Business and Social Sciences, University of Applied Sciences - Hochschule Osnabrück, Osnabrück, Germany
| | - Patricia Driusso
- Women's Health Research Laboratory, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil.
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Miotto VG, Fernades ACNL, de la Ossa AMP, Bazanelli GS, Fretta TDB, de Paula NA, Homsi Jorge C. Women with functional constipation have a worse ability to relax their pelvic floor muscle: A cross sectional study. Neurourol Urodyn 2023; 42:123-132. [PMID: 36208110 DOI: 10.1002/nau.25057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Functional intestinal constipation (FIC) has a high prevalence worldwide. It is higher in adult and elderly women, and in those with alterations in the pelvic floor muscle (PFM) structure and function. OBJECTIVE The primary aim of this study was to characterize PFM function, including tone, of women with and without FIC. The secondary aim was to assess and compare the general and symptom-related quality of life (QoL) between participants with and without FIC and its correlation with the assessed PFM function. METHODS This was a cross-sectional observational study, the outcomes were assessed using vaginal palpation, vaginal manometry and validated questionnaires: the Pelvic Floor Impact Questionnaire Short Form 7 (PFIQ-7), the Pelvic Floor Distress inventory (PFDI-20), and the Short-Form Health Survey (SF-36). This study included 60 women, 30 with FIC and 30 without FIC. The mean age of women with FIC was 48.2 years (standard deviation [SD] 12.22) and 51 years (SD 13.47) for those without FIC. Both groups were overweight. There was a significant difference between groups in the bowel domain of the PFIQ-7 (p = 0.016) and in the anal dysfunction domain of the PFDI-20 (p < 0.001), being higher in those women with FIC. Women with FIC presented a significantly worse ability to voluntarily relax their PFM (38.3%) than those without FIC (11.7%; p = 0.008). participants without FIC presented higher values of maximum voluntary contraction (MVC) assessed by vaginal manometry compared to participants without FIC (p = 0.008). PFM tone was not different between groups. CONCLUSION Women with FIC have more difficulty in relaxing their PFM and lower MVC values than women without FIC. FIC negatively impacts women's symptom-related QoL. The main contribution of this study was to reavel the difficulty of the participants with FIC to relax their PFM. This finding is important to guide clinical decision making for an adequate treatment program direct to women with FIC.
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Affiliation(s)
- Viviane G Miotto
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana C N L Fernades
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Aura M P de la Ossa
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Gabriela S Bazanelli
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Tatiana de B Fretta
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Nicole A de Paula
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cristine Homsi Jorge
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Mikuš M, Kalafatić D, Vrbanić A, Šprem Goldštajn M, Herman M, Živković Njavro M, Živković K, Marić G, Ćorić M. Efficacy Comparison between Kegel Exercises and Extracorporeal Magnetic Innervation in Treatment of Female Stress Urinary Incontinence: A Randomized Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121863. [PMID: 36557065 PMCID: PMC9784675 DOI: 10.3390/medicina58121863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: To estimate the effectiveness of Kegel exercises versus extracorporeal magnetic innervation (EMI) in the treatment of stress urinary incontinence (SUI). Materials and Methods: A parallel group, randomized clinical trial was conducted in the Department of Obstetrics and Gynecology, Clinical Hospital Centre Zagreb, Croatia. After assessing the inclusion/exclusion criteria, each eligible participant was randomized to one of the two observed groups by flipping a coin: the first group underwent treatment with Kegel exercises for 8 weeks, while the second group underwent EMI during the same time interval. The primary outcome was the effectiveness of treatment as measured by the ICIQ-UI-SF overall score, eight weeks after the commencement of treatment. Results: During the study period, 117 consecutive patients with SUI symptoms were assessed for eligibility. A total of 94 women constituted the study population, randomized into two groups: Group Kegel (N = 48) and Group EMI (N = 46). After 8 weeks of follow-up, intravaginal pressure values in the EMI group were 30.45 cmH2O vs. the Kegel group, whose values were 23.50 cmH2O (p = 0.001). After 3 months of follow-up, the difference was still observed between the groups (p = 0.001). After the end of treatment and 3 months of follow-up, the values of the ICIQ-UI SF and ICIQ-LUTSqol questionnaires in the EMI group were lower than in the Kegel group (p < 0.001). Treatment satisfaction was overall better in the EMI group than in the Kegel group (p < 0.001). Conclusions: Patients treated with EMI had a lower number of incontinence episodes, a better quality of life, and higher overall satisfaction with treatment than patients who performed Kegel exercises.
