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Bø K, Lillegård RH, Skaug KL. Pelvic Floor Muscle Training on Stress Urinary Incontinence in Power- and Weightlifters: a Pilot Study. Int Urogynecol J 2024:10.1007/s00192-024-05801-8. [PMID: 38758455 DOI: 10.1007/s00192-024-05801-8] [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: 01/24/2024] [Accepted: 04/06/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is defined as involuntary leakage of urine on physical effort and is prevalent among power- and weightlifters. However, there is scant knowledge on treatment options for this population. The aim of this pilot study was to evaluate the potential outcomes and feasibility of a pelvic floor muscle training (PFMT) program on SUI in nulliparous female power- and weightlifters. METHODS This was a case-series study, including one weightlifter and two powerlifters aged 21-32 years. The participants conducted 12 weeks of PFMT at home, with weekly follow-up by a physiotherapist. Change in total score of the International Consensus of Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was the primary outcome. Secondary outcome was perceived change assessed by the Patient Global Impression of Improvement (PGI-I) Scale and impact on sport participation. PFM strength, endurance, and resting pressure was measured using vaginal manometry. Feasibility was evaluated as adherence to training and self-efficacy (Self Efficacy Scale for Practicing Pelvic Floor Exercises). RESULTS One athlete reduced their ICIQ-UI-SF score and experienced improvement in symptoms. One athlete reported no change, and one reported a worsening of symptoms. All three participants improved PFM strength and endurance, completed the testing, and 12 weeks of PFMT, but adherence varied between 40 and 80%. Participants reported a lack of time and energy and forgetting to perform the exercises, as reasons for low adherence. CONCLUSION There were varying effects of a 12-week PFMT program on SUI in three strength athletes. The results can create the basis for a future randomized controlled trial.
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Affiliation(s)
- Kari Bø
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.
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Park J, Lee K, Lee K. Effect of Fluid and Caffeine Management on Quality of Life in Older Women with Overactive Bladder in Rural Korea: A Pilot Study. J Multidiscip Healthc 2024; 17:1549-1559. [PMID: 38617084 PMCID: PMC11016249 DOI: 10.2147/jmdh.s441256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose This study aimed to investigate the effectiveness of the simplified intervention, consisting of fluid and caffeine management alone in older women with overactive bladder symptoms. Patients and Methods A quasi-experimental pretest-posttest design was used. Rural, community-dwelling older women were recruited at four senior centers in South Korea. Of the 63 participants initially enrolled, 34 met the inclusion criteria. One group (n = 15) used fluid and caffeine management alone (FM), and the other group (n = 12) used a combination of fluid and caffeine management and pelvic floor muscle training (FM+PFMT). Urinary symptom-specific health-related quality of life was measured using the Korean version of KHQ. Sleep quality was measured using the Pittsburgh Sleep Quality Index. After the intervention, participants were assessed 4 and 8 weeks. A linear mixed model was used for the analysis. Results The mean age of the participants was 74.44 ± 5.67 years. Among the nine domains of KHQ, impact on life and physical limitations decreased significantly in both groups, without significant between-group differences. Sleep/energy increased in both groups, and the scores in the FM+PFMT group were significantly improved. The number of micturition episodes per day and the quality of sleep did not differ significantly between the two groups. Conclusion A simplified intervention, consisting of fluid and caffeine management alone can be considered as the first-line intervention to improve health-related quality of life in rural, community-dwelling, older women with overactive bladder symptoms. Healthcare providers should consider providing a relatively simple, but equally effective intervention to maximize the adherence and effectiveness.
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Affiliation(s)
- Jeongok Park
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Kyoungjin Lee
- College of Nursing, Kyungbok University, Gyeonggi-do, South Korea
| | - Kayoung Lee
- College of Nursing, Gachon University, Incheon, South Korea
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Harper RC, Sheppard S, Miller E, Stewart C, Clark CJ. #DryByChristmas: A patient and public involvement study on women's engagement with humorous pelvic floor muscle training digital nudges on social media. Health Expect 2024; 27:e14033. [PMID: 38556833 PMCID: PMC10982603 DOI: 10.1111/hex.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/08/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Patient and public involvement (PPI) is essential for women's health research. Little is known about how women engage with humorous social media and behavioural health messaging targeting pelvic floor muscle training (PFMT). This PPI aimed to understand how women engage with a humorous social media campaign encouraging PFMT. The study findings will influence the co-design of a digital intervention to support women's adherence to PFMT. METHODS The Guidance for Reporting Involvement of Patients and the Public Version 2 short form was used to report the study's findings. The study examined public engagement with a humorous social media campaign encouraging PFMT in women. A healthcare professional and comedian ran the campaign following the national guidelines for engagement in PFMT. Instagram analytics gave insight into the demographics of the public who engaged, how they engaged and the most popular content. The behaviour change techniques (BCTs) used in the digital nudges that generated the highest levels of engagement were analysed using the Capability Opportunity Motivation Behaviour Change Wheel. RESULTS The majority (96%) of the population showing the highest levels of engagement were women aged 35-44 years and were based in the United Kingdom (77%). The Instagram account saw an increase in engagement by 12% over the 3-month campaign, with 22,032 users seeing digital nudges and 2645 engaging with the digital nudges. The preferred way of engaging was using Likes (9723). The common themes in the digital nudges that generated the highest levels of engagement were BCTs associated with the 'social influences' theoretical domain framework that targeted the core behaviour opportunity. CONCLUSION The study findings suggest humour may improve women's engagement with online PFMT programmes; however, more rigorous research is required to better understand diverse women's experiences of humorous online PFMT nudges. Future studies may use PFMT mobile apps instead of social media to capture true user engagement and adherence to PFMT more accurately. The insights gained from the study will be taken forward to co-design a digital behavioural intervention as part of a larger study. PUBLIC CONTRIBUTION Members of the public were involved in the co-design of a digital health intervention that will be trialled as part of a larger research study. The public was involved using the social media platform Instagram. Public engagement with a humorous social media campaign to encourage women to engage with pelvic floor exercises was captured using Instagram analytics, for example, the timing of engagement.
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Affiliation(s)
- Rosie C. Harper
- Faculty of Health and Social SciencesCentre for Midwifery and Women's HealthBournemouth UniversityPooleUK
| | | | - Elaine Miller
- Chartered Society of Physiotherapy and ComedianLondonUK
| | - Carly Stewart
- Faculty of Science and TechnologyBournemouth UniversityPooleUK
| | - Carol J. Clark
- Faculty of Health and Social SciencesCentre for Midwifery and Women's HealthBournemouth UniversityPooleUK
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Weinstein MM, Dunivan GC, Guaderrama NM, Richter HE. A Motion-based Device Urinary Incontinence Treatment: A Longitudinal Analysis at 18 and 24 Months. Int Urogynecol J 2024; 35:803-810. [PMID: 38252280 PMCID: PMC11052829 DOI: 10.1007/s00192-023-05721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION AND HYPOTHESIS There are sparse data regarding the long-term efficacy of pelvic floor muscle training (PFMT) for the treatment of urinary incontinence (UI). The objective of this study was to evaluate the impact of an 8-week PFMT program guided by a motion-based intravaginal device versus a standard home program over 24 months. METHODS Between October 2020 and March 2021, a total of 363 women with stress or stress-predominant mixed UI were randomized and completed an 8-week PFMT program using a motion-based intravaginal device (intervention group) or a home program following written/video instructions (control group). Participants were not asked to continue training after the 8-week program. At 18 and 24 months' follow-up, the Urogenital Distress Inventory, short-form (UDI-6) and Patient Global Impression of Improvement (PGI-I) were collected. In the original trial, a total of 139 participants in each arm were needed to detect a 0.3 effect size (alpha = 0.05, power 0.8, one-tailed t test) in the difference in UDI-6 scores. RESULTS A total of 231 participants returned 24-month data. Mean age at 24 months was 51.7 ± 14.5 years, and mean BMI was 31.8 ± 7.4 kg/m2. Mean change in UDI-6 scores from baseline to 24 months was greater in the intervention group than the control group (-21.1 ± 24.5 vs -14.8 ± 19.4, p = 0.04). Reported improvement using PGI-I was greater in the intervention group than in the control group at 24 months (35% vs 22%, p = 0.03, OR 1.95(95% CI 1.08, 3.57). CONCLUSIONS Pelvic floor muscle training guided by a motion-based prescription intravaginal device yielded durable and significantly greater UI symptom improvement than a standard home program, even in the absence of continued therapy.
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Affiliation(s)
- Milena M Weinstein
- Department of Obstetrics, Gynecology and Reproductive Biology, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gena C Dunivan
- University of Alabama at Birmingham, Birmingham, AL, USA
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Fisher SR, Villasante-Tezanos A, Allen LM, Pappadis MR, Kilic G. Comparative effectiveness of pelvic floor muscle training, mirabegron, and trospium among older women with urgency urinary incontinence and high fall risk: a feasibility randomized clinical study. Pilot Feasibility Stud 2024; 10:1. [PMID: 38178267 PMCID: PMC10765875 DOI: 10.1186/s40814-023-01440-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Untreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling. METHODS Forty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling. DISCUSSION The proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population. TRIAL REGISTRATION NCT05880862. Registered on 30 May 2023.
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Affiliation(s)
- Steve R Fisher
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA.
| | | | - Lindsay M Allen
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Monique R Pappadis
- Department of Population Health and Health Disparities, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Gokhan Kilic
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, USA
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Briskin RS, Luck AM. Effects of Pure Barre Exercise on Urinary Incontinence Symptoms: A Prospective Observational Cross-Sectional Study. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:938-945. [PMID: 37195816 DOI: 10.1097/spv.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
IMPORTANCE Pure Barre is a form of physical exercise using low-impact, high-intensity, pulsatile isometric movements that may serve as a treatment option for urinary incontinence. OBJECTIVE The objective of this study was to measure the effects of the Pure Barre workout on urinary incontinence symptoms and sexual function. STUDY DESIGN This was a prospective observational study of new, female Pure Barre clients with urinary incontinence. Eligible participants completed 3 validated questionnaires at baseline and at follow-up after 10 Pure Barre classes within 2 months. Questionnaires included the Michigan Incontinence Symptoms Index (M-ISI), the Pelvic Floor Distress Inventory-20, and the Female Sexual Function Index-6. Matched differences in domain questionnaire scores between baseline and follow-up were analyzed. RESULTS All questionnaire domains significantly improved for all 25 participants after 10 Pure Barre classes. Median M-ISI severity domain scores decreased from 13 (interquartile range, 9-19) at baseline to 7 at follow-up (interquartile range, 3-10; P < 0.0001). Mean ± SD M-ISI urgency urinary incontinence domain scores decreased from 6.40 ± 3.06 to 2.96 ± 2.13 ( P < 0.0001). Mean ± SD M-ISI stress urinary incontinence scores decreased from 5.24 ± 2.71 to 2.48 ± 1.58 ( P < 0.0001). Mean ± SD Urinary Distress Inventory domain scores decreased from 42.17 ± 17.15 to 29.67 ± 13.73 ( P < 0.0001). Matched rank sum analysis indicated increasing Female Sexual Function Index-6 scores from baseline to follow-up ( P = 0.0022). CONCLUSION The Pure Barre workout may be an enjoyable, conservative management option that improves symptoms of urinary incontinence and sexual function.
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Affiliation(s)
- Rebeccah S Briskin
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Henry Ford Health, Detroit, MI
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Harper RC, Sheppard S, Stewart C, Clark CJ. Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e45947. [PMID: 38032694 PMCID: PMC10722367 DOI: 10.2196/45947] [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: 01/23/2023] [Revised: 07/01/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women. OBJECTIVE We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core "capability, opportunity, and motivation" (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care. METHODS We conducted a scoping review of the literature. Published quantitative literature that compared the use of a PFMT mobile app to a control group was included to address the objectives of the study. The electronic bibliographic databases searched included MEDLINE, CINAHL, Scopus, Web of Science, and PEDro, along with CENTRAL. Studies were also identified from reference searching of systematic reviews. Original articles written in English from 2006 onward were included. Nonexperimental quantitative studies, qualitative studies, studies that use male participants, case studies, web-based interventions, and interventions that use vaginal probes were excluded. Narrative synthesis was conducted on eligible articles based on the aims of the study. RESULTS Of the 114 records retrieved from the search, a total of 6 articles met the eligibility and inclusion criteria. The total number of participants in the studies was 471. All PFMT mobile apps used the BCT "prompts and cues." Opportunity was the core COM behavior targeted by the PFMT mobile apps. Higher levels of adherence to PFMT were observed among women using PFMT mobile apps. CONCLUSIONS Digital "prompts and cues" are a BCT commonly used in PFMT mobile apps, and further research is required to practically assess whether a future randomized controlled trial that investigates the effectiveness of digital "prompts and cues" on PFMT adherence in women can be conducted.
