Journal of women's health physical therapy最新文献_第4页

Beyond the Musculoskeletal System: Considering Whole-Systems Readiness for Running Postpartum 超越肌肉骨骼系统:考虑产后跑步的全系统准备

Journal of women's health physical therapy

Pub Date : 2022-01-01 DOI: 10.1097/JWH.0000000000000218

G. Donnelly, E. Brockwell, A. Rankin, I. Moore

Supplemental Digital Content is Available in the Text. Background: Postpartum women frequently engage in running. In the absence of official guidance on returning-to-running postpartum, physical therapists rely on clinical experience alongside the available literature. Subsequently, the traditional evaluation of postpartum readiness for running tends to focus on musculoskeletal factors. This clinical commentary addresses how to evaluate and manage postpartum return-to-running in a systematic order by discussing relevant whole-systems considerations beyond the musculoskeletal system, while also highlighting possible interactions between relevant considerations. Discussion: Using a whole-systems biopsychosocial approach, physical therapists should consider the following when managing and evaluating readiness to return-to-running: physical deconditioning, changes to body mass, sleeping patterns, breastfeeding, relative energy deficiency in sport, postpartum fatigue and thyroid autoimmunity, fear of movement, psychological well-being, and socioeconomic considerations. Undertaking a risk-benefit analysis on a case-by-case basis using clinical reasoning to determine readiness to return-to-running postpartum should incorporate these considerations and their possible interactions, alongside considerations of a musculoskeletal evaluation and graded exercise progression. Conclusions: Return-to-running postpartum requires an individualized, whole-systems biopsychosocial approach with graded exercise progression, similar to the management of return to sport following musculoskeletal injuries. A video abstract for this article is available at: http://links.lww.com/JWHPT/A51

补充数字内容可在文本中获得。背景:产后女性经常跑步。在缺乏关于产后恢复跑步的官方指导的情况下，物理治疗师依靠临床经验和现有文献。随后，传统的产后跑步准备评估倾向于关注肌肉骨骼因素。这篇临床评论通过讨论肌肉骨骼系统之外的相关全系统考虑因素，同时也强调了相关考虑因素之间可能的相互作用，阐述了如何以系统的顺序评估和管理产后恢复跑步。讨论:使用全系统的生物心理社会方法，物理治疗师在管理和评估重返跑步的准备情况时应考虑以下因素:身体状况的改善、体重的变化、睡眠模式、母乳喂养、运动中的相对能量缺乏、产后疲劳和甲状腺自身免疫、运动恐惧、心理健康和社会经济因素。在个案分析的基础上进行风险-收益分析，使用临床推理来确定产后恢复跑步的准备情况，应考虑这些因素及其可能的相互作用，同时考虑肌肉骨骼评估和分级运动进展。结论:产后恢复跑步需要一种个性化的、全系统的生物心理社会方法和逐步的运动进展，类似于肌肉骨骼损伤后恢复运动的管理。本文的视频摘要可在:http://links.lww.com/JWHPT/A51

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引用次数: 5

The Importance of Information: Prenatal Education Surrounding Birth-Related Pelvic Floor Trauma Mitigates Symptom-Related Distress 信息的重要性:产前教育周围的分娩相关盆底创伤减轻症状相关的困扰

Journal of women's health physical therapy

Pub Date : 2021-12-16 DOI: 10.1097/JWH.0000000000000229

K. Johnson, Paula G. Williams, A. Hill

Background: Birth-related pelvic floor trauma and its sequelae (PFTS) are associated with higher rates of perinatal mood and anxiety disorders in the fourth trimester. The fourth trimester is a critical window for long-term health outcomes, and identifying factors that buffer the impact of PFTS is an important research priority. Objectives: We hypothesized that lack of prenatal pelvic floor-focused education may be associated with greater distress following PFTS. Study Design: Hypotheses were investigated using a repeated-measures (study 1; n = 36) and cross-sectional (study 2; n = 226) design among participants reporting PFTS. Questionnaires were completed online, and included qualitative and quantitative responses. Methods: Study 1 participants completed a questionnaire within the first 8 weeks and approximately 3 months postpartum. Study 2 participants (≤5 years postpartum) completed a 1-time questionnaire. We examined associations among pelvic floor education, pelvic floor symptoms, and indices of mental health. Moderation analyses were conducted (study 2) to test whether the association between pelvic floor and mental health symptoms varied depending on level of discrepancy between postpartum expectation and experience. Results: In both studies, a high percentage of participants reported a lack of pelvic floor education, and significant associations were seen between pelvic floor and psychological symptoms. In study 2, individuals who reported high discrepancy between expectations and experience had the strongest associations between pelvic floor and psychological symptoms; for those reporting low discrepancy, the association was nonsignificant. Conclusion: Prenatal pelvic floor education is a key aspect not just in reducing risk of PFTS, but mitigating distress if it does occur.