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Affiliation(s)
- Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-99-400-6639
| | - Držislav Kalafatić
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Adam Vrbanić
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Marina Šprem Goldštajn
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Mislav Herman
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
| | | | - Klara Živković
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Goran Marić
- Faculty of Humanities and Social Sciences, University of Zagreb, 10000 Zagreb, Croatia
| | - Mario Ćorić
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10000 Zagreb, Croatia
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Sheng Y, Carpenter JS, Ashton-Miller JA, Miller JM. Mechanisms of pelvic floor muscle training for managing urinary incontinence in women: a scoping review. BMC Womens Health 2022; 22:161. [PMID: 35562699 PMCID: PMC9103460 DOI: 10.1186/s12905-022-01742-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pelvic floor muscle training is recommended as first line treatment for urinary incontinence in women based on three proposed theorized mechanisms: 'Enhanced Pelvic Floor Muscle Strength,' 'Maximized Awareness of Timing,' and 'Strengthened Core Muscles'. The purpose of this scoping review was to systematically map evidence for and against theorized mechanisms through which pelvic floor muscle training interventions work to reduce urinary incontinence in women. METHODS The scoping review is based upon a comprehensive search of relevant literature published from 1990 to 2020 in PubMed, CINAHL, PsycINFO, ClinialTrials.gov, reference lists from review articles, and hand searches of articles by known researchers in the field. We included English-language, peer-reviewed articles on pelvic floor muscle training as an intervention for adult women if they provided empirical evidence to testing the theorized intervention mechanisms. Two independent reviewers screened articles for inclusion and extracted data to describe details of each study (author, year, country, design, sampling), measures of pelvic floor muscle strength and urinary incontinence, statistical analysis of linkage between changes in the measures, and pelvic floor muscle training regimens. Data were summarized to facilitate the integration of diverse evidence to draw conclusions on supporting or refuting the three proposed theorized mechanisms for managing urinary incontinence in women. RESULTS Of the 278 articles identified with the search, 13 (4.7%) met inclusion criteria. There was weak to no evidence for the mechanism of enhanced pelvic floor muscle strength, equivocal support for maximized awareness of timing, and no evidence for strengthened core muscles. CONCLUSIONS This review revealed extremely limited data supporting the proposed theorized mechanisms underlying pelvic floor muscle training programs to manage urinary incontinence in women. Such evidence is needed to help women and clinicians understand how, why and when a woman benefits from pelvic floor muscle training. Future studies should specifically state and report statistical analysis that relates the theorized mechanisms to the training outcomes observed.
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Affiliation(s)
- Ying Sheng
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA.
| | - Janet S Carpenter
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA
| | - James A Ashton-Miller
- Department of Mechanical Engineering, 2350 Hayward, Ann Arbor, MI, 48109, USA
- Institute of Gerontology, University of Michigan, 300 N Ingalls St, Ann Arbor, MI, 48109, USA
| | - Janis M Miller
- Department of Health Behavior and Biological Science, School of Nursing, 426 N Ingalls St, Ann Arbor, MI, 48104, USA
- Department of Obstetrics and Gynecology, Medical School, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
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Śnieżek A, Czechowska D, Curyło M, Głodzik J, Szymanowski P, Rojek A, Marchewka A. Physiotherapy according to the BeBo Concept as prophylaxis and treatment of urinary incontinence in women after natural childbirth. Sci Rep 2021; 11:18096. [PMID: 34508116 PMCID: PMC8433362 DOI: 10.1038/s41598-021-96550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022] Open
Abstract
Pelvic floor muscle dysfunctions can lead to urinary incontinence, a condition which often affects women both during pregnancy and after childbirth. As a result of this, certain exercises are recommended during and after pregnancy to prevent and treat this incontinence, and the BeBo Concept is one of these methods used to prevent pelvic floor muscle dysfunction. The aim of the present study was to evaluate the effects of a 6-week course of physical therapy according to the BeBo Concept on the improvement of perineal muscle strength and endurance as well as urinary continence in women after their first vaginal delivery. The study was conducted on a group of 56 women who were randomly assigned to the exercise (n = 30) or control (n = 26) group. The exercising group participated in a 6-week physical therapy program according to the BeBo Concept. Pelvic floor muscles were assessed using the perineometer and palpation Perfect Test. UDI6 and ICIQ-SF questionnaires were used to obtain information about the symptoms of urinary incontinence, evaluate the frequency, severity and impact of urine leakage on the quality of life. In all women after natural childbirth, regardless of treatment, it was observed that measured parameters improved, but the improvement was slightly more explicit in those who participated in the Bebo Concept exercise group (e.g. ICIQ-SF exercise group p = 0.001, control group p = 0.035). Due to its positive impact on the pelvic floor, this exercise program should be recommended to women after natural childbirth.
