Pub Date : 2019-05-16DOI: 10.1097/JWH.0000000000000135
Natalie Russell, Bevin Daniels, Betty J. Smoot, D. Allen
Background: Chronic pelvic pain (CPP) is a multifactorial condition affecting 20% of women in the United States. Treatment includes pharmacological interventions, physical therapy, and lifestyle modifications. Previous studies show yoga effectively managing low back pain and pregnancy-related low back and pelvic pain, yet evidence related to CPP is limited. Objective: To synthesize the existing literature on the effect of yoga on pain and quality of life (QOL) in women with CPP. Study Design: PubMed, PEDro, and CINAHL were searched for intervention studies that used yoga to treat women with CPP and reported pain and QOL outcomes. Methods: Effect sizes (ES) and 95% confidence intervals (CI) were calculated from study means and standard deviations for pain and QOL. Individual study ESs were pooled using the fixed-effects or random-effects models for within-group and between-group analyses. Results: Three studies met the inclusion criteria. Statistically significant improvements were seen following the yoga intervention for within-group analysis of QOL (ES =−1.4, CI: −1.8 to 1.1) and pain (ES: −2.2, CI: −2.7 to −1.6). Between-group analysis found statistically significant differences in QOL (ES =−1.5, CI: −2.0 to −1.0) and pain (ES = −1.4, CI: −1.7 to −1.0), favoring the yoga group. Studies varied in dosage and were of low to moderate quality. Conclusion: The results support the use of yoga to improve pain and QOL in women with CPP. Future studies should aim to determine the minimal dosage needed for a successful yoga intervention and use a randomized controlled design with assessor blinding to increase the quality of evidence.
{"title":"Effects of Yoga on Quality of Life and Pain in Women With Chronic Pelvic Pain: Systematic Review and Meta-Analysis","authors":"Natalie Russell, Bevin Daniels, Betty J. Smoot, D. Allen","doi":"10.1097/JWH.0000000000000135","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000135","url":null,"abstract":"Background: Chronic pelvic pain (CPP) is a multifactorial condition affecting 20% of women in the United States. Treatment includes pharmacological interventions, physical therapy, and lifestyle modifications. Previous studies show yoga effectively managing low back pain and pregnancy-related low back and pelvic pain, yet evidence related to CPP is limited. Objective: To synthesize the existing literature on the effect of yoga on pain and quality of life (QOL) in women with CPP. Study Design: PubMed, PEDro, and CINAHL were searched for intervention studies that used yoga to treat women with CPP and reported pain and QOL outcomes. Methods: Effect sizes (ES) and 95% confidence intervals (CI) were calculated from study means and standard deviations for pain and QOL. Individual study ESs were pooled using the fixed-effects or random-effects models for within-group and between-group analyses. Results: Three studies met the inclusion criteria. Statistically significant improvements were seen following the yoga intervention for within-group analysis of QOL (ES =−1.4, CI: −1.8 to 1.1) and pain (ES: −2.2, CI: −2.7 to −1.6). Between-group analysis found statistically significant differences in QOL (ES =−1.5, CI: −2.0 to −1.0) and pain (ES = −1.4, CI: −1.7 to −1.0), favoring the yoga group. Studies varied in dosage and were of low to moderate quality. Conclusion: The results support the use of yoga to improve pain and QOL in women with CPP. Future studies should aim to determine the minimal dosage needed for a successful yoga intervention and use a randomized controlled design with assessor blinding to increase the quality of evidence.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JWH.0000000000000135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47152501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1097/JWH.0000000000000140
A. Abraham, K. Scott, A. Christie, Patricia Morita-Nagai, A. Chhabra, P. Zimmern
Background: Transvaginal synthetic mesh and mesh sling placement for the treatment of stress urinary incontinence and pelvic organ prolapse can yield adverse outcomes, including pelvic pain and dyspareunia, that persist after implant removal. Objective: To describe the clinical presentations of women with residual pelvic pain or dyspareunia after synthetic vaginal mesh and/or mesh sling removal and the effectiveness of treatments using a multidisciplinary approach. Study Design: After receiving institutional review board approval, a neutral reviewer retrospectively analyzed a prospectively maintained database of women who experienced pelvic pain/dyspareunia after implant removal and were referred to a physiatrist specializing in pelvic rehabilitation medicine. Methods: Included were women who were evaluated by a physiatrist following implant removal. Excluded were women seen for symptoms other than pain or pending subsequent resection procedures. Primary outcome was pelvic pain score assessed by a Numeric Pain Rating Scale obtained at each physiatrist and physical therapy visit. Success was defined as a 50% or greater reduction in pain score. All patients underwent pelvic floor physical therapy, with medications and injections as necessary. Results: From 2010 to 2015, 37 women were included in the analysis. Of these, 4 had isolated dyspareunia and the remaining 33 had general pelvic pain. Eight of these 33 (24%) achieved a successful outcome. When evaluating compliance, half (14 of 28) of the compliant patients achieved improvement in pain scores. Compliant patients treated for isolated dyspareunia experienced more than 80% improvement. Conclusion: Pelvic pain-focused interventions are a worthwhile recommendation in women with refractory pelvic pain after vaginal mesh or mesh sling removal.
