Tuesday, May 31, 2011

Neurourology and urodynamics vol 30, issue 1 and 4 2011

Neurourology and urodynamics vol 30, issue 1 2011

Reference values for the nocturnal bladder capacity index – this paper adds to the complexity possible with measured voided volume diaries.  I highly recommend having patient measure volumes and calculating nocturnal polyuria or low bladder capacity if possible.

Protracted postpartum urinary retention – This is very important for the acute postpartum patient. Second stage of labor and vacuum were significant independent risk factors.  Complete resolution should occur within 28 days.

Friday, May 27, 2011

Eight interesting articles

Review of Physical Therapy Journal March

This month’s issue has three articles that caught my eye.  Maybe you have some input.
  • Utilization and clinical outcomes of out patient physical therapy for Medicare beneficiaries with musculoskeletal conditions – very interesting – worth reading
  • Depressive symptoms, anatomical region, and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain.  – higher depression in women and those with chronic pain. Depression “contributed additional variance” to pain intensity.  Our patients fall into this category and it is important to recognize the influence of depression. 
  • Responsiveness to change of 10 physical tests used for patients with back pain

Monday, May 23, 2011

Vaginismus on Discovery/TLC television

Some of you may have already seen this but thought it was worth posting again.  It aired on TLC April 3, 2011.  
This version is without commercials and takes about 22 minutes. It is very well done and quite accurate except for insurance coverage.  The treatment described includes simultaneous treatment by a PT and a psychologist.  I do not have experience with the billing of co-treatments.  I do separate PT treatments and do receive coverage by most insurances under the code muscle spasm.  I am sure many of you have the same experience.

 I have read their book Private Pain.  It is a good book for supporting patients as it has many testimonials about the impact of vaginismus and the success of the treatment.  The treatments are not described.  I would be happy to offer private or group distance learning on the physical therapy treatment of vaginismus.  Certainly there is a range of severity and many patients have success with primary physical treatment.  Email me if you are interested

Sunday, May 15, 2011

Evidence of Benefit of Transverse Abdominus Training Alone or in Combination with Pelvic Floor Muscle Training to Treat Female UI: A Systematic Review.

PFMT is recommended for first line of treatment of SUI and Mixed UI (50 RCTs). Due to synergistic activity between TrA and PFM with normal trunk activities, it is theorized that one can train TrA to enhance PFMT. The authors reviewed journal publications to find evidence to support TrA training alone or in combination with PFMT for treatment of SUI and mixed UI in women to determine if current clinical practice should be replaced  with new model or if current practice should change.
Sapsford et al dispute several issues in this study via a letter to the editor. Their comments are listed in bold.

Physical exam findings by physical therapists compared with physicians of musculoskeletal factors in women with chronic pelvic pain Journal of the Section on Women's Health, Sept- Dec 2010, pp73-79

Introduction: PTs and physiatrist have extensive MS training. Purpose was to compare ability of physiatrist and PTs ability to differentiate women with CPP from those without it.

48 non pregnant women aged 18-55, mean age 35, CCP group and non pain group
4 blinded examiners (2 MD, 2 PT), 1 MD and 1 PT would see pt 30 minutes apart and do the MS exam maneuvers.  Goal was to diagnosis / identify CPP.  This is quite different from evaluating a patient to determine a PT plan of care.

Friday, May 13, 2011

Celebrate Women's Health Week May 8-14

I guess they have a “week” for everything.  Great to hear there is a Women’s Health week.  This was posted on the APTA newsletter. “On Wednesday, the Pennsylvania House of Representatives unanimously adopted HR 277, recognizing the role of physical therapists in promoting the health of women.”  I am always excited to hear women’s health PT being recognized in main stream medicine.  A step forward HAY!!!!      

Tuesday, May 10, 2011

Single blind, randomized controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women

Bo K, Talseth T, Holme I. Single blind, randomized controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999, 318:487-493.

Subjects: 107 females 24 to 70 yo
Groups – 6 months of treatment
  • PFM exercises – 8 to 12 contractions TID with weekly PT visits
  • Electrical stimulation – intermittent, 50 Hz, 30 min qd, monthly PFM re eval, instructed not to do PFM contractions
  • Vaginal cones – 20 min per day, monthly PFM re eval
  • Control – given pads

Monday, May 2, 2011

Neurourology and Urodynamics (vol 29, issue 8) - 2010 winter issue

This issue, as usual, has a number of very interesting papers.  The editorial gives an update on the journal itself.  Time to print is decreasing and the number of pages will be increased this year.

Pelvic floor muscle training in the treatment of lower urinary tract dysfunction in women with multiple sclerosis (Lucio)  This RTC is supportive of PFM exercises in patient with MS.  Treatment group received pressure biofeedback treatment twice per week for 12 weeks.   They were asked to perform 30 long holds and 3 minutes of fast twitch exercises 3 times per day without feedback.  Unfortunately the PERFECT scale was used to measure muscle function – not very reliable.  Even so, post treatment measurements showed improvements in endurance, number of repetitions and fast twitch contractions with little change in “power” a trend that I see clinically with many patient populations.