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Affiliation(s)
- Aneta Śnieżek
- Department of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland.
| | - Dorota Czechowska
- Department of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland
| | - Marta Curyło
- Department of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland
| | - Jacek Głodzik
- Department of Physical Medicine and Biological Recovery, University of Physical Education in Krakow, Krakow, Poland
| | - Paweł Szymanowski
- Department of Gynecology and Obstetrics, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Anna Rojek
- Gabinet Fizjoterapii ReSport, Tarnów, Poland
| | - Anna Marchewka
- Department of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland
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Berhe A, Alamer A, Negash K, Assefa B. Urinary incontinence and associated factors among pregnant women attending antenatal care in public health facilities of Mekelle city, Tigray, Ethiopia. ACTA ACUST UNITED AC 2021; 16:1745506520952009. [PMID: 33028167 PMCID: PMC7707857 DOI: 10.1177/1745506520952009] [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] [Indexed: 11/24/2022]
Abstract
Background: Urinary incontinence is any involuntary leakage of urine. It has serious negative health impacts on quality of life in pregnant women. According to the scientific committee of the International Continence Society report, worldwide prevalence of urinary incontinence estimated ranges between 32% and 64% among pregnant women. However, there is scarcity of evidence on prevalence and associated factors of urinary incontinence in Ethiopia. Objective: The aims of this study were to assess prevalence and associated factors of urinary incontinence among pregnant women attending antenatal care in public health facilities of Mekelle city, Tigray, Ethiopia. Methodology: Institution-based cross-sectional study design was conducted. Data were collected using an interviewer-administered structured questionnaire. Physical examination was done to assess the strength of pelvic floor muscles. The data were entered to EPI Info version 7 and analyzed using SPSS version 23. Bivariate and multivariate logistic regression analyses were done to investigate the factors associated with urinary incontinence. Results: Among 317 respondents, the prevalence of urinary incontinence was 23%. The contributing factors that had statistically significant association with urinary incontinence were gestational age (adjusted odds ratio: 9.6 (1.87–49.39, 95%), parity (adjusted odds ratio: 6.32 (1.48–27.05), 95% confidence interval), prior miscarriage (adjusted odds ratio: 6.28 (2.15–18.28), 95% confidence interval), constipation (adjusted odds ratio: 8.25 (3.12–21.84), 95% confidence interval), respiratory problem (adjusted odds ratio: 6.31 (2.05–19.43), 95% confidence interval), and weak pelvic floor muscle (adjusted odds ratio: 7.55 (2.51–22.67), 95% confidence interval). Conclusion: The prevalence of urinary incontinence is moderate compared to other studies. Gestational age, parity, prior miscarriage, having constipation, having respiratory problem, and weak pelvic floor muscle had significant association with urinary incontinence. This finding will help to increase the awareness of health care professionals involved in the care of pregnant women about urinary incontinence.
