The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis After Pregnancy: A Longitudinal Prospective Cohort Study

OBJECTIVE

The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis (DRA) from 3 to 12 months postpartum.

METHODS

In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12 months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and DRA (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as nonexercisers (n = 105), minimal low-impact exercisers (n = 249), regular low-impact exercisers (n = 117), and high-impact exercisers (n = 32). Between-group differences and within-group changes from 3 to 12 months were calculated using Chi-square tests, Kruskal-Wallis tests, and Friedman analysis of variance.

RESULTS

At 3 months, no differences in symptom prevalence were seen between the groups. Nonexercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in nonexercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in nonexercisers from 3 to 12 months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and DRA decreased, and pelvic floor strength increased from 3 to 12 months.

CONCLUSION

The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, nonexercisers reported an increase in stress urinary incontinence between 3 and 12 months postpartum.

IMPACT

Physical therapists should encourage women to start with low-impact exercise early after pregnancy.

LAY SUMMARY

This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence.

Experiences of hospital rotation from family medicine residents' points of view an empirical holistic study

OBJECTIVE

Trainees or medical residents' experiences of hospital rotations and training have not been sufficiently studied. More empirical holistic studies of experiences of General Practice/Family Medicine (GP/FM) residents in Sweden are needed. The purpose of this study was to describe experiences of hospital rotation during residency.

DESIGN

Empirical-holistic study.

SETTING

GP/FM residents were invited by email to participate in the study. They could describe their experiences anonymously by answering two questions via an esMaker internet survey. Analyses of the responses were carried out with content analysis as the analytical methodology. Both manifest and latent responses were analyzed.

SUBJECTS

Fifty-nine GP/FM residents participated in the study.

MAIN OUTCOME MEASURE

The results identified four main topics: structure, resources, effects, and constructive supervision.

RESULTS

GP/FM residents experienced hospital rotations as effective when there was a structured schedule and adequate time allotted for introduction and meeting patients. Hospital rotations that lacked, or had unstructured, supervision caused uncertainty and insecurity, which led to rotations being experienced as less beneficial, which was, from a GP/FM perspective, not constructive.

CONCLUSION

The study suggests that family medicine residents required a structured and planned schedule during hospital rotations. This study may contribute to increased quality of hospital rotations during residency as a family physician.

Facing a new life-The healthy transition to motherhood: What individual and environmental factors are needed? A phenomenological-hermeneutic study

OBJECTIVE

The aim of the study was to highlight first-time mothers' experiences of the transition to motherhood uncovering personal and environmental conditions facilitating or preventing the process of a healthy transition in a Swedish context.

DESIGN

A qualitative study with interview data analyzed using a phenomenological hermeneutic method.

SETTING AND PARTICIPANTS

Ten recent first-time mothers were selected from three primary healthcare centers in western Sweden.

FINDINGS

Four themes emerged, and the transition could be divided into several phases, interpreted as facing a new life, while feeling unprepared for identity and existential issues. The experience of becoming a mother was described as oscillation between a loss of former identity from previous life, and on the other hand, the joy and expectations of forming a new family. The mothers had high demands of themselves, often influenced by social media and needed to value the flow of information and `let go of control` to be able to make adequate decisions. The close family of origin was invaluable in this process being able to provide confirmation in the new role, facilitating the development of their own security and self-confidence.

KEY CONCLUSIONS

The vulnerability expressed by new mothers shows that support from the family of origin, partners and professionals are indispensable. The desired result after the transition to motherhood is a prosperous, maturity and confident mother. The main promoting factor in this process seems to be having a safe base that can provide required support.

IMPLICATIONS FOR PRACTICE

The level of wellbeing after the transition is crucial and the possibility of a warm, responsive and secure parenting needs to be strengthened. The challenge to preventive health care will be to identify a lack of support and ensure that these mothers gain sufficient support to meet today´s demands and still feel that they are good enough mothers for their children.