背景：出生相关的盆底创伤及其后遗症（PFTS）与妊娠晚期围产期情绪和焦虑障碍的发生率较高有关。妊娠晚期是长期健康结果的关键窗口，确定缓冲PFTS影响的因素是重要的研究重点。目的：我们假设缺乏以盆底为中心的产前教育可能与PFTS后更大的痛苦有关。研究设计：在报告PFTS的参与者中，使用重复测量（研究1；n=36）和横断面设计（研究2；n=226）对假设进行调查。问卷是在网上完成的，包括定性和定量回答。方法：研究1的参与者在产后前8周和大约3个月内完成了问卷调查。研究2名参与者（产后≤5年）完成了一次问卷调查。我们研究了盆底教育、盆底症状和心理健康指标之间的关系。进行了适度分析（研究2），以测试盆底和心理健康症状之间的关联是否因产后期望和经历之间的差异程度而不同。结果：在这两项研究中，高比例的参与者报告缺乏盆底教育，盆底与心理症状之间存在显著关联。在研究2中，报告期望和经历之间存在高度差异的个体在盆底和心理症状之间的关联最强；对于那些报告低差异的人来说，这种关联并不显著。结论：产前盆底教育是一个关键方面，不仅可以降低PFTS的风险，而且可以在发生PFTS时减轻痛苦。

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引用次数: 0

From the Core to the Floor—Utilizing a Webinar to Provide Pelvic Health Education 从核心到底层——利用网络研讨会提供盆腔健康教育

Journal of women's health physical therapy

Pub Date : 2021-10-28 DOI: 10.1097/JWH.0000000000000225

Cara Morrison, Angela Pereira, Kimika Masuda, Kari Bargstadt-Wilson, Julie Peterson, Kailey Snyder

Background: Childbirth can increase the risk of urinary and fecal incontinence and pelvic organ prolapse; however, research indicates postpartum women have limited knowledge of these conditions. Objectives: (1) To determine whether a webinar can improve postpartum women's knowledge related to the structures, functions, muscles, and strengthening of the pelvic floor and (2) to explore changes in perception of postpartum women's understanding of the core/pelvic floor and their role in urinary incontinence (UI) and pelvic organ prolapse (POP). Methods: Women who had given birth within the last year and were older than 19 years were recruited via social media. Women completed a demographic survey, Prolapse and Incontinence Knowledge Questionnaire (PIKQ), and a telephonic interview before and after viewing a 1-time online webinar produced by a Women's Health Physical Therapy (DPT) Resident. Survey data were analyzed via independent t tests. Qualitative data were analyzed via a latent content recurrent cross-sectional analysis. Results: A total of 16 women participated in this study. There were significant improvements in pre- versus postwebinar. Specific to qualitative findings, the main knowledge changes seen from pre- to postwebinar interviews included greater awareness of specific exercises with proper progression and sequencing, improved descriptions of UI and POP, and improved cuing of a Kegel. Conclusion: A pelvic health education webinar can result in improvements in pelvic health knowledge. More research is needed to determine whether this increase in knowledge translates to a greater likelihood to engage in pelvic floor strengthening exercises and ultimately whether it reduces pelvic floor dysfunction.