{"title":"Outcomes Following Multidisciplinary Management of Women With Residual Pelvic Pain and Dyspareunia Following Synthetic Vaginal Mesh and/or Mesh Sling Removal","authors":"A. Abraham, K. Scott, A. Christie, Patricia Morita-Nagai, A. Chhabra, P. Zimmern","doi":"10.1097/JWH.0000000000000140","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000140","url":null,"abstract":"Background: Transvaginal synthetic mesh and mesh sling placement for the treatment of stress urinary incontinence and pelvic organ prolapse can yield adverse outcomes, including pelvic pain and dyspareunia, that persist after implant removal. Objective: To describe the clinical presentations of women with residual pelvic pain or dyspareunia after synthetic vaginal mesh and/or mesh sling removal and the effectiveness of treatments using a multidisciplinary approach. Study Design: After receiving institutional review board approval, a neutral reviewer retrospectively analyzed a prospectively maintained database of women who experienced pelvic pain/dyspareunia after implant removal and were referred to a physiatrist specializing in pelvic rehabilitation medicine. Methods: Included were women who were evaluated by a physiatrist following implant removal. Excluded were women seen for symptoms other than pain or pending subsequent resection procedures. Primary outcome was pelvic pain score assessed by a Numeric Pain Rating Scale obtained at each physiatrist and physical therapy visit. Success was defined as a 50% or greater reduction in pain score. All patients underwent pelvic floor physical therapy, with medications and injections as necessary. Results: From 2010 to 2015, 37 women were included in the analysis. Of these, 4 had isolated dyspareunia and the remaining 33 had general pelvic pain. Eight of these 33 (24%) achieved a successful outcome. When evaluating compliance, half (14 of 28) of the compliant patients achieved improvement in pain scores. Compliant patients treated for isolated dyspareunia experienced more than 80% improvement. Conclusion: Pelvic pain-focused interventions are a worthwhile recommendation in women with refractory pelvic pain after vaginal mesh or mesh sling removal.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":"43 1","pages":"171 - 179"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JWH.0000000000000140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46550519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-10DOI: 10.1097/JWH.0000000000000134
M. Bussey, D. Aldabe, Lynnette M Jones
Background Context: Transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction is a common method of reconstruction performed after mastectomy. However, the short and long-term effect on posture, balance, and coordination is unknown. Purpose: The purpose of this study was to investigate the effects of TRAM flap breast reconstruction on anticipatory postural control and balance in a breast cancer survivor. Study Design: A repeated-measures cohort design. Patient Sample: A 47-year-old woman who underwent ipsilateral mastectomy and TRAM flap breast reconstruction. Outcome Measure: Anticipatory muscle activity including muscle onset timing, magnitude of muscle activation, and center-of-pressure displacement during a modified Trendelenburg task. Muscle onsets occurring before initiation of weight shift were considered “early activation” and likely to represent a feedforward postural control mechanism whereas muscle onsets occurring after weight shift were considered “late activation” representing reliance on feedback mechanism for postural control. Methods: Electromyographic muscle activity and displacement of center of pressure were examined in a single-subject design with pre- and post-TRAM flap surgery measures taken 6 days preoperation, 6 weeks, and 13 weeks postoperation. Results: The timing of muscle onset differed significantly day-to-day for all muscles. Preoperatively, the unaffected side presented earlier activation compared with the affected side. At 6 weeks, there were no early activations. At 13 weeks, early activation was identified in 6 of 8 muscles. Reaction time and balance instability were significantly greater at 6 weeks and highest on the affected. Conclusions: The permanent disruption of the rectus abdominis had an immediate and significant impact on muscle activity and balance, which was restored by 13 weeks postoperation without specifically targeted stability rehabilitation.