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Affiliation(s)
- Rosie C Harper
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
- National Institute of Health Research ARC Wessex, Southampton, United Kingdom
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Sally Sheppard
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Carly Stewart
- Faculty of Science and Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Carol J Clark
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
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Kijmanawat A, Saraluck A, Manonai J, Wattanayingcharoenchai R, Aimjirakul K, Chinthakanan O. Mobile Application Based Pelvic Floor Muscle Training for Treatment of Stress Urinary Incontinence: An Assessor-Blind, Randomized, Controlled Trial. J Clin Med 2023; 12:7003. [PMID: 38002618 PMCID: PMC10672388 DOI: 10.3390/jcm12227003] [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: 09/10/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to increase treatment adherence. This study compared a reduction in SUI, exercise adherence, and quality of life in PFMT with animation vs. standard instruction. A prospective, single-blind, randomized control trial was collected. SUI patients were randomized into the application or control groups confirmed using a one-hour pad test. In the intervention group, the PFMT application was applied via mobile phone (PFMT with animations, recording system, and reminder system). The standard exercise protocol was similar in both groups. Additional follow-up was conducted at 4, 8, and 12 weeks. A total of 51 participants were randomized to the application (n = 26) and control groups (n = 25), respectively. At the 12-week follow-up, there was no significant difference between the two groups in terms of SUI cure rate, SUI severity by pad test, and daily SUI episodes from the bladder diary (p-value of 0.695, 0.472, and 0.338, respectively). The mean PFME adherence in the application group was higher than the control group at 8 weeks (66.3 ± 13.6 vs. 52.7 ± 16.6, p = 0.002) and 12 weeks (59.1 ± 13.9 vs. 37.8 ± 11.0, p = 0.001). The application group reported no difference from the conventional PFMT group in terms of improvements in SUI cure rate, symptom severity, and quality of life effects at 12-week follow-up. However, the improvement evaluated by the mean difference in SUI episodes and quality of life effects (ICIQ-UI SF) reported a better outcome in the mobile app group. The PFMT application has been proven to be an effective tool that improves PFMT adherence.
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Affiliation(s)
| | | | | | | | | | - Orawee Chinthakanan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (A.K.); (A.S.); (J.M.); (R.W.); (K.A.)
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Chen L, Liu S, Zhang D, Cai W. Sitting on the fence: A qualitative study of perceptions regarding pelvic floor muscle training among pregnant women with urinary incontinence. Int J Nurs Sci 2023; 10:540-548. [PMID: 38020834 PMCID: PMC10667308 DOI: 10.1016/j.ijnss.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/05/2023] [Accepted: 09/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To explore the perceptions of pregnant women with urinary incontinence toward pelvic floor muscle training (PFMT). Methods Semi-structured personal interviews were used to collect data. Pregnant women with urinary incontinence and no contraindications to PFMT were recruited for semi-structured interviews in the Outpatient Department of Obstetrics in a Class A tertiary hospital in Shenzhen from October to November 2021. Purposive sampling was performed, and Braun & Clarke thematic analysis was used for the data analysis. Results Sixteen pregnant women with urinary incontinence and a mean age of (30.81 ± 3.66) years participated in the interview. "Sitting on the fence" was the predominant theme acquired after analysis. Pregnant women had contradictory attitudes toward PFMT. A total of four themes and nine sub-themes have been extracted: "It is normal and does not really matter" (normalized urinary incontinence, insufficient attention to PFMT); "There is nothing I can do" (insufficient subjective motivations, limitation of objective conditions, lack of social support); "We have to take care of ourselves" (the increasing self-care awareness, emerging autonomous motivation to practice PFMT); "Training should be guaranteed" (requiring the guidance, suggestions, and surveillance of healthcare professionals; requiring the perceptive benefits). Conclusions This study reveals varying attitudes towards PFMT among pregnant women with urinary incontinence. To better promote pregnant women's engagement in PFMT, it is necessary to provide professional guidance, increase self-care awareness, improve social support, and emphasize the benefits of PFMT.
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Affiliation(s)
- Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Sha Liu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Danli Zhang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
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Borello-France D, Newman DK, Markland AD, Propst K, Jelovsek JE, Cichowski S, Gantz MG, Balgobin S, Jakus-Waldman S, Korbly N, Mazloomdoost D, Burgio KL. Adherence to Perioperative Behavioral Therapy With Pelvic Floor Muscle Training in Women Receiving Vaginal Reconstructive Surgery for Pelvic Organ Prolapse. Phys Ther 2023; 103:pzad059. [PMID: 37318279 PMCID: PMC10476875 DOI: 10.1093/ptj/pzad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 02/05/2023] [Accepted: 06/13/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The objective of this study was to describe adherence to behavioral and pelvic floor muscle training in women undergoing vaginal reconstructive surgery for organ prolapse and to examine whether adherence was associated with 24-month outcomes. METHODS Participants were women ≥18 years of age, with vaginal bulge and stress urinary incontinence symptoms, planning to undergo vaginal reconstructive surgery for stages 2 to 4 vaginal or uterine prolapse. They were randomized to either sacrospinous ligament fixation or uterosacral ligament suspension and to perioperative behavioral and pelvic floor muscle training or usual care. Measurements included anatomic failure, pelvic floor muscle strength, participant-reported symptoms, and perceived improvement. Analyses compared women with lower versus higher adherence. RESULTS Forty-eight percent of women performed pelvic floor muscle exercises (PFMEs) daily at the 4- to 6-week visit. Only 33% performed the prescribed number of muscle contractions. At 8 weeks, 37% performed PFMEs daily, and 28% performed the prescribed number of contractions. No significant relationships were found between adherence and 24-month outcomes. CONCLUSION Adherence to a behavioral intervention was low following vaginal reconstructive surgery for pelvic organ prolapse. The degree of adherence to perioperative training did not appear to influence 24-month outcomes in women undergoing vaginal prolapse surgery. IMPACT This study contributes to the understanding of participant adherence to PFMEs and the impact that participant adherence has on outcomes at 2, 4 to 6, 8, and 12 weeks and 24 months postoperatively. It is important to educate women to follow up with their therapist or physician to report new or unresolved pelvic symptoms.
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Affiliation(s)
- Diane Borello-France
- Department of OB/GYN, Magee-Womens Hospital, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Diane K Newman
- Division of Urology, Penn Center for Continence and Pelvic Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alayne D Markland
- Department of Medicine, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center at the Birmingham VA Health Care System, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katie Propst
- Department of Obstetrics & Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - J Eric Jelovsek
- Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina, USA
| | - Sara Cichowski
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Marie G Gantz
- Department of Biostatistics and Epidemiology, RTI International, Triangle Park, North Carolina, USA
| | - Sunil Balgobin
- Department of Obstetrics & Gynecology, University of Texas Southwestern, Dallas, Texas, USA
| | - Sharon Jakus-Waldman
- Department of Obstetrics, Gynecology and Urogynecology, Kaiser Permanente, Downey, California, USA
| | - Nicole Korbly
- Department of Obstetrics & Gynecology, Brown University, Providence, Rhode Island, USA
| | - Donna Mazloomdoost
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Kathryn L Burgio
- Department of Medicine, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center at the Birmingham VA Health Care System, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Chen L, Zhang D, Li T, Liu S, Hua J, Cai W. Effect of a Mobile App-Based Urinary Incontinence Self-Management Intervention Among Pregnant Women in China: Pragmatic Randomized Controlled Trial. J Med Internet Res 2023; 25:e43528. [PMID: 37368465 DOI: 10.2196/43528] [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: 10/14/2022] [Revised: 03/30/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a highly prevalent health concern commonly observed during and after pregnancy that can substantially impact women's physical and psychological well-being and quality of life. Owing to its numerous advantages, mobile health may be a promising solution; however, it is unclear whether the app-based intervention can effectively improve UI symptoms during and after pregnancy. OBJECTIVE This study aimed to evaluate the effectiveness of the Urinary Incontinence for Women (UIW) app-based intervention for UI symptom improvement among pregnant women in China. METHODS Singleton pregnant women without incontinence before pregnancy who were aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and were randomly allocated (1:1) to either an experimental group (n=63) or a control group (n=63). The experimental group received the UIW app intervention and oral pelvic floor muscle training (PFMT) instructions, whereas the control group received oral PFMT instructions alone. Neither the participants nor the researchers were blinded to the intervention. The primary outcome was UI severity. The secondary outcomes included quality of life, self-efficacy with PFMT, and knowledge of UI. All data were collected at baseline, 2 months after randomization, and 6 weeks post partum through electronic questionnaires or by checking the electronic medical record system. Data analysis followed the intention-to-treat principle. A linear mixed model was used to examine the intervention effect on primary and secondary outcomes. RESULTS Participants in the experimental and control groups were comparable at baseline. Of the 126 overall participants, 117 (92.9%) and 103 (81.7%) women completed follow-up visits at 2 months after randomization and 6 weeks after delivery, respectively. A statistically significant difference in UI symptom severity was observed between the experimental group and control group (2 months after randomization: mean difference -2.86, 95% CI -4.09 to -1.64, P<.001; 6 weeks post partum: mean difference -2.68, 95% CI -3.87 to -1.49, P<.001). For the secondary outcomes, a statistically significant intervention effect on the quality of life, self-efficacy, and UI knowledge was found at the 2-month follow-up (all P<.05) and 6 weeks post partum (all P<.001). CONCLUSIONS The app-based UI self-management intervention (UIW) effectively improved UI symptom severity, quality of life, self-efficacy with PFMT, and knowledge of UI during the late pregnancy and early postnatal periods. Larger multicenter studies with a longer postpartum follow-up are required to further extend these findings. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/22771.
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Affiliation(s)
- Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Danli Zhang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Tiantian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Sha Liu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jie Hua
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
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12
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Xu P, Jin Y, Guo P, Xu X, Wang X, Zhang W, Mao M, Feng S. Barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence: a qualitative analysis using the theoretical domains framework. BMC Pregnancy Childbirth 2023; 23:300. [PMID: 37118702 PMCID: PMC10148524 DOI: 10.1186/s12884-023-05633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Stress urinary incontinence during pregnancy is closely related to the occurrence of postpartum and long-term urinary incontinence. Early pelvic floor management is of great significance in promoting the recovery of pelvic floor tissues in pregnant women. However, effective management of urinary incontinence is far from achievable owing to the low adherence of pregnant women in partaking in pelvic floor rehabilitation. As a comprehensive framework for behavioural theory, the Theoretical Domain Framework allows for comprehensive identification of behavioural determinants. Using Theoretical Domain Framework, this study aimed to identify barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence. METHODS A descriptive, qualitative design was used in this study. Face-to-face semi-structured interviews were conducted with pregnant women with stress urinary incontinence based on the Theoretical Domain Framework. The data were analysed using a combination of inductive and deductive methods. RESULTS Twenty pregnant women with stress urinary incontinence were interviewed. Seven themes were summarised and used to explain the pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence. The seven themes were (1) individual knowledge and experience of pelvic floor management, (2) judgments about expected outcomes, (3) interactions of interpersonal situations, (4) environment, resources, and decision-making processes, (5) personal goal-setting and efforts towards behaviour change, (6) emotional influences on decision-making, and (7) personal characteristics. Besides the "Optimism" domain, 13 of the 14 Theoretical Domains Framework domains were found to influence pregnant patients' pelvic floor rehabilitation behaviours after deductive mapping of themes to the Theoretical Domains Framework. In addition, the inductive analysis generated a theme of personal characteristics that did not map to any of the Theoretical Domains Framework domains. CONCLUSIONS The pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence are complex and are affected by many factors. The findings confirm the need for multiple interventions to support pelvic floor management in pregnant women with stress urinary incontinence, focusing on enhancing knowledge and skills in pelvic floor care and using appropriate behaviour change techniques (such as prompts) to provide a supportive environment.
