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Pelvic Floor: Rehabilitation

Postnatal pelvic floor muscle training for preventing and treating urinary incontinence: where do we stand?
Dumoulin C
Curr Opin Obstet Gynecol. 2006 Oct;18(5):538-43.

PURPOSE OF REVIEW: Postnatal pelvic floor muscle training aims to rehabilitate the pelvic floor muscles. To be effective, a certain exercise dosage must be respected. Recent trials evaluated the effect of different programs on prevention/treatment of urinary incontinence immediately after delivery and in treatment of persistent incontinence. RECENT FINDINGS: Only three systematic reviews, six trials, and four follow-up studies have been published in the past two decades. High heterogeneity in postnatal pelvic floor muscle training programs is observed throughout the literature, making comparisons difficult. In the prevention/treatment of postnatal urinary incontinence immediately after delivery and in persistent incontinence, supervised intensive programs prove more effective than standard postnatal care. Longer-term results have yet to show advantages for postnatal training programs. SUMMARY: Although a certain exercise dosage must be respected for a postnatal pelvic floor muscle training program to be effective, a few randomized controlled trials present such dosage. Randomized controlled trials should study the effect of supervised, intensive training protocols with adherence aids. As standard care does not seem to reduce the prevalence of postnatal urinary incontinence, obstetrics services must address delivery of postnatal pelvic floor muscle training.

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Pelvic floor muscle training is not effective in women with UI in pregnancy: a randomised controlled trial.
Woldringh C, van den Wijngaart M, Albers-Heitner P, Lycklama A Nijeholt AA, Lagro-Janssen T
Int Urogynecol J Pelvic Floor Dysfunct. 2006 Aug 26;.

The objective of this study was to test the short- and long-term effects of pelvic floor muscle training (PFMT) during pregnancy in women at risk, i.e. women who were already affected by urinary incontinence (UI) during pregnancy. The intervention consisted of three sessions of PFMT between week 23 and 30 during pregnancy and one session 6 weeks after delivery, combined with written information. The research design was a randomised, controlled trial with four follow-ups up to 1 year after delivery. Participants in the study were 264 otherwise healthy women with UI during pregnancy, allocated at random to the intervention (112) or usual care (152) group. The main outcome measure was a UI severity scale and a 7-day bladder diary. No effect of pelvic floor muscle training was shown in this study at (half) a year after pregnancy. UI decreased strongly after pregnancy, irrespective of usual care or PMFT during pregnancy. For most women, usual care appears to be sufficient. The results support a 'wait and see' policy: wait for the urinary incontinence to take its natural course and see if, for women still incontinent half a year after pregnancy, pelvic floor muscle training is effective.


Placement of probes in electrostimulation and biofeedback training in pelvic floor dysfunction.
der Zalm PJ, Pelger RC, van Heeswijk-Faase IC, Elzevier HW, Ouwerkerk TJ, Verhoef J, Nijeholt GA
Acta Obstet Gynecol Scand. 2006;85(7):850-5.

Background. We examined the positioning of five commonly used probes in electrostimulation and biofeedback training. Materials and methods. Ultrasound and MRI were used to evaluate the position of these probes in two multiparous women, in reference to pelvic floor anatomy. Results. From caudal to cranial we identified the anal external sphincter, puborectal muscle, and levator group. Positioning of probes varied considerably: the recording plates are situated from 1 cm caudal to 6 cm cranial of the puborectal muscle. Most probes stretched, due to a relatively large diameter, the vagina wall, anal external sphincter, or puborectal muscle beyond physiological proportions. On straining, all probes were pushed upwards into the rectum. Conclusion. The positioning of all examined probes varied considerably. Hence it is not likely that these probes give a reliable and uniform registration of muscular activity of the pelvic floor function or are all optimal for electrostimulation.

'I'm not that sick!' Overcoming the barriers to hospice discussions.
Russell KM, LeGrand SB
Cleve Clin J Med. 2006 Jun;73(6):517, 520-2, 524.