{"title":"Reorganization of Postural Stability After Tram Flap Breast Reconstruction Surgery: A Longitudinal Case Report","authors":"M. Bussey, D. Aldabe, Lynnette M Jones","doi":"10.1097/JWH.0000000000000134","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000134","url":null,"abstract":"Background Context: Transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction is a common method of reconstruction performed after mastectomy. However, the short and long-term effect on posture, balance, and coordination is unknown. Purpose: The purpose of this study was to investigate the effects of TRAM flap breast reconstruction on anticipatory postural control and balance in a breast cancer survivor. Study Design: A repeated-measures cohort design. Patient Sample: A 47-year-old woman who underwent ipsilateral mastectomy and TRAM flap breast reconstruction. Outcome Measure: Anticipatory muscle activity including muscle onset timing, magnitude of muscle activation, and center-of-pressure displacement during a modified Trendelenburg task. Muscle onsets occurring before initiation of weight shift were considered “early activation” and likely to represent a feedforward postural control mechanism whereas muscle onsets occurring after weight shift were considered “late activation” representing reliance on feedback mechanism for postural control. Methods: Electromyographic muscle activity and displacement of center of pressure were examined in a single-subject design with pre- and post-TRAM flap surgery measures taken 6 days preoperation, 6 weeks, and 13 weeks postoperation. Results: The timing of muscle onset differed significantly day-to-day for all muscles. Preoperatively, the unaffected side presented earlier activation compared with the affected side. At 6 weeks, there were no early activations. At 13 weeks, early activation was identified in 6 of 8 muscles. Reaction time and balance instability were significantly greater at 6 weeks and highest on the affected. Conclusions: The permanent disruption of the rectus abdominis had an immediate and significant impact on muscle activity and balance, which was restored by 13 weeks postoperation without specifically targeted stability rehabilitation.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JWH.0000000000000134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47957043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-03DOI: 10.1097/JWH.0000000000000129
Seraphina G. Provenzano, J. Hafer, Jillian Peacock, Samantha Kempner, J. Zendler, C. Agresta
Background: Biomechanical changes in gait during pregnancy have been well studied in walking but not in running. Objective: To specifically examine adaptations in running biomechanics pre- to post-pregnancy, especially in the pelvis and trunk. Study Design: Pilot study. Methods: Five regular runners who were pregnant for the first time participated in this study. Participants ran at a self-selected speed on an instrumented treadmill while trunk, pelvis, and lower extremity kinematics were recorded. Baseline biomechanics were recorded prior to conception or within the first 14 weeks of gestation. Follow-up testing occurred at 6 weeks postpartum. Digital surveys were administered at baseline and 6 weeks postpartum, as well as at 14, 22, and 30 weeks of gestation. Surveys queried information regarding training characteristics, experience of pain, and perceived injury risk compared with pre-pregnancy. Results: Pelvis and trunk rotation excursions, sagittal hip range of motion, and cadence decreased from baseline to post-pregnancy, whereas stance time, step width, and sagittal knee range of motion increased. Average running volume and pace decreased postpartum, although variation occurred among participants. Abdominal pain was reported by 2 participants during pregnancy, with 2 participants reporting increased perceived injury risk. Conclusion: Taken together, these findings suggest postpartum runners restrict pelvis and trunk motion and increase gait stability, potentially as a protective response. Despite sample size, this pilot study presents initial evidence of biomechanical changes to running gait that occur pre- to post-pregnancy, which may have implications in developing support for pregnant and postpartum women interested in continuing or returning to running.
{"title":"Restriction in Pelvis and Trunk Motion in Postpartum Runners Compared With Pre-pregnancy","authors":"Seraphina G. Provenzano, J. Hafer, Jillian Peacock, Samantha Kempner, J. Zendler, C. Agresta","doi":"10.1097/JWH.0000000000000129","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000129","url":null,"abstract":"Background: Biomechanical changes in gait during pregnancy have been well studied in walking but not in running. Objective: To specifically examine adaptations in running biomechanics pre- to post-pregnancy, especially in the pelvis and trunk. Study Design: Pilot study. Methods: Five regular runners who were pregnant for the first time participated in this study. Participants ran at a self-selected speed on an instrumented treadmill while trunk, pelvis, and lower extremity kinematics were recorded. Baseline biomechanics were recorded prior to conception or within the first 14 weeks of gestation. Follow-up testing occurred at 6 weeks postpartum. Digital surveys were administered at baseline and 6 weeks postpartum, as well as at 14, 22, and 30 weeks of gestation. Surveys queried information regarding training characteristics, experience of pain, and perceived injury risk compared with pre-pregnancy. Results: Pelvis and trunk rotation excursions, sagittal hip range of motion, and cadence decreased from baseline to post-pregnancy, whereas stance time, step width, and sagittal knee range of motion increased. Average running volume and pace decreased postpartum, although variation occurred among participants. Abdominal pain was reported by 2 participants during pregnancy, with 2 participants reporting increased perceived injury risk. Conclusion: Taken together, these findings suggest postpartum runners restrict pelvis and trunk motion and increase gait stability, potentially as a protective response. Despite sample size, this pilot study presents initial evidence of biomechanical changes to running gait that occur pre- to post-pregnancy, which may have implications in developing support for pregnant and postpartum women interested in continuing or returning to running.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":"Publish Ahead of Print 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JWH.0000000000000129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45496070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.1097/jwh.0000000000000131
Meryl Alappattu, Sandra Hilton, Mark Bishop
Background: Pelvic pain (PP) is a debilitating condition that is challenging to manage. Despite differences in suspected etiologies of different PP conditions, common clinical signs and symptoms make it appropriate to group these diagnoses. The presence of neuro-musculoskeletal impairments in PP suggests that physical therapists are ideally situated to be included as part of the health care team managing this condition; however, little information is available to guide physical therapist management of PP.