背景：分娩会增加大小便失禁和盆腔器官脱垂的风险；然而，研究表明，产后妇女对这些情况的了解有限。目的：（1）确定网络研讨会是否可以提高产后妇女对盆底结构、功能、肌肉和强化的相关知识；（2）探讨产后妇女对核心/盆底的理解及其在尿失禁（UI）和盆腔器官脱垂（POP）中的作用的感知变化。方法：通过社交媒体招募去年内分娩且年龄超过19岁的女性。女性在观看由女性健康物理治疗（DPT）住院医师制作的一次在线网络研讨会前后，完成了一项人口统计调查、脱垂和失禁知识问卷（PIKQ）和电话采访。调查数据通过独立t检验进行分析。定性数据通过潜在内容重复横断面分析进行分析。结果：共有16名女性参与了这项研究。网络研讨会前后相比有了显著的改进。具体到定性研究结果，从网络研讨会前到会后的访谈中看到的主要知识变化包括对具有适当进展和顺序的特定练习的认识提高，对UI和POP的描述改进，以及对Kegel的提示改进。结论：骨盆健康教育网络研讨会可以提高骨盆健康知识。需要进行更多的研究，以确定知识的增加是否会增加参与盆底强化运动的可能性，以及最终是否会减少盆底功能障碍。

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引用次数: 1

Book Reviews 书评

Journal of women's health physical therapy

Pub Date : 2021-10-01 DOI: 10.1097/jwh.0000000000000220

Rachel Hohman, W. Bartley

引用次数: 0

Movement Impairments in Women with and without Urinary Urgency/Frequency. 有无尿急/尿频的妇女的运动障碍。

Journal of women's health physical therapy

Pub Date : 2021-10-01 DOI: 10.1097/jwh.0000000000000211

Nicole A Erbes, Stefanie Nicole Foster, Marcie Harris-Hayes, Theresa M Spitznagle

Objectives: 1) examine the relationship between spine, hip, and pelvis movement patterns and urinary urgency and frequency 2) report the prevalence of pelvic girdle and hip joint impairments among women with and without urinary urgency and frequency 3) report the most common movement impairments observed in women with and without urinary urgency and frequency.

Methods: Women age 18-60 with urinary urgency and frequency were matched 1:1 to women without on age, body mass index, and vaginal parity. Participants completed primary movement tests of the hip, pelvis and spine. Additional clinical tests included Stork test, sidelying position, pubic symphysis palpation, flexion-abduction-external rotation, flexion-adduction-internal rotation, and seated hip internal and external rotation. Urge symptoms were monitored before and during each test. Movement patterns and positioning of the thoracic and lumbar spine, pelvis, and hips were observed. Secondary tests to correct a movement or positional impairment were performed if an impairment was noted or if symptoms were provoked during the primary test.

Results: 42 women completed testing. More participants with urinary urgency and frequency 1) demonstrated impairments during forward bend, single leg stance, sidelying and Stork tests; 2) reported urgency provocation during forward bend, flexion-adduction-internal rotation test, pubic symphysis palpation, and hip internal rotation; and 3) reported symptom relief with sidelying position secondary test; and secondary tests of the thoracic, lumbar and hip regions compared to those without.

Conclusion: Musculoskeletal impairments may be associated with urinary urgency and frequency and should therefore be considered when determining management options for these patients.

目的:1)检查脊柱、髋关节和骨盆运动模式与尿急和尿频之间的关系;2)报告有尿急和尿频的女性中骨盆带和髋关节损伤的患病率;3)报告在有尿急和尿频的女性中观察到的最常见的运动障碍。方法:将18-60岁有尿急和尿频的女性与没有年龄、体重指数和阴道产次的女性进行1:1匹配。参与者完成了髋关节、骨盆和脊柱的基本运动测试。其他临床检查包括Stork试验、侧卧位、耻骨联合触诊、屈曲-外展-外旋、屈曲-内收-内旋、坐位髋关节内外旋。在每次测试前和测试过程中监测冲动症状。观察胸椎、腰椎、骨盆和髋部的运动模式和定位。如果注意到损伤或在初次测试期间引起症状，则进行二次测试以纠正运动或位置损伤。结果:42名妇女完成了检测。在前屈、单腿站立、侧卧和Stork试验中，尿频和尿急的受试者较多;2)在前屈、屈曲-内收-内旋试验、耻骨联合触诊和髋关节内旋试验中报告的急迫性诱发;3)侧卧位二次试验报告症状缓解;以及胸部，腰椎和臀部的二次测试，与没有测试的人相比。结论:肌肉骨骼损伤可能与尿急和尿频有关，因此在确定这些患者的治疗方案时应考虑到这一点。

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引用次数: 3

How Do We Define Pelvic Health? 如何定义盆腔健康?