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Affiliation(s)
- Ping Xu
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Ying Jin
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Pingping Guo
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Xuefen Xu
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Xiaojuan Wang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Wei Zhang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Minna Mao
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Suwen Feng
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China.
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Papanikolaou DT, Lampropoulou S, Giannitsas K, Skoura A, Fousekis K, Billis E. Pelvic floor muscle training: Novel versus traditional remote rehabilitation methods. A systematic review and meta-analysis on their effectiveness for women with urinary incontinence. Neurourol Urodyn 2023; 42:856-874. [PMID: 36808744 DOI: 10.1002/nau.25150] [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: 08/30/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To investigate the effectiveness of supervised remote rehabilitation programs comprising novel methods of pelvic floor muscle (PFM) training for women with urinary incontinence (UI). DESIGN A systematic review and meta-analysis including randomized controlled trials (RCTs), involving novel supervised PFM rehabilitation programs as intervention groups (e.g., mobile applications programs, web-based programs, vaginal devices) versus more traditional PFM exercise groups (acting as control); both sets of groups being offered remotely. METHODS Data have been searched and retrieved from the electronic databases of Medline, PUBMED, and PEDro using relevant key words and MeSH terms. All included study data were handled as reported in the Cochrane Handbook for Systematic Reviews of Interventions and the evaluation of their quality was undertaken utilizing the Cochrane risk-of-bias tool 2 (RoB2) for RCTs. The included RCTs, involved adult women with stress UI (SUI) or mixed urinary incontinence, where SUI were the most predominant symptoms. Exclusion criteria involved pregnant women or up to 6-month postpartum, systemic diseases and malignancies, major gynecological surgeries or gynecological problems, neurological dysfunction or mental impairments. The searched outcomes included subjective and objective improvements of SUI and exercise adherence in PFM exercises. Meta-analysis was conducted and included studies pulled by the same outcome measure. RESULTS The systematic review included 8 RCTs with 977 participants. Novel rehabilitation programs included mobile applications (1 study), web-based programs (1 study) and vaginal devices (6 studies) versus more traditional remote PFM training, involving home-based PFM exercise programs (8 studies). Estimated quality with Cochrane's RoB2, presented the 80% of the included studies as "some concerns" and the 20% as "high risk." Meta-analysis included 3 studies with no heterogeneity (I2 = 0) across them. Weak-evidenced results presented home PFM training equally effective with novel PFM training methods (mean difference: 0.13, 95% confidence interval: -0.47, 0.73), with small total effect size (0.43). CONCLUSIONS Novel PFM rehabilitation programs presented as effective (but not superior) to traditional ones in women with SUI, both offered remotely. However, individual parameters of novel remote rehabilitation including supervision by the health professional, remains in question and larger RCTs are required. Connection between devices and applications in combination with real-time synchronous communication between patient and clinician during treatment is challenged for further research across novel rehabilitation programs.
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Affiliation(s)
- Dimitra Tania Papanikolaou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Sofia Lampropoulou
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | | | - Anastasia Skoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Konstantinos Fousekis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Evdokia Billis
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
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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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15
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Fernandes ACNL, Palacios-Ceña D, Pena CC, Duarte TB, de la Ossa AMP, Jorge CH. Conservative non-pharmacological interventions in women with pelvic floor dysfunction: a systematic review of qualitative studies. BMC Womens Health 2022; 22:515. [PMID: 36503437 PMCID: PMC9743653 DOI: 10.1186/s12905-022-02097-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Women's adherence is essential to physiotherapeutic treatment of pelvic floor dysfunction, but its related factors are not usually considered in the development of treatment approaches. This study aims to understand how women with pelvic floor dysfunction experience pelvic floor conservative non-pharmacological treatment options. METHODS A systematic review of qualitative studies. The electronic search was performed in MEDLINE/PubMed, CINAHL, Lilacs, SCOPUS, and Web of Science databases. Primary articles on qualitative methods focused on the experience of women regarding pelvic floor conservative non-pharmacological interventions, i.e., pelvic floor muscle training (PFMT), either associated or not with biofeedback, perineal massage, vaginal dilators, and others. A meta-aggregation was performed. RESULTS It was included 22 manuscripts in this review. It was found seven studies about the use of vaginal devices, two about manual intervention and 14 studies on women's experience with PFMT. The findings were synthesized as follows: I) women's experience of manual interventions; II) women's experience using vaginal devices changes according to health professional attitudes; III) women's experiences using vaginal devices varied depending on their pelvic floor dysfunction; IV) reported side effects due to the use of vaginal devices; V) external factors influencing PFMT performance; VI) women's perception of their own personal factors influencing PFMT performance; VII) PFMT characteristics influencing women's adherence; VIII) strategies used by women to include PFMT in their routine. CONCLUSION Women's experience with pelvic floor conservative non-pharmacological treatment options is a complex phenomenon that involves many more variables than simply personal aspects. This is a systematic review of qualitative studies registered in the PROSPERO (CRD42018080244).
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Affiliation(s)
- Ana Carolina Nociti Lopes Fernandes
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900 Brazil
| | - Domingo Palacios-Ceña
- grid.28479.300000 0001 2206 5938University Rey Juan Carlos, Av. Atenas s/n, CP: 28922 Alcorcón, Madrid, Spain
| | - Caroline Caetano Pena
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900 Brazil
| | - Thaiana Bezerra Duarte
- University Center of Northern, Av. Joaquim Nabuco, 1232, Centro, Manaus, AM CEP: 69020-031 Brazil
| | - Aura Maria Paternina de la Ossa
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900 Brazil
| | - Cristine Homsi Jorge
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900 Brazil
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16
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Sawettikamporn W, Sarit-apirak S, Manonai J. Attitudes and barriers to pelvic floor muscle exercises of women with stress urinary incontinence. BMC Womens Health 2022; 22:477. [DOI: 10.1186/s12905-022-02067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
Background
Pelvic floor muscle exercise (PFME) is a first-line treatment for stress urinary incontinence (SUI), but adherence to PFME is often problematic. The aim of this study was to better understand the attitudes and barriers to practicing pelvic floor muscle exercise among women with SUI.
Methods
We conducted a qualitative study using semi-structured interviews. Purposive sampling was used to approach eligible participants. The interview included questions focused on women’s perceptions regarding SUI and PFME, sources of information, support, and barriers and motivators of PFME. In-depth interviews were conducted until data saturation occurred. After several readings of written interview transcripts, codes were retrieved, and thematic analysis was conducted.
Results
Seven women participated in the study (average age 53.2 years), and most (4/7) were retired. Three salient themes emerged from the data: (1) perception of SUI, (2) barriers to PFME, and (3) motivators to exercise. Participants highlighted various barriers to PFME: (1) lack of self-discipline owing to both intrinsic and extrinsic factors, (2) lack of confidence in how to perform the exercises properly, and (3) skepticism regarding the efficacy of treatment according to women’s direct and indirect experiences. Achievement of desired outcomes, symptom severity, women’s expectations, and fear of surgery were motivators to regularly perform PFME.
Conclusions
The main barriers to regular PFME were inadequate self-discipline, knowledge, and confidence in performing the exercises, and a poor perception about the effectiveness of PFME.
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Sayner AM, Tang CY, Toohey K, Mendoza C, Nahon I. Opportunities and Capabilities to Perform Pelvic Floor Muscle Training Are Critical for Participation: A Systematic Review and Qualitative Meta-Synthesis. Phys Ther 2022; 102:6652914. [PMID: 35913726 DOI: 10.1093/ptj/pzac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/07/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Pelvic floor muscle training (PFMT) is considered a behavioral task that requires the interaction of physical, social, and cognitive processes. Enablers and barriers to participation in PFMT have been explored primarily in women. This review aimed to identify the barriers and enablers that influence participation in PFMT in all adult populations. METHODS A systematic review and meta-synthesis of qualitative literature was conducted. The inclusion criteria comprised qualitative studies with populations of people aged 18 years and older who have been recommended for PFMT. Line-by-line coding and an inductive thematic analysis identified themes that were applied to the Theoretical Domains Framework and Capabilities, Opportunities, and Motivation Behavioral Model to determine behavioral influences on PFMT. RESULTS Twenty full-text articles met inclusion criteria. PFMT was mostly influenced by individual opportunities impacted by social determinants and competing demands. Capability of carrying out PFMT was impacted by knowledge, understanding, and appropriate skill acquisition linked to self-efficacy. CONCLUSION Increasing opportunities and capabilities for engagement in PFMT are the most important factors in optimizing positive behavior changes. Ways to address these factors include clear patient communication to boost confidence in skill acquisition and using technology to encourage autonomy and improve convenience. Future research should address the impact of health professionals' beliefs about patient participation, assess the role of social values and gender roles, and explore the timing of the implementation of behavioral change strategies to improve PFMT. IMPACT This is believed to be the first systematic review and qualitative meta-synthesis to consider the enablers and barriers to participation in PFMT for all adult populations, purposes, and symptom complexes. Patient opportunities and capabilities are the greatest influencers on participation and self-efficacy. Individualized treatment approaches that acknowledge and address social influencers and competing demands will optimize self-efficacy and participation. LAY SUMMARY If you have pelvic floor muscle dysfunction, your opportunities and capabilities are the greatest influencers on participation and self-efficacy in PFMT. Your physical therapist can design individualized treatment approaches that acknowledge and address social influencers and competing demands to help you optimize participation.
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Affiliation(s)
- Alesha M Sayner
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia.,Chronic and Complex Care/Department of Physiotherapy, Western Health, St Albans, Victoria, Australia.,Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia.,Allied Health Department, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Clarice Y Tang
- Chronic and Complex Care/Department of Physiotherapy, Western Health, St Albans, Victoria, Australia.,School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kellie Toohey
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia.,Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Chennelle Mendoza
- Chronic and Complex Care/Department of Physiotherapy, Western Health, St Albans, Victoria, Australia
| | - Irmina Nahon
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia.,Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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18
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Araya-Castro P, Roa-Alcaino S, Celedón C, Cuevas-Said M, de Sousa Dantas D, Sacomori C. Barriers to and facilitators of adherence to pelvic floor muscle exercises and vaginal dilator use among gynecologic cancer patients: a qualitative study. Support Care Cancer 2022; 30:9289-9298. [PMID: 36065026 PMCID: PMC9444700 DOI: 10.1007/s00520-022-07344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/24/2022] [Indexed: 12/24/2022]
Abstract
Objective Women with gynecologic cancer may suffer from pelvic floor dysfunction (PFD). Before radiotherapy, prehabilitation with pelvic floor muscle exercises (PFME) and vaginal dilator (VD) might prevent it and foster sexual life. This study aims to explore the experience of gynecologic cancer patients getting external beam radiation treatments regarding barriers to and facilitators of adherence to a prehabilitation program to prevent PFD. Methods This qualitative research with thematic content analysis included 11 women with gynecologic cancer and different levels of adherence to PFME and VD. Participants were interviewed based on a semi-structured script. The information was analyzed manually, assisted with Nvivo12® software, and triangulated with open coding. Results High self-motivation, desire to improve their health, symptoms of improvement, availability of time, the desire to resume sexual life, and the support of the partner were facilitators of adherence. The instructional exercise audio, clarity of the information, and closer communication with the physical therapist were also valued. The main barriers were general malaise secondary to oncological treatments, forgetfulness, lack of time, misinformation, lack of coordination with the treatment team, discomfort with the VD, and a feeling of shame. Feedback from the attending physician was a facilitator when present or a barrier when absent. Conclusion These barriers and facilitators should be considered when designing and implementing preventive programs with PFME and VD. Behavioral counselling should consider the desire to remain sexually active; in such cases, including the partner in the therapeutic process is appraised. Otherwise, the focus should be on benefits for maintenance of pelvic floor function.
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Affiliation(s)
- Paulina Araya-Castro
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.,Programa de Doctorado en Educación, Universidad Internacional Iberoamericana, Campeche, México
| | - Sonia Roa-Alcaino
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | | | | | - Cinara Sacomori
- Programa de Doctorado en Educación, Universidad Internacional Iberoamericana, Campeche, México. .,Universidad Bernardo O´Higgins, Santiago, Chile.