Objectives: As a first step to developing management guidelines, we sought to determine common interventions currently used by physical therapists to manage PP.
Study design: Descriptive survey.
Methods: A modified Delphi approach was used to identify broad categories of interventions that were then used to build a survey. Purposeful selection with snowball recruiting methods was used to collect responses from practitioners. Frequency data were collected for survey responses. Chi-square analysis determined associations among responses based on practitioner training.
Results: A total of 984 responses from 17 different countries were analyzed. The primary responses were from physical therapists in the USA and Canada. The majority of respondents were board-certified clinical specialists. More than 80% of physical therapist respondents indicated that they "frequently used" education, exercise, and manual therapy for patients with PP. The most common interventions considered effective but not frequently used were cognitive-behavioral therapy, dry needling, acupuncture, topical medications, and internal pelvic manual therapy techniques. Geographical differences in patterns of usespecific manual therapy and exercise interventions were noted. Differences were also noted on the basis of the levels of advanced postprofessional training.
Conclusion: Physical therapists routinely use education, manual therapy, and exercise to manage pelvic pain conditions.
{"title":"An International Survey of Commonly Used Interventions for Management of Pelvic Pain.","authors":"Meryl Alappattu, Sandra Hilton, Mark Bishop","doi":"10.1097/jwh.0000000000000131","DOIUrl":"https://doi.org/10.1097/jwh.0000000000000131","url":null,"abstract":"<p><strong>Background: </strong>Pelvic pain (PP) is a debilitating condition that is challenging to manage. Despite differences in suspected etiologies of different PP conditions, common clinical signs and symptoms make it appropriate to group these diagnoses. The presence of neuro-musculoskeletal impairments in PP suggests that physical therapists are ideally situated to be included as part of the health care team managing this condition; however, little information is available to guide physical therapist management of PP.</p><p><strong>Objectives: </strong>As a first step to developing management guidelines, we sought to determine common interventions currently used by physical therapists to manage PP.</p><p><strong>Study design: </strong>Descriptive survey.</p><p><strong>Methods: </strong>A modified Delphi approach was used to identify broad categories of interventions that were then used to build a survey. Purposeful selection with snowball recruiting methods was used to collect responses from practitioners. Frequency data were collected for survey responses. Chi-square analysis determined associations among responses based on practitioner training.</p><p><strong>Results: </strong>A total of 984 responses from 17 different countries were analyzed. The primary responses were from physical therapists in the USA and Canada. The majority of respondents were board-certified clinical specialists. More than 80% of physical therapist respondents indicated that they \"frequently used\" education, exercise, and manual therapy for patients with PP. The most common interventions considered effective but not frequently used were cognitive-behavioral therapy, dry needling, acupuncture, topical medications, and internal pelvic manual therapy techniques. Geographical differences in patterns of usespecific manual therapy and exercise interventions were noted. Differences were also noted on the basis of the levels of advanced postprofessional training.</p><p><strong>Conclusion: </strong>Physical therapists routinely use education, manual therapy, and exercise to manage pelvic pain conditions.</p>","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":"43 2","pages":"82-88"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/jwh.0000000000000131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38011234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-07DOI: 10.1097/JWH.0000000000000130
S. Dufour, S. Bernard, B. Murray-Davis, N. Graham
Purpose: Pregnancy-related diastasis rectus abdominis (DRA) is a prevalent condition. Consequences of a widened linea alba ultimately remain unknown. Current evidence on conservative management is conflicting, creating debate among practitioners. This study aims at developing a set of expert consensus-based recommendations for the assessment and conservative management of DRA. Methods: Selected Canadian women's health physiotherapists were invited to participate in a 3-phase Delphi consensus study. Phase I comprised 82 items divided into 6 domains, and to determine agreement, each item was rated on a 5-point Likert scale. Consensus was defined as agreement greater than 80%. In phase II, items receiving consensus were ranked and collapsed and summary descriptions were proposed. In phase III, final consensus was determined. Results: A total of 21 of the 28 (75%) invited experts participated. Phase I generated 38 consensus statements. Phase II translated into 30 consensus statements as well as modifications to proposed summary statements for each data category. Remaining items did not reach consensus. Consensus for 28 expert-based recommendations was achieved in phase III. Conclusions: This study generated 28 expert-based recommendations achieved through a 3-phase consensus process for the assessment and conservative management of DRA. Nationally recognized Canadian expert physiotherapists in women's health agree that the impairments and dysfunctions related to DRA are multidimensional and emphasize the need for a global and tailored care approach. Clinical Relevance: This is the first study to establish consensus across key stakeholders to assist in bridging the current evidence-practice gap regarding pregnancy-related DRA. Our findings point to matters that require further study. Level of Evidence: 5 (expert opinion).