Journal of women's health physical therapy

Pub Date : 2021-10-01 DOI: 10.1097/jwh.0000000000000219

C. Chiarello

引用次数: 0

Efficacy of a Core Strengthening Program for Diastasis Rectus Abdominis in Postpartum Women: A Prospective Observational Study 核心强化计划对产后妇女腹直肌转移的疗效:一项前瞻性观察研究

Journal of women's health physical therapy

Pub Date : 2021-08-17 DOI: 10.1097/JWH.0000000000000214

M. Leopold, Kristen A Santiago, Jennifer Cheng, Leah A. Keller, Zafir Abutalib, J. Bonder, G. Sharma, A. Tenforde, E. Casey

Supplemental Digital Content is Available in the Text. Background: Diastasis rectus abdominis (DRA) is characterized by a widening between the rectus abdominis muscles and thinning of the linea alba. It is common during pregnancy and may contribute to postpartum low back pain (LBP) and stress urinary incontinence (SUI). Core strengthening is thought to improve DRA, but there is no widely accepted exercise program. Objectives: To assess changes in interrectus distance (IRD) and participant-reported outcomes (PROs) after an online core strengthening program in postpartum women with DRA. Study Design: Prospective observational study. Methods: Forty-three postpartum women (36.7 ± 3.5 years) with DRA, which was diagnosed as an IRD 2.0 cm or more using musculoskeletal ultrasound, participated in a 12-week online core strengthening program focused on daily transversus abdominis activation with coordinated breathing and pelvic floor muscle engagement. IRD and PROs were assessed at baseline and 12 weeks. A subset of 19 women participated in an additional 12-week maintenance phase, and outcomes assessments were performed at 24 weeks. Results: The 12-week online core strengthening program significantly decreased IRD above and below the umbilicus at rest (slope [95% confidence interval]: −0.56 [−0.74, −0.38] and −0.26 [−0.45, −0.06]; P < .001 and P = .009, respectively) and below the umbilicus during contraction (−0.39 [−0.58, −0.20]; P < .001). Improvements in LBP-related disability (P = .002) and SUI (P = .001) were also observed. Participation in the maintenance phase significantly improved IRD at 24 weeks compared with 12 weeks (P < .0125). Satisfaction averaged 7.43 ± 2.23. Conclusions: The 12-week online core strengthening program reduced IRD and improved LBP-related disability and SUI. Program participation for 12 additional weeks further reduced IRD. These results suggest that the online core strengthening program can be used in postpartum women with DRA.

补充数字内容可在文本中获得。背景:腹直肌分离症(DRA)的特征是腹直肌之间变宽和白线变薄。它在怀孕期间很常见，并可能导致产后腰痛(LBP)和压力性尿失禁(SUI)。核心强化被认为可以改善DRA，但没有被广泛接受的锻炼计划。目的:评估在线核心强化计划后，产后DRA妇女的肠间距离(IRD)和参与者报告的结果(PROs)的变化。研究设计:前瞻性观察性研究。方法:43名患有DRA的产后妇女(36.7±3.5岁)，通过肌肉骨骼超声诊断为IRD 2.0 cm或更高，参加了为期12周的在线核心强化计划，重点是日常腹横肌激活，协调呼吸和盆底肌活动。在基线和12周时评估IRD和PROs。19名妇女参加了额外的12周维持期，并在24周时进行了结果评估。结果:12周的在线核心强化计划显著降低了脐部上下休息时的IRD(斜率[95%置信区间]:−0.56[−0.74，−0.38]和−0.26[−0.45，−0.06];P < 0.001和P = 0.009)和脐下部位(- 0.39 [- 0.58，- 0.20];P < 0.001)。同时观察到lbp相关残疾(P = 0.002)和SUI (P = 0.001)的改善。与12周相比，参与维持期可显著改善24周时的IRD (P < 0.0125)。满意度平均为7.43±2.23。结论:为期12周的在线核心强化计划减少了IRD，改善了lbp相关的残疾和SUI。参加额外12周的计划进一步减少了IRD。这些结果表明在线核心强化程序可用于产后DRA妇女。