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Al Dandan HB, Galvin R, Robinson K, McClurg D, Coote S. Feasibility and acceptability of transcutaneous tibial nerve stimulation for the treatment of bladder storage symptoms among people with multiple sclerosis. Pilot Feasibility Stud 2022; 8:161. [PMID: 35908067 PMCID: PMC9338631 DOI: 10.1186/s40814-022-01120-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Neurogenic lower urinary tract dysfunction is an abnormality in the presence of underlying neurologic disease. A recent systematic review and meta-analysis demonstrated that storage phase symptoms are the predominant symptoms among people with multiple sclerosis (PwMS). Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive treatment for bladder storage symptoms; however, the potential efficacy of stimulation among PwMS is based on a small number of studies with the absence of high-quality evidence. The aim of this study was to evaluate the feasibility, acceptability, and safety of TTNS in PwMS using an affordable transcutaneous electrical nerve stimulation (TENS) unit. Methods A total of 23 participants with MS enrolled in the study. The primary outcomes included recruitment/retention rate, completion of the outcomes and the intervention, adherence to the protocol, adverse events, and acceptability of the intervention. The primary outcomes were assessed using diaries and a satisfaction questionnaire. The secondary outcomes included changes in urinary symptoms and quality of life assessed using a set of validated outcome measures including a 3-day bladder diary, PPIUS, ICIQ-OAB, and KHQ at baseline and post-intervention. Results Twenty participants completed the study. Three participants (13.04%) withdrew. All 20 participants completed the 6-week intervention and all the outcome measures (100%), with no reported adverse events. Participants were satisfied and found the unit acceptable. Three-day bladder diary showed changes in urinary frequency from a daily median of 10 times to 8 times and daily median urgency changed from 6 times at baseline to 2 times post-intervention. PPIUS showed changes in daily median sever urgency from 3 points (IQR=4) to 1 point (IQR=1) post-intervention. ICIQ-OAB total scores changed from 8 points (IQR=2.25) to 4 points (IQR=2.5) post-intervention. Median and mean scores of KHQ showed a clinical meaningful change of QoL in part-two and part-three of the questionnaire. Conclusions TTNS is feasible, safe, and acceptable for PwMS. Changes of urinary symptoms scores and QoL post-intervention suggested improvements. Future implications need to consider the treatment protocol including frequency of treatment sessions, duration of treatment, and the electrical stimulation parameters as well as the outcome measures followed in the current study for the implementation of the future pilot RCT. Trial registration ClinicalTrials.gov NCT04528784. Registered on 27 August 2020. https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01120-1.
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Affiliation(s)
- Hawra B Al Dandan
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland. .,Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Aging Research Centre, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Aging Research Centre, University of Limerick, Limerick, Ireland
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Susan Coote
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Physical Activity for Health Research Centre, University of Limerick, Limerick, Ireland.,Multiple Sclerosis Society of Ireland, Dublin, Ireland
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Chao HT, Chang PC, Lin YK, Huang WC, Wu CC, Chang LI, Liao YM. Longitudinal Effects of a Combined Program of Pelvic Floor Muscle Training and Yoga on Genitourinary Symptoms in Asian Women of Older Age: A Randomized Experimental Study. Geriatr Nurs 2022; 46:27-38. [PMID: 35597057 DOI: 10.1016/j.gerinurse.2022.04.018] [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: 11/27/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
This parallel-two-group randomized experimental study including a supervised group and an unsupervised group examined the longitudinal effects of pelvic floor muscle training (PFMT) combined with yoga on genitourinary symptoms and the health-related quality of life (HRQOL), and compared practice adherence rates of the two groups. A sample of women experiencing ≥1 genitourinary symptom(s) were recruited and assigned to a supervised group or an unsupervised group. The supervised group attended supervised group practice sessions and performed at-home practice of PFMT and yoga. The unsupervised group performed at-home practice of PFMT and yoga. Information was collected at five time points (n = 91). Generalized estimating equation procedures were used to examine the intervention effects. An independent t-test was conducted to compare the practice adherence rates. Both groups' genitourinary symptoms and HRQOL significantly improved over time. The supervised group displayed greater improvements in genitourinary symptoms and HRQOL and better adherence than did the unsupervised group.
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Affiliation(s)
- Hsiang-Tai Chao
- Obstetrics and Gynecology Department, Taipei Veterans General Hospital, 201 Shi-Pai Road, Section 2, Taipei City 11217, Taiwan, Republic of China (R.O.C.); College of Medicine, National Yang Ming Chiao Tung University, 155 Li-Nong Street, Section 2, Taipei City 112, Taiwan, Republic of China (R.O.C.)
| | - Pi-Chen Chang
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Xinyi District, Taipei City 110, Taiwan, Republic of China (R.O.C.)
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, 250 Wenhua 1st Road, Guishan, Taoyuan 333, Taiwan, Republic of China (R.O.C.)
| | - Wen-Chen Huang
- Department of Obstetrics and Gynecology, Cathy General Hospital, 280 Ren-Ai Road, Section 4, Taipei City 106, Taiwan, Republic of China (R.O.C.); Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Xing Street, Xinyi District, Taipei City 110, Taiwan, Republic of China (R.O.C.)
| | - Chien-Chih Wu
- Department of Urology, Taipei Medical University Hospital, 252 Wu-Xing Street, Xinyi District, Taipei City 110, Taiwan, Republic of China (R.O.C.); Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Xing Street, Xinyi District, Taipei City 110, Taiwan, Republic of China (R.O.C.)
| | - Lu-I Chang
- Department of Nursing, College of Medicine, Tzu Chi University, 701 Zhong-Yang Road, Section 3, Hualien City 97004, Taiwan, Republic of China (R.O.C.)
| | - Yuan-Mei Liao
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, 155 Li-Nong Street, Section 2, Taipei City 112, Taiwan, Republic of China (R.O.C.).
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Firet L, Teunissen TAM, Kool RB, Notten KJB, Lagro-Janssen ALM, van der Vaart H, Assendelft WJJ. Usage of an eHealth intervention for women with stress urinary incontinence: a mixed-methods study (Preprint). J Med Internet Res 2022; 24:e38255. [DOI: 10.2196/38255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/07/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
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Al‐Zaidi Z, Lindam A, Fransson P, Samuelsson E. A mobile app as support for pelvic floor muscle training started prior to radical prostatectomy. BJUI COMPASS 2022; 4:114-122. [PMID: 36569504 PMCID: PMC9766858 DOI: 10.1002/bco2.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To evaluate the usefulness of a mobile app to support pelvic floor muscle training (PFMT) started prior to radical prostatectomy (RP). Materials and methods A prospective cohort study conducted in Sweden from June 2018 to February 2021 including men for whom RP was planned within 12 months. Users responded anonymously to questionnaires at baseline, 1 and 3 months. Our primary aim was to evaluate if the app could facilitate PFMT and increase confidence in performing pelvic floor muscle (PFM) contractions correctly. Our second aim was to describe the change in urinary incontinence (UI) after RP, based on the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Results Of the 3043 users at baseline, 388 met the primary inclusion criteria. Of those, 71 (18.3%) were incontinent, predominantly with slight symptoms. The most common type was urge UI, 39/71 (54.9%). Of the 388 users, 159 (41.0%) answered the questionnaire at 1 month, and 131 (33.7%) at 3 months within 89-135 days. Of those 131, 127 (96.9%) indicated that the app facilitated their training 'a lot' or 'somewhat'. Confidence in performing PFM contractions correctly increased from 39.7% at baseline to 74.0% at 1 month and 87.8% at 3 months (p < 0.001). At baseline, 19.8% performed PFM contractions at least daily, which increased to 74.0% at 1 month and 77.9% at 3 months (p < 0.001). At 3 months, 115/131 (87.8%) had undergone RP, 93.6% of which were robot-assisted. Of the 115, 103 (89.6%) were incontinent, and stress UI dominated. The mean ICIQ-UI SF score increased from 1.2 (2.4 SD) at baseline to 9.6 (5.2 SD), p < 0.001, after surgery. Conclusions The mobile app facilitated pelvic floor muscle training for men who were planned to undergo radical prostatectomy and used the app.
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Affiliation(s)
- Zinah Al‐Zaidi
- Family Medicine, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Anna Lindam
- Unit of Research, Education, and Development, Östersund Hospital, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | | | - Eva Samuelsson
- Family Medicine, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
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Jaffar A, Mohd-Sidik S, Foo CN, Admodisastro N, Abdul Salam SN, Ismail ND. Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study. JMIR Hum Factors 2022; 9:e30989. [PMID: 35113025 PMCID: PMC8855292 DOI: 10.2196/30989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but their effectiveness in pregnant women was limited. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. OBJECTIVE This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. METHODS We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. RESULTS A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design-11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. CONCLUSIONS The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study.
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Affiliation(s)
- Aida Jaffar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.,Primary Care Unit, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Wilayah Persekutuan, Malaysia
| | - Sherina Mohd-Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Chai Nien Foo
- Department of Population Medicine, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Novia Admodisastro
- Software Engineering & Information System Department, Faculty of Computer Science & Information Technology, Universiti Putra Malaysia, Selangor, Malaysia
| | - Sobihatun Nur Abdul Salam
- School of Multimedia Technology and Communication, College of Arts and Sciences, Universiti Utara Malaysia, Kedah, Malaysia
| | - Noor Diana Ismail
- Klinik Kesihatan Bt 9 Cheras, Ministry of Health, Selangor, Malaysia
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What Influences Women to Adhere to Pelvic Floor Exercises after Physiotherapy Treatment? A Qualitative Study for Individualized Pelvic Health Care. J Pers Med 2021; 11:jpm11121368. [PMID: 34945840 PMCID: PMC8706048 DOI: 10.3390/jpm11121368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 12/29/2022] Open
Abstract
Conservative treatment of pelvic floor dysfunction (PFD) includes therapeutic exercise for pelvic floor muscle (PFM) training or other complementary exercise modalities, such as hypopressive exercises. However, the long-term effectiveness of the conservative treatment depends on a patient's adherence to the exercises and the integration of professional health advice into their daily life. The objective of this study was to establish the adherence experience of women with diagnosed PFD in home-based exercises after an intensive face-to-face physiotherapy treatment. A qualitative study from an interpretive paradigm was developed. Semi-structured individual and group interviews were performed 6 months after finishing individual physiotherapy treatment. The interviews were recorded, fully transcribed and analyzed thematically by creating categories. Thirty-one women were interviewed. The women reported that their adherence to home PFM exercises depended on the exercise program itself, its efficacy, their personal experiences with the exercises, intrinsic factors such as self-awareness or beliefs, and extrinsic factors, such as professional or instrumental feedback. Thus, therapeutic adherence could be more likely with effective physiotherapy programs that include mutually agreed home exercises and simple movements women can build into their daily lives. Improving awareness and knowledge of the pelvic region and the importance of PFM treatment as well as consideration for potential worsening of PFD will also encourage women to adhere to the exercises.
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Wu C, Newman D, Palmer MH. Postmenopausal women's adherence to pelvic floor muscle exercises over 2 years. Climacteric 2021; 25:401-406. [PMID: 34881664 DOI: 10.1080/13697137.2021.2006177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to investigate women's adherence patterns to pelvic floor muscle exercises (PFME), their associated factors and within-pattern changes. METHODS This was a secondary analysis using data collected from 647 women aged 55 years and older in the USA. Women were randomly assigned to either a 2-h class group or an equivalent content 20-min DVD group to receive PFME complemented with adherence enhancement strategies. Adherence was assessed at 3, 12 and 24 months using three self-reported items matching PFME parameters. The k-mean clustering and multinomial logistic regression were used to investigate adherence patterns and their associated factors, respectively. Descriptive statistics were used for within-pattern changes over time. RESULTS Four adherence patterns, A, B, C and D, were identified. Women who displayed optimal adherence to all three aforementioned items, i.e. adherence pattern A, constituted 49.1%, 38.2% and 37.2% of women at 3, 12 and 24 months, respectively. Women with income > US$100,000 were more likely to display adherence pattern A within 12 months. Of women who had adherence pattern A at 3 months, 63.9% and 49.2% continued in this pattern at 12 and 24 months. CONCLUSIONS Fewer than half of women displayed adherence pattern A for 2 years. Early optimal adherence predicted women's subsequent optimal adherence.