{"title":"Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study","authors":"S. Dufour, S. Bernard, B. Murray-Davis, N. Graham","doi":"10.1097/JWH.0000000000000130","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000130","url":null,"abstract":"Purpose: Pregnancy-related diastasis rectus abdominis (DRA) is a prevalent condition. Consequences of a widened linea alba ultimately remain unknown. Current evidence on conservative management is conflicting, creating debate among practitioners. This study aims at developing a set of expert consensus-based recommendations for the assessment and conservative management of DRA. Methods: Selected Canadian women's health physiotherapists were invited to participate in a 3-phase Delphi consensus study. Phase I comprised 82 items divided into 6 domains, and to determine agreement, each item was rated on a 5-point Likert scale. Consensus was defined as agreement greater than 80%. In phase II, items receiving consensus were ranked and collapsed and summary descriptions were proposed. In phase III, final consensus was determined. Results: A total of 21 of the 28 (75%) invited experts participated. Phase I generated 38 consensus statements. Phase II translated into 30 consensus statements as well as modifications to proposed summary statements for each data category. Remaining items did not reach consensus. Consensus for 28 expert-based recommendations was achieved in phase III. Conclusions: This study generated 28 expert-based recommendations achieved through a 3-phase consensus process for the assessment and conservative management of DRA. Nationally recognized Canadian expert physiotherapists in women's health agree that the impairments and dysfunctions related to DRA are multidimensional and emphasize the need for a global and tailored care approach. Clinical Relevance: This is the first study to establish consensus across key stakeholders to assist in bridging the current evidence-practice gap regarding pregnancy-related DRA. Our findings point to matters that require further study. Level of Evidence: 5 (expert opinion).","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":"45 1","pages":"73–81"},"PeriodicalIF":0.0,"publicationDate":"2019-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JWH.0000000000000130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61633427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-20DOI: 10.1097/JWH.0000000000000122
Heather R. Deja, Cheyenne Smith, Joshua St. Peter, L. Tuttle, M. Rauh
Background: Few studies have examined characteristics that may affect the health and performance of collegiate dancers. Objectives: This study examined health characteristics of collegiate dancers, particularly disordered eating, menstrual dysfunction, injury occurrence, and urogenital distress. Study Design: Cross-sectional design. Methods: Forty-one female collegiate dancers (age: 20.1 ± 1.5 y; body mass index: 23.2 ± 2.7) completed the Eating Disorder Examination Questionnaire and a questionnaire inquiring about their prior injury occurrence, menstrual history, and urogenital distress. The dancers' height and weight were measured to calculate body mass index. Results: Twenty (48.8%) of the forty-one collegiate dancers reported a prior lower extremity injury during the past year, with 7 (17.1%) sustaining a stress fracture. Fourteen (34.1%) dancers were classified as having disordered eating. Six (14.6%) dancers were classified as having menstrual dysfunction in the past year. While only 13 (31.7%) reported at least 1 urogenital distress occurrence during dancing, 32 (78%) dancers reported at least 1 urogenital distress occurrence during nondance activities. Conclusion: These findings indicated that collegiate dancers had a high prevalence of disordered eating and related pathogenic behaviors. The results also indicated that dancers sustained a high lower extremity injury occurrence during the past year and experienced greater urogenital distress occurrence during nondance activities.
