Pelvic Physiotherapy

Free Stuff

2012-02-19T13:32:00.000-08:00

Just want to remind everyone of the large amount of free articles available in the field of Pelvic PT.

Pub Med http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed

Just did a quick search with “pelvic floor muscle exercises” and came up with 715 documents – 73 free full text. Some are not in English and a few are very old but the majority are very good papers published by good researchers in reputable journals.

Free full PDF.com http://www.freefullpdf.com/

This site is not so good at finding a specific paper but will help with a wide search. The filters are not so good and many that come up are not appropriate. I plugged in “pelvic floor muscle exercises” and came up with 147,000. The first is an article on the comparison of two PFM training programs published in 2011 – nice article, third citation is a Cochrane review.

Saturday, April 16, 2011 post on this blog also has free resources

http://pelvicpt.blogspot.com/2011/04/free-resources-for-pelvic-physical.html

IOPTWH http://www.ioptwh.org/

Also wanted to remind members of the Section on Women’s Health that they are also members of the International Organization of Women’s Health Physical Therapists and have access to many list servs to ask clinical questions. Reach out, ask questions, read, or post. Just keep learning.

The Journal of Sexual Medicine. Volume 9, Issue 2

2012-02-04T16:44:00.000-08:00

Exercise is Associated with Better Erectile Function in Men Under 40 as Evaluated by the International Index of Erectile Function. Wayland Hsiao MD, Adam B. Shrewsberry MD, Kelvin A. Moses MD, PhD, Timothy V. Johnson MD, Amanda W. Cai BA, Peter Stuhldreher MD, Beau Dusseault MD, Chad W.M. Ritenour MD^.The Journal of Sexual Medicine. Volume 9, Issue 2, pages 524–530, February 2012.

The title of this paper says it all. Get those men out and exercising.

Sexual Functioning in Women and Men with Fibromyalgia. Fernando Rico-Villademoros MD1,*, Elena P. Calandre MD1, Carmen M. Rodríguez-López MD1, Jocelyne García-Carrillo PhD1, Javier Ballesteros MD2, Javier Hidalgo-Tallón MD1, Juan M. García-Leiva PhD1. The Journal of Sexual Medicine. Volume 9, Issue 2, pages 542–549, February 2012.

293 patients with fibromyalgia (276 females and 17 males) and 86 healthy controls (72 females and 14 males). The frequency of sexual dysfunction was significantly higher in patients with fibromyalgia than in controls for both females (86.9% vs. 23.6%) and males (76.5% vs. 6.7%).

Vaginismus: Heightened Harm Avoidance and Pain Catastrophizing Cognitions. Charmaine Borg MSc1,*, Madelon L. Peters PhD2, Willibrord Weijmar Schultz MD, PhD3, Peter J. de Jong PhD1. The Journal of Sexual Medicine. Volume 9, Issue 2, pages 558–567, February 2012

This study consisted of three groups: a lifelong vaginismus group (N = 35), a dyspareunia group (N = 33), and women without sexual complaints (N = 54). The study found women with vaginismus showed significantly heightened levels of catastrophic pain cognitions compared with the other two groups. This finding was shown to have cumulative predictive validity for the presence of vaginismus and may be important in treatment offered.

The urine stream interruption test (UST)

2012-02-01T19:01:00.001-08:00

For many years healthcare practitioners have been recommending that patients stop their urine to learn and training the PFMs. Below is a collection of papers on the maneuver. You may draw your own conclusion but I do not recommend this test as a measure of function or a training maneuver.

1. Sampselle CM, DeLancey JOD. The urine stream interruption test and pelvic muscle function Nurs Res 1992 41(2):73-77.

First article describe the test using a uroflow chair. The showed repeatability and correlation between decreased PFM strength and slower speed of interrupting urine flow.

Average time till stop:

· Nulliparous = 1.96 seconds

· Primiparas = 3.6 seconds

· Multiparous = 4.4 seconds. 20 subjects.

