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Concurrent Validity of Noninvasive Coccygeal Motion Palpation and Transabdominal Ultrasound Imaging in the Assessment of Pelvic Floor Function in Women 非侵入性足趾运动触诊和经腹部超声成像评估女性盆底功能的同时有效性
Pub Date : 2020-08-07 DOI: 10.1097/JWH.0000000000000175
R. Maher, Jenna Iberle
Supplemental Digital Content is Available in the Text. Background: No gold standard exists for assessing pelvic floor muscle (PFM) function. However, a significant correlation exists between digital palpation and transabdominal ultrasound imaging (TAUS), with studies indicating that the coccyx moves during contractions. Objectives: To determine concurrent validity of external coccyx motion palpation (CMP) versus TAUS to identify the former's validity in assessing PFM function. Study Design: A cross-sectional observational study. Methods: Sixty-four women were screened. Those who could perform a PFM contraction were enrolled (n = 37; mean 31.5 years). A single investigator was assigned to either TAUS or CMP. Participants were randomly assigned to perform either a PFM contraction, bearing down, or nothing under randomly assigned testing positions: standing, sitting, and side-lying while simultaneous TAUS and CMP occurred. Investigators were blinded to each other's assessment, and participant-assigned tasks. Participants were blinded to TAUS. Results: Sensitivity and specificity were 94% and 79%, respectively, for CMP versus TAUS. χ2 tests and phi coefficient (ϕ) revealed a significant strong relationship between TAUS and CMP across positions: standing χ2(1, n = 37) = 17.87, P < .001, ϕ = 0.7; sitting χ2(1, n = 37) = 15.79, P < .001, ϕ = 0.65; and side-lying χ2(1, n = 37) = 17.88, P < .001, ϕ = 0.7, respectively. Conclusions: CMP is a valid screening method that can be used by all clinicians. It may decrease unnecessary internal digital assessment while being more acceptable to women who decline an internal digital assessment, or in pregnant women for whom a digital assessment may be contraindicated. We have included a Video Abstract that highlights our ultrasound cine-loops and findings in our article (see the Video Abstract, Supplemental Digital Content, available at: http://links.lww.com/JWHPT/A31).
文本中提供了补充数字内容。背景:目前尚无评估盆底肌(PFM)功能的金标准。然而,数字触诊和经腹部超声成像(TAUS)之间存在显著相关性,研究表明尾骨在收缩过程中会移动。目的:确定外尾骨运动触诊(CMP)与TAUS的同时有效性,以确定前者在评估PFM功能方面的有效性。研究设计:横断面观察性研究。方法:对64名女性进行筛查。那些能够进行PFM收缩的患者被纳入研究(n=37;平均31.5年)。一名研究者被分配到TAUS或CMP。参与者被随机分配在随机分配的测试位置下进行PFM收缩、向下压或什么都不做:站立、坐着和侧卧,同时进行TAUS和CMP。研究人员对彼此的评估视而不见,参与者分配任务。参与者对TAUS视而不见。结果:CMP与TAUS的敏感性和特异性分别为94%和79%。χ2检验和φ系数(ξ)显示,TAUS和CMP之间存在显著的强相关性:站立χ2(1,n=37)=17.87,P<.001,ξ=0.7;坐位χ2(1,n=37)=15.79,P<.001,ξ=0.65;侧卧χ2(1,n=37)=17.88,P<.001,ξ=0.7。结论:CMP是一种有效的筛查方法,所有临床医生都可以使用。它可以减少不必要的内部数字评估,同时更容易被拒绝内部数字评估的女性或数字评估可能禁忌的孕妇接受。我们在文章中包含了一个视频摘要,突出了我们的超声波电影循环和发现(请参阅视频摘要,补充数字内容,可在以下网址获得:http://links.lww.com/JWHPT/A31)。
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引用次数: 3
An International Survey of Women's and Pelvic Health Physical Therapy Organizational Practice 妇女盆腔健康物理治疗组织实践的国际调查
Pub Date : 2020-07-30 DOI: 10.1097/jwh.0000000000000174
J. Boissonnault, Allyson Kuhn, M. Meeker, S. Strong, R. Stephenson
Supplemental Digital Content is Available in the Text. Background: The current International Organization of Physical Therapists in Pelvic and Women's Health (IOPTPWH) “scope of practice” document was disseminated in 2013 and based on a survey fielded in 1999-2000. The scope of practice within this field is evolving, necessitating an updated “scope of practice” document. Objective: To collect data from IOPTPWH member organizations' chief delegates on the focus and practice of their organizations. Study Design: Online survey. Methods and Measure: A validated survey