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引用次数: 2

Effect of Rehabilitative Ultrasound Imaging (RUSI) Biofeedback on Improving Pelvic Floor Muscle Function in Individuals With Stress Urinary Incontinence: A Systematic Review 康复性超声成像（RUSI）生物反馈改善压力性尿失禁患者盆底肌功能的系统评价

Journal of women's health physical therapy

Pub Date : 2021-08-13 DOI: 10.1097/JWH.0000000000000217

Jennifer A. LaCross, Laurel Proulx, Kelli J Brizzolara, J. Humphrey

Background: Pelvic floor muscle training is a common intervention for the treatment of stress urinary incontinence (SUI). One method utilized to augment muscle training is biofeedback. Rehabilitative ultrasound imaging (RUSI) is a noninvasive biofeedback tool. Objectives: The purpose of this review was to determine the effect of RUSI on pelvic floor muscle function, quality of life, volume of urinary leakage, and severity of urinary leakage in females and males with urinary incontinence and, when possible, compare these results to those of other biofeedback interventions. Study Design: Systematic review. Methods: PubMed, CINAHL, Science Direct, Scopus, Web of Science, and MEDLINE were searched for titles from peer-reviewed journals and conference proceedings from January 2010 to May 2020. An updated search was performed in January 2021. Inclusion criteria included studies with participants 18 years or older with urinary incontinence. The primary experimental intervention was transabdominal or transperineal RUSI. Results: Nine studies were included in this review. The ability to correctly contract the pelvic floor was achieved by more than 95% of participants following RUSI biofeedback training. Although outcomes were not consistently reported, RUSI intervention resulted in a decrease in incontinence severity and number of incontinence episodes per week, as well as improved pelvic floor strength, self-rating of improvement, task-specific self-efficacy, and quality of life. Conclusion: The results of this review provide moderate evidence to support the use of RUSI biofeedback via a transabdominal or transperineal approach in males and females with SUI to improve motor performance of the pelvic floor.

背景:盆底肌肉训练是治疗压力性尿失禁(SUI)的常见干预措施。增强肌肉训练的一种方法是生物反馈。康复超声成像(RUSI)是一种无创的生物反馈工具。目的:本综述的目的是确定入路干预对女性和男性尿失禁患者盆底肌功能、生活质量、尿漏量和尿漏严重程度的影响，并在可能的情况下将这些结果与其他生物反馈干预的结果进行比较。研究设计:系统评价。方法:检索2010年1月至2020年5月PubMed、CINAHL、Science Direct、Scopus、Web of Science和MEDLINE的同行评议期刊和会议记录。2021年1月进行了更新的搜索。纳入标准包括18岁及以上尿失禁患者的研究。主要的实验干预是经腹部或经会阴RUSI。结果:本综述纳入了9项研究。超过95%的参与者在入寺生物反馈训练后能够正确收缩骨盆底。尽管结果没有一致的报道，入寺干预导致尿失禁严重程度和每周尿失禁发作次数的减少，以及骨盆底力量、自我改善评分、任务特异性自我效能和生活质量的改善。结论:本综述的结果提供了中等程度的证据，支持通过经腹或经会阴入路在SUI男性和女性患者中使用RUSI生物反馈来改善盆底运动性能。

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引用次数: 1

Nurses' Perspectives of the Need for Physical Therapy Services During an Acute Postpartum Stay: A Focus Group 护士对急性产后住院期间物理治疗服务需求的看法:焦点小组

