Pub Date : 2021-07-15DOI: 10.1097/JWH.0000000000000215
Pamela Kays
Background: Despite 25 years of evidence emphasizing problematic health care experiences for women with chronic pelvic pain and the benefits of clinical empathy and patient-centered care, negative patient-provider interactions for women with chronic pelvic pain persist. Purpose: The purpose of the current study was to investigate the lived experiences of patient-provider interactions from the perspective of women with chronic pelvic pain. Subjects: Thirteen women aged 18 to 65 years who had chronic pelvic pain for a minimum of 6 months and who had pursued medical consultation/care were included. Materials/Methods: This phenomenological qualitative study used semi-structured, in-depth interviews. A topic guide was used for interview questions and consisted of 5 semi-structured questions with probes, as necessary. Each participant was interviewed face-to-face and one-on-one, and interviews were audio-recorded. Qualitative data analysis software was used to manually code and analyze the data through thematic nodes using an open and inductive approach and constant comparison to facilitate interpretive phenomenological analysis. Results: Participants described negative patient-provider interactions during their health care encounters through patterns of health care provider behaviors and traits with a particular lack of empathy. Conclusions: These findings highlight the need for improved integration of research into health care provider education to develop empathetic patient-provider interactions. Provider effort to help may be a major component missing in negative patient-provider interactions for this population. Cultivating positive patient-provider interactions can advance best practices and ultimately result in the best care for women with chronic pelvic pain.
{"title":"Empathy During Patient-Provider Interactions for Women With Chronic Pelvic Pain: A Qualitative Study","authors":"Pamela Kays","doi":"10.1097/JWH.0000000000000215","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000215","url":null,"abstract":"Background: Despite 25 years of evidence emphasizing problematic health care experiences for women with chronic pelvic pain and the benefits of clinical empathy and patient-centered care, negative patient-provider interactions for women with chronic pelvic pain persist. Purpose: The purpose of the current study was to investigate the lived experiences of patient-provider interactions from the perspective of women with chronic pelvic pain. Subjects: Thirteen women aged 18 to 65 years who had chronic pelvic pain for a minimum of 6 months and who had pursued medical consultation/care were included. Materials/Methods: This phenomenological qualitative study used semi-structured, in-depth interviews. A topic guide was used for interview questions and consisted of 5 semi-structured questions with probes, as necessary. Each participant was interviewed face-to-face and one-on-one, and interviews were audio-recorded. Qualitative data analysis software was used to manually code and analyze the data through thematic nodes using an open and inductive approach and constant comparison to facilitate interpretive phenomenological analysis. Results: Participants described negative patient-provider interactions during their health care encounters through patterns of health care provider behaviors and traits with a particular lack of empathy. Conclusions: These findings highlight the need for improved integration of research into health care provider education to develop empathetic patient-provider interactions. Provider effort to help may be a major component missing in negative patient-provider interactions for this population. Cultivating positive patient-provider interactions can advance best practices and ultimately result in the best care for women with chronic pelvic pain.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42460735","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 : 2021-07-01DOI: 10.1097/jwh.0000000000000209
Stefanie N Foster, Theresa M Spitznagle, Lori J Tuttle, Siobhan Sutcliffe, Karen Steger-May, Jerry L Lowder, Melanie R Meister, Chiara Ghetti, Jinli Wang, Michael J Mueller, Marcie Harris-Hayes
Background: Urgency and frequency are common lower urinary tract symptoms (UF-LUTS) in women. There is limited evidence to guide physical therapist-led treatment.
Objectives: To compare hip and pelvic floor muscle strength between women with and without UF-LUTS. We hypothesized women with UF-LUTS would demonstrate 1) diminished hip external rotator and abductor strength and 2) equivalent pelvic floor strength and diminished endurance compared to controls.
Study design: A matched case-control study.
Methods: Women with UF-LUTS (cases) and controls were matched on age, body mass index (BMI), vaginal parity. Examiner measured participants' 1) hip external rotator and abductor strength via dynamometry (maximum voluntary effort against fixed resistance) and 2) pelvic floor muscle strength (peak squeeze pressure) and endurance (squeeze pressure over a 10 second hold) via vaginal manometry. Values compared between cases and controls with paired-sample t-tests (hip) or Wilcoxon signed rank tests (pelvic floor).