Conceptualising migraine attacks from a biopsychosocial model using qualitative and functional behavioural analysis

OBJECTIVE

The aim of this study was to explore patients' experiences and management of pain in connection with a migraine attack in episodic migraine.

DESIGN, SETTING AND SUBJECTS

This qualitative study used a semi-structured interview format based on functional behavioural analysis as commonly used in cognitive behavioural therapy. We interviewed eight participants and analysed their responses using systematic text condensation.

RESULTS

Participants' descriptions of their experiences and management of pain from episodic migraine were sorted into three description First physical sensations, Automatic reactions and Acts according to the interpretation.

CONCLUSION

From a biopsychosocial perspective, a migraine attack is much more complex than just an experience of pain. The purely biological pain prompts a number of automatic reactions leading to strategies for pain management.

Tobacco impact on quality of life, a cross-sectional study of smokers, snuff-users and non-users of tobacco

BACKGROUND

Tobacco smoking is a major public health issue, and also affects health-related quality of life. There has been considerable debate as to whether oral moist snuff, a form of tobacco placed in the oral cavity between the upper lip and gum as in sublabial administration, can be considered a safe alternative to smoking. The aim of this study was to investigate the association between health-related quality of life and smoking, snuff use, gender and age.

METHOD

This cross-sectional study included 674 women and 605 men aged 18 to 65 recruited through a Swedish population database. Subjects completed a questionnaire about tobacco use and the 36-item Short Form Health Survey (SF-36). Multivariable logistic regression analyses were performed for the association between health-related quality of life and tobacco use, gender and age. The median perceived health-related quality of life (SF-36) for an age-matched Swedish population was used as the cutoff: above the cutoff indicated better-than-average health coded as 1, or otherwise coded as 0. The independent variables were smoking (pack-decades), snuff-use (box-decades), gender and age in decades. The outcome was presented as the Odds Ratio (OR) with a 95% confidence interval (CI) for each independent variable.

RESULTS

The experience of cigarette smoking is associated with decreased physical functioning (PF), general health (GH), vitality (VT), social functioning (SF) and mental health (MH) as well as both lower physical component summary (PCS) and mental component summary (MCS). Further, the experience of snuff use is associated with bodily pain (BP), lower VT, and lower PCS. In the study population older age is associated with lower PF,GH, VT, MH, PCS and MCS. Female gender is associated with lower PF and VT.

CONCLUSION

This study shows that smoking is associated with lower health-related quality of life. The results also illuminate the detrimental health effects of using snuff, implying that snuff too is a health hazard. As studies on the bodily effects of snuff are relatively scarce, it is imperative that we continue to address and investigate the impact on the population using snuff on a regular basis.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT05409963 05251022 08/06/22.

Effect of group education and person-centered support in primary health care on mental health and quality of life in women aged 45-60 years with symptoms commonly associated with stress: a randomized controlled trial

BACKGROUND

Mental illness and somatic symptoms are common causes of long-term sick leave for women during menopause, which usually occurs between the ages of 45 and 55. Many women experience a lack of knowledge about menopause and its associated symptoms. This study evaluates the effect of group education and person-centered individual support in primary health care (PHC) on mental health and quality of life for women in menopause with symptoms that are usually associated with stress.

METHODS

The randomized controlled clinical trial (RCT) with a two-factor design was conducted in PHC in southwestern Sweden, from 2018 to 2019. A total of 370 women aged 45-60 were allocated in four groups: 1, group education (GE) 2, GE and person-centered individual support (PCS) 3, PCS and 4, control group. GE comprised four weekly sessions and PCS included five sessions with topics related to menopause. The effect of the interventions were followed up at 6 and 12 months. Linear and ordinal regression were used to analyse the effect of the intervention, either group education or person-centred individual support.

RESULTS

The main findings: Improved quality of life and physical, psychological, and urogenital symptoms. GE and PCS resulted in improvement of the quality of life at six months. At the 12-month follow-up these results were significantly strengthened for PCS and improved health-related quality of life, and reduced mental, urogenital, and stress-related symptoms with an effect lasting at least 12 months. These results suggest that this intervention could be an effective intervention in PHC for improving women's health in menopause.

