10-10-12 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

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This month’s discussion

Rosenbaum TY and Padoa A. Managing pregnancy and delivery in women with sexual pain disorders. J Sex Med 2012;9:1726–1735.

 Outline with thought provoking questions also provided.  Please review and be ready to discuss.

Two resources for pelvic pain classification and treatment

European Association of Urology (EUA) has published guidelines on chronic pelvic pain with a useful classification system and suggestions for treatment. (Engeler 2010)

http://www.uroweb.org/gls/pdf/24_Chronic_Pelvic_Pain_LR%20March%2023th.pdf

o   Axis 1

§  Specific disease associated pelvic pain

§  Pelvic pain syndrome

o   Axis 2 – System

o   Axis 3 – end organ pain syndrome

o   Axis 4 - referral characteristics

o   Axis 5 – temporal characteristics

o   Axis 6 – character

o   Axis 7 – associated symptoms

o   Axis 8 – psychological symptoms

The association between pelvic floor muscle function (PFM) and pelvic girdle pain (PGP)---A matched case control 3D ultrasound study. Britt Stuge*, Kaja Sætre, Ingeborg Hoff Brækken Manual Therapy 17 (2012)

Ann Dunbar PT,DPT,MS WCS

September 5, 2012

Primary Aim: To investigate the difference in voluntary pelvic floor muscle function in women with and without clinically diagnosed PGP.

Subjects:  49 consecutive women who were at least 6 months postpartum and were patients of physical therapists (diagnosis criteria listed in article) in Oslo, Norway, matched with 49 controls for age, number of vaginal deliveries and age of her children.

Study Design: 0ne-to-one matched case-controlled study

Methods:

Procedures

• Completed a questionnaire of sociodemographic data, gynecological health status, and functional status (see pg 151 for instruments used)
• PFM function assessed by visual observation and vaginal palpation with subject in supine.
• Vaginal manometry with middle of balloon placed 3.5 cm internal from vaginal introitus
• Vaginal 3D ultrasound with probe on perineum in sagittal plane as per recommendations of Dietz (2004)

--Participants performed 3 PFM contractions in supine and each recorded

 --In 18 participants this was repeated immediately for test-restest analysis

Searching for pelvic floor muscle exercises on YouTube: what individuals may find and where this might fit with health service programmes to promote continence.

Ann Dunbar PT, DPT, MS, WCS

September 5, 2012                                              

Primary Aim: to increase awareness of the type of video clips available to the public on pelvic floor muscle exercises (PFME) by investigating, categorizing/characterizing the clips from the perspective of the ‘wisdom of the crowd’ and to assist in developing information used for continence education.

Data Focus: used ‘snow ball’ technique for search and navigation protocol; used terms “Pelvic Floor Exercise” in YouTube search

                Excluded: clips only mentioning PFME or providing pelvic floor anatomy, clips with sexual focus,

                                clips used only to advertise a product

                Inclusions: clips useful in supporting or motivating women toward PFME

Study Design: Descriptive

Maternal Position and Other Variables: Effects on Perineal Outcomes in 557 Births. Meyvis I, Rompaey BV, Goormans K, Truijen S, Lambers S, Mestdagh E, Mistiaen W BIRTH 39:2 June 2012

Trisha Jenkyns 8-8-12

Primary Aim: To investigate the effect of the maternal position (lateral vs lithotomy) and other variables (demographic characteristics, gravidity, parity, duration of pregnancy, reason for admission, and mode of labor) on perineal outcomes or the occurrence of perineal damage

Study Design:  retrospective cross-sectional design

Methods:

Hospital records were collected & examined from a regional hospital in Belgium from November 2008 to November 2009 of all women (between 37 and 42 weeks gestation) who were delivering vaginally.  Exclusion criteria: premature delivery & any kind of operative delivery because these conditions could necessitate episiotomy.

Does the Epi-No® Birth Trainer reduce levator trauma? A randomized controlled trial Shek, KL, Chantarasorn V, Langer S, Phipps H, Dietz HP

Trisha Jenkyns 8-8-2012

Primary Aim:
To evaluate whether antepartum use of a birth trainer (Epi-No®) may reduce levator trauma.

Null hypothesis was: “Antepartum use of the Epi-No® device does not reduce the incidence of trauma to the puborectalis muscle”.

 

“The Epi-No® Birth Trainer (Starnberg Medical, Tecsana GMBH, Muenchen, Germany) was designed by a German doctor, Wilhelm Horkel. He designed an inflatable silicon balloon coupled to a pressure display hand pump to gradually stretch the vagina and perineum in late pregnancy to reduce the risk of perineal trauma during vaginal birth. To date, the limited data available in the literature seem to support his observation.”

Study Design: Randomized controlled pilot study