{"title":"Health Characteristics of Competitive Collegiate Dancers","authors":"Heather R. Deja, Cheyenne Smith, Joshua St. Peter, L. Tuttle, M. Rauh","doi":"10.1097/JWH.0000000000000122","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000122","url":null,"abstract":"Background: Few studies have examined characteristics that may affect the health and performance of collegiate dancers. Objectives: This study examined health characteristics of collegiate dancers, particularly disordered eating, menstrual dysfunction, injury occurrence, and urogenital distress. Study Design: Cross-sectional design. Methods: Forty-one female collegiate dancers (age: 20.1 ± 1.5 y; body mass index: 23.2 ± 2.7) completed the Eating Disorder Examination Questionnaire and a questionnaire inquiring about their prior injury occurrence, menstrual history, and urogenital distress. The dancers' height and weight were measured to calculate body mass index. Results: Twenty (48.8%) of the forty-one collegiate dancers reported a prior lower extremity injury during the past year, with 7 (17.1%) sustaining a stress fracture. Fourteen (34.1%) dancers were classified as having disordered eating. Six (14.6%) dancers were classified as having menstrual dysfunction in the past year. While only 13 (31.7%) reported at least 1 urogenital distress occurrence during dancing, 32 (78%) dancers reported at least 1 urogenital distress occurrence during nondance activities. Conclusion: These findings indicated that collegiate dancers had a high prevalence of disordered eating and related pathogenic behaviors. The results also indicated that dancers sustained a high lower extremity injury occurrence during the past year and experienced greater urogenital distress occurrence during nondance activities.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":"44 1","pages":"97 - 106"},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JWH.0000000000000122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42283045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1097/jwh.0000000000000117
Jennifer Trahan, Erin Leger, Marlena Allen, Rachel Koebele, Mary Brian Yoffe, Corey Simon, Meryl Alappattu, Carol Figuers
Background: Pelvic floor physical therapy is a noninvasive option for relieving pain associated with dyspareunia, genital pain associated with sexual intercourse. Manual therapy is a clinical approach used by physical therapists to mobilize soft tissues, reduce pain, and improve function. To date, the systematic efficacy of manual therapy for treating dyspareunia has not been investigated.
Objective: To examine the efficacy of manual therapy in reducing pelvic pain among females with dyspareunia.
Study design: Systematic review.
Methods: A systematic literature search was conducted in MEDLINE, EMBASE, and CINAHL databases for articles published between June 1997 and June 2018. Articles were reviewed and selected on the basis of defined inclusion and exclusion criteria. The articles were assessed for quality using the PEDro and Modified Downs and Black scales.
Results: Three observational studies and 1 randomized clinical trial met inclusion criteria. The primary outcome measured was the pain subscale of the Female Sexual Function Index. All studies showed significant improvements in the pain domain of the Female Sexual Function Index (P < .5), corroborating manual therapy as a viable treatment in relieving pain associated with dyspareunia. However, the quality across studies ranged from poor to good.
Conclusions: Although these findings support the use of manual therapy for alleviating pain with intercourse, few studies exist to authenticate this claim. Moreover, the available studies were characterized by small sample sizes and were variable in methodological quality. More extensive research is needed to establish the efficacy of manual therapy for dyspareunia and the specific mechanisms by which manual therapy is beneficial.
{"title":"The Efficacy of Manual Therapy for Treatment of Dyspareunia in Females: A Systematic Review.","authors":"Jennifer Trahan, Erin Leger, Marlena Allen, Rachel Koebele, Mary Brian Yoffe, Corey Simon, Meryl Alappattu, Carol Figuers","doi":"10.1097/jwh.0000000000000117","DOIUrl":"https://doi.org/10.1097/jwh.0000000000000117","url":null,"abstract":"<p><strong>Background: </strong>Pelvic floor physical therapy is a noninvasive option for relieving pain associated with dyspareunia, genital pain associated with sexual intercourse. Manual therapy is a clinical approach used by physical therapists to mobilize soft tissues, reduce pain, and improve function. To date, the systematic efficacy of manual therapy for treating dyspareunia has not been investigated.</p><p><strong>Objective: </strong>To examine the efficacy of manual therapy in reducing pelvic pain among females with dyspareunia.</p><p><strong>Study design: </strong>Systematic review.</p><p><strong>Methods: </strong>A systematic literature search was conducted in MEDLINE, EMBASE, and CINAHL databases for articles published between June 1997 and June 2018. Articles were reviewed and selected on the basis of defined inclusion and exclusion criteria. The articles were assessed for quality using the PEDro and Modified Downs and Black scales.</p><p><strong>Results: </strong>Three observational studies and 1 randomized clinical trial met inclusion criteria. The primary outcome measured was the pain subscale of the Female Sexual Function Index. All studies showed significant improvements in the pain domain of the Female Sexual Function Index (<i>P</i> < .5), corroborating manual therapy as a viable treatment in relieving pain associated with dyspareunia. However, the quality across studies ranged from poor to good.</p><p><strong>Conclusions: </strong>Although these findings support the use of manual therapy for alleviating pain with intercourse, few studies exist to authenticate this claim. Moreover, the available studies were characterized by small sample sizes and were variable in methodological quality. More extensive research is needed to establish the efficacy of manual therapy for dyspareunia and the specific mechanisms by which manual therapy is beneficial.</p>","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":"43 1","pages":"28-35"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/jwh.0000000000000117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39237967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1097/JWH.0000000000000120