CONCLUSIONS

PCS can be an effective intervention in PHC for improving women's health in menopause and possibly also prevent the development of exhaustion syndrome.

TRIAL REGISTRATION

Universal trial number is U1111-1219-6542 and the registration number in ClinicalTrials.gov is NCT03663075, date of registration 10/09/2018.

Can Clinical Postpartum Muscle Assessment Help Predict the Severity of Postpartum Pelvic Girdle Pain? A Prospective Cohort Study

OBJECTIVE

The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum.

METHODS

Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3 months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12 months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted.

RESULTS

Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (β = -3.13 [95% CI = -5.77 to -0.48]) at 2 to 3 months postpartum, with a higher prediction of a middle to high PGQ score (β = -6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35 mm predicted an increased PGQ score (β = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain.

CONCLUSION

The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35 mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed.

IMPACT

This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain.

Promoting health literacy and sense of coherence in primary care patients with long-term impaired work ability-a pilot study

OBJECTIVE

Evaluate feasibility, partnerships, and study design of intervention to minimise sick leave.

DESIGN AND SETTING

The design was a pilot single arm intervention study in primary health care. Outcome measures at follow-ups for each participant were compared with baseline data for the same person.

SUBJECTS

Twenty primary health care patients with recurrent or long-term sick leave or health-related unemployment.

INTERVENTION

Patient education through interactive study groups that met half a day a week for eight subsequent weeks. Groups were led by experienced but not medically trained facilitators. The intervention was designed to improve participant health literacy, sense of coherence, health-related quality of life, and patient involvement in healthcare.

MAIN OUTCOME MEASURES

Primary outcome was the level of sick leave. Sick leave data were obtained from medical records when available, otherwise patient reported. Secondary outcomes regarding health literacy, sense of coherence, and health-related quality of life were measured with validated questionnaires at baseline and follow-ups.

RESULTS

Level of sick leave decreased significantly and participation in work preparatory activities increased during follow-up. Health literacy, sense of coherence (subscale sense of meaningfulness), and health-related quality of life (subscale social functioning) showed statistically significant improvement. Intervention, partnerships, and study design were feasible.

CONCLUSION

An educational programme, conducted in cooperation between primary health care and partners outside the healthcare system, was feasible and showed an impact on sick leave, health literacy, sense of coherence, and health-related quality of life.KEY FINDINGSA pilot study to evaluate an educational programme with study groups conducted in cooperation between primary health care and partners outside the healthcare system showed good feasibility.Sick leave decreased significantly six months after baseline.Health literacy, sense of coherence (subscale sense of meaningfulness), and health-related quality of life (subscale social function) improved significantly 6 months after baseline.

Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study

OBJECTIVES

Evaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum.

DESIGN

A multicentre inter-rater reliability study.

SETTING

Three primary care rehabilitation centres in Sweden.

PARTICIPANTS

A total of 222 participants were recruited via advertising at Swedish maternity care units and social media. Eligibility for participation included female gender, ≥18 years, at maximum 3 months after childbirth. Exclusion criteria were chronic pelvic girdle pain and/or low back pain and/or pelvic floor tear grade III/IV. At each centre, 2 physiotherapists, with training and experience in pelvic floor assessment, assessed the 222 women according to a standardised protocol in random order.

OUTCOME MEASURES

Inter-rater reliability of the assessment of pelvic floor muscle function (involuntary and voluntary contraction and voluntary relaxation) and diastasis recti abdominis (width, depth and bulging).

RESULTS

Vaginal palpation of maximal voluntary contraction revealed a kappa value of 0.69 (95% CI 0.62 to 0.76). Assessments of involuntary contraction and voluntary relaxation yielded inconsistent results, with slight-to-moderate weighted kappa values ranging from 0.10 to 0.51. After 2 months of training in applying this method, diastasis recti abdominis width measured at the umbilicus by calliper yielded an intraclass correlation coefficient value of 0.83 (95% CI 0.76 to 0.87). Assessments of diastasis recti abdominis depth and bulging showed moderate kappa values, with reservation for some inconsistency between the centres.