was electronically fielded to the 30 IOPTPWH member organizations. Chief delegates responded on behalf of their member organizations. Multiple choice and open-ended questions were asked. Responses and frequency counts were analyzed. Results: Nineteen of the 30 member organizations responded to the survey. All respondents reported that their organizations focused on at least 1 subcondition within obstetrics and urological/pelvic floor dysfunction. Fifteen of the 19 member organizations reported a focus on at least 1 subcondition within gastrointestinal health, reproductive health, pelvic pain, and sexual disorders. Responses presented an increase in organizational focus on men, children, and transgender individuals. Conclusions: Practice in women's health physical therapy is evolving, as evidenced by changes in organizational focus on particular patient populations and conditions noted by survey respondents. Findings from this survey may serve as a resource for the development of an updated IOPTPWH “scope of practice” document. A video abstract for this article is available at: http://links.lww.com/JWHPT/A30.
补充数字内容可在文本中获得。背景:目前国际盆腔和妇女健康物理治疗师组织(IOPTPWH)的“执业范围”文件于2013年发布,基于1999-2000年的一项调查。这一领域的业务范围正在演变,因此需要更新“业务范围”文件。目的:收集IOPTPWH成员组织首席代表对其组织工作重点和实践的数据。研究设计:在线调查。方法和措施:通过电子方式向30个IOPTPWH成员组织发送有效的调查问卷。首席代表代表其成员组织作了答复。多选题和开放式问题。分析反应和频率计数。结果:30个成员组织中有19个回应了调查。所有的应答者报告说,他们的组织集中在产科和泌尿/盆底功能障碍至少一个亚条件。19个成员组织中有15个报告了对胃肠道健康、生殖健康、盆腔疼痛和性功能障碍中至少一种亚状况的关注。调查结果显示,组织对男性、儿童和变性人的关注有所增加。结论:妇女健康物理治疗的实践正在发展,调查答复者指出,组织对特定患者群体和条件的关注发生了变化,这证明了这一点。这项调查的结果可以作为更新IOPTPWH“业务范围”文件的资源。本文的视频摘要可在:http://links.lww.com/JWHPT/A30。
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引用次数: 2
COVID-19: The New Normal 新冠肺炎:新常态
Pub Date : 2020-07-01 DOI: 10.1097/jwh.0000000000000176
C. Chiarello
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引用次数: 9
Book Review 书评
Pub Date : 2020-07-01 DOI: 10.1097/jwh.0000000000000177
Jennifer Miller
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引用次数: 0
Fracture Risk Assessment Tool and Quantitative Ultrasound for Bone Screening: A Case Series 骨折风险评估工具和骨筛查的定量超声:一个病例系列
Pub Date : 2020-07-01 DOI: 10.1097/JWH.0000000000000172
Matthew de Ruig, C. J. Watson
Introduction/Background: This case series assessed the clinical utility of the Fracture Risk Assessment (FRAX) tool and quantitative ultrasound (QUS) at the distal radius to screen subjects for higher fracture risk. The current gold standard to diagnose osteoporosis is the dual-energy x-ray absorptiometry (DXA) scan. QUS is a valid and less expensive procedure for measuring properties of bone that can be performed over several body sites, including the distal radius. Our hypothesis was that the addition of QUS, to current bone health screening using FRAX alone, would identify more postmenopausal women with higher fracture risk. Case Description: In this case series, 2 postmenopausal women were screened with the FRAX tool. In addition, the nondominant distal radius was screened with QUS and the results were compared with the results of the respective subject’s DXA scans. Outcomes: The QUS measurement results placed our subjects in the same fracture risk category as their DXA scan bone mineral density scores. Discussion: In this case series, we present 2 postmenopausal women who demonstrate low fracture risk as predicted by the FRAX alone. Subsequent QUS measures detected that one of the women was at higher risk for fracture. Follow-up DXA scan confirmed that the QUS, which also directly assesses bone quality, correctly stratified the patients into low and high fracture risk categories. In addition to FRAX, QUS may be an important low-cost screening tool for physical therapists to use, to increase early referral for medical management.