Results: 21 pairs (42 women): Hip external rotation (67.0 ± 19.0 N vs 83.6 ± 21.5 N; P=0.005) and hip abduction strength (163.1 ± 48.1 N vs 190.1 ± 53.1 N; P=0.04) were significantly lower in cases than controls. There was no significant difference in pelvic floor strength (36.8 ± 19.9 cmH20 vs 41.8 ± 21.0 cmH20; P=0.40) or endurance (234.0 ± 149.6 cmH20*seconds vs 273.4 ± 149.1 cmH20*seconds; P=0.24).
Conclusion: Women with UF-LUTS had weaker hip external rotator and abductor muscles, but similar pelvic floor strength and endurance compared to controls. Hip strength may be important to assess in patients with UF-LUTS, further research is needed.
背景:急迫性和频率是女性常见的下尿路症状(UF-LUTS)。指导物理治疗师主导的治疗的证据有限。目的:比较有和没有UF-LUTS的女性髋关节和盆底肌力。我们假设与对照组相比，患有UF-LUTS的女性会表现出1)髋外旋肌和外展肌力量减弱，2)骨盆底力量和耐力减弱。研究设计:配对病例对照研究。方法:将UF-LUTS患者(病例)与对照组在年龄、体重指数(BMI)、阴道胎次等方面进行匹配。主考官通过测力法(对固定阻力的最大自主力)测量参与者的髋关节外旋肌和外展肌力量，通过阴道测压法测量参与者的骨盆底肌肉力量(峰值挤压压力)和耐力(保持10秒的挤压压力)。用配对样本t检验(髋部)或Wilcoxon符号秩检验(骨盆底)比较病例和对照组之间的值。结果:21对(42名女性):髋关节外旋(67.0±19.0 N vs 83.6±21.5 N);P=0.005)和髋关节外展强度(163.1±48.1 N vs 190.1±53.1 N);P=0.04)显著低于对照组。盆底强度(36.8±19.9 cmH20 vs 41.8±21.0 cmH20)无显著差异;P=0.40)或耐力(234.0±149.6 cmH20*秒vs 273.4±149.1 cmH20*秒);P = 0.24)。结论:与对照组相比，患有UF-LUTS的女性髋外旋肌和外展肌较弱，但骨盆底力量和耐力相似。髋部力量对UF-LUTS患者的评估可能很重要，需要进一步的研究。
{"title":"Hip and Pelvic Floor Muscle Strength in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms.","authors":"Stefanie N Foster, Theresa M Spitznagle, Lori J Tuttle, Siobhan Sutcliffe, Karen Steger-May, Jerry L Lowder, Melanie R Meister, Chiara Ghetti, Jinli Wang, Michael J Mueller, Marcie Harris-Hayes","doi":"10.1097/jwh.0000000000000209","DOIUrl":"https://doi.org/10.1097/jwh.0000000000000209","url":null,"abstract":"<p><strong>Background: </strong>Urgency and frequency are common lower urinary tract symptoms (UF-LUTS) in women. There is limited evidence to guide physical therapist-led treatment.</p><p><strong>Objectives: </strong>To compare hip and pelvic floor muscle strength between women with and without UF-LUTS. We hypothesized women with UF-LUTS would demonstrate 1) diminished hip external rotator and abductor strength and 2) equivalent pelvic floor strength and diminished endurance compared to controls.</p><p><strong>Study design: </strong>A matched case-control study.</p><p><strong>Methods: </strong>Women with UF-LUTS (cases) and controls were matched on age, body mass index (BMI), vaginal parity. Examiner measured participants' 1) hip external rotator and abductor strength via dynamometry (maximum voluntary effort against fixed resistance) and 2) pelvic floor muscle strength (peak squeeze pressure) and endurance (squeeze pressure over a 10 second hold) via vaginal manometry. Values compared between cases and controls with paired-sample t-tests (hip) or Wilcoxon signed rank tests (pelvic floor).