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Affiliation(s)
- Arsema Berhe
- Department of Physiotherapy, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abayneh Alamer
- Department of Physiotherapy, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Kiflom Negash
- Department of Physiotherapy, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Belete Assefa
- School of Public Health, College of Health Science, Mekelle University, Mekelle, Ethiopia
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Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama'i MS, Schizas A, Slieker-Ten Hove M, Takahashi S, Voelkl Guevara J. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 2021; 40:1217-1260. [PMID: 33844342 DOI: 10.1002/nau.24658] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The terminology for female and male pelvic floor muscle (PFM) assessment has expanded considerably since the first PFM function and dysfunction standardization of terminology document in 2005. New terms have entered assessment reports, and new investigations to measure PFM function and dysfunction have been developed. An update of this terminology was required to comprehensively document the terms and their definitions, and to describe the assessment method and interpretation of the finding, to standardize assessment procedures and aid diagnostic decision making. METHODS This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) Working Group 16, with contributions from recognized experts in the field and external referees. A logical, sequential, clinically directed assessment framework was created against which the assessment process was mapped. Within categories and subclassifications, each term was assigned a numeric coding. A transparent process of 12 rounds of full working group and external review was undertaken to exhaustively examine each definition, plus additional extensive internal development, with decision making by collective opinion (consensus). RESULTS A Terminology Report for the symptoms, signs, investigations, and diagnoses associated with PFM function and dysfunction, encompassing 185 separate definitions/descriptors, has been developed. It is clinically based with the most common assessment processes defined. Clarity and user-friendliness have been key aims to make it interpretable by clinicians and researchers of different disciplines. CONCLUSION A consensus-based Terminology Report for assessment of PFM function and dysfunction has been produced to aid clinical practice and be a stimulus for research.
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Affiliation(s)
- Helena Frawley
- School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Beth Shelly
- Beth Shelly Physical Therapy, Moline, Illinois, USA.,Department of Physical Therapy, Saint Ambrose University Davenport, Iowa, USA
| | - Melanie Morin
- School of Rehabilitation Faculty of Medecine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Stéphanie Bernard
- Department of Rehabilitation, Faculté de Médecine, Université Laval, Québec, Quebec, Canada
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Akershus University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Giuseppe Alessandro Digesu
- Academic Department of Obstetrics and Gynaecology, St. Mary's Hospital, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tamara Dickinson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Mohammad S Rahnama'i
- Uniklinik RWTH, University Hospital of Aachen, Aachen, Germany.,Society of Urological Research and Education (SURE), Heerlen, The Netherlands
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Marijke Slieker-Ten Hove
- Department Gynaecology, University of Erasmus, Rotterdam, The Netherlands.,Pelvic Floor Physiotherapy, ProFundum Instituut, Dordrecht, The Netherlands
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The effect of parity on the function of pelvic floor musculature in the long term: cross-sectional study. Obstet Gynecol Sci 2020; 63:577-585. [PMID: 32933227 PMCID: PMC7494773 DOI: 10.5468/ogs.19236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/12/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Parity is associated with an increased risk of pelvic floor muscle dysfunction. The aim of this study was to evaluate the long-term effects of parity on this musculature. Methods This cross-sectional study was completed at the Department of Physical Therapy, Federal University of São Carlos, Brazil. In total, 143 women participated in the study and were classified into three groups according to parity: nulliparae, primiparae, and secundiparae women. All parous participants had last given birth between 1 and 6 years prior. Pelvic floor muscle function was assessed through unidigital vaginal palpation using the PERFECT scheme, with the contraction grade classified according to the Modified Oxford Scale and through manometry. Results There was no difference in scores on the Modified Oxford Scale (the means and standard deviations were 2.5±0.8 in nulliparae women, 2.3±0.9 in primiparae women, and 2.2±0.9 in secundiparae women; P=0.482) and manometry findings (the means and standard deviations were 42.3±22.7 in nulliparae women, 35.0±21.8 in primiparae women, and 33.2±20.0 in secundiparae women; P=0.144) among the assessed groups. Conclusion Parity had no effect, regardless of mode of birth, on the function of pelvic floor muscles and the presence of urinary symptoms, such as long-term urinary incontinence after birth.