Pelvic Organ Prolapse on TV

2012-01-28T09:52:00.000-08:00

Good publicity for pelvic organ prolapse. I suggest patients listen. Share with your patients.

http://www.secondopinion-tv.org/episode/pelvic-organ-prolapse#Full_Episode

Four interesting articles

2012-01-24T04:47:00.000-08:00

Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet, Volume 378, Issue 9798, Pages 1244 - 1253, 1 October 2011

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960749-6/abstract?elsca1=ETOC-LANCET&elsca2=email&elsca3=segment

15 min per day or 90 min per week of moderate exercise had a 14% reduced risk of morality. This was true across all ages, sexes, and even when cardiovascular risks were present.

Etiological, Diagnostic and Therapeutic Consideration of the Myofascial Component in Chronic Pelvic Pain. Díaz-Mohedo E, Barón-López FJ, Pineda-Galán C. Actas Urol Esp. 2011 Sep 12. [Epub ahead of print] [Article in English, Spanish]

http://www.ncbi.nlm.nih.gov/pubmed?term=Etiological%2C%20Diagnostic%20and%20Therapeutic%20Consideration%20of%20the%20Myofascial%20Component%20in%20Chronic%20Pelvic%20Pain.

Too bad my Spanish is not better. Full article is available but only the abstract is in English. Very interesting.

Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 2011 Sep 28;306(12):1344-1351. Barry MJ et al. http://www.ncbi.nlm.nih.gov/pubmed/21954478

Study is not in support benefit of saw palmetto use.

Management of nocturia. Faisal Rauf Khan et al. Trends in urology and men’s health. Vol 2, issue 5, 4-43, sept/ oct 2011 http://onlinelibrary.wiley.com/doi/10.1002/tre.223/pdf

Wells done summary. Full article available free.

A randomized clinical trial for women with vulvodynia: cognitive-behavioral therapy vs. supportive psychotherapy.

2012-01-18T09:01:00.000-08:00

Masheb R. M., Kerns R. D., Lozano C. et al. A randomized clinical trial for women with vulvodynia: cognitive-behavioral therapy vs. supportive psychotherapy. Pain. 2009; 141: 31-40.

Appraiser: Stephanie Bush, DPT

1/11/12

Clinical Bottom Line:

Psychosocial treatments for vulvodynia are effective and well-tolerated, and CBT, a directed treatment approach that involves specific pain-relevant coping and self-management skills, yields better outcomes in pain severity, sexual function, and patient satisfaction compared to a less directed approach.

Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation.

2012-01-18T08:59:00.000-08:00

Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead W. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum. 2007;50:428-441.

Appraised by: Beth Northrop PT, DPT

January 11, 2012

Clinical Bottom Line: Incorporating biofeedback training with behavioral training is effective for improving constipation symptoms and quality of life in patients with pelvic floor dyssynergia.

Study design: single-blinded randomized controlled trial with intention to treat

PTJ January 2012 and J of Women’s Health PT December 2011

2012-01-08T15:01:00.001-08:00

This month’s issue of PTJ has several interesting articles.

“Catastrophizing during and after pregnancy” sheds some light on pain perception surrounding pregnancy and postpartum recovery. The tool sited (Pain catastrophizing scale) is easily available by a quick Google search http://www.aaompt.org/education/conference10/Break_Out_Sessions/Pain_Catastrophizing_Scale.doc with scoring information http://www.qcomp.com.au/media/29380/pain-catastrophising-scale---scoringpcs[1].pdf and validation studies http://www.ncbi.nlm.nih.gov/pubmed/10984864 . Centralization of pain is a topic rightfully receiving a great deal of research, discussion and publications. A recent publication in PTJ (Psychological Factors in Chronic Pelvic Pain in Women: Relevance and Application of the Fear-Avoidance Model of Pain PHYS THER October 2011 91:1542-1550) discussed the use of the “Fear avoidance scale” in patients with pelvic pain. I suspect this tool (Pain catastrophizing scale) could also be used in CPP.

December Journal of Women’s Health PT has a wonderful article along this same topic “The puzzle of pelvic pain”. It dives into the topic of pain perception and gives practical suggestions with evidence. Great article (might be in the March journal club). Must read. CSM programing will also support this topic.