引言/背景:本病例系列评估了骨折风险评估(FRAX)工具和桡骨远端定量超声(QUS)在筛查骨折风险较高受试者方面的临床实用性。目前诊断骨质疏松症的金标准是双能x射线吸收仪(DXA)扫描。QUS是一种有效且成本较低的测量骨骼特性的程序,可以在多个身体部位进行,包括桡骨远端。我们的假设是,在目前仅使用FRAX进行骨健康筛查的基础上,添加QUS,将发现更多绝经后女性骨折风险更高。病例描述:在该病例系列中,2名绝经后妇女使用FRAX工具进行筛查。此外,用QUS筛查非显性桡骨远端,并将结果与相应受试者的DXA扫描结果进行比较。结果:QUS测量结果将我们的受试者与他们的DXA扫描骨密度评分归入相同的骨折风险类别。讨论:在这个病例系列中,我们介绍了2名绝经后妇女,她们表现出单独FRAX预测的低骨折风险。随后的QUS测量发现,其中一名女性骨折的风险更高。随访DXA扫描证实,QUS也直接评估骨质量,正确地将患者分为低骨折风险和高骨折风险两类。除了FRAX,QUS可能是物理治疗师使用的一个重要的低成本筛查工具,以增加医疗管理的早期转诊。
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引用次数: 0
Hip Angles, Joint Moments, and Muscle Activity During Gait in Women With and Without Self-reported Stress Urinary Incontinence 有或没有自我报告的压力性尿失禁妇女的髋关节角度、关节力矩和步态中的肌肉活动
Pub Date : 2020-06-12 DOI: 10.1097/JWH.0000000000000166
Erin H. Hartigan, J. McAuley, Michael A. Lawrence, Willis Brucker, Adam King, B. Tryon, M. DeSilva
Supplemental Digital Content is Available in the Text. Background: Women with stress urinary incontinence (SUI) have different hip strength, mobility, and unique between-leg differences compared with women without SUI. This article describes gait biomechanics in these same women to provide insight into their function and neuromuscular system. Objective: To compare gait biomechanics between women with and without self-reported SUI. Study Design: Descriptive. Methods: Hip angles, moments (net forces), and muscle activity were analyzed during 3 phases of stance (weight acceptance [WA], mid-stance [MS], and terminal stance [TS]), using 3-dimensional cameras, force plates, and surface electromyography. Values were compared between groups (SUI, n = 21; no SUI, n = 20) and limbs (dominant, D; nondominant, ND) (significance: P ≤ .05). Results: Between-Group Comparisons: Both limbs in the SUI group had greater abduction (ABD) moments (WA: D: P = .039; ND: P = .030), external rotation (ER) moments (WA: D: P = .002, ND: P = .004; and MS: D: P = .033, ND: P = .035), and gluteus maximus activity (TS: D: P < .001, ND: P = .005). The SUI group's ND-limb had greater adduction angles (WA: P = .043), internal rotation (IR) angles (WA: P = .011; MS: P = .028), flexion (FL) moments (TS: P = .050), and tensor fasciae latae activity (TS: P = .044). The SUI group's D-limb had greater ABD moments (TS: P = .034). Between-Limb Comparisons Unique to Each Group: The SUI group's ND-limb had greater IR angles (WA: P = .007, MS: P = .032, TS: P = .027), relative lesser ER angles (MS: P = .003, TS: P = .007), and lesser FL angles (MS: P = .029). The without SUI group's ND-limb had greater ER moments (MS: P = .022). Conclusions: Women with SUI demonstrate unique gait mechanics, predominantly in the transverse plane and in the ND-limb. A video abstract for this article is available at: http://links.lww.com/JWHPT/A29.