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Jose-Vaz LA, Andrade CL, Cardoso LC, Bernardes BT, Pereira-Baldon VS, Resende APM. Can abdominal hypropressive technique improve stress urinary incontinence? an assessor-blinded randomized controlled trial. Neurourol Urodyn 2020; 39:2314-2321. [PMID: 32813928 DOI: 10.1002/nau.24489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/17/2020] [Accepted: 07/27/2020] [Indexed: 11/07/2022]
Abstract
AIM To verify which one improves better stress urinary incontinence (SUI) symptoms: abdominal hypopressive technique (AHT) or pelvic floor muscle training (PFMT). METHODS Randomized controlled trial. Women with SUI who had not participated of physiotherapy program before were invited. The outcome measures were 7-day bladder diary, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and pelvic floor muscles (PFM) function measured by Modified Oxford grading System with vaginal palpation and manometry with Peritron. Intervention consisted by 12 weeks of exercises program including PFMT or AHT program, in groups of maximum three women, twice a week, with physiotherapist supervision. RESULTS AHT and PFMT groups reduced urinary leakage episodes in 7 days, -0.64 and -1.91, respectively, but PFMT was superior, whit mean difference -1.27 (95% confidence interval [CI]: -1.92 to -0,62) and effect size was 0.94 in favor to PFMT. Regarding to total score of ICIQ-SF, both groups improved, with mean difference between groups -4.7 (95% CI: -6.90 to -2.50) and effect size was 1.04 in favor to PFMT. Manometry also presented improvement after treatment for both groups with mean difference between them of 11 (95% CI: 6.33-15.67) and effect size was 1.15 also in favor to PFMT. CONCLUSION Regarding to SUI symptoms, quality of life impact and PFM function both groups presented improvement, however, PFMT was superior to AHT among all of them.
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Affiliation(s)
- Luciene A Jose-Vaz
- Physiotherapy Department, Federal University of Uberlândia, Minas Gerais, Brazil
| | - Carine L Andrade
- Physiotherapy Department, Federal University of Uberlândia, Minas Gerais, Brazil
| | - Laura C Cardoso
- Physiotherapy Department, Federal University of Uberlândia, Minas Gerais, Brazil
| | - Bruno T Bernardes
- Gynecology and Obstetrics Department, Urogynaecology Ambulatory Unit, Federal University of Uberlândia, Minas Gerais, Brazil
| | | | - Ana Paula M Resende
- Physiotherapy Department, Federal University of Uberlândia, Minas Gerais, Brazil
- Gynecology and Obstetrics Department, Urogynaecology Ambulatory Unit, Federal University of Uberlândia, Minas Gerais, Brazil
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10
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Duarte TB, Bø K, Brito LGO, Bueno SM, Barcelos TM, Bonacin MA, Ferreira CH. Perioperative pelvic floor muscle training did not improve outcomes in women undergoing pelvic organ prolapse surgery: a randomised trial. J Physiother 2020; 66:27-32. [PMID: 31843420 DOI: 10.1016/j.jphys.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
QUESTION In women undergoing surgery for pelvic organ prolapse (POP), what is the average effect of the addition of perioperative pelvic floor muscle training on pelvic organ prolapse symptoms, pelvic floor muscle strength, quality of life, sexual function and perceived improvement after surgery? DESIGN Randomised controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. PARTICIPANTS Ninety-six women with an indication for POP surgery. INTERVENTION The experimental group received a 9-week pelvic floor muscle training protocol with four sessions before the surgery and seven sessions after the surgery. The control group received surgery only. OUTCOME MEASURES Symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20), which is scored from 0 'unaffected' to 300 'worst affected'. Secondary outcomes were assessed using vaginal manometry, validated questionnaires and Patient Global Impression of Improvement, which is scored from 1 'very much better' to 7 'very much worse'. All participants were evaluated 15 days before surgery, and at Days 40 and 90 after surgery. RESULTS There was no substantial difference in POP symptoms between the experimental and control groups at Day 40 (31 (SD 24) versus 38 (SD 42), adjusted mean difference -6, 95% CI -25 to 13) or Day 90 (27 (SD 27) versus 33 (SD 33), adjusted mean difference -4, 95% CI -23 to 14). The experimental group perceived marginally greater global improvement than the control group; mean difference -0.4 (95% CI -0.8 to -0.1) at Day 90. However, the estimated effect of additional perioperative pelvic floor muscle training was estimated to be not beneficial enough to be considered worthwhile for any other secondary outcomes. CONCLUSION In women undergoing POP surgery, additional perioperative pelvic floor muscle training had negligibly small effects on POP symptoms, pelvic floor muscle strength, quality of life or sexual function. TRIAL REGISTRATION ReBEC, RBR-29kgz5.