</p><p><strong>Results: </strong>21 pairs (42 women): Hip external rotation (67.0 ± 19.0 N vs 83.6 ± 21.5 N; P=0.005) and hip abduction strength (163.1 ± 48.1 N vs 190.1 ± 53.1 N; P=0.04) were significantly lower in cases than controls. There was no significant difference in pelvic floor strength (36.8 ± 19.9 cmH<sub>2</sub>0 vs 41.8 ± 21.0 cmH<sub>2</sub>0; <i>P</i>=0.40) or endurance (234.0 ± 149.6 cmH<sub>2</sub>0*seconds vs 273.4 ± 149.1 cmH<sub>2</sub>0*seconds; <i>P</i>=0.24).</p><p><strong>Conclusion: </strong>Women with UF-LUTS had weaker hip external rotator and abductor muscles, but similar pelvic floor strength and endurance compared to controls. Hip strength may be important to assess in patients with UF-LUTS, further research is needed.</p>","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345818/pdf/nihms-1688858.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39299995","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 : 2021-07-01DOI: 10.1097/jwh.0000000000000213
C. Chiarello
{"title":"The Health of a Few","authors":"C. Chiarello","doi":"10.1097/jwh.0000000000000213","DOIUrl":"https://doi.org/10.1097/jwh.0000000000000213","url":null,"abstract":"","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41518721","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 : 2021-05-26DOI: 10.1097/JWH.0000000000000203
T. Crouss, K. Whitmore
Background: A large proportion of patients with interstitial cystitis have concomitant pelvic floor muscle dysfunction. Objective: To assess voiding dysfunction in patients with interstitial cystitis who have varying degrees of pelvic floor dysfunction. Study Design: A retrospective cohort study. Methods: Women with interstitial cystitis who underwent cystoscopy/bladder hydrodistension and urodynamic testing from November 2015 to February 2019 were divided into 2 cohorts based on severity of pelvic floor dysfunction (nonsevere and severe). The primary outcome was voiding dysfunction (bladder outlet obstruction and/or pelvic floor muscle dyssynergia by electromyography during voiding). Symptom severity, cystoscopy findings, and urodynamic findings were compared. Results: Fifty-one patients were included—36 in the severe and 15 in the nonsevere cohort. The mean age was 48 years. Those in the severe cohort showed higher rates of voiding dysfunction than those in the nonsevere cohort (89.7% vs 64.3%, respectively, P = .045). Seventy-three percent of subjects had glomerulations and 12% had Hunner's lesions. The presence of Hunner's lesions was associated with a lower first urge volume on urodynamic testing compared with non-Hunner's lesions (75.8 vs 148 mL, P = .046). Modest negative correlations were obtained between interstitial cystitis symptom severity and most urodynamic volumes. Conclusion: Patients with interstitial cystitis with more severe pelvic floor dysfunction demonstrated higher rates of dysfunctional voiding than those with nonsevere dysfunction, and may benefit from advanced pelvic floor therapy.