文本中提供了补充数字内容。背景:与无压力性尿失禁的女性相比,有压力性尿尿失禁(SUI)的女性有不同的臀部力量、灵活性和独特的腿部差异。本文描述了这些女性的步态生物力学,以深入了解她们的功能和神经肌肉系统。目的:比较有和没有自我报告SUI的女性步态生物力学。研究设计:描述性。方法:使用三维相机、力板和表面肌电图,分析站立三个阶段(重量接受[WA]、中间站立[MS]和最后站立[TS])的髋关节角度、力矩(净力)和肌肉活动。比较两组(SUI,n=21;无SUI,n=20)和肢体(显性,D;非显性,ND)之间的值(显著性:P≤.05)。结果:组间比较:SUI组的两个肢体都有更大的外展(ABD)力矩(WA:D:P=.039;ND:P=.030)、外旋(ER)力矩(WA:D:P=.002,ND:P=.004;MS:D:P=0.033,ND:P=0.035),SUI组的ND肢体具有较大的内收角(WA:P=0.043)、内旋角(IR)(WA:P=0.011;MS:P=0.28)、屈曲力矩(FL)(TS:P=0.050),和阔筋膜张肌活动(TS:P=0.44)。SUI组的D肢体有更大的ABD力矩(TS:P=0.034)。各组独特的肢体间比较:SUI组ND肢体有更高的IR角(WA:P=0.007,MS:P=0.032,TS:P=0.027),相对较小的ER角(MS:P=0.003,TS:P=0.007),和较小的FL角(MS:P=0.029)。无SUI组的ND肢体具有较大的ER力矩(MS:P=0.022)。结论:患有SUI的女性表现出独特的步态力学,主要在横切面和ND肢体。本文的视频摘要可在以下网址获得:http://links.lww.com/JWHPT/A29.
{"title":"Hip Angles, Joint Moments, and Muscle Activity During Gait in Women With and Without Self-reported Stress Urinary Incontinence","authors":"Erin H. Hartigan, J. McAuley, Michael A. Lawrence, Willis Brucker, Adam King, B. Tryon, M. DeSilva","doi":"10.1097/JWH.0000000000000166","DOIUrl":"https://doi.org/10.1097/JWH.0000000000000166","url":null,"abstract":"Supplemental Digital Content is Available in the Text. Background: Women with stress urinary incontinence (SUI) have different hip strength, mobility, and unique between-leg differences compared with women without SUI. This article describes gait biomechanics in these same women to provide insight into their function and neuromuscular system. Objective: To compare gait biomechanics between women with and without self-reported SUI. Study Design: Descriptive. Methods: Hip angles, moments (net forces), and muscle activity were analyzed during 3 phases of stance (weight acceptance [WA], mid-stance [MS], and terminal stance [TS]), using 3-dimensional cameras, force plates, and surface electromyography. Values were compared between groups (SUI, n = 21; no SUI, n = 20) and limbs (dominant, D; nondominant, ND) (significance: P ≤ .05). Results: Between-Group Comparisons: Both limbs in the SUI group had greater abduction (ABD) moments (WA: D: P = .039; ND: P = .030), external rotation (ER) moments (WA: D: P = .002, ND: P = .004; and MS: D: P = .033, ND: P = .035), and gluteus maximus activity (TS: D: P < .001, ND: P = .005). The SUI group's ND-limb had greater adduction angles (WA: P = .043), internal rotation (IR) angles (WA: P = .011; MS: P = .028), flexion (FL) moments (TS: P = .050), and tensor fasciae latae activity (TS: P = .044). The SUI group's D-limb had greater ABD moments (TS: P = .034). Between-Limb Comparisons Unique to Each Group: The SUI group's ND-limb had greater IR angles (WA: P = .007, MS: P = .032, TS: P = .027), relative lesser ER angles (MS: P = .003, TS: P = .007), and lesser FL angles (MS: P = .029). The without SUI group's ND-limb had greater ER moments (MS: P = .022). Conclusions: Women with SUI demonstrate unique gait mechanics, predominantly in the transverse plane and in the ND-limb. A video abstract for this article is available at: http://links.lww.com/JWHPT/A29.","PeriodicalId":74018,"journal":{"name":"Journal of women's health physical therapy","volume":"44 1","pages":"107 - 116"},"PeriodicalIF":0.0,"publicationDate":"2020-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JWH.0000000000000166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44906776","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}
引用次数: 2
Effect of Exercises and Diet Intervention in Pregnancy on Postpartum Weight Retention and Obesity Markers: Findings in Indian Women 妊娠期运动和饮食干预对产后体重保持和肥胖指标的影响:在印度妇女中的发现