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Affiliation(s)
- Thaiana B Duarte
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences and Department of Obstetrics and Gynecology, University Hospital, Lørenskog, Norway
| | - Luiz Gustavo O Brito
- Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sabrina M Bueno
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Thays Mr Barcelos
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marília Ap Bonacin
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Cristine Hj Ferreira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
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11
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Silva JBD, Sato TO, Rocha APR, Driusso P. "Comparative intra- and inter-rater reliability of maximal voluntary contraction with unidigital and bidigital vaginal palpation and construct validity with Peritron manometer". Neurourol Urodyn 2019; 39:721-731. [PMID: 31873956 DOI: 10.1002/nau.24263] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/15/2019] [Indexed: 11/11/2022]
Abstract
AIMS Evaluate the intra- and inter-rater reliability of maximal voluntary contraction (MVC) of pelvic floor muscle (PFM) assessment by unidigital and bidigital vaginal palpation. As a secondary aim, evaluate the construct validity of vaginal palpation and a manometer. METHODS A total of 120 women were recruited and allocated into three groups according to age (group 1 [G1]: 18-35; G2: 36-59; G3: ≥60 years). Examiner A conducted an interview and examiners B and C performed evaluations of PFM function using both unidigital and bidigital vaginal palpation. Seven to 10 days later, examiner B repeated both types of vaginal palpation and measured the MVC pressure with a Peritron. Reliability was analyzed using Cohen's linear weighted Kappa (κw ). The construct validity was calculated using the Spearman's correlation (rs ). RESULTS Intra-rater reliability of unidigital and bidigital palpation was κw = 0.75 and κw = 0.58 in G1, κw = 0.59 and κw = 0.73 in G2, and κw = 0.79 and κw = 0.86 in G3, respectively. Inter-rater reliability of unidigital and bidigital palpation was κw = 0.52 and κw = 0.48 in G1, κw = 0.47 and κw = 0.52 in G2, and κw = 0.50 and κw = 0.64 in G3, respectively. Spearman's correlation coefficients were significant at rs = 0.79 and rs = 0.80 for unidigital and bidigital vaginal palpation, respectively. CONCLUSIONS Unidigital or bidigital vaginal palpation were indicated to evaluate G1 and G2 but bidigital palpation was more reliable in G3 when two examiners performed the evaluation. For the assessment conducted by one examiner, unidigital palpation was more reliable in G1 while bidigital palpation was more reliable in G2 and G3. Both unidigital and bidigital palpation have high measures of validity.
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Affiliation(s)
- Jordana B da Silva
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Tatiana O Sato
- Preventive Physical Therapy and Ergonomics Laboratory, Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Ana P R Rocha
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Patricia Driusso
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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12
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Pereira-Baldon VS, Avila MA, Dalarmi CB, de Oliveira AB, Driusso P. Effects of different regimens for pelvic floor muscle training in young continent women: Randomized controlled clinical trial. J Electromyogr Kinesiol 2018; 44:31-35. [PMID: 30481699 DOI: 10.1016/j.jelekin.2018.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Physical therapy is recommended as first-line treatment to urinary incontinence (UI), and pelvic floor muscles (PFM) training is one of the most used resources for this purpose, no ideal PFM training protocol has been established. OBJECTIVES The purpose of the present study was to verify whether more daily sessions of PFM training lead to better PFM function. METHODS Twenty-five young continent women volunteered and were randomly assigned to 2 different groups; group 1, in which they performed one PFM training session daily, and group 2, in which they performed 3 daily PFM training sessions. All volunteers were evaluated regarding PFM function, based on the Modified Oxford Scale, maximum voluntary contraction, with a manometer, and PFM activation, with electromyography. Both groups trained during 8 consecutive weeks and were evaluated before and after treatment. All evaluations had the reproducibility tested by intraclass correlation coefficients. Statistical analyzes included data normality (Shapiro-Wilks), intragroup (Wilcoxon) and intergroup (Mann-Whitney U) comparisons. Effect sizes were calculated to all variables analyzed. Significance level was set al p < 0.05. RESULTS Even though an increase in PFM strength, pressure and muscle activation was achieved by both groups (p < 0.05, effect sizes from 0.24 to 0.81), no differences between groups for any variables were detected (p > 0.05). CONCLUSIONS The number of daily training sessions does not interfere in the improvement of PFM function in young women without PFM dysfunction.