背景：大量间质性膀胱炎患者伴有盆底肌肉功能障碍。目的：评估不同程度盆底功能障碍的间质性膀胱炎患者的排尿功能障碍。研究设计：一项回顾性队列研究。方法：根据盆底功能障碍的严重程度（非严重和严重），将2015年11月至2019年2月接受膀胱镜检查/膀胱水动力学和尿动力学测试的间质性膀胱炎女性分为2组。主要结果是排尿功能障碍（排尿过程中肌电图检查的膀胱出口梗阻和/或盆底肌肉协同失调）。比较症状严重程度、膀胱镜检查结果和尿动力学结果。结果：51名患者被纳入，其中36名为重症患者，15名为非重症患者。平均年龄48岁。严重队列患者的排尿功能障碍发生率高于非严重队列患者（分别为89.7%和64.3%，P=.045）。73%的受试者患有肾小球，12%患有亨纳氏病变。与非Hunner’s病变相比，Hunner病变的存在与尿动力学测试中的第一次冲动量较低有关（75.8 vs 148 mL，P=0.046）。间质性膀胱炎症状严重程度与大多数尿动力学量之间存在适度的负相关性。结论：具有更严重盆底功能障碍的间质性膀胱炎患者表现出比具有非严重功能障碍的患者更高的功能障碍性排尿率，并且可能受益于先进的盆底治疗。
{"title":"Voiding Dysfunction in Interstitial Cystitis Patients and the Relation to Pelvic Floor Dysfunction","authors":"T. Crouss, K. Whitmore","doi":"10.1097/JWH.0000000000000203","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000203","url":null,"abstract":"Background: A large proportion of patients with interstitial cystitis have concomitant pelvic floor muscle dysfunction. Objective: To assess voiding dysfunction in patients with interstitial cystitis who have varying degrees of pelvic floor dysfunction. Study Design: A retrospective cohort study. Methods: Women with interstitial cystitis who underwent cystoscopy/bladder hydrodistension and urodynamic testing from November 2015 to February 2019 were divided into 2 cohorts based on severity of pelvic floor dysfunction (nonsevere and severe). The primary outcome was voiding dysfunction (bladder outlet obstruction and/or pelvic floor muscle dyssynergia by electromyography during voiding). Symptom severity, cystoscopy findings, and urodynamic findings were compared. Results: Fifty-one patients were included—36 in the severe and 15 in the nonsevere cohort. The mean age was 48 years. Those in the severe cohort showed higher rates of voiding dysfunction than those in the nonsevere cohort (89.7% vs 64.3%, respectively, P = .045). Seventy-three percent of subjects had glomerulations and 12% had Hunner's lesions. The presence of Hunner's lesions was associated with a lower first urge volume on urodynamic testing compared with non-Hunner's lesions (75.8 vs 148 mL, P = .046). Modest negative correlations were obtained between interstitial cystitis symptom severity and most urodynamic volumes. Conclusion: Patients with interstitial cystitis with more severe pelvic floor dysfunction demonstrated higher rates of dysfunctional voiding than those with nonsevere dysfunction, and may benefit from advanced pelvic floor therapy.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48437823","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 : 2021-04-01DOI: 10.1097/JWH.0000000000000201
Rebekah Edie, Alexis Lacewell, Christine Streisel, L. Wheeler, E. George, J. Wrigley, Laura S. Pietrosimone, C. Figuers
Supplemental Digital Content is Available in the Text. Background: Exercise is a safe and beneficial way of improving physical and psychological well-being in postpartum people; yet, postpartum people are less likely to meet the recommended guidelines for physical activity. Identifying the barriers to exercise in the postpartum period may assist health care professionals to better understand how to counsel this population on strategies for exercise. Objective: To synthesize the current literature on barriers to exercise in postpartum people. Study Design: A mixed-methods systematic review. Methods: A systematic literature search was conducted in MEDLINE/PubMed, EMBASE, Scopus, and CINAHL databases of both qualitative and quantitative studies that examined the barriers to exercise among postpartum people. The articles were selected on the basis of predetermined inclusion and exclusion criteria. The Downs and Black Checklist of Methodological Quality was used to assess study quality. Results: Ten studies met the inclusion criteria (7 qualitative and 3 quantitative). Barriers were categorized into the following categories: intrapersonal, interpersonal, sociocultural/demographic, physical environment, and health care environment. The most reported barriers in each category were tiredness and/or lack of sleep (7 out of 10 mentioned), time and/or unpredictable routines/schedule and busy with domestic chores/care/responsibilities (both 8 out of 10 mentioned), lack of support from family, friends, and other mothers (9 out of 10 mentioned), weather (7 out of 10 mentioned), and breastfeeding (3 out of 10 mentioned), respectively. Conclusion: Physical therapists and other health care professionals should be aware of the major reported barriers to exercise among postpartum people, as this will help guide them in providing meaningful education and counseling strategies to increase exercise in this unique population. Further research is needed to capture a more diverse group of postpartum people, as well as considering how policy may affect exercise postpartum.