Journal of women's health physical therapy

Pub Date : 2021-08-10 DOI: 10.1097/jwh.0000000000000216

Kate Divine, Paige Duvall, Lenzie Weicht, Karen Abraham

Hypothesis/Purpose: Complications in the postpartum period can include pain, urinary incontinence, diastasis recti abdominis, and pelvic floor injury. Physical therapists are in a unique position to address these concerns during the acute postpartum stay. However, there is a lack of consensus regarding the role of physical therapy (PT) in this patient population. Mother-Baby (MB) nurses work closely with postpartum mothers; therefore, the purpose of this study was to gain nurses' perspectives of their knowledge of and need for PT in the acute postpartum setting. Subjects: Nine MB nurses and 1 newly graduated nurse with MB experience from 2 hospitals near Winchester, Virginia, participated. Materials/Methods: Contact was made with nurse managers to arrange a time for the focus group. A demographic questionnaire was distributed prior to the session. A student moderator led the semistructured interview with preselected open-ended questions. The focus groups were audio/video recorded and transcribed. Transcriptions were used for theme coding and concept map development. Results: Five participants were present for each focus group. Four main themes and 1 subtheme emerged. These included lack of understanding of PT scope of practice with a subtheme of special circumstances, limited time, role overlap, and appropriate timing of PT. Lack of understanding of PT scope of practice was the overarching theme. Conclusion: MB nurses demonstrated a limited understanding of the PT scope of practice and their potential role postpartum. Further education and interdisciplinary collaboration may be beneficial to enhance postpartum care in the United States.

假设/目的：产后并发症包括疼痛、尿失禁、腹直肌分离和盆底损伤。物理治疗师在产后急性停留期间处于独特的地位来解决这些问题。然而，对于物理治疗（PT）在这一患者群体中的作用，缺乏共识。母婴护士与产后母亲密切合作；因此，本研究的目的是获得护士对产后急性期PT的知识和需求的看法。受试者：来自弗吉尼亚州温彻斯特附近两家医院的9名MB护士和1名具有MB经验的新毕业护士参加了研究。材料/方法：与护士经理联系，为焦点小组安排时间。会前分发了一份人口调查问卷。一位学生主持人用预选的开放式问题主持了半结构化的采访。对重点小组进行了音频/视频记录和转录。转录被用于主题编码和概念图开发。结果：每个重点小组有五名参与者。出现了四个主要主题和一个子主题。其中包括对PT的实践范围缺乏理解，分主题为特殊情况、时间有限、角色重叠和PT的适当时机。对PT实践范围缺乏了解是首要主题。结论：MB护士对PT的实践范围及其产后潜在作用的了解有限。进一步的教育和跨学科合作可能有利于加强美国的产后护理。

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引用次数: 0

Mini-Trampoline Jumping as an Exercise Intervention for Postmenopausal Women Who Experienced a Stroke: A Case Report 迷你蹦床作为一种运动干预绝经后妇女谁经历过中风:一个案例报告

Journal of women's health physical therapy

Pub Date : 2021-07-22 DOI: 10.1097/JWH.0000000000000212

A. Fricke, P. Fink, Sally D. Lark, T. Mundel, Sarah P. Shultz

Introduction: This case report details a mini-trampoline exercise intervention for a 56-year-old postmenopausal woman who experienced a stroke 7 years ago, which has not previously been reported in medical literature. Case Description: The patient was diagnosed with a cerebral infarction on the left hemisphere following 3 aneurysms at 49 years of age. The patient underwent extensive physical rehabilitation for 6 years, which included physiotherapy, swimming, walking, and attending a cardiac exercise clinic. Although she is able to walk unaided, she still experiences a right-sided hemiparetic gait. Outcomes: The patient showed great improvements in walking speed, lower leg strength, flexibility, pelvic floor muscle strength, bone health, and some aspects of balance following a supervised 12-week mini-trampoline exercise intervention and 12-week follow up. Discussion: This article represents a case in which a mini-trampoline exercise intervention improved physical function and female-specific health risk factors in a postmenopausal woman who experienced a stroke 7 years ago.

引言：本病例报告详细介绍了一名56岁绝经后妇女7年前中风的迷你蹦床运动干预，这在医学文献中没有报道。病例描述：患者在49岁时被诊断为左半球3个动脉瘤后的脑梗死。患者接受了6年的广泛身体康复，包括理疗、游泳、散步和参加心脏运动诊所。尽管她能够独立行走，但她仍然会出现右侧偏瘫步态。结果：经过12周的迷你蹦床运动干预和12周的随访，患者在行走速度、小腿力量、灵活性、盆底肌肉力量、骨骼健康和某些平衡方面都有了很大改善。讨论：这篇文章代表了一个案例，在一名7年前经历中风的绝经后妇女中，迷你蹦床运动干预改善了身体功能和女性特有的健康风险因素。

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引用次数: 1