August 10, 2011 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

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This month’s discussion

Stuge B, Garrett A, Jenssen H, Grotle M: The Pelvic Girdle Questionnaire: A Condition-Specific Instrument for Asssessing Activity Limitations and Symptoms in People with Pelvic Girdle Pain. Phys Ther. 2011;91:1-11.

Benetti TH, Santos MF, Mergulhao MEA, Fagundes JJ, Ayrizono MJS, Coy CSR: Variation of the Anal Resting Pressure Induced by Postexpiratory Apnea Effort in Patients with Constipation. Arq Gastroenterol 2011; 48(1):30-5.

New links to FDA alert on POP mesh

The FDA has posted three new links with information on the surgical complications of mesh for the treatment of POP.  This is creating quite a stir.  Check it out.
http://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM262760.pdf
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/UroGynSurgicalMesh/default.htm

Would be great to hear the reaction from MDs.

FDA: Surgical placement of mesh to repair pelvic organ prolapse poses risks

On July 13, 2011 the FDA posted a news release and an alert on the risks of mesh in the treatment of pelvic organ prolapse (POP).  Link to the news release using the title of this post or the link below This is a quick summary and includes this statement by the FDA.

“The FDA issued a safety communication in 2008 due to increasing concerns about adverse events associated with the transvaginal placement of mesh. Since then, the number of adverse events has continued to climb. From 2008 to 2010, the FDA received 1503 adverse event reports associated with mesh used for POP repair, five times as many as the agency received from 2005 to 2007.” 

The full alert can be found at http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm  It includes recommendations for healthcare providers and recommendations for patients.  It does suggest consideration of non-surgical options but does not list any specific non-surgical treatments. 

Sherrie Palm from the Association for Pelvic Organ Prolapse Support has posted another side of the story which is also important to consider.  http://pelvicorganprolapsesupport.org/library/sherrie_palm_articles  I would expect other medical professional groups will also formally respond.  Will be interesting to see the results of the meeting in September. 

REFERENCES for Sherrie's post

https://www.augs.org/AboutAUGS/MediaCenter/PressReleases/PelvicFloorDisordersWillImpactasManyasOne/tabid/491/Default.aspx .

http:www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm262752.htm.2011;July 13 .

http://www.intelihealth.com/IH/ihtPrint/WSIHW000/333/8988/14066249.html .

http:www.ehow.com/about_5660232_hernia-mesh-complications.html

http://www.modernmom.com/article/statistics-on-complications-of-cosmetic-surgery .

It is important for PTs to know about this discussion and the resultant regulations or recommendations.   Would be nice if this resulted in more conservative treatment!!! 

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm262752.htm 

Behavioral Therapy With or Without Biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy UI a randomized controlled study

JAMA July 20,2011

Research paper which supports the use of conservative therapy for men who have persistent UI one year after prostate surgery.   This may be the patient population urologists are more likely to send to PT.  A good marketing tool.  

http://jama.ama-assn.org/content/305/2/151.full.pdf+html

Chronic Diarrhea Treatment Guide

Came across this web page looking for resources for a patient.  It provides a great list of suggestions for diarrhea (especially as related to IBS).  Information looks solid – easy to read.  Although there are many links which may confuse and overwhelm some patients.  Would recommend PTs take a look at this site. Click on title of this post or follow this link.   http://ibs.about.com/od/diarrhea/tp/ChronicDiarrhea.htm

Cherkin DC et al. A Comparison of effects of 2 types of massage and usual care on chronic low back pain. Ann of Int Med. 2011;155:1-9.

Subjects – patients with “uncomplicated”, chronic low back pain (LBP) of 3 months with an intensity of at least 3 on a scale of 0 to 10.  Many types of patients were excluded including those with an identified cause of LBP such as fracture or spinal stenosis, complicated LBP such as sciatica or post surgical, and severe fibromyalgia.  These exclusions were listed as a limitation to the study and do limit its applicability to the general PT LBP patient. 

401 subjects were included (mostly white, female, and employed) average age mid 60. Subjects were randomized and fairly good blinding was done.  Blinding was compromised in less that 10% of cases.

Junginger B, Baessler K, Spasford R, Hodges PW: Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J. 2010; 21: 69-77.

Pelvic Physiotherapy Think Tank

July 6, 2011

Ann Dunbar PT, DPT, MS

Introduction

1.     Contraction of pelvic floor muscles (PFMs) elevates bladder neck and compresses urethra and provides firm base against which urethra is closed by increases in intra-abdominal pressure (IAP)

a.    Authors conclude this is important for continence but probably not determined by PFM activity alone (eg: increased IAP may prevent elevation)

2.    Study aims: (1)” to compare displacement of bladder neck, IAP, PFM and abdominal EMG between range of different abdominal and PFM contractions that aim to induce different pressures and m. activation patterns including sub-maximal efforts and (2) compare activity of PFM and abdominal m. and IAP between maximum contractions of each m.”

Braekken IH, Majida M, Engh ME, Bo, K: Morphological Changes after Pelvic Floor Muscle Training Measured by 3-Dimensional Ultrasonography. Obstet and Gynec. 2010; 115(2):317-24.

Pelvic Physiotherapy Think Tank

July 6, 2011

Ann Dunbar PT, DPT, MS

Objective: To investigate morphological and functional changes after pelvic floor muscle (PFM) training in women with pelvic organ prolapse (POP). 

Introduction:

1.       Authors report RCT and systematic reviews exist to demonstrate that PFM training effective in rx SUI for 44-80% adult females but few data exist to suggest PFM training also effective to reduce sx of POP.

2.       Suggest 2 hypotheses explaining mechanism of action of PFM training for rx of SUI/POP. (1) Teaching women to contract PFM before and during increased intra-abdom pressure; (2) Strength training of PFM builds m volume, elevates organs and closes levator hiatus

July 6, 2011 Pelvic Physiotherapy Distance Journal Club

This month’s call created a great deal of discussion about intra-abdominal pressure, what we know and what we don’t know.  Additional articles were referenced and evidence was discussed.  We have also gone international with the addition of Helena Frawley PT from Australia on the call.  Outlines will be posted on this blog in the next two posts.  This would be a recording to listen to right from the computer, downloaded on your IPod, or burn a cd.  Stay tuned for more stimulating discussion next month Aug 10, 2011.

This month’s discussion

Junginger B, Baessler K, Sapsford R, Hodges P. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck.  Int Urogynecol J 2010 21:69-77.

Hoff Braekken I, Majida M, Engh ME, Bo K. Morphological changes after pelvic floor muscle training measured by 3-dimentional ultrasonography A randomized controlled trial. Ob Gyn 2010 115(2):317-324.