{"title":"Barriers to Exercise in Postpartum Women: A Mixed-Methods Systematic Review","authors":"Rebekah Edie, Alexis Lacewell, Christine Streisel, L. Wheeler, E. George, J. Wrigley, Laura S. Pietrosimone, C. Figuers","doi":"10.1097/JWH.0000000000000201","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000201","url":null,"abstract":"Supplemental Digital Content is Available in the Text. Background: Exercise is a safe and beneficial way of improving physical and psychological well-being in postpartum people; yet, postpartum people are less likely to meet the recommended guidelines for physical activity. Identifying the barriers to exercise in the postpartum period may assist health care professionals to better understand how to counsel this population on strategies for exercise. Objective: To synthesize the current literature on barriers to exercise in postpartum people. Study Design: A mixed-methods systematic review. Methods: A systematic literature search was conducted in MEDLINE/PubMed, EMBASE, Scopus, and CINAHL databases of both qualitative and quantitative studies that examined the barriers to exercise among postpartum people. The articles were selected on the basis of predetermined inclusion and exclusion criteria. The Downs and Black Checklist of Methodological Quality was used to assess study quality. Results: Ten studies met the inclusion criteria (7 qualitative and 3 quantitative). Barriers were categorized into the following categories: intrapersonal, interpersonal, sociocultural/demographic, physical environment, and health care environment. The most reported barriers in each category were tiredness and/or lack of sleep (7 out of 10 mentioned), time and/or unpredictable routines/schedule and busy with domestic chores/care/responsibilities (both 8 out of 10 mentioned), lack of support from family, friends, and other mothers (9 out of 10 mentioned), weather (7 out of 10 mentioned), and breastfeeding (3 out of 10 mentioned), respectively. Conclusion: Physical therapists and other health care professionals should be aware of the major reported barriers to exercise among postpartum people, as this will help guide them in providing meaningful education and counseling strategies to increase exercise in this unique population. Further research is needed to capture a more diverse group of postpartum people, as well as considering how policy may affect exercise postpartum.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49399710","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 : 2021-04-01DOI: 10.1097/JWH.0000000000000204
C. Chiarello
{"title":"Gratitude and Acknowledgment","authors":"C. Chiarello","doi":"10.1097/JWH.0000000000000204","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000204","url":null,"abstract":"","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49515150","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 : 2021-03-31DOI: 10.1097/JWH.0000000000000202
A. Fricke, S. Lark, P. Fink, T. Mundel, S. Shultz
Background: An estimated 200 million people worldwide live with urinary incontinence, and women are more affected than men. The World Health Organization and the International Continence Society recommend pelvic floor muscle training to treat urinary incontinence in women. Objective: The purpose of this systematic review was to examine pelvic floor muscle function and understand its impact on urinary incontinence in women older than 50 years. Methods: Medline, PsycINFO, Webscience, CINAHL, and Scopus were searched for articles from 1988 to May 2019. Included studies had a comparison or control group, exercise intervention aimed to train the pelvic floor musculature, women 50 years and older, and had been published in peer-reviewed journals. Results: Eight studies were included in this review. Exercise interventions included home-based as well as supervised pelvic floor muscle-strengthening, and indirect pelvic floor muscle-strengthening exercises via co-contraction of surrounding muscles. All interventions were able to improve pelvic floor muscle strength as well as urinary incontinence symptoms, with bigger improvements found in supervised interventions. Conclusion: This review has shown that exercise interventions targeting the pelvic floor muscles may be effective in improving pelvic floor muscle strength, urinary incontinence symptoms, and even quality of life measures. Exercise interventions that were supervised or included some type of biofeedback device showed greater and faster improvements than interventions without additional assistance.