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Affiliation(s)
- Vanessa S Pereira-Baldon
- Physical Education and Physical Therapy Faculty, Universidade Federal de Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Mariana Arias Avila
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | - Ana Beatriz de Oliveira
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Patricia Driusso
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil.
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13
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Bocardi DAS, Pereira-Baldon VS, Ferreira CHJ, Avila MA, Beleza ACS, Driusso P. Authors' reply. Climacteric 2018; 21:618-619. [PMID: 30299973 DOI: 10.1080/13697137.2018.1520826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D A S Bocardi
- a Physical Therapy Department , Federal University of São Carlos , São Carlos , São Paulo , Brazil
| | - V S Pereira-Baldon
- b Faculty of Physical Education and Physiotherapy , Federal University of Uberlândia , Uberlândia , Minas Gerais , Brazil
| | - C H J Ferreira
- c Physical Therapy Department , Universidade de São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - M A Avila
- a Physical Therapy Department , Federal University of São Carlos , São Carlos , São Paulo , Brazil.,d Post-Graduate Program on Physical Therapy , Federal University of São Carlos , São Carlos , Brazil
| | - A C S Beleza
- a Physical Therapy Department , Federal University of São Carlos , São Carlos , São Paulo , Brazil
| | - P Driusso
- a Physical Therapy Department , Federal University of São Carlos , São Carlos , São Paulo , Brazil.,d Post-Graduate Program on Physical Therapy , Federal University of São Carlos , São Carlos , Brazil
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14
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Rocha F, Carvalho J, Jorge Natal R, Viana R. Evaluation of the pelvic floor muscles training in older women with urinary incontinence: a systematic review. Porto Biomed J 2018; 3:e9. [PMID: 31595241 PMCID: PMC6726312 DOI: 10.1016/j.pbj.0000000000000009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Urinary incontinence (UI) is defined as any involuntary urine loss that predominantly affects older women. There is evidence that pelvic floor muscles training (PFMT) program is effective on the treatment of pelvic floor (PF) dysfunctions and is considered to be first-line treatment. The evaluation of pelvic floor muscles (PFM) function and strength is central to validate the effectiveness of the training protocol in UI decrease. The Oxford Grading Scale and manometry are fundamental to evaluate the PFM function and strength. Objective: The aim of the study was to systematize the scientific evidence about the effects of PFMT in older women, assessing the PF function and strength through Oxford Grading Scale and manometry. Methods: The research of randomized controlled clinical trials was performed through B-on, EBSCO, PEDro, Pubmed, and SciELO data carried out from 2003 to 2016. Results: A total of 35 studies were identified, 26 of these were selected and fully analyzed. From the analyzed studies (n = 26), 20 were excluded for not meeting the criteria for inclusion, and only 6 studies were classified as high methodological quality, scoring an overall 4 points according the PEDro scale. Conclusion: The PFMT seems to be effective in treating UI in older women; the Oxford Grading Scale and manometry are considered the most reliable in the random and controlled clinical trials results. However, future investigations with high methodological quality with older women are necessary to support these results.