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Affiliation(s)
- C Wu
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - D Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M H Palmer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hagen S, Bugge C, Dean SG, Elders A, Hay-Smith J, Kilonzo M, McClurg D, Abdel-Fattah M, Agur W, Andreis F, Booth J, Dimitrova M, Gillespie N, Glazener C, Grant A, Guerrero KL, Henderson L, Kovandzic M, McDonald A, Norrie J, Sergenson N, Stratton S, Taylor A, Williams LR. Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: the OPAL RCT. Health Technol Assess 2021; 24:1-144. [PMID: 33289476 DOI: 10.3310/hta24700] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Urinary incontinence affects one in three women worldwide. Pelvic floor muscle training is an effective treatment. Electromyography biofeedback (providing visual or auditory feedback of internal muscle movement) is an adjunct that may improve outcomes. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of biofeedback-mediated intensive pelvic floor muscle training (biofeedback pelvic floor muscle training) compared with basic pelvic floor muscle training for treating female stress urinary incontinence or mixed urinary incontinence. DESIGN A multicentre, parallel-group randomised controlled trial of the clinical effectiveness and cost-effectiveness of biofeedback pelvic floor muscle training compared with basic pelvic floor muscle training, with a mixed-methods process evaluation and a longitudinal qualitative case study. Group allocation was by web-based application, with minimisation by urinary incontinence type, centre, age and baseline urinary incontinence severity. Participants, therapy providers and researchers were not blinded to group allocation. Six-month pelvic floor muscle assessments were conducted by a blinded assessor. SETTING This trial was set in UK community and outpatient care settings. PARTICIPANTS Women aged ≥ 18 years, with new stress urinary incontinence or mixed urinary incontinence. The following women were excluded: those with urgency urinary incontinence alone, those who had received formal instruction in pelvic floor muscle training in the previous year, those unable to contract their pelvic floor muscles, those pregnant or < 6 months postnatal, those with prolapse greater than stage II, those currently having treatment for pelvic cancer, those with cognitive impairment affecting capacity to give informed consent, those with neurological disease, those with a known nickel allergy or sensitivity and those currently participating in other research relating to their urinary incontinence. INTERVENTIONS Both groups were offered six appointments over 16 weeks to receive biofeedback pelvic floor muscle training or basic pelvic floor muscle training. Home biofeedback units were provided to the biofeedback pelvic floor muscle training group. Behaviour change techniques were built in to both interventions. MAIN OUTCOME MEASURES The primary outcome was urinary incontinence severity at 24 months (measured using the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form score, range 0-21, with a higher score indicating greater severity). The secondary outcomes were urinary incontinence cure/improvement, other urinary and pelvic floor symptoms, urinary incontinence-specific quality of life, self-efficacy for pelvic floor muscle training, global impression of improvement in urinary incontinence, adherence to the exercise, uptake of other urinary incontinence treatment and pelvic floor muscle function. The primary health economic outcome was incremental cost per quality-adjusted-life-year gained at 24 months. RESULTS A total of 300 participants were randomised per group. The primary analysis included 225 and 235 participants (biofeedback and basic pelvic floor muscle training, respectively). The mean 24-month International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form score was 8.2 (standard deviation 5.1) for biofeedback pelvic floor muscle training and 8.5 (standard deviation 4.9) for basic pelvic floor muscle training (adjusted mean difference -0.09, 95% confidence interval -0.92 to 0.75; p = 0.84). A total of 48 participants had a non-serious adverse event (34 in the biofeedback pelvic floor muscle training group and 14 in the basic pelvic floor muscle training group), of whom 23 (21 in the biofeedback pelvic floor muscle training group and 2 in the basic pelvic floor muscle training group) had an event related/possibly related to the interventions. In addition, there were eight serious adverse events (six in the biofeedback pelvic floor muscle training group and two in the basic pelvic floor muscle training group), all unrelated to the interventions. At 24 months, biofeedback pelvic floor muscle training was not significantly more expensive than basic pelvic floor muscle training, but neither was it associated with significantly more quality-adjusted life-years. The probability that biofeedback pelvic floor muscle training would be cost-effective was 48% at a £20,000 willingness to pay for a quality-adjusted life-year threshold. The process evaluation confirmed that the biofeedback pelvic floor muscle training group received an intensified intervention and both groups received basic pelvic floor muscle training core components. Women were positive about both interventions, adherence to both interventions was similar and both interventions were facilitated by desire to improve their urinary incontinence and hindered by lack of time. LIMITATIONS Women unable to contract their muscles were excluded, as biofeedback is recommended for these women. CONCLUSIONS There was no evidence of a difference between biofeedback pelvic floor muscle training and basic pelvic floor muscle training. FUTURE WORK Research should investigate other ways to intensify pelvic floor muscle training to improve continence outcomes. TRIAL REGISTRATION Current Controlled Trial ISRCTN57746448. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 70. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Dunedin, New Zealand
| | - Mary Kilonzo
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Wael Agur
- NHS Ayrshire and Arran, Kilmarnock, UK
| | - Federico Andreis
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Joanne Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maria Dimitrova
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nicola Gillespie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Cathryn Glazener
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Aileen Grant
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Karen L Guerrero
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lorna Henderson
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Marija Kovandzic
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Nicole Sergenson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Susan Stratton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Anne Taylor
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Louise R Williams
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Home Biofeedback Versus Physical Therapy for Stress Urinary Incontinence: A Randomized Trial. Female Pelvic Med Reconstr Surg 2021; 27:587-594. [PMID: 33208658 DOI: 10.1097/spv.0000000000000993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the study was to assess whether home biofeedback is noninferior to supervised pelvic floor physical therapy (PFPT) for the treatment of stress urinary incontinence (SUI) in women. METHODS The study used a randomized controlled noninferiority trial to compare a home biofeedback device with PFPT. Women older than 18 years with SUI and no history of a prior incontinence surgery or PFPT were eligible. Forty-two participants were required to determine noninferiority for the primary outcome, improvement in quality of life as measured by the International Consultation on Incontinence Questionnaire Short Form. The noninferiority margin was 4 points. Secondary outcomes included sexual function, overactive bladder symptoms, and patient impression of improvement. RESULTS From June 2018 to October 2019, 54 women with SUI were recruited (27 biofeedback, 27 PFPT) and 43 (21 biofeedback, 22 PFPT) completed follow-up. The groups had comparable baseline characteristics. For the primary outcome of change in mean International Consultation on Incontinence Questionnaire-Short Form scores (where lower scores indicate less incontinence), home biofeedback was found to be noninferior to PFPT with a mean decrease from baseline of -3.95 (95% confidence interval [CI] = -2.21 to -5.70) in the home biofeedback group versus -4.73 (95% CI = -3.21 to -6.25) and -3.95 (95% CI = -2.21 to -5.70) in the PFPT group (P = 0.009). The PFPT group showed more improvement in overactive bladder symptoms, but not in incontinence severity without difference in sexual function. CONCLUSIONS Home biofeedback was noninferior to PFPT for the primary treatment of SUI in women at 3 months. These results support the use of personal biofeedback devices for the treatment of SUI.Clinical Trial Registration: ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT03443687.
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Xu J, Chen K, Ding B, Zhu M, Yao S, Ren M, Shen Y. Effectiveness of self-myofascial release combined with biofeedback and electrical stimulation for the management of myofascial pelvic pain: A randomized controlled trial. Eur J Pain 2021; 26:405-416. [PMID: 34592023 DOI: 10.1002/ejp.1867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 09/18/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Myofascial pelvic pain (MFPP) caused by myofascial trigger points (MTrPs) is a major contributor to chronic pelvic pain in women. However, the effect of the patient's self-myofascial release (SMFR) is unclear. This study aimed to investigate the effect of SMFR combined with biofeedback and electrical stimulation (BES) therapy in comparison with BES alone in patients with MFPP. METHODS A prospective randomized controlled study was conducted. Sixty-eight patients were randomly allocated into BES-SMFR group (n = 34) and BES group (n = 34). Every patient received 4 weeks of treatment, evaluated at baseline (T0), 4 weeks post-intervention (T4) and 12-week follow-up (T12). The primary outcome was pain intensity. The secondary outcomes were degree of activation of MTrPs, surface electromyography (sEMG) levels and Patient Global Impression of Improvement (PGI-I). RESULTS Compared with the effect of BES, BES-SMFR treatment significantly decreased pain intensity and the degree of activation of MTrPs in the levator ani (p = 0.02) and obturator internus (p = 0.03), as well as the sEMG levels of the pre-test resting baseline and post-test resting baseline (all p < 0.01). The degree of activation of MTrPs in the piriformis and coccygeus (all p > 0.05) and the sEMG levels of the quick flicks and endurance contraction were not significantly different. The BES-SMFR treatment improved the PGI-I scale at T4 (p = 0.02) but not at T12 (p = 0.40). CONCLUSIONS This study confirmed that the addition of SMFR to BES treatment resulted in superior outcomes compared with those with BES alone in patients with MFPP. SIGNIFICANCE STATEMENT Myofascial pelvic pain (MFPP) is a major contributor of female chronic pelvic pain. Myofascial release has been used commonly for better pain release; however, poor therapeutic effect due to poor patient compliance is common in clinical practice. Therefore, in future research, there is a need to investigate the effect of patient's self-myofascial release (SMFR) technique, which can eliminate the need for frequent office visits and improve patient compliance to some extent, in patients with MFPP.
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Affiliation(s)
- Jingyun Xu
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Kai Chen
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Howard University Hospital, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Bo Ding
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Mingyue Zhu
- Department of Obstetrics and Gynecology, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Shanshan Yao
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Mulan Ren
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
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29
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Fernandes ACNL, Palacios-Ceña D, Hay-Smith J, Pena CC, Sidou MF, de Alencar AL, Ferreira CHJ. Women report sustained benefits from attending group-based education about pelvic floor muscles: a longitudinal qualitative study. J Physiother 2021; 67:210-216. [PMID: 34147398 DOI: 10.1016/j.jphys.2021.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 03/17/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022] Open
Abstract
QUESTION Among women who have participated in group-based education about the pelvic floor, what are their perceptions of the program and the group format? DESIGN Exploratory longitudinal qualitative study. PARTICIPANTS Community-dwelling women aged ≥ 18 years who participated in three or four sessions of pelvic floor education in a group format at a university clinic. DATA EXTRACTION AND ANALYSIS Semi-structured group or individual interviews were conducted at three time points: 1 week, 3 months and ≥ 5 months after the education activity. Data were inductively content analysed and independently coded, with iterative theme development. RESULTS Women considered the content and delivery appropriate and useful. New knowledge was assimilated and shared with others, and many tried to adopt pelvic floor muscle training in daily life. The women felt that the education sessions might benefit other women, with and without pelvic floor dysfunction symptoms, and that such education would ideally be more widely available. A perception of the value of the education persisted over time, even though maintenance of some health-promoting behaviours, such as pelvic floor muscle training, decreased. CONCLUSION The pelvic floor group education sessions appeared to fulfil the purpose of increasing knowledge about pelvic floor (dys)function and applying this in daily life. Overall, the participants, who had completed three or four of the four sessions, found the program to be useful. A unique feature of this study was longitudinal data collection and it seemed that the perception of value persisted over time.