{"title":"Exercise Interventions to Improve Pelvic Floor Muscle Functioning in Older Women With Urinary Incontinence: A Systematic Review","authors":"A. Fricke, S. Lark, P. Fink, T. Mundel, S. Shultz","doi":"10.1097/JWH.0000000000000202","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000202","url":null,"abstract":"Background: An estimated 200 million people worldwide live with urinary incontinence, and women are more affected than men. The World Health Organization and the International Continence Society recommend pelvic floor muscle training to treat urinary incontinence in women. Objective: The purpose of this systematic review was to examine pelvic floor muscle function and understand its impact on urinary incontinence in women older than 50 years. Methods: Medline, PsycINFO, Webscience, CINAHL, and Scopus were searched for articles from 1988 to May 2019. Included studies had a comparison or control group, exercise intervention aimed to train the pelvic floor musculature, women 50 years and older, and had been published in peer-reviewed journals. Results: Eight studies were included in this review. Exercise interventions included home-based as well as supervised pelvic floor muscle-strengthening, and indirect pelvic floor muscle-strengthening exercises via co-contraction of surrounding muscles. All interventions were able to improve pelvic floor muscle strength as well as urinary incontinence symptoms, with bigger improvements found in supervised interventions. Conclusion: This review has shown that exercise interventions targeting the pelvic floor muscles may be effective in improving pelvic floor muscle strength, urinary incontinence symptoms, and even quality of life measures. Exercise interventions that were supervised or included some type of biofeedback device showed greater and faster improvements than interventions without additional assistance.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46786054","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 : 2021-03-26DOI: 10.1097/JWH.0000000000000200
Mary Dockter, Emma Ulmer, Cailey Wulf, Morgan Gunderson, Jordan Bornhorst, Alissa Joneson, Karen Abraham, Rebecca Reisch
Supplemental Digital Content is Available in the Text. Background: Scarce evidence has been found on factors that determine physical therapist (PT) students' comfort level in addressing sexual issues with patients. Determining influential factors and barriers may help educators adjust their curriculum to better prepare students. Objectives: To identify the comfort level of PT students in addressing sexual issues with patients, demographic factors that impact the students' comfort level, and barriers to PT students addressing sexual issues with patients. Study Design: A cross-sectional survey design. Methods: A survey was sent to current PT students enrolled at 3 Doctorate of Physical Therapy (DPT) programs. The survey consisted of demographic and scenario questions related to the students' comfort level in addressing sexual issues. Wilcoxon signed rank tests were performed to compare the differences in the comfort levels for male and female students. A χ2 analysis was performed to determine which demographic factors were significantly (P < .05) associated with the respondent's comfort level. Results: First-, second-, and third-year students (N = 106) completed the survey and represented programs from diverse geographic locations and religious affiliations. Less than half (41.5%) agreed that they had the necessary skills to address sexual issues, and only 23.58% of respondents were likely to initiate discussion. While students were most comfortable addressing issues with their own gender, collectively there was increased comfort level with conversations with females. Main barriers included lack of experience and knowledge, fear of patient misunderstanding, and patient comfort level. Conclusion: PT students lack comfort in addressing sexual issues due to multiple barriers. Demographic information, including geological location and religious background, was not significantly associated with comfort level (see the Video, Supplemental Digital Content 1, which summarizes this study available at: http://links.lww.com/JWHPT/A44).
{"title":"Comfort Level of Current Physical Therapist Students in Addressing Sexual Issues With Patients","authors":"Mary Dockter, Emma Ulmer, Cailey Wulf, Morgan Gunderson, Jordan Bornhorst, Alissa Joneson, Karen Abraham, Rebecca Reisch","doi":"10.1097/JWH.0000000000000200","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000200","url":null,"abstract":"Supplemental Digital Content is Available in the Text. Background: Scarce evidence has been found on factors that determine physical therapist (PT) students' comfort level in addressing sexual issues with patients. Determining influential factors and barriers may help educators adjust their curriculum to better prepare students. Objectives: To identify the comfort level of PT students in addressing sexual issues with patients, demographic factors that impact the students' comfort level, and barriers to PT students addressing sexual issues with patients. Study Design: A cross-sectional survey design. Methods: A survey was sent to current PT students enrolled at 3 Doctorate of Physical Therapy (DPT) programs. The survey consisted of demographic and scenario questions related to the students' comfort level in addressing sexual issues. Wilcoxon signed rank tests were performed to compare the differences in the comfort levels for male and female students. A χ2 analysis was performed to determine which demographic factors were significantly (P < .05) associated with the respondent's comfort level. Results: First-, second-, and third-year students (N = 106) completed the survey and represented programs from diverse geographic locations and religious affiliations. Less than half (41.5%) agreed that they had the necessary skills to address sexual issues, and only 23.58% of respondents were likely to initiate discussion. While students were most comfortable addressing issues with their own gender, collectively there was increased comfort level with conversations with females. Main barriers included lack of experience and knowledge, fear of patient misunderstanding, and patient comfort level. Conclusion: PT students lack comfort in addressing sexual issues due to multiple barriers. Demographic information, including geological location and religious background, was not significantly associated with comfort level (see the Video, Supplemental Digital Content 1, which summarizes this study available at: http://links.lww.com/JWHPT/A44).","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47865912","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 : 2021-03-19DOI: 10.1097/JWH.0000000000000199
Rebecca Reisch, R. Zúñiga, R. Das
Background: Overactive bladder (OAB) is a common condition that negatively affects quality of life. Urinary urgency is the dominant symptom and behavioral therapy is the first-line approach. Mindfulness practices have been proposed for urgency management, but studies on mindfulness for OAB have not included components of behavioral therapy commonly used in clinical practice. Objectives: The primary objective was to examine the feasibility of implementing a novel mindfulness-informed group-based behavioral therapy intervention for OAB, using behavioral therapy specific to OAB. The secondary purpose was to examine the potential clinical utility of the program. Study Design: Pilot feasibility study. Methods: This was a single-arm pilot study using a convenience sample. The intervention was developed by 2 physical therapists and 1 licensed psychologist. Women with OAB symptoms were recruited from the community for a 6-week, 2 h/wk group-based program that included information on bladder health, urinary tract function, and mindfulness-informed practices. Participants were asked to engage in mindfulness activities between sessions. Results: Five women fit the inclusion criteria and 4 completed the study, attending all 6 sessions (retention rate: 80%). Time and resources required to deliver the intervention were deemed feasible. All participants showed improvements on some or all self-reported symptoms questionnaires. Conclusions: This novel program appears to be feasible and shows the potential for clinical utility. Future studies should include a longer recruitment period to achieve a larger sample size and should compare this intervention with other established interventions for OAB.
{"title":"Feasibility and Effectiveness of an Interprofessional Mindfulness-Informed Group-Based Intervention for Treatment of Overactive Bladder: A Pilot Study","authors":"Rebecca Reisch, R. Zúñiga, R. Das","doi":"10.1097/JWH.0000000000000199","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000199","url":null,"abstract":"Background: Overactive bladder (OAB) is a common condition that negatively affects quality of life. Urinary urgency is the dominant symptom and behavioral therapy is the first-line approach. Mindfulness practices have been proposed for urgency management, but studies on mindfulness for OAB have not included components of behavioral therapy commonly used in clinical practice. Objectives: The primary objective was to examine the feasibility of implementing a novel mindfulness-informed group-based behavioral therapy intervention for OAB, using behavioral therapy specific to OAB. The secondary purpose was to examine the potential clinical utility of the program. Study Design: Pilot feasibility study. Methods: This was a single-arm pilot study using a convenience sample. The intervention was developed by 2 physical therapists and 1 licensed psychologist. Women with OAB symptoms were recruited from the community for a 6-week, 2 h/wk group-based program that included information on bladder health, urinary tract function, and mindfulness-informed practices. Participants were asked to engage in mindfulness activities between sessions. Results: Five women fit the inclusion criteria and 4 completed the study, attending all 6 sessions (retention rate: 80%). Time and resources required to deliver the intervention were deemed feasible. All participants showed improvements on some or all self-reported symptoms questionnaires. Conclusions: This novel program appears to be feasible and shows the potential for clinical utility. Future studies should include a longer recruitment period to achieve a larger sample size and should compare this intervention with other established interventions for OAB.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47029860","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 : 2021-02-12DOI: 10.1097/JWH.0000000000000210