Pub Date : 2020-06-12 DOI: 10.1097/JWH.0000000000000173
A. Pawalia, S. Kulandaivelan, V. Yadav
Background: Women are increasingly becoming overweight and obese in India. Pregnancy increases this risk further. Preventive measures at this stage can benefit both the mother and her offspring. Objectives: The aim of this study was to evaluate effectiveness of supervised and unsupervised antenatal exercises with and without diet component as behavioral interventions on obesity markers in pregnant Indian women. Study Design: It is an experimental study with different subject designs (parallel group pre- and post-comparisons). Methods: One hundred forty pregnant women recruited from a maternity hospital were divided into 5 groups, that is, control, diet, home exercise, supervised exercise, and supervised exercise with diet. Outcome Measures: Weight (excess gestational weight gain and postpartum weight retention), body mass index, waist circumference, hip circumference, and waist to hip ratio. Outcome measures were assessed at 3 time points, that is, during early pregnancy, at delivery, and at 2 months postdelivery. Statistics: Descriptive, parametric and nonparametric tests and effect size (ES) were used to present these results. Results: Both the supervised exercise interventions were most effective in managing obesity markers such as waist circumference (large ES = 0.809 and 0.756, P = .001). Home exercises were effective for body mass index control (ES = 0.501). Supervised exercise groups also had least weight retention at 2-month follow-up (ES = 0.597 and 0.501), followed by the home exercise (ES = 0.438) and diet (ES = 0.138) groups as compared with the control group. Conclusion: Interventions of supervised exercises are most effective in reducing the rise of obesity markers in young Indian women up to 2 months postdelivery. Home exercise and diet care could be the next best intervention.
背景:在印度,女性越来越超重和肥胖。怀孕会进一步增加这种风险。这一阶段的预防措施可以使母亲和她的后代都受益。目的:本研究的目的是评估有监督和无监督的产前锻炼(含和不含饮食成分)对印度孕妇肥胖标志物的行为干预效果。研究设计:这是一项具有不同主题设计的实验研究(平行组前后比较)。方法:将某妇产医院140例孕妇分为对照组、饮食组、家庭锻炼组、监督锻炼组和饮食监督锻炼组。结果指标:体重(妊娠期超重和产后体重保持)、体重指数、腰围、臀围和腰臀比。在3个时间点,即妊娠早期、分娩时和分娩后2个月,对结果指标进行评估。统计学:使用描述性、参数性和非参数性检验以及效应大小(ES)来呈现这些结果。结果:两种监督运动干预措施在管理腰围等肥胖标志物方面最有效(大ES=0.809和0.756,P=0.001)。家庭运动对控制体重指数有效(ES=0.501)。监督运动组在2个月的随访中体重保持率最低(ES=0.597和0.501),其次是家庭锻炼组(ES=0.438)和饮食组(ES=0.0138)。结论:在产后2个月内,监督锻炼的干预措施在减少印度年轻女性肥胖标志物的上升方面最为有效。家庭锻炼和饮食护理可能是下一个最好的干预措施。
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引用次数: 1
Unsung Heroes Unsung超能英雄
Pub Date : 2020-05-01 DOI: 10.18356/5b61d23c-en
Cynthia M. Chiarello
SME manufacturers across the UK are playing a vital role in keeping the manufacturing economy ticking over whilst producing key components for critical medical equipment
英国各地的中小企业制造商在为关键医疗设备生产关键部件的同时,在保持制造业经济运转方面发挥着至关重要的作用
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引用次数: 0
Book Reviews 书评
Pub Date : 2020-04-01 DOI: 10.1097/jwh.0000000000000168
Amanda Olson, R. Stephenson
Angeliki Spiropoulou and Theodora Tsimbouki, Αγγελική Σπυροπούλου και Θεοδώρα Τσιμπούκη, editors. Σύγχρονη Ελληνική Πεζογραφία: Διεθνείς Προσανατολισμοί και Διασταυρώσεις (Contemporary Greek Prose Fiction: International Orientations and Crossings). Athens: Alexandria. 2002. Pp. 335. Paperback $65. Peter Mackridge and Eleni Yannakakis, editors. Contemporary Greek Fiction in a United Europe: From Local History to the Global Individual. Oxford: Legenda. 2004. Pp. xii + 208. Paperback $65.
