5/9/12 Pelvic Physiotherapy Distance Journal Club

                      

Time - 8:30 PM EST for one hour

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This month’s discussion

The effect of abdominal and pelvic floor muscle activation on urine flow in women. Sapsford RR, Hodges PW. Int Urogynecol J; Jan 26, 2012 (Epub ahead of print)

MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value. Reiner CS, Tutuian R, Solopova AE, Pohl D, Marincek B, Weishaupt D. BJRad 2011 (84):136-144.

New Practice Guidlines

Low Back Pain Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association

ANTHONY DELITTO, PT, PhD • STEVEN Z. GEORGE, PT, PhD • LINDA VAN DILLEN, PT, PhD • JULIE M. WHITMAN, PT, DSc GWENDOLYN SOWA, MD, PhD • PAUL SHEKELLE, MD, PhD • THOMAS R. DENNINGER, DPT • JOSEPH J. GODGES, DPT, MA

J Orthop Sports Phys Ther. 2012;42(4):A1-A57. doi:10.2519/jospt.2012.0301

58 pages of evidenced based medicine for one of our most common conditions.  Remember this is not specific for pelvic pain.  Check it out.

http://www.orthopt.org/uploads/content_files/ICF/Updated_Guidelines/Low_Back_Pain_Clinical_Practice_Guidelines___JOSPT_2012.pdf

Relationship between Toe Temperature and Lower Urinary Tract Symptoms

WOW an entirley different idea on why general exercise helps. Check it out.

Hiroo INOUE, Osamu ISHIZUKA*, Tetsuya IMAMURA, Takahiro YAMAGISHI, Wataru NOGUCHI, Hitoshi YOKOYAMA, Yoshiki KURIZAKI, Osamu NISHIZAWA

Article first published online: 11 APR 2012   LUTS: Lower Urinary Tract Symptoms

DOI: 10.1111/j.1757-5672.2012.00151.x

Objective: Cold stress can elicit increases in urinary urgency and frequency. We determined if there was a relationship between finger and toe temperatures and lower urinary tract symptoms (LUTS).

Methods: We studied 50 people who visited a public health management seminar. The participants were divided into two groups according to self-described sensitivity to cold stress. The cold non-sensitive (CNS) group consisted of 3 males and 20 females (66.9 ± 10.8 years old), and the cold sensitive (CS) group consisted of 4 males and 23 females (65.8 ± 8.01 years old). Each participant was assessed to determine international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), and quality of life (QOL) score. They were then instructed on lifestyle changes and exercises that could improve peripheral blood flow and provide relief for their LUTS. Next, the temperatures of their middle fingers and toes were measured before and after 5–10 min of the exercises. Two weeks later, the IPSS, OABSS, and QOL scores were reassessed.

Results: Before exercise, the middle fingers were significantly warmer than the middle toes. Exercise had no significant effect on the middle finger temperature of either group; however, it did increase the middle toe temperature for both groups. The increase was greatest for the CS group. The CS group had higher LUTS storage symptoms than the CNS group, and these improved after 2 weeks of lifestyle changes and exercise.

Conclusion: Improvements in lifestyle and daily exercise may be effective for LUTS in CS people.

Newly published articles

Newly published articles.  Article on adherence and its lack of influence on PFM training success is interesting (#3).  Also interesting is the systemic review of literature on PFM exercises.  No abstract is available – might be a letter to the editor.  I will search this one out myself.  Check them out on Pubmed.  Enjoy.

1. Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: A randomized controlled trial. Yang EJ, Lim JY, Rah UW, Kim YB. Gynecol Oncol. 2012 Mar 31. [Epub ahead of print]

2. The interplay of dyadic and individual planning of pelvic-floor exercise in prostate-cancer patients following radical prostatectomy. Burkert S, Knoll N, Luszczynska A, Gralla O. J Behav Med. 2012 Mar 28. [Epub ahead of print]

3. Exercise adherence to pelvic floor muscle strengthening is not a significant predictor of symptom reduction for women with urinary incontinence. Hung HC, Chih SY, Lin HH, Tsauo JY  Arch Phys Med Rehabil. 2012 Mar 22. [Epub ahead of print]

4. Re: pelvic floor exercise for urinary incontinence: a systematic literature review. Wein AJ  J Urol. 2012 Apr;187(4):1353-4. Epub 2012 Feb 21

5. Incontinence: conservative treatment of postprostatectomy incontinence Chughtai B, Sandhu JS Nat Rev Urol. 2011 May;8(5):237-8. Epub 2011 Apr 5.

A randomized clinical trial comparing Pelvic Floor Muscle training to a Pilates exercise program for improving pelvic muscle strength

A randomized clinical trial comparing Pelvic Floor Muscle training to a Pilates exercise program for improving pelvic muscle strength  Culligan PJ, Scherer J, Dyer K, Priestley JL, Guingon-White G, Delvecchio D, Vangeli M. Int Urogynecol J 2010;21:401-408.

April 4, 2011 Pelvic PT Journal Club Jane O’Brien, PT, presented by Cindy Neville

Primary Aim

To compare Pilates exercise program to PFMT for improving pelvic muscle strength.