A. Crowle, C. Harley
Background: Traditional treatments for pelvic organ prolapse (POP) assume weak pelvic tissue as the cause. Pelvic floor muscle training has been shown to improve POP symptoms but not prolapse stage and does not reduce rates of referral for future treatment (eg, pessary or surgery). An alternative hypothesis is proposed that excessive tissue stiffness causes tension and pulling, which disrupts pelvic organ arrangement. Objectives: Treating pelvic tissue stiffness through Biotensegrity Focused Therapy is anticipated to improve organ position and prolapse symptoms. Study Design: Nonrandomized prospective clinical case series. Methods: Women presenting to a private physiotherapy practice in the United Kingdom with POP received Biotensegrity Focused Therapy. Treatment included a series of 1-hour physiotherapy sessions focusing on identifying areas of stiff pelvic tissue and using a direct myofascial release technique to normalize elasticity to restore dynamic equilibrium within the pelvis. Prolapse grade (mild, moderate, severe), pelvic floor strength (Modified Oxford Grading Scale), and self-reported symptoms (Pelvic Floor Distress Inventory, PFDI-20) were assessed at baseline and after final treatment. Results: Thirty-three women received treatment. At baseline, 23 of 33 (70%) women presented with moderate to severe prolapse. After final treatment, 3 of 33 (9%) women had moderate prolapse and 0 of 33 (0%) women had severe prolapse. A total of 12 of 33 (36%) women achieved complete recovery of organ position and shape. A total of 27 of 33 (81.82%) women improved by at least 1 prolapse stage. Pelvic floor strength improved from mean: 1.28 (SD: 0.85) at baseline to 3.33 (SD: 0.78) after final treatment. Self-reported PFDI-20 scores corroborated clinical observations, reducing from mean: 98.77 (SD: 42.43) at baseline to 49.87 (SD: 27.28) after final treatment, suggesting a clinically meaningful improvement. Mean treatment received was 6.06 (SD: 2.28) sessions over a duration of 4.39 (SD: 2.46) months. Discussion: Biotensegrity Focused Therapy was shown to have a beneficial impact on organ position and prolapse symptoms and may be an appropriate treatment for women with POP.
{"title":"Biotensegrity Focused Therapy for Pelvic Organ Prolapse: A Nonrandomized Prospective Clinical Case Series","authors":"A. Crowle, C. Harley","doi":"10.1097/JWH.0000000000000210","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000210","url":null,"abstract":"Background: Traditional treatments for pelvic organ prolapse (POP) assume weak pelvic tissue as the cause. Pelvic floor muscle training has been shown to improve POP symptoms but not prolapse stage and does not reduce rates of referral for future treatment (eg, pessary or surgery). An alternative hypothesis is proposed that excessive tissue stiffness causes tension and pulling, which disrupts pelvic organ arrangement. Objectives: Treating pelvic tissue stiffness through Biotensegrity Focused Therapy is anticipated to improve organ position and prolapse symptoms. Study Design: Nonrandomized prospective clinical case series. Methods: Women presenting to a private physiotherapy practice in the United Kingdom with POP received Biotensegrity Focused Therapy. Treatment included a series of 1-hour physiotherapy sessions focusing on identifying areas of stiff pelvic tissue and using a direct myofascial release technique to normalize elasticity to restore dynamic equilibrium within the pelvis. Prolapse grade (mild, moderate, severe), pelvic floor strength (Modified Oxford Grading Scale), and self-reported symptoms (Pelvic Floor Distress Inventory, PFDI-20) were assessed at baseline and after final treatment. Results: Thirty-three women received treatment. At baseline, 23 of 33 (70%) women presented with moderate to severe prolapse. After final treatment, 3 of 33 (9%) women had moderate prolapse and 0 of 33 (0%) women had severe prolapse. A total of 12 of 33 (36%) women achieved complete recovery of organ position and shape. A total of 27 of 33 (81.82%) women improved by at least 1 prolapse stage. Pelvic floor strength improved from mean: 1.28 (SD: 0.85) at baseline to 3.33 (SD: 0.78) after final treatment. Self-reported PFDI-20 scores corroborated clinical observations, reducing from mean: 98.77 (SD: 42.43) at baseline to 49.87 (SD: 27.28) after final treatment, suggesting a clinically meaningful improvement. Mean treatment received was 6.06 (SD: 2.28) sessions over a duration of 4.39 (SD: 2.46) months. Discussion: Biotensegrity Focused Therapy was shown to have a beneficial impact on organ position and prolapse symptoms and may be an appropriate treatment for women with POP.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44232246","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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