Angeliki Spiropulou和Theodora Tsimbuki,Angeliki斯皮罗普洛和Theodola Tsimbuki。当代希腊散文小说:国际定位与交叉。雅典:亚历山大。2002年,第335页。Paperback 65美元。编辑Peter Mackridge和Eleni Yannakakis。统一欧洲的当代希腊小说:从地方史到全球个体。牛津:传说。2004年,第xii208页。Paperback 65美元。
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引用次数: 0
“No One Told Me About This Part”: What Breastfeeding Women Want and Need to Support Their Physical Health “没有人告诉我这部分”:母乳喂养女性想要什么,需要什么来支持她们的身体健康
Pub Date : 2020-03-12 DOI: 10.1097/JWH.0000000000000195
Kailey Snyder, Julie Peterson, Kari Bargstadt-Wilson
Background: Breastfeeding women struggle to achieve recommendations of obtaining 150 minutes of moderate activity per week or more. Pelvic floor dysfunction may be hindering postpartum physical activity. However, the severity and type of dysfunction remain poorly understood. Objective: This study had the following objectives: (1) to determine the severity of symptoms of pelvic floor dysfunction among breastfeeding women, with a secondary objective (1a) to determine whether this varied on the basis of exclusive breastfeeding versus supplementation of solids foods and/or formula and (2) to determine what breastfeeding women perceive they need in a physical activity intervention and (2a) how their activity levels change from before to after pregnancy. Study Design: This was a concurrent embedded mixed-methods cross-sectional survey. Methods: A survey consisting of demographic questions, physical activity experiences, the Pelvic Floor Distress Inventory (PFDI-20), and open-ended questions was disseminated to currently breastfeeding mothers. Results: Survey findings conclude that breastfeeding women are primarily sedentary or engage in light physical activity and experience greater symptom severity related to urinary incontinence than anal or pelvic organ prolapse distress. Symptoms are not influenced by breastfeeding exclusivity. Many women are hindered from being active by time constraints associated with feeding their infant. Women would like a combination of in-person/online pelvic floor and general exercise resources. Conclusion: A large proportion of breastfeeding women are sedentary or engaging only in light activity. Furthermore, breastfeeding women report urinary incontinence symptoms and these symptoms are not influenced by breastfeeding exclusivity. Breastfeeding women desire increased education and resources to support their physical activity.
背景:母乳喂养的妇女很难达到每周150分钟或更长时间的适度运动的建议。盆底功能障碍可能会妨碍产后的身体活动。然而,功能障碍的严重程度和类型仍然知之甚少。目的:本研究有以下目的:(1)确定母乳喂养妇女盆底功能障碍症状的严重程度,第二个目的(1a)确定纯母乳喂养与补充固体食物和/或配方食品的基础上是否存在差异;(2)确定母乳喂养妇女认为她们在体育活动干预中需要什么;(2a)怀孕前后她们的活动水平如何变化。研究设计:这是一项并行嵌入式混合方法横断面调查。方法:对正在哺乳的母亲进行人口统计问题、体育活动经历、骨盆底窘迫量表(PFDI-20)和开放式问题调查。结果:调查结果表明,母乳喂养的妇女主要是久坐不动或从事轻微的体力活动,与肛门或盆腔器官脱垂的痛苦相比,尿失禁的症状更严重。症状不受纯母乳喂养的影响。许多妇女由于与喂养婴儿有关的时间限制而无法积极活动。女性则希望结合面对面或在线的骨盆底和一般运动资源。结论:很大比例的母乳喂养妇女是久坐不动或只从事轻度活动。此外,母乳喂养的妇女报告尿失禁症状,这些症状不受母乳喂养的影响。母乳喂养的妇女希望得到更多的教育和资源,以支持她们的体育活动。
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引用次数: 1
期刊
Journal of women's health physical therapy
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