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