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Affiliation(s)
| | - Joana Carvalho
- Faculty of Sports, University of Porto.,Research Centre in Physical Activity, Health and Leisure CIAFEL
| | - Renato Jorge Natal
- Faculty of Engineering.,Institute of Science and Innovation in Mechanical and Industrial Engineering INEGI
| | - Rui Viana
- Faculty of Health Sciences, University of Fernando Pessoa.,Physical Medicine and Rehabilitation Department, Centro Hospitalar São João EPE, Porto, Portugal
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15
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Ignácio Antônio F, Herbert RD, Bø K, Rosa-E-Silva ACJS, Lara LAS, Franco MDM, Ferreira CHJ. Pelvic floor muscle training increases pelvic floor muscle strength more in post-menopausal women who are not using hormone therapy than in women who are using hormone therapy: a randomised trial. J Physiother 2018; 64:166-171. [PMID: 29914808 DOI: 10.1016/j.jphys.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 10/28/2022] Open
Abstract
QUESTION Are there differences in the effectiveness of pelvic floor muscle training on pelvic floor muscle strength and urinary incontinence symptoms in postmenopausal women who are and are not using hormone therapy? DESIGN Randomised, controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. PARTICIPANTS Ninety-nine postmenopausal women, 38 of whom were using daily systemic oestrogen/progestogen therapy. INTERVENTION The experimental group (n=51) received an intensive supervised pelvic floor muscle training protocol, and the control group (n=48) received no intervention. The randomisation was stratified by hormone therapy use. OUTCOME MEASURES Change in pelvic floor muscle strength assessed with manometry at 12 weeks. Prevalence and severity of urinary incontinence symptoms were assessed using questionnaires. RESULTS Eighty-eight women provided data that could be included in the analysis. Pelvic floor muscle training increased pelvic floor muscle strength by 8.0 cmH2O (95% CI 3.4 to 12.6) in women not using hormone therapy and by -0.9 cmH20 (95% CI -6.5 to 4.8) in women using hormone therapy (interaction p=0.018). A sensitivity analysis showed that the greater training effect in women who were not using hormone therapy was still apparent if the analysis was conducted on percentage change in strength rather than absolute change in strength. There was also a significantly greater effect of training in women not using hormone therapy on prevalence of urinary incontinence symptoms (ratio of odds ratios=7.4; interaction p=0.028). The difference in effects on severity of urinary incontinence symptoms was not statistically significant (interaction p=0.37). CONCLUSION Pelvic floor muscle training increases pelvic floor muscle strength more in women who are not using hormone therapy than in women using hormone therapy. TRIAL REGISTRATION ClinicalTrials.gov NCT02549729. [Ignácio Antônio F, Herbert RD, Bø K, Rosa-e-Silva ACJS, Lara LAS, Franco MdM, Ferreira CHJ (2018) Pelvic floor muscle training increases pelvic floor muscle strength more in post-menopausal women who are not using hormone therapy than in women who are using hormone therapy: a randomised trial. Journal of Physiotherapy 64: 166-171].
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Affiliation(s)
- Flávia Ignácio Antônio
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Kari Bø
- Norwegian School of Sport Sciences Department of Sports Medicine, Oslo and Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | | | - Lúcia Alves Silva Lara
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, Univesity of São Paulo, Ribeirão Preto, Brazil
| | - Maira de Menezes Franco
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Duarte TB, Bonacin MAP, Brito LGO, Frawley H, Dwyer PL, Thomas E, Ferreira CHJ. Does pelvic floor muscle maximum voluntary contraction improve after vaginal pelvic organ prolapse surgery? A prospective study. Neurourol Urodyn 2018. [DOI: 10.1002/nau.23503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Thaiana B. Duarte
- Department of Biomechanics; Medicine and Rehabilitation; Postgraduate Program in Rehabilitation and Performance; Ribeirão Preto Medical School; University of São Paulo; Brazil
| | - Marília A. P. Bonacin
- Department of Biomechanics; Medicine and Rehabilitation; Postgraduate Program in Rehabilitation and Performance; Ribeirão Preto Medical School; University of São Paulo; Brazil
| | - Luiz G. O. Brito
- Department of Gynecology and Obstetrics; School of Medical Sciences; University of Campinas; Brazil
| | - Helena Frawley
- Department of Physiotherapy; School of Primary and Allied Health Care; Monash University; Melbourne Australia
| | - Peter L. Dwyer
- Urogynaecology Department; Mercy Hospital for Women; Melbourne Australia
| | - Elizabeth Thomas
- Urogynaecology Department; Mercy Hospital for Women; Melbourne Australia
| | - Cristine H. J. Ferreira
- Department of Biomechanics; Medicine and Rehabilitation; Postgraduate Program in Rehabilitation and Performance; Ribeirão Preto Medical School; University of São Paulo; Brazil
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17
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Novel instrumented probe for measuring 3D pressure distribution along the vaginal canal. J Biomech 2017; 58:139-146. [DOI: 10.1016/j.jbiomech.2017.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 04/25/2017] [Accepted: 04/30/2017] [Indexed: 11/17/2022]
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