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Affiliation(s)
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Jean Hay-Smith
- Physiotherapist Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | | | - Mayra Feltrin Sidou
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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30
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Firet L, Teunissen TAM, Kool RB, van Doorn L, Aourag M, Lagro-Janssen ALM, Assendelft WJJ. Women's adoption of a web-based intervention for stress urinary incontinence: a qualitative study. BMC Health Serv Res 2021; 21:574. [PMID: 34118900 PMCID: PMC8199839 DOI: 10.1186/s12913-021-06585-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/21/2021] [Indexed: 02/01/2023] Open
Abstract
Background Stress urinary incontinence (SUI) is common among women and affects their quality of life. Pelvic floor muscle training is an effective conservative therapy, but only a minority of women seek help. E-health with pelvic floor muscle training is effective and increases access to care. To implement an e-Health intervention in a sustainable way, however, we need to understand what determines adoption. The aim is to investigate the barriers and facilitators to adopting an e-Health intervention among Dutch women with stress urinary incontinence. Methods Semi-structured telephonic interviews were carried out among participants of the Dutch e-Health intervention for women with stress urinary incontinence. Women were purposively sampled. The ‘Fit between Individuals, Task and Technology’ (FITT) framework was used for both the data collection and data analysis, to gain a more in-depth insight into the adoption of the intervention. Results Twenty women were interviewed, mean age 51 years and mostly highly educated. The adoption of e-Health for women with SUI mainly depends on the interaction between users and e-Health, and users and pelvic floor muscle training exercises. Facilitators for the adoption were the preference for an accessible self-management intervention, having a strong sense of self-discipline and having the ability to schedule the exercises routinely. Women needed to possess self-efficacy to do this intervention independently. Barriers to the adoption of e-Health were personal circumstances restricting time for scheduling pelvic floor muscle training and lacking skills to perform the exercises correctly. Despite guidance by technical features several women remained uncertain about their performance of the exercises and, therefore, wanted additional contact with a professional. Conclusions For stress urinary incontinence e-Health is an appropriate option for a target audience. Use of the FITT framework clearly demonstrates the conditions for optimal adoption. For a subgroup it was a suitable alternative for medical care in person. For others it identified the need for further support by a health care professional. This support could be provided by improvements of technical features and incorporating modes for digital communication. The additional value of integration of the e-Health intervention in primary care might be a logical next step. Trial registration The study was prospectively registered in the Netherlands Trial Registry (NTR) NTR6956. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06585-z.
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Affiliation(s)
- Lotte Firet
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands.
| | - Theodora Alberta Maria Teunissen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Rudolf Bertijn Kool
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lukas van Doorn
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Manal Aourag
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Antoinette Leonarda Maria Lagro-Janssen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Willem Jan Jozef Assendelft
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
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Paquette J, McDermott CD, Acquaviva B, Faghani N, Lovatsis D. Real-World Effectiveness of Pelvic Floor Muscle Training for Women With Urinary Tract Symptoms and/or Prolapse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1247-1253.e1. [PMID: 34048957 DOI: 10.1016/j.jogc.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the real-world effectiveness of pelvic floor muscle therapy (PFMT) recommendations for patients. METHODS We conducted a cross-sectional study of 70 women who were advised to undergo PFMT after their initial urogynaecology consultation for lower urinary tract symptoms and/or pelvic organ prolapse. About half (51%) of potential participants consented to answer our telephone survey. We calculated the proportion of patients who complied with the recommendation of PFMT, and we subjectively assessed whether these patients found PFMT to be helpful. We also collected demographic data and looked for reasons why patients did not attend PFMT. Chi-square, 2-tailed t, or Fisher exact tests were used to compare differences between patients who attended and those who did not. RESULTS During the 6-month period after their initial consultation, only 28 of 70 women (40%) followed the recommendation to attend PFMT. Sixteen of the 28 women who attended PFMT (57%) reported that they found it helpful. Therefore, the "real-world effectiveness" of the entire study sample was 23%, with only 16 of 70 women benefiting from PFMT. Time constraints (27%) and cost (18%) were the top 2 reasons given for not attending. CONCLUSIONS Despite evidence-based recommendations in favour of PFMT for various pelvic floor disorders, its real-world effectiveness is quite low. A public health commitment to providing access to PFMT would be of significant benefit.
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Affiliation(s)
- Joalee Paquette
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, ON.
| | - Colleen D McDermott
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, ON
| | - Bianca Acquaviva
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, ON
| | - Nelly Faghani
- Physiotherapy - Pelvic Health Solutions, Toronto, ON
| | - Danny Lovatsis
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, ON
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Self-management of incontinence using a free mobile app: factors associated with improvement. Int Urogynecol J 2021; 33:877-885. [PMID: 33825925 PMCID: PMC9021135 DOI: 10.1007/s00192-021-04755-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/03/2021] [Indexed: 12/03/2022]
Abstract
Background Pelvic floor muscle training (PFMT) is first-line treatment for urinary incontinence (UI) in women. Self-management via a mobile app is a new cost-effective method for PFMT delivery. This study analyzes factors associated with improvement among app users. Methods A pragmatic observational study in a community setting. Upon downloading the app Tät®, users answered questions regarding their age, education, residence, and UI symptoms. After 3 months, users answered follow-up questions regarding symptoms and frequency of training and app usage, and the validated Patient Global Impression of Improvement (PGI-I) questionnaire. Only non-pregnant, non-postpartum adult women with UI who answered the PGI-I questionnaire were included. Multivariate logistic regression was used to analyze possible associations between these factors with any improvement and with great improvement according to the PGI-I. The models were adjusted for age. Results The study included 2,153 participants who had completed self-management, that is, 11.5% of eligible women who completed the baseline questionnaire. Of these participants, 65.6% reported improvement of UI. Any improvement was associated with age, frequency of PFMT, and app use, accounting for 27.9% of variability (Nagelkerke R2). Lower incontinence severity, frequency of PFMT, and app use were associated with great improvement. Conclusion Self-management of urinary incontinence is easily accessible to many women and improvement rates are comparable with other forms of PFMT. Demographic factors and incontinence severity showed no or incongruent association, whereas regular PFMT and app use predicted any and great improvement. App use showed an additional effect beyond frequency of training.
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Slade SC, Morris ME, Frawley H, Hay-Smith J. Comprehensive reporting of pelvic floor muscle training for urinary incontinence: CERT-PFMT. Physiotherapy 2021; 112:103-112. [PMID: 34062452 DOI: 10.1016/j.physio.2021.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Indexed: 12/18/2022]
Abstract
AIM To produce a pelvic floor muscle training variation of the Consensus on Exercise Reporting Template (CERT-PFMT). METHODS Qualitative methods were used to explore the perspectives of physiotherapists who have postgraduate continence and pelvic floor rehabilitation qualifications on using research evidence to implement pelvic floor muscle training for urinary incontinence. The same experienced facilitator guided the discussions with questions derived from systematic reviews and content experts. The face-to-face focus groups were audio-recorded and verbatim transcripts were thematically analysed. For each CERT item the authors collated participant quotations that identified required explanation or elaboration for the CERT-PFMT. Systematic reviews of pelvic floor muscle training for urinary incontinence were searched by the research team for examples of good reporting. RESULTS Twenty- nine continence physiotherapists participated in one of seven focus groups. Participants agreed that all key elements they needed for replicating pelvic floor muscle training interventions from a research report were provided in the published CERT checklist. CERT items 2 (qualifications), 6 (motivation), 7 (progression rules), 8 (exercise description), 13 (intervention description) and 15 (starting level) required additional explanations for pelvic floor muscle training. Clinicians reported that original CERT explanations for items 1, 3-5, 8-12, 14 and 16 could be used without modification. CONCLUSIONS The CERT-PFMT reporting guideline has been designed with clinician input to inform how to document pelvic floor muscle training to enable replication in clinical practice. It can be used for research protocols, to construct manuscripts reporting pelvic floor muscle training for urinary incontinence and by journal editors and reviewers.
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Affiliation(s)
- Susan C Slade
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, La Trobe University, Australia; Healthscope, Victorian Rehabilitation Centre Healthscope, 99 Springvale Road, Glen Waverley, Australia.
| | - Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, School Allied Health, La Trobe University, Australia; Healthscope, Victorian Rehabilitation Centre Healthscope, 99 Springvale Road, Glen Waverley, Australia
| | - Helena Frawley
- Melbourne School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Australia
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit (RTRU), Department of Medicine, University of Otago, Wellington, New Zealand
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Takahashi S, Takei M, Asakura H, Gotoh M, Ishizuka O, Kato K, Koyama M, Takeyama M, Tomoe H, Yamanishi T, Yokoyama O, Yoshida M, Yoshimura Y, Yoshizawa T. Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition). Int J Urol 2021; 28:474-492. [PMID: 33650242 DOI: 10.1111/iju.14492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100 mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100 mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masami Takeyama
- Urogynecology Center, First Towakai Hospital, Takatsuki, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasukuni Yoshimura
- Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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Mathew S, Nyhus MØ, Salvesen Ø, Salvesen KÅ, Stafne SN, Volløyhaug I. The effect of preoperative pelvic floor muscle training on urinary and colorectal-anal distress in women undergoing pelvic organ prolapse surgery-a randomized controlled trial. Int Urogynecol J 2021; 32:2787-2794. [PMID: 33580809 PMCID: PMC8455377 DOI: 10.1007/s00192-021-04684-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis Pelvic floor muscle training (PFMT) improves urinary incontinence and mild pelvic organ prolapse (POP). We aimed to investigate the effect of preoperative PFMT on urinary and colorectal-anal distress and related quality of life (QoL) in women with severe POP scheduled for surgery. Methods Randomized controlled trial of 159 women scheduled for POP surgery (intervention = 81, controls = 78). Intervention consisted of daily PFMT from inclusion to the day of surgery. Symptoms and QoL were assessed at inclusion, day of surgery and 6 months postoperatively using the Urinary Distress Inventory (UDI-6), Colorectal-Anal Distress Inventory (CRADI-8), Urinary Impact Questionnaire (UIQ) and Colorectal-Anal Impact Questionnaire (CRAIQ) (range 0–100). Mixed model statistical analyses were used. Results One hundred fifty-one (95%) women completed the study (intervention = 75, controls = 76). Mean waiting times until surgery and follow-up were 22 and 28 weeks. There was no difference in mean postoperative symptom and QoL scores (95% CI) between the intervention and control group: UDI-6 16 (12–21) vs. 17 (13–22), CRADI-8 15 (11–18) vs. 13 (10–16), UIQ 11 (7–15) vs. 10 (6–13) and CRAIQ 5 (2–7) vs. 6 (4–9), all p > 0.05. Overall mean scores were reduced from baseline to postoperative follow-up: UDI-6 37 (33–41) vs. 17 (14–20), CRADI-8 22 (19–25) vs. 14 (11–16); UIQ 28 (24–32) vs. 10 (7–13) and CRAIQ 16 (12–19) vs. 5 (3–7), all p < 0.01. Conclusions We found no added effect of preoperative PFMT on symptoms or QoL related to urinary and colorectal-anal distress in women scheduled for POP surgery. They achieved symptomatic improvement postoperatively regardless of PFMT. Clinical trial registration The study was registered in clinicaltrials.gov: NCT 03,064,750.
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Affiliation(s)
- Seema Mathew
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway. .,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Maria Øyasæter Nyhus
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Services, St. Olavs University Hospital, Trondheim, Norway
| | - Ingrid Volløyhaug
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Evaluation of Awareness, Adherence, and Barriers of Pelvic Floor Muscle Training in Pregnant Women: A Cross-sectional Study. Female Pelvic Med Reconstr Surg 2021; 27:e122-e126. [PMID: 32604200 DOI: 10.1097/spv.0000000000000852] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Adherence to pelvic floor muscle training (PFMT) may be enhanced when the women become aware of its preventive/therapeutic role in pelvic floor disorders. OBJECTIVE This study is conducted to evaluate the PFMT awareness, adherence, and barriers in pregnant women. METHOD We studied the awareness, adherence, and barriers of PFMT in 200 pregnant women attended in prenatal care clinic in their third trimester of pregnancy using semistructured interviews with open and closed questions derived from recent literature review on PFMT. RESULT Fifty-four (27%) of studied women were familiar with PFMT, 175 (87.5%) of patients thought that the UI is normal during pregnancy, and 25 (32.05%) had experienced UI episodes and had consulted with their obstetrician. Twenty-one (10.5%) of patients did the PFMT exercises before their pregnancy, 14 (66.6%) of them continued their PFMT exercises during their pregnancy, and 7 (33.4%) stopped it. Concerns about miscarriage were the main reason of discontinuing the exercises during pregnancy. Routes of knowledge acquisition were the Internet in 24 cases (44.4%), health system in 13 cases (24.07%), family and friends in 11 cases (20.3%), and books/magazines in 6 cases (11.1%). Main means of mass communication (including TV, radio, and newspapers) had no role in knowledge distribution in this filed. CONCLUSIONS Pregnant women require more health education regarding PFMT. Health care professionals should be more involved in patient education process. Internet resources are used widely by women and need more academic/scientific supervision.