CONCLUSIONS

Vaginal palpation of pelvic floor muscle strength is a reliable method for the postpartum muscle assessment. Additional research is needed to identify reliable assessment method for other pelvic floor muscle functions like involuntary contraction and voluntary relaxation. With some training, a calliper is a reliable instrument for measuring the postpartum diastasis recti abdominis width. This study provides novel thoughts about how to measure diastasis recti abdominis depth and bulging.

TRIAL REGISTRATION NUMBER

NCT03703804.

'Making of a Strong Woman': a constructivist grounded theory of the experiences of young women around menarche in Papua New Guinea

Background

Menarche, the first menstruation, is a significant developmental milestone for females. In Papua New Guinea (PNG), menarche is an important socio-cultural event marking transition from girlhood to womanhood. PNG is a culturally and linguistically diverse nation, with wide-ranging socio-cultural beliefs and practices around menarche. This study explored post-menarcheal women’s understanding about body changes and menarche, preparation for menarche, and related cultural beliefs and practices at menarche.

Methods

A constructivist grounded theory study was conducted with 98 female participants who originated from four PNG provinces: Eastern Highlands Province; East Sepik Province; Milne Bay Province; and National Capital District. The participants were purposively and theoretically sampled, with 10 focus group discussions and six individual interviews conducted using a semi-structured interview guide for data collection. Focus group discussions and interviews were voice recorded and transcribed. Data were inductively analyzed using initial, intermediate and advanced coding, memos and constant comparative methods to develop a theoretical model that explains women’s experiences at menarche. Interview participants also identified actions required to improve future experiences of girls at menarche in PNG.

Results

A grounded theory comprising the core category of ‘Making of a Strong Woman’ and four interconnecting categories (‘Having Baby Sense’; ‘Beginning of Learning’; ‘Intensifying Learning’; and ‘Achieving Womanhood’) was constructed. ‘Urban’ and ‘Rural’ represented both geographical and socio-cultural intervening conditions that influence the experiences of girls at menarche. Experiences of young women at menarche were rooted in socio-cultural beliefs and practices. Women reported being physically and emotionally distressed and unprepared at onset of menarche. Mothers were considered important support, however, their ability to adequately prepare their daughters is limited by shame and secrecy. Despite these limitations, cultural practices at menarche provided an opportunity for intensive preparation of girls for womanhood.

Conclusion

Limited pre-menarcheal awareness of the meaning of body changes and menarche of girls was linked to culture of shame and secrecy about open discussion on sexuality. However, traditional cultural practices provide an opportunity for collective support and focused learning for girls. Findings from this study have implications for broader sexual and reproductive health education programs in addressing menstrual health and hygiene in PNG, and the Pacific.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01229-0.

Prognostic factors for future mental, physical and urogenital health and work ability in women, 45-55 years: a six-year prospective longitudinal cohort study

BACKGROUND

Impaired health due to stress is a common cause of long-term illness in women aged 45-55 years. It is a common cause for visits to primary health care (PHC) and may influence work-ability. The aim of this study was to investigate prognostic factors for future mental, physical and urogenital health as well as work-ability in a population of average women aged 45-55 years.

METHODS

This longitudinal cohort study initially assessed 142 women from PHC centers in southwestern Sweden. One houndred and ten accepted participation and were followed for 6 years. They were assessed using the self-reported questionnaires: the Menopause Rating Scale (MRS), the Montgomery-Asberg Depression Rating Scale (MADRS-S), the Short-Form Health Survey (SF-36). Descriptive data are presented of health, education, relationships and if they are working. Multicollinearity testing and logistic regression were used to test the explanatory variables.

RESULT

Severity of symptoms in the MRS somatic and urogenital domains decreased while they increased in the psychological and depressive domains. Having tertiary education was associated with decreased overall mental health, vitality and social role functioning. Living with a partner was associated with increased physical role functioning, social role functioning and emotional role functioning.