J. Kinder, T. Davenport, A. Lee
Background: Pelvic fl oor dysfunctions (PFD) affect women, men, and children globally. While physical therapy (PT) has been shown to improve PFDs, overall access to PT is limited because of provider shortage and expertise. We hypothesize telerehabilitation (TR) is a novel approach to address access and expertise care for PFD. Study Design: Case series. Case Descriptions: Three pelvic health patients (1 male and 2 females) volunteered to receive initial and follow-up care via TR. The male patient was treated for premature ejaculation, and the female patients were seen for postpartum recovery, stress urinary incontinence, and diastasis recti. A total of 9 visits were completed. Outcomes: Using a HIPAA-compliant, cloud-based, synchronous mobile app, a 14-question survey, and the Premature Ejaculation Diagnostic Tool (for the male health participant), participants rated their experience with TR. INTRODUCTION Pelvic fl oor dysfunctions (PFDs) affect women, men, and children globally. Urinary incontinence alone affects 200 million people worldwide. 1 Almost 25% of women in the United States have at least one kind of PFD, including urinary incontinence, fecal incontinence, and pelvic organ prolapse. 2 Evidence indicates that the growth of PFD will signifi cantly outpace the growth of the American population. 3 According to the US National Health and Nutrition Examination Survey (NHANES), the proportion of women experiencing at least one PFD increases with age, from 39% of women aged 60 to 79 years to 50% of women 80 years or older. 4 Men demonstrate similar age-related trends, with 4.4% prevalence of urinary incontinence between 19 and 44 years of age, increasing to 11.2% at 45 to 64 years of age, and peaking at 21.2% to 32.2% at older than 65 years. 5 By school age, 10% of children are unable to control urination during the day and at night. Furthermore, children of parents with a history of nocturnal enuresis (bed-wetting) have a 70% chance of bed-wetting. 6 Physical therapy (PT) is a successful treatment option for PFDs and is considered a mainstay in the care for incontinence and other lower urinary tract symptoms. 7–9 Whether combined or used alone, pelvic fl oor muscle training (PFMT) has been shown to 1 Notre Dame de Namur University, Belmont, California. 2 University of Pacifi c, Stockton, California. 3 Mount Saint Mary’s University, Los Angeles, California. Confl ict of Interest: Jennifer Kinder, PT, DPTSc, MS, is a member of the Women’s Health Section and of the Frontiers in Rehabilitation Science and Technology (FiRST) Council at American Physical Therapy Association. Dr Kinder is the Chief Pelvic Health Advisor for BlueJay Health. Todd Davenport, PT, DPT, MPH, OCS, is a member of the Frontiers in Rehabilitation Science and Technology (FiRST) Council at American Physical Therapy Association. Dr Davenport is the Chief Research and Academic Advisor for BlueJay Health. Alan Chong W. Lee, PT, PhD, DPT, CWS, GCS, serves as the lead telehealth coor
{"title":"Telerehabilitation for Treating Pelvic Floor Dysfunction: A Case Series of 3 Patients' Experiences","authors":"J. Kinder, T. Davenport, A. Lee","doi":"10.1097/JWH.0000000000000120","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000120","url":null,"abstract":"Background: Pelvic fl oor dysfunctions (PFD) affect women, men, and children globally. While physical therapy (PT) has been shown to improve PFDs, overall access to PT is limited because of provider shortage and expertise. We hypothesize telerehabilitation (TR) is a novel approach to address access and expertise care for PFD. Study Design: Case series. Case Descriptions: Three pelvic health patients (1 male and 2 females) volunteered to receive initial and follow-up care via TR. The male patient was treated for premature ejaculation, and the female patients were seen for postpartum recovery, stress urinary incontinence, and diastasis recti. A total of 9 visits were completed. Outcomes: Using a HIPAA-compliant, cloud-based, synchronous mobile app, a 14-question survey, and the Premature Ejaculation Diagnostic Tool (for the male health participant), participants rated their experience with TR. INTRODUCTION Pelvic fl oor dysfunctions (PFDs) affect women, men, and children globally. Urinary incontinence alone affects 200 million people worldwide. 1 Almost 25% of women in the United States have at least one kind of PFD, including urinary incontinence, fecal incontinence, and pelvic organ prolapse. 2 Evidence indicates that the growth of PFD will signifi cantly outpace the growth of the American population. 3 According to the US National Health and Nutrition Examination Survey (NHANES), the proportion of women experiencing at least one PFD increases with age, from 39% of women aged 60 to 79 years to 50% of women 80 years or older. 4 Men demonstrate similar age-related trends, with 4.4% prevalence of urinary incontinence between 19 and 44 years of age, increasing to 11.2% at 45 to 64 years of age, and peaking at 21.2% to 32.2% at older than 65 years. 