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Aka EK, Fanny M, Koffi A, Olou N, Horo A, Kone M. [Opinion survey on postpartum pelvic floor rehabilitation among Ivorian practitioners]. Pan Afr Med J 2020; 37:367. [PMID: 33796180 PMCID: PMC7992408 DOI: 10.11604/pamj.2020.37.367.23426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 12/13/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION the purpose of this study was to report health care providers' experience of perineal rehabilitation in the Maternity Hospital of Abidjan by assessing their level of knowledge and their practical attitudes. METHODS we performed a survey among obstetricians and midwives working in a Maternity Hospital in Abidjan over a period of at least two years. The information were collected using a questionnaire including direct, open and semi-open questions. RESULTS the study included 120 practitioners, 66 midwives and 54 obstetricians. Seventy-nine point six percent of obstetricians and 37.9% of midwives worked in a university hospital. Midwifery knowledge was good or average in 25% of cases (interquartile range [IIQ] 16.8-48.3); 65% of obstetricians had a good or medium level of knowledge (IIQ 41.1 -48.3). The majority of providers summoned women in the postpartum period, but only 7 out of 10 caregivers performed perineal assessment and 2 out of 10 obstetricians suggested the need for rehabilitation. CONCLUSION the low level of knowledge of Ivorian midwives and obstetricians regarding postpartum pelvic floor rehabilitation and the lack of practice suggest the need for ongoing training.
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Affiliation(s)
- Edele Kacou Aka
- Université Félix Houphouët Boigny (FHB), Abidjan, Côte d´Ivoire
- Service de gynécologie Obstétrique, Centre Hospitalier Universitaire de Yopougon, Yopougon, Côte d´Ivoire
| | - Mohamed Fanny
- Université Félix Houphouët Boigny (FHB), Abidjan, Côte d´Ivoire
- Service de gynécologie Obstétrique, Centre Hospitalier Universitaire de Yopougon, Yopougon, Côte d´Ivoire
| | - Abdoul Koffi
- Université Félix Houphouët Boigny (FHB), Abidjan, Côte d´Ivoire
- Service de gynécologie Obstétrique, Centre Hospitalier Universitaire de Yopougon, Yopougon, Côte d´Ivoire
| | - N´guessan Olou
- Université Félix Houphouët Boigny (FHB), Abidjan, Côte d´Ivoire
- Service de gynécologie Obstétrique, Centre Hospitalier Universitaire de Yopougon, Yopougon, Côte d´Ivoire
| | - Apollinaire Horo
- Université Félix Houphouët Boigny (FHB), Abidjan, Côte d´Ivoire
- Service de gynécologie Obstétrique, Centre Hospitalier Universitaire de Yopougon, Yopougon, Côte d´Ivoire
| | - Mamourou Kone
- Université Félix Houphouët Boigny (FHB), Abidjan, Côte d´Ivoire
- Service de gynécologie Obstétrique, Centre Hospitalier Universitaire de Yopougon, Yopougon, Côte d´Ivoire
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Erel CT, Fistonić I, Gambacciani M, Oner Y, Fistonić N. Er:YAG laser in hysterectomized women with stress urinary incontinence: a VELA retrospective cohort, non-inferiority study. Climacteric 2020; 23:S18-S23. [PMID: 33124456 DOI: 10.1080/13697137.2020.1814728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To test whether the erbium-doped yttrium aluminum garnet (Er:YAG) SMOOTH® laser treatment efficacy on stress urinary incontinence (SUI) in hysterectomized patients is non-inferior to its efficacy in non-hysterectomized patients.Methods: In this real-world, retrospective cohort study performed in Turkey, Croatia and Italy, we enrolled a consecutive sample of 35 hysterectomized and 34 non-hysterectomized patients with SUI. We used the Er:YAG SMOOTH® laser (Fotona, Slovenia) with a wave length of 2940 nm. The primary outcome was median reduction of SUI symptoms measured by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short-Form (ICIQ-SF) with the non-inferiority margin defined as the minimum clinically important difference of ICIQ-SF (δ < 2.52 points).Results: In hysterectomized patients, the ICIQ-SF was reduced by 5 points (95% confidence interval 3-8; p < 0.001), a reduction of 45% (95% confidence interval 36-67%). After adjustment for baseline ICIQ-SF and five covariates, the reduction of symptoms in the hysterectomized group was not inferior to the reduction in the non-hysterectomized group.Conclusion: The Er:YAG SMOOTH® laser treatment seems to improve the symptoms of SUI in hysterectomized women not clinically relevantly less than in non-hysterectomized women. It seems that the beneficial effect of Er:YAG SMOOTH® laser treatment for SUI in hysterectomized women is time-limited.
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Affiliation(s)
- C T Erel
- Department of Obstetrics and Gynecology, İstanbul Cerrahpaşa University, İstanbul, Turkey
| | - I Fistonić
- Institute for Women's Health, Zagreb, Croatia
| | - M Gambacciani
- Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
| | - Y Oner
- Department of Obstetrics and Gynecology, İstanbul Cerrahpaşa University, İstanbul, Turkey
| | - N Fistonić
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia
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Ho L, Macnab A, Matsubara Y, Peterson K, Tsang B, Stothers L. Rating of Pelvic Floor Muscle Training Mobile Applications for Treatment of Urinary Incontinence in Women. Urology 2020; 150:92-98. [PMID: 32890617 DOI: 10.1016/j.urology.2020.08.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify pelvic floor muscle therapy mobile health applications (apps) targeting women with urinary incontinence (UI), and evaluate them in a standardized fashion. METHODS A systematic search of English language apps on the Canadian App Store (iOS) and Google Play (Android) Store was performed. Eligible apps were evaluated independently by 5 reviewers using the validated Mobile App Rating Scale (MARS) tool. Descriptive characteristics were summarized and MARS subscale and overall quality scores werereported. RESULTS Of 139 mobile health apps identified, 20 unique apps were included for full review, of which there were 7 iOS only apps, 6 Android only apps, and 7 apps available in both stores. At the time of analysis, most apps had been updated within the last year (60%). Only 1 app had been trialed and verified by evidence in scientific literature. The majority of apps were free to download (80%). The median (interquartile range) MARS overall quality score was 3.7 (0.8) on a 0-5 scale, ranging from 2.7 to 4.1. The highest-rated subscale was "functionality" with a median score of 4.1 (0.6); the lowest-rated was "information" with a median score of 3.4 (0.6). The median MARS subjective quality score was 2.9 (1.0). CONCLUSION There are both free and paid apps available on-line that deliver pelvic floor muscle therapy programs. Evaluation using the MARS tool identified that many apps are not of high quality, and only 1 was evidence-based and has been trialed clinically. This knowledge is relevant to the choice of apps by both patients and caregivers.
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Affiliation(s)
- Louisa Ho
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Macnab
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
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Brennen R, Lin KY, Denehy L, Frawley HC. The Effect of Pelvic Floor Muscle Interventions on Pelvic Floor Dysfunction After Gynecological Cancer Treatment: A Systematic Review. Phys Ther 2020; 100:1357-1371. [PMID: 32367126 DOI: 10.1093/ptj/pzaa081] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 11/10/2019] [Accepted: 02/11/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify, evaluate, and synthesize the evidence from studies that have investigated the effect of nonsurgical, nonpharmacological, pelvic floor muscle interventions on any type of pelvic floor dysfunction or health-related quality of life in patients after any type of treatment for gynecological cancer. METHODS Six electronic databases (Cochrane Library 2018, CINAHL 1982-2018, MEDLINE 1950-2018, EMBASE 1980-2018, PsycINFO 1806-2018, and EMCARE 1995-2018) were systematically searched in June 2018. Reference lists of identified articles were hand searched. Randomized controlled trials (RCTs), cohort studies, and case series were included if they investigated the effects of conservative treatments, including pelvic floor muscle training or dilator training, on bladder, bowel, or sexual function in patients who had received treatment for gynecological cancer. Risk of bias was assessed using the Physiotherapy Evidence Database scale for RCTs and the Newcastle-Ottawa scale for cohort studies. RESULTS Five RCTs and 2 retrospective cohort studies were included (n = 886). The results provided moderate-level evidence that pelvic floor muscle training with counseling and yoga or core exercises were beneficial for sexual function (standardized mean difference = -0.96, 95% CI = -1.22 to -0.70, I2 = 0%) and health-related quality of life (standardized mean difference = 0.63, 95% CI = 0.38 to 0.88, I2 = 0%) in survivors of cervical cancer and very low-level evidence that dilator therapy reduced vaginal complications in survivors of cervical and uterine cancer (odds ratio = 0.37, 95% CI = 0.17 to 0.80, I2 = 54%). There were insufficient data for meta-analysis of bladder or bowel function. CONCLUSION Conservative pelvic floor muscle interventions may be beneficial for improving sexual function and health-related quality of life in survivors of gynecological cancer. Given the levels of evidence reported in this review, further high-quality studies are needed, especially to investigate effects on bladder and bowel function. IMPACT This review provides moderate-level evidence for the role of pelvic floor rehabilitation to improve health outcomes in the gynecological cancer survivorship journey. Clinicians and health service providers should consider how to provide cancer survivors the opportunity to participate in supervised pelvic floor rehabilitation programs.
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Affiliation(s)
- Robyn Brennen
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Frankston, Victoria, Australia, and Monash Health Community Continence Service, Specialist Clinics, Monash Health, Dandenong, Australia
| | - Kuan-Yin Lin
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University; and Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan
| | - Linda Denehy
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia.,Department of Allied Health, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Helena C Frawley
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University
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[Physical activity for symptoms of the lower urinary tract due to benign prostatic obstruction]. Urologe A 2020; 59:1107-1109. [PMID: 32748064 DOI: 10.1007/s00120-020-01287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Xu L, Fu C, Zhang Q, Xiong F, Peng L, Liang Z, Chen L, He C, Wei Q. Efficacy of biofeedback, repetitive transcranial magnetic stimulation and pelvic floor muscle training for female neurogenic bladder dysfunction after spinal cord injury: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e034582. [PMID: 32759239 PMCID: PMC7409967 DOI: 10.1136/bmjopen-2019-034582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/14/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Neurogenic bladder dysfunction is prevalent in female patients with spinal cord injury (SCI), and previous guidelines have recommended pelvic floor muscle training (PFMT) for first-line conservative treatment. However, the actual regimen of PFMT varies widely and the single treatment does not satisfy the need of some patients. Therefore, this study aims to provide a detailed rationale and methodology for comparing the effectiveness of PFMT, biofeedback and repetitive transcranial magnetic stimulation (rTMS) as adjunct treatments for neurogenic bladder dysfunction. METHODS AND ANALYSIS This trial is a single-centre randomised controlled trial for female patients with urinary incontinence (UI) in phase of chronic SCI. Eligible participants will be randomised to one of four arms: (1) PFMT, (2) PFMT with biofeedback, (3) PFMT and rTMS and (4) PFMT with biofeedback and rTMS. There will be 44 participants in each arm and all the subjects will undergo 20 treatment sessions, five times a week for 4 weeks. The outcomes will be evaluated at 4 weeks, 3 months and 6 months after randomisation. The primary outcome is the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, and the secondary outcomes include bladder diary, pelvic floor muscle function and the International Spinal Cord Injury Quality of Life Basic Data Set. ETHICS AND DISSEMINATION The Clinical Research and Biomedical Ethics Committee of the West China Hospital, Sichuan University has approved this trial and the approval number is 2019-885. All participants will be provided written informed consent after verification of the eligibility criteria. The results of this study will be accessible in peer-reviewed publications and be presented at academic conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1900026126).
