International Continence Society 2013 Review

No funds for international travel

No time to read the entire abstract journal issue

No worries

This one hour phone discussion will review abstracts and presentation given at the International Continence Society 2013 annual meeting in Barcelona August 28 to 30.  Abstracts most relevant to pelvic PT will be the focus.  Although we should not base clinical decision making on one abstract - these snap shots of research are the cutting edge and often foreshadow upcoming changes in practice.  So, if you want to be on the cutting edge of pelvic therapy - join us for a interactive discussion.   

Host and main speaker: Dr Beth Shelly PT, DPT, WCS, BCB PMD

Guest speakers: we will be joined  by several leaders in the field of pelvic PT
Cost - $20
Date - Wednesday October 23rd 8:30 EST

Registration for the course will include live conference call, access to conference call download (just in case you cannot attend the live version) and handout.  Instructions to access abstracts also available. 

Start by going to my web site and registering for the course. It is only necessary to complete those items with the red asterisk       http://www.bethshelly.com/courses.html   

Payment for the course can be completed at my web site.  http://www.bethshelly.com/pay_online.html   click "pay now".  You may use a PayPal account.  If you do not have a PayPal account click "don't have a PayPal account"  and it will bring up the credit card payment.

Upon receipt of registration I will send information on calling in.  Outline of course will be emailed before the course and link to conference recording will be emailed after the course.  

Please email me at beth@bethshelly.com if you have questions. 

Women with provoked vestibulodynia experience clinically significant reductions in pain regardless of treatment: Results from a 2-year follow-up study.

Davis SNP, Bergeron S, Binik YM, and Lambert B.

Article first published online: 12 SEP 2013 DOI: 10.1111/jsm.12309

The Journal of Sexual Medicine
Top of Form

Introduction Provoked vestibulodynia (PVD) is a prevalent genital pain syndrome that has been assumed to be chronic, with little spontaneous remission. Despite this assumption, there is a dearth of empirical evidence regarding the progression of PVD in a natural setting. Although many treatments are available, there is no single treatment that has demonstrated efficacy above others.

Aims The aims of this secondary analysis of a prospective study were to (i) assess changes over a 2-year period in pain, depressive symptoms, and sexual outcomes in women with PVD; and (ii) examine changes based on treatment(s) type.

Methods Participants completed questionnaire packages at Time 1 and a follow-up package 2 years later.

Main Outcome Measures Visual analog scale of genital pain, Global Measure of Sexual Satisfaction, Female Sexual Function Index, Beck Depression Inventory, Dyadic Adjustment Scale, and sexual intercourse attempts over the past month.

Results Two hundred thirty-nine women with PVD completed both time one and two questionnaires. For the sample as a whole, there was significant improvement over 2 years on pain ratings, sexual satisfaction, sexual function, and depressive symptoms. The most commonly received treatments were physical therapy, sex/psychotherapy, and medical treatment, although 41.0% did not undergo any treatment. Women receiving no treatment also improved significantly on pain ratings. No single treatment type predicted better outcome for any variable except depressive symptoms, in which women who underwent surgery were more likely to improve.

Discussion These results suggest that PVD may significantly reduce in severity over time. Participants demonstrated clinically significant pain improvement, even when they did not receive treatment. Furthermore, the only single treatment type predicting better outcomes was surgery, and only for depressive symptoms, accounting for only 2.3% of the variance. These data do not demonstrate the superiority of any one treatment and underscore the need to have control groups in PVD treatment trials, otherwise improvements may simply be the result of natural progression.

Does self-motivation improve success rates in pelvic floor muscle training in women with urinary incontinence in a secondary care setting?

Vella M, Nellist E, Cardozo L, Mastoroudes H, Giarenis I, Duckett J.

Int Urogynecol J 2013. Published online: May 24, 2013

Ann Dunbar PT, DPT, MS, WCS

September 11, 2013

Primary Aim:  To determine the effect of women’s self-motivation to perform pelvic floor muscle training (PFMT) on outcome, assessing both pre- and post-treatment with PFMT

Subjects:  Women with stress-predominant UI were recruited from 3 urogynecology clinics.  Exclusion criteria included:  Urgency predominant mixed UI; pregnancy/breastfeeding; symptomatic prolapse; surgery for UI in past 6 months; hematuria; UTI; bladder or urethral pain; anticholinergic medication.

Study Design:  Correlational  

Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women

Bo K, Hilde Gunvor, Jensen JS, Siafarikas F, Engh ME

Int Urogynecol J. 2013, June 08 published online

September 11, 2013

Ann Dunbar PT, DPT, MS, WCS

Primary Aim:  To investigate the influence of vaginal resting pressure (VRP), PFM strength (measured as maximum voluntary contraction (MVC)), and endurance at midpregnancy on delivery outcomes.

Subjects:  At week 18 of their first pregnancy, 300 women were recruited at the time of their US assessment.  Exclusion criteria:  multiple pregnancies or miscarriages after week gestational 16; premature birth before 32 weeks, stillbirth, or serious illness of child or mother.

Study Design: Prospective cohort  

New concept in biofeedback home trainers

Well here it is telemetry pressure PFM training.  This device works with your smart phone and a web based platform to provide individualized home biofeedback.  The device is a vaginal pressure biofeedback which displays contraction on the patient's phone.  It is programmed and monitored by the PT.  Very good for compliance checking or in situations where the PT is very far from the patient.  I certainly think there is a patient population for this device and it is worth a look for the treatment of simple PFM weakness.  Just to be sure I would never prescribe this without an internal exam and EMG evaluation in my clinic to identify overactive PFM.  Pressure is not useful for overactive PFM down training - need to stick with EMG, imaging or palpation for that.  Also want to monitor closely to make sure they are not bearing down and provide other treatments like bladder training and coordination of PFM during lifting and sneezing.   I would love to hear your thoughts on this device. 
  www.birdisolutions.com

Four new articles

1.	Care pathways to improve care co-ordination and quality between primary and hospital care for patients with radical prostatectomy: a quality improvement project.
	Van Houdt S, Heyrman J, Vanhaecht K, Sermeus W, De Lepeleire J.
	Qual Prim Care. 2013;21(3):149-55.
	PMID: 23968264 [PubMed - in process]
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2.	Women's experiences of doing long-term pelvic floor muscle exercises for the treatment of pelvic organ prolapse symptoms.
	Hyland G, Hay-Smith J, Treharne G.
	Int Urogynecol J. 2013 Aug 17. [Epub ahead of print]
	PMID: 23955582 [PubMed - as supplied by publisher]
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3.	Pelvic floor muscle training for urinary incontinence: a comparison of outcomes in premenopausal versus postmenopausal women.
	Betschart C, Mol SE, Lütolf-Keller B, Fink D, Perucchini D, Scheiner D.
	Female Pelvic Med Reconstr Surg. 2013 Jul-Aug;19(4):219-24. doi: 10.1097/SPV.0b013e31829950e5.
	PMID: 23797521 [PubMed - indexed for MEDLINE]
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4.	Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I-III pelvic organ prolapse.
	Kashyap R, Jain V, Singh A.
	Int J Gynaecol Obstet. 2013 Apr;121(1):69-73. doi: 10.1016/j.ijgo.2012.11.012. Epub 2013 Jan 17.
	PMID: 23332657 [PubMed - indexed for MEDLINE]
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