5 By school age, 10% of children are unable to control urination during the day and at night. Furthermore, children of parents with a history of nocturnal enuresis (bed-wetting) have a 70% chance of bed-wetting. 6 Physical therapy (PT) is a successful treatment option for PFDs and is considered a mainstay in the care for incontinence and other lower urinary tract symptoms. 7–9 Whether combined or used alone, pelvic fl oor muscle training (PFMT) has been shown to 1 Notre Dame de Namur University, Belmont, California. 2 University of Pacifi c, Stockton, California. 3 Mount Saint Mary’s University, Los Angeles, California. Confl ict of Interest: Jennifer Kinder, PT, DPTSc, MS, is a member of the Women’s Health Section and of the Frontiers in Rehabilitation Science and Technology (FiRST) Council at American Physical Therapy Association. Dr Kinder is the Chief Pelvic Health Advisor for BlueJay Health. Todd Davenport, PT, DPT, MPH, OCS, is a member of the Frontiers in Rehabilitation Science and Technology (FiRST) Council at American Physical Therapy Association. Dr Davenport is the Chief Research and Academic Advisor for BlueJay Health. Alan Chong W. Lee, PT, PhD, DPT, CWS, GCS, serves as the lead telehealth coor","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JWH.0000000000000120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46921221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1097/jwh.0000000000000118
J. Boissonnault, Ziádee Cambier, S. Hetzel
Background: Career and 12-month prevalence for inappropriate patient sexual behavior (IPSB) among physical therapy practitioners is 84% and 47%, respectively. Risk factors include fewer years of patient care, treating patients with cognitive impairment, female-practitioner sex, and male-patient sex. The IPSB risk specific to PT pelvic health practitioners and those treating in sensitive body areas has not been investigated. Objectives: Determine prevalence and risk of IPSB in physical therapy practitioners performing internal examinations and working in sensitive body areas, and whether differences exist in IPSB response-strategies among these practitioners versus general PT respondents. Study Design: Mixed-methods survey research. Methods: A survey fielded through sections of the American Physical Therapy Association and selected PT and physical therapist assistant educational programs in 2016 collected responses to questions on internal examinations and on working in sensitive body areas. Comparisons were made to the general survey respondents. Results: Most IPSB events were unrelated to working in sensitive body areas for general respondents, but occurred significantly more often for pelvic health practitioners (13.8% vs 3.8%; P = .036). Performing internal examinations was not a significant risk factor for IPSB. The pelvic health physical therapists were mostly experienced female practitioners, treating mostly women. They terminated and transferred care to others more often in the face of IPSB. Conclusion: Pelvic health physical therapy practitioners incurred more IPSB when treating sensitive body areas and transferred and terminated care more often than general respondents. Future research may determine whether internal examination is a stand-alone risk factor.
{"title":"Inappropriate Patient Sexual Behavior When Working in Sensitive Areas of the Body: Results From a National Physical Therapy Survey","authors":"J. Boissonnault, Ziádee Cambier, S. Hetzel","doi":"10.1097/jwh.0000000000000118","DOIUrl":"https://doi.org/10.1097/jwh.0000000000000118","url":null,"abstract":"Background: Career and 12-month prevalence for inappropriate patient sexual behavior (IPSB) among physical therapy practitioners is 84% and 47%, respectively. Risk factors include fewer years of patient care, treating patients with cognitive impairment, female-practitioner sex, and male-patient sex. The IPSB risk specific to PT pelvic health practitioners and those treating in sensitive body areas has not been investigated. Objectives: Determine prevalence and risk of IPSB in physical therapy practitioners performing internal examinations and working in sensitive body areas, and whether differences exist in IPSB response-strategies among these practitioners versus general PT respondents. Study Design: Mixed-methods survey research. Methods: A survey fielded through sections of the American Physical Therapy Association and selected PT and physical therapist assistant educational programs in 2016 collected responses to questions on internal examinations and on working in sensitive body areas. Comparisons were made to the general survey respondents. Results: Most IPSB events were unrelated to working in sensitive body areas for general respondents, but occurred significantly more often for pelvic health practitioners (13.8% vs 3.8%; P = .036). Performing internal examinations was not a significant risk factor for IPSB. The pelvic health physical therapists were mostly experienced female practitioners, treating mostly women. They terminated and transferred care to others more often in the face of IPSB. Conclusion: Pelvic health physical therapy practitioners incurred more IPSB when treating sensitive body areas and transferred and terminated care more often than general respondents. Future research may determine whether internal examination is a stand-alone risk factor.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":"43 1","pages":"36–43"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/jwh.0000000000000118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48891327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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