Hospice programs care for patients facing life-limiting illness. Although patients and family members report that they are satisfied once they are enrolled in a hospice service, many patients are referred late or not at all. Several barriers and misconceptions about hospice likely contribute to its underuse. We explore these issues and provide guidance to more effectively communicate with patients about hospice services.

Yoga for rehabilitation in chronic pancreatitis.
Sareen S, Kumari V
Gut. 2006 Jul;55(7):1051.


Rehabilitation therapy and urinary incontinence after radical retropubic prostatectomy. A critical review of the literature.
Viola D, Comerci F, Martorana G
Urol Int. 2006;76(3):193-8.

Introduction: To assess the efficacy and evidence-based data in the literature about rehabilitation therapy in patients with post-prostatectomy urinary incontinence. Materials and Methods: An analysis of published full-length papers identified by a Medline search from 1990 through 2004 was carried out. Abstracts published in peer-reviewed journals in the same period of time were also considered. Results: Efficacy, tolerability and safety of rehabilitation therapy were evaluated, according to the available data in the literature, with special regard to randomized controlled trials in order to define a clear-cut, evidence-based efficacy of this form of therapy. Conclusions: Rehabilitation therapy is a simple and safe way of managing post-prostatectomy urinary incontinence. Nonetheless, few randomized controlled studies have been carried out so far to establish its evidence-based efficacy and it is thus not possible to be scientifically sure of its value. It is therefore necessary to undertake well-designed randomized controlled studies, with a large number of patients, a well-matched control group and an adequate follow-up. Copyright (c) 2006 S. Karger AG, Basel.


Learning outcomes of a group behavioral modification program to prevent urinary incontinence.

Sampselle CM, Messer KL, Seng JS, Raghunathan TE, Hines SH, Diokno AC
Int Urogynecol J Pelvic Floor Dysfunct. 2005 Nov-Dec;16(6):441-6. Epub 2005 Mar 15.

This study describes acquisition of knowledge and motor skill in bladder training (BT) and pelvic floor muscle training (PFMT) and adherence following a behavioral modification program (BMP). Essentially continent (0-5 episodes in past year) community-dwelling older women (n = 359) were randomized to treatment (n = 164), a 2-h group education session supplemented by one brief individualized session of approximately 10 min, or control (n = 195), no instruction, and followed for 12 months. Knowledge, motor skill, and adherence to the BMP were documented. Changes in pelvic muscle function and voiding interval were used to validate self-reported adherence. Following group instruction, mean BT and PFMT knowledge was 90 and 86%, respectively; 68% demonstrated correct PFMT technique without additional instruction, 29% required brief instruction, and 3% were unable to learn PFMT technique. Adherence ranged from 63 to 82% for PFMT and 58 to 67% for BT. Group instruction supplemented with brief individual instruction as needed is an effective teaching method for BT and PFMT.

The state of rehabilitation research: art or science?
Tate DG
Arch Phys Med Rehabil. 2006 Feb;87(2):160-6.

The state of rehabilitation research: art or science? Rehabilitation research has been criticized as not standing up enough to the rigors of scientific method to be called "science." The field has been portrayed as slow to promote its scientific achievements and to include them under the rubric of evidence-based rehabilitation. Following in the footsteps of psychology, rehabilitation as a broad-based discipline has faced many similar obstacles in achieving scientific status. Controversy exists about what exactly constitutes rehabilitation science versus its art and its respective multidisciplinary domains. The conception of these domains is directly related to current methods available to assess the state of the discipline and its research accomplishments. I used quantitative methods, such as randomized clinical and/or controlled trials (RCTs) and systematic reviews, to assess the status of rehabilitation research. Findings suggest that, as a field, rehabilitation makes significant contributions to science, measurable by the number and quality of RCTs and systematic reviews conducted so far on topics of critical importance for clinical care. In "artful" complement, qualitative approaches can be used as research tools to aid investigators in seeking knowledge beyond that obtained by quantitative methods, assessing many complexities associated with the various contexts of rehabilitation research. Other requirements to develop a common vision of rehabilitation science are also discussed.

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