Subjects: 

52 females over 18, (62 enrolled, 10 dropped out) with little to no PFM dysfunction

Study Design/Method – randomized clinical study – feasibility study

            Randomly assigned to 1 of 2 groups

1.      PFMT with Physical Therapist

2.      Pilates exercise with Pilates instructor.

3.      Both had 24, 1 hour sessions bi-weekly.

4.      PFM strength measured pre and post via Perineometry (Pathway CT 2000) by one clinical research nurse.

PFMT Group:

• Computerized biofeedback, vaginal manip (Thiels massage??) , NM re-ed, manual PT on pelvic floor—strength measured each time. TrA and hip external rotation training
• Pilates Group: Mat exercises
• Neither group was blinded, nor were therapists.

Outcome Measures

1. Mean PFM strength
2. PFDI-20 (Pelvic floor distress inventory 20) worst outcome = 300
3. PFIQ-7  Pelvic Floor Impact Questionaire—same.

Pilates Group                                      PFMT

            1.  Pre  12.5 ± 10.4 cmH²0                  14.9 ± 12.5 cm H²0

            Post—improved by 6.6 ± 7.4              6.2 ± 7.5 cm H²0

                        no significant difference p=0.85 PFM closure pressure

            2.  Pre  59.2 ± 42.3                              51.9 ± 37.8

            Post improved by 28.4 ± 36 pts.         27.4 ± 24.7 (53%)

                                            (48%)

                        no significant difference p=0.86 PFDI

            3.  25 ± 29.9                                        22.4 ± 31.1

            Post improved by 10.9 ± 28 (44%)     12.3 ± 30.9 pts. (55%)

                        No significant difference  p=0.91 PFIQ

Assessing Outcome

1.      No “intention to treat” analysis because drop outs left before final data was collected.

2.      Drop Outs             Pilates (2)                                PFMT (8)

Sick child                                            Did not care for invasive treatment  

Injured wrist

Results

Both groups had increased PFM strength     

More studies needed to determine if Pilates can treat PFD

Conclusion

Group discussed programs like Total Control and Roll for Control for wellness PFM health and post PT strength training. 

It was pointed out that it is necessary to make sure participants can perform the PFM contraction correctly before starting a group class

Individual versus group Pilates was also questioned as results may be different in a class

Clinical Significance

1. Would patients be more compliant, or is there more appeal, to a long term more active program that benefits full body (results they can see)?
2. Would this be a good program for mild to no PFM dysfunction – wellness
3. Would this type of program help extend results after PT

Effects of early pelvic floor muscle exercise for sexual dysfunction radical prostatectomy recipients

Effects of early pelvic floor muscle exercise for sexual dysfunction radical prostatectomy recipients Lin Y, Yu T, Chia-Hsiang, Wand H, Lu K. Cancer Nursing 2012;35(2):106-114.

April 3,  2012 journal club, Jane O'Brien, PT. presented by Beth Shelly

Primary aim

To explore prevalence  of sexual dysfunction and to define the effect of PFM ex on sexual dysfunction after RP over several months.

Subjects

Men, aged 45-80 with normal erectile function pre surgery

Control group n= 27 (this group had more open procedures than the exercise group)

Experimental group= 35

Randomly chosen using sealed envelopes.

Study design/method

Experimental design

PreIntervention: 1 hour class on prostate anatomy, RP procedure, complications (UI & Ed ), IIEF-5 questionnaire, within 15 days after surgery, then again @ 3,6,9,12 months after intervention.

Ex group

PFM Ex, three 10 sec: 10 sec, hold relax, max 2x/day, in supine, sit, stand

PFM DVD

PFM biofeedback, 1st and 2nd visit

Control group

Nothing for 3 months

At 3 months, they started program the exercise group had done

Both groups

1 st month, weekly reminder calls

2 nd month, 1 x reminder calls until 12 months

Patients family also taught PFME and suggested to do with patient.

Groups treated equally, YES

Not blinded- subjects, therapists or assessors

Assessing outcome

outcome measures:

*family members asked about patient frequency (no compliance charting)

*IIEF-5. ( dx tool for ED) scores 5-25, 5-7 severe, 22-25, no ED

Good validity, accuracy and reliability for ED, after RP

Acceptable drop out rate... yes (14%)

72 recruited-62 completed study, 9 excluded, 1 w/d due to severe complications

Intention to treat, YES

Treatment effect.. Improved Sexual function

Results

Sexual dysfunction rate measured at Baseline, 3 mo, 6 mo, 9 mo, 12 mo

Percent of sever sexual dysfunction

Ex group: 100%, 94.3, 88.6, 82.9, 65.7

Control group: 100%, 100, 100, 96.3 92.6

See table 3

Question 2

Improved sexual function due to ex

See table 4 , significant difference in ex group

Conclusion

Early PFME is beneficial for improving sexual function post RD.

Impact on practice/ clinical significance

clinicians need to be involved with patients soon after RD. good marketing info for MDs to send these patients to us for education. Ortho PTs often train knee patients with exercises before their surgery. What if PTs were to see RD patients B4 surgery to educate them on these exercises  then soon after surgery , nurses train patients or they get referred to us. Perhaps more docs would send patients to PT if they know the info. If  patients were aware of the info, they would be more apt to come in.

Michelle shared her protocol for electrical stimulation for ED and night time leaking -

Pre mod 100 MHz, 20 min in clinic for 3 sessions, then at home if patient perceives a benefit. Electrodes placed at S1 and S4 – channel one on the right and channel 2 on the left.