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Affiliation(s)
- Lin Xu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chenying Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Qing Zhang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Feng Xiong
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Lihong Peng
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Zejun Liang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Li Chen
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chengqi He
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
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Multidisciplinary approach between physicians and physiotherapists in urogynecology: how can we make it stronger? Int Urogynecol J 2020; 31:2187-2188. [PMID: 32681346 DOI: 10.1007/s00192-020-04417-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/28/2020] [Indexed: 10/23/2022]
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Vereeck S, Neels H, Govaerts J, Jacquemyn Y. Re: Effect of preoperative pelvic floor muscle training on pelvic floor muscle contraction and symptomatic and anatomical pelvic organ prolapse after surgery: randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:120-121. [PMID: 32608567 DOI: 10.1002/uog.22113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Affiliation(s)
- S Vereeck
- Department of Obstetrics and Gynecology, University Hospital of Antwerp (UZA), ASTARC, Women's Pelvic Health Antwerp, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - H Neels
- Department of Obstetrics and Gynecology, University Hospital of Antwerp (UZA), ASTARC, Women's Pelvic Health Antwerp, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - J Govaerts
- Department of Obstetrics and Gynecology, University Hospital of Antwerp (UZA), ASTARC, Women's Pelvic Health Antwerp, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Y Jacquemyn
- Department of Obstetrics and Gynecology, University Hospital of Antwerp (UZA), ASTARC, Women's Pelvic Health Antwerp, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Brucker BM, Lee RK, Newman DK. Optimizing Nonsurgical Treatments of Overactive Bladder in the United States. Urology 2020; 145:52-59. [PMID: 32598892 DOI: 10.1016/j.urology.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Overactive bladder syndrome is a prevalent condition impacting quality of life, activities of daily living, work productivity, physical and psychological health, sleep, and sexuality. Published guideline recommendations and effective behavioral, pharmacologic, and neuromodulatory therapies exist; however, adherence can be poor. Clinicians have important roles educating patients, setting treatment expectations, and providing follow-up. Determining patient goals, routinely assessing and adjusting therapy, and combining treatment strategies may improve outcomes. We review the benefits and challenges of overactive bladder treatments and propose approaches to improve patient management, with the goals of initiating therapy earlier and achieving better patient satisfaction, functioning, and quality of life.
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Affiliation(s)
| | | | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Nyhus MØ, Mathew S, Salvesen Ø, Salvesen KÅ, Stafne S, Volløyhaug I. Effect of preoperative pelvic floor muscle training on pelvic floor muscle contraction and symptomatic and anatomical pelvic organ prolapse after surgery: randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:28-36. [PMID: 32144829 DOI: 10.1002/uog.22007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/12/2020] [Accepted: 02/22/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the effect of preoperative pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction, symptoms of pelvic organ prolapse (POP) and anatomical POP, 6 months after prolapse surgery, and to assess the overall changes in PFM contraction, POP symptoms and pelvic organ descent after surgery. METHODS This was a randomized controlled trial of 159 women with symptomatic POP, Stage 2 or higher, scheduled for surgery. Participants were randomized to intervention including daily PFMT from inclusion to surgery (n = 81) or no intervention (controls; n = 78). Participants were examined at inclusion, on the day of surgery and 6 months after surgery. PFM contraction was assessed by: vaginal palpation using the Modified Oxford scale (MOS; 0-5); transperineal ultrasound, measuring the percentage change in levator hiatal anteroposterior diameter (APD) from rest to maximum PFM contraction; vaginal manometry; and surface electromyography (EMG). POP distance from the hymen in the compartment with the most dominant prolapse and organ descent in the anterior, central and posterior compartments were measured on maximum Valsalva maneuver. POP symptoms were assessed based on the sensation of vaginal bulge, which was graded using a visual analog scale (VAS; 0-100 mm). Linear mixed models were used to assess the effect of PFMT on outcome variables. RESULTS Of the 159 women randomized, 151 completed the study, comprising 75 in the intervention and 76 in the control group. Mean waiting time for surgery was 22 ± 9.7 weeks and follow-up was performed on average 28 ± 7.8 weeks after surgery. Postoperatively, no difference was found between the intervention and control groups with respect to PFM contraction assessed by vaginal palpation (MOS, 2.4 vs 2.2; P = 0.101), manometry (19.4 vs 19.7 cmH2 O; P = 0.793), surface EMG (33.5 vs 33.1 mV; P = 0.815) and ultrasound (change in hiatal APD, 20.9% vs 19.3%; P = 0.211). Furthermore, no difference between groups was found for sensation of vaginal bulge (VAS, 7.4 vs 6.0 mm; P = 0.598), POP distance from the hymen in the dominant prolapse compartment (-1.8 vs -2.0 cm; P = 0.556) and sonographic descent of the bladder (0.5 vs 0.8 cm; P = 0.058), cervix (-1.3 vs -1.1 cm; P = 0.569) and rectal ampulla (0.3 vs 0.4 cm; P = 0.434). In all patients, compared with findings at initial examination, muscle contraction improved after surgery, as assessed by palpation (MOS, 2.1 vs 2.3; P = 0.007) and ultrasound (change in hiatal APD, 17.5% vs 20.1%; P = 0.001), and sensation of vaginal bulge was reduced (VAS, 57.6 vs 6.7 mm; P < 0.001). In addition, compared with the baseline examination, POP distance from the hymen in the dominant prolapse compartment (1.9 vs -1.9 cm; P < 0.001) and sonographic descent of the bladder (1.3 vs 0.6 cm; P < 0.001), cervix (0.0 vs -1.2 cm; P < 0.001) and rectal ampulla (0.9 vs 0.4 cm; P = 0.001) were reduced. CONCLUSIONS We found no effect of preoperative PFMT on PFM contraction, POP symptoms or anatomical prolapse after surgery. In all patients, PFM contraction and POP symptoms were improved at the 6-month follow-up, most likely due to the anatomical correction of POP. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Ø Nyhus
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Mathew
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ø Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Å Salvesen
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Services, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - I Volløyhaug
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Araya-Castro P, Sacomori C, Diaz-Guerrero P, Gayán P, Román D, Sperandio FF. Vaginal Dilator and Pelvic Floor Exercises for Vaginal Stenosis, Sexual Health and Quality of Life among Cervical Cancer Patients Treated with Radiation: Clinical Report. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:513-527. [PMID: 32364016 DOI: 10.1080/0092623x.2020.1760981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This clinical report aimed to evaluate the effectiveness of the combination of vaginal dilator (VD) and pelvic floor muscle exercises (PFME) on vaginal stenosis, sexual health and quality of life among women undergoing radiotherapy treatment for cervical cancer; PFME were instructed prior to radiotherapy with six-month follow-up. An intention-to-treat analysis was performed for the 28 women. At four-months after radiotherapy, most of the women (90.9%) maintained/increased one size of the VD and were sexually active (81.8%). Adherence to VD was high. Regarding quality of life, there was more limitation in emotional functioning. VD and PFME were effective at preventing stenosis.
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Affiliation(s)
- Paulina Araya-Castro
- Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
- Health Sciences Faculty, Universidad San Sebastián, Santiago, Chile
| | - Cinara Sacomori
- Escuela de Kinesiología, Universidad Bernardo O'Higgins, Santiago, Chile
| | | | - Patricio Gayán
- Gynecology Unit, Instituto Nacional del Cáncer, Santiago, Chile
| | - Devora Román
- Escuela de Kinesiología, Universidad Bernardo O'Higgins, Santiago, Chile
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Navarro-Brazález B, Prieto-Gómez V, Prieto-Merino D, Sánchez-Sánchez B, McLean L, Torres-Lacomba M. Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial. J Clin Med 2020; 9:E1149. [PMID: 32316686 PMCID: PMC7230910 DOI: 10.3390/jcm9041149] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023] Open
Abstract
Hypopressive exercises have emerged as a conservative treatment option for pelvic floor dysfunction (PFD). The aim of this study was to compare the effects of an eight-week hypopressive exercise program to those of an individualized pelvic floor muscle (PFM) training (PFMT) program, and to a combination of both immediately after treatment and at follow-up assessments at 3, 6 and 12 months later. The study was a prospective, single-centre, assessor-blinded, randomised controlled trial. Ninety-four women with PFD were assigned to PFMT (n = 32), hypopressive exercises (n = 31) or both (n = 31). All programs included the same educational component, and instruction about lifestyle interventions and the knack manoeuvre. Primary outcomes were the Pelvic Floor Distress Inventory Short Form (PFDI-20); the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7); PFM strength (manometry and dynamometry) and pelvic floor basal tone (dynamometry). There were no statistically significant differences between groups at baseline, nor after the intervention. Overall, women reduced their symptoms (24.41-30.5 on the PFDI-20); improved their quality of life (14.78-21.49 on the PFIQ-7), improved their PFM strength (8.61-9.32 cmH2O on manometry; 106.2-247.7 g on dynamometry), and increased their pelvic floor basal tone (1.8-22.9 g on dynamometry). These data suggest that individual PFMT, hypopressive exercises and a combination of both interventions significantly reduce PFD symptoms, enhance quality of life, and improve PFM strength and basal tone in women with PFD, both in the short and longer term.
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Affiliation(s)
- Beatriz Navarro-Brazález
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
| | - Virginia Prieto-Gómez
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
| | - David Prieto-Merino
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
- Applied statistical methods in Medical Research Group, Catholic University of Murcia (UCAM), 30107 Murcia, Spain
| | - Beatriz Sánchez-Sánchez
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group. Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain; (B.N.-B.); (V.P.-G.); (D.P.-M.); (M.T.-L.)
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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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Wang X, Xu X, Luo J, Chen Z, Feng S. Effect of app-based audio guidance pelvic floor muscle training on treatment of stress urinary incontinence in primiparas: A randomized controlled trial. Int J Nurs Stud 2020; 104:103527. [PMID: 32058140 DOI: 10.1016/j.ijnurstu.2020.103527] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Stress urinary incontinence is a distressing and burdensome condition affecting approximately one third of pregnant women and pelvic floor muscle training is recommended as the first-line treatment. Convenient and cost-effective regimen of pelvic floor muscle training is required to facilitate the treatment of stress urinary incontinence and improve the adherence to treatment in pregnant women. OBJECTIVE To determine the effectiveness of app-based audio guidance pelvic floor muscle training on the treatment of stress urinary incontinence in primiparas. DESIGN The study was a two-arm, parallel, randomized controlled clinical trial. SETTING The study was conducted in the obstetric clinic of a tertiary maternity hospital in Hangzhou, China. PARTICIPANTS A total of 108 eligible primiparas were enrolled from January to April 2018. METHODS Participants were randomly allocated (1:1) to the audio group or the control group. Primary outcomes included severity of stress urinary incontinence and adherence to pelvic floor muscle training assessed by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the Broome Pelvic Muscle Self-Efficacy Scale, respectively. Secondary outcomes included pelvic floor muscle strength, bladder neck mobility and sexual function measured by vaginal palpation and pelvic floor muscle surface electromyography, perineal ultrasound and Female Sexual Function Index, respectively. Data analysis followed the intention-to-treat principle. Generalized estimation equation model, t-test and chi-square test were used to examine intervention effect on primary outcomes and secondary outcomes, respectively. RESULTS Participants showed significant improvement in symptom severity across the study, which was most significant at 6 weeks postpartum (β = -4.245, p < 0.001). No significant difference was found in symptom severity between groups (β = -0.344, p = 0.168). The interaction effect between intervention and time on adherence was significant. Compared with the control group, greater self-efficacy was shown in the audio group at 6 weeks (β = 4.425, p = 0.009), 3 months (β = 3.204, p < 0.001) and 6 months (β = 4.457, p < 0.001) postpartum. Participants in the audio group indicated less bladder neck descent (16.5 vs. 19.5, p = 0.020) at 6 weeks postpartum, better pelvic floor muscle strength (12.5% vs. 34.0%, p = 0.012; 4.2% vs. 18.0%, p = 0.030) and sexual function (22.2 vs. 17.3, p = 0.007) at 6 months postpartum. CONCLUSIONS The app-based audio guidance pelvic floor muscle training was more effective and much easier to comply for treatment of stress urinary incontinence in primiparas than the conventional home-based pelvic floor muscle training.
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Affiliation(s)
- Xiaojuan Wang
- Zhejiang University School of Medicine, No.866 Yu Hang Tang Road, Hangzhou 310058, Zhejiang Province, China.
| | - Xuefen Xu
- Zhejiang University School of Medicine, No.866 Yu Hang Tang Road, Hangzhou 310058, Zhejiang Province, China; Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou 310006, Zhejiang Province, China.
| | - Jiamin Luo
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou 310006, Zhejiang Province, China.
| | - Zhengfei Chen
- Zhejiang University School of Medicine, No.866 Yu Hang Tang Road, Hangzhou 310058, Zhejiang Province, China.
| | - Suwen Feng
- Women's Hospital, Zhejiang University School of Medicine, No.1 Xue Shi Road, Hangzhou 310006, Zhejiang Province, China.
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