CONCLUSION

Quality of life seems to be enhanced by a good relationship with the partner, social support and work/life balance. Therefore, to improve women health women should early discuss ways in which these issues can be incorporated as they pursue their academic or career goals. Hence, we emphasize the importance of supporting women to gain increased awareness about a healthy life balance and to have realistic goals in work as well as in their social life.

Patient experiences of living with chronic leg ulcers and making the decision to seek professional health-care

OBJECTIVE:

The aim of the study was to elucidate how patients experience living with chronic leg ulcers before consulting a health professional, and to determine the reasons behind the decision to visit a health-care centre.

METHOD:

A qualitative interview study was carried out. There were 11 participants, five men and six women (age range: 27-83 years old). All participants in the study were patients visiting the public primary medical centre in western Sweden for the first time for a chronic leg ulcer. The data was obtained by recorded interviews. Systematic text condensation (STC) by Malterud was applied to the analysis.

RESULTS:

The analysis identified five main categories of the issues relating to ulcers to their ulcers: convictions, pain, emotions, strategies, and health-care treatment. At first, patients accepted the inconvenience of a leg ulcer. Gradually, they focused more on strategies dealing with the ulcer, and withdrew from their social context, while their fears increased. Many needed support in the decision to seek professional care.

CONCLUSION:

Despite pain, anxiety, emotional lability, and disappointment, they had strategies to cope with ulcers on their own. A social network seems crucial for the decision to seek professional health care and greater knowledge of leg ulcers, particularly in the elderly population, is needed.

Prevalence of somatic and urogenital symptoms as well as psychological health in women aged 45 to 55 attending primary health care: a cross-sectional study

BACKGROUND

Women's physical and mental ill-health such as stress-related symptoms, depression, pain, hypertension and urogenital health shows a marked increase around the ages 45-55 years. These women are an important group for Primary Health Care (PHC) due to their prevalent symptoms and illnesses. The aim of this study was to estimate the prevalence of somatic, psychological and urogenital symptoms in women aged 45-55 attending PHC and evaluate factors associated with severe symptoms.

METHODS

One hundred and thirty-one women were recruited from PHC in southwestern Sweden. Data were obtained from two self-reported questionnaires, the Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS).

RESULTS

Exhaustion, depressive mood, muscle and joint problems, sleep and sexual problems were the most prevalent reported symptoms. Half of the women reported heart discomfort. Depression and increasing age were correlated to more severe symptoms.

CONCLUSION

We recommend that cardiovascular risk factors, musculoskeletal symptoms, sexual problems, sleeping problems and mental health should be actively asked for when women aged 45 to 55 attend PHC. We propose that preventive counselling of women in PHC before the age 45 should be evaluated in future studies.

Reducing menopausal symptoms for women during the menopause transition using group education in a primary health care setting-a randomized controlled trial

OBJECTIVES

Women's physical and mental ill-health shows a marked increase during menopause, which usually occurs between 45 and 55 years of age. Mental illness and somatic symptoms are common causes of long-term sick leave. Women suffer from a lack of knowledge about the menopause transition and its associated symptoms. The aim of the study was to investigate whether group education for women in primary health care (PHC) about the menopause transition can improve their physical and mental ill-health.

STUDY DESIGN

This randomized controlled study was conducted in PHC and aimed to evaluate a group education programme for women aged 45-55 years, around the menopause transition. A total of 131 women were randomized to group education or no intervention. The group intervention included two education sessions with topics related to menopause. They answered two questionnaires at baseline and at four-month follow-up: the Menopause Rating Scale (MRS) and the Montgomery-Asberg Depression Rating Scale (MADRS).

MAIN OUTCOME MEASURE

Change in MRS and MADRS scores over the four months.

RESULTS

The intervention group experienced a slight reduction in symptoms while the control group mostly experienced the opposite.

CONCLUSION

This study showed that it was feasible to implement group education on menopause for women aged 45-55 years.

THE CLINICAL TRIAL REGISTRATION NUMBER

NTC02852811.