January PTJ also includes a comparison of several tools used in the assessment of pelvic girdle pain. The Pelvic Girdle Questionnaire came out on top with good psychometrics and discriminant validity. Caution should be given as one of the authors of this study (Britt Stuge) is one of the researchers of the Pelvic Girdle Questionnaire. Still it is a very good tool. The full scale is available in the July 2011 PTJ. This paper was also reviewed in the August Pelvic Physiotherapy Distance Journal club http://pelvicpt.blogspot.com/2011/08/stuge-b-garrett-jenssen-h-grotle-m.html

So good to see pelvic PT in the main stream publications on a regular basis.

January 11,2012 Pelvic Physiotherapy Distance Journal Club

2012-01-06T07:59:00.000-08:00

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com
Please keep background noise to a minimum (see below for more details)

This month’s discussion

Masheb RM, et al. A randomized clinical trial for women with vulvodynia: cognitive behavioral therapy vs supportive psychotherapy. Pain 2009;141:31-40.

Heyman S, et al. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Disc Colon Rect 2007;50(4):428-441.

Pelvic PT Blog 2011

2011-12-29T18:47:00.001-08:00

Saturday February 5, 2011 the first post was placed on this blog. It has been a busy year in research and I hope this blog has helped you stay on top. Joining this blog will help as alerts on new posts will be sent to your email. Look forward to more updates and summaries this year.

72 posts

14 members

4,372 page views

10 countries

· US – 2,393

· Germany – 212

· UK - 164

· India – 149

· Russia – 139

· Australia – 114

· Netherlands – 68

· South Korea – 49

· France – 47

· Canada - 44

The Pelvic Physiotherapy Distance Journal club has been very successful and we have a busy year ahead. Check out the year end summary http://pelvicpt.blogspot.com/2011/12/2011-pelvic-physiotherapy-distance.html#more Email me at beth@bethshelly.com if you would like to join.

There is also a LinkedIn group associated with the journal club. http://www.linkedin.com/groups?gid=3997188&trk=hb_side_g

Also remember the IOPTWH list serv. As a member of the SOWH you can join any (or all) of the IOPTWH list servs. There you can post patient questions or comment on others. Check out the members only section of the web site http://www.womenshealthapta.org/

Keep in touch and post comments or share new info. Keep the journal going and always be joyful. God Bless to you and yours.

Beth

Radical prostatectomy versus watchful waiting in early prostate cancer

2011-12-14T06:11:00.000-08:00

Might be a game changer for urologists. - Longest-Running Trial of Watchful Waiting -

The study shows that, at 15 years, the cumulative incidence of death from prostate cancer was 14.6% among 347 men randomized to prostatectomy and 20.7% among 348 men being observed without treatment.

However, the survival benefit was confined to men younger than 65 years of age. For men older than 65 years, survival was highly similar in the 2 groups. The new data from the ongoing Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) appear in the May 5 issue of the New England Journal of Medicine. It has been conducted in men with predominantly symptom-detected early prostate cancer. All the men had clinical stage T1 or T2 disease, well or moderately well differentiated histologic findings, and a prostate-specific antigen (PSA) level of below 50 ng/mL. Worth reading.

Hung H, Hsiao S, Chih S, Lin H, Tsauo J. Effect of Pelvic-Floor Muscle Strengthening on Bladder Neck Mobility: A Clinic al Trial

2011-12-12T17:29:00.000-08:00

Pelvic Physiotherapy Think Tank
December 7, 2011
Michelle Spicka
Objective: The aim of the study was to investigate the effect of PFM strengthening on bladder neck mobility for women with stress UI or mixed UI.

Subjects: 23 patients between 18 and 65 who had at least one episode of SUI or MUI during the previous month. .

Study Design/Method: Each participant underwent a PFM strengthening program for 4 months. Participants were asked to perform 3-5 sets of 6 near-maximal contractions daily (hold for 10 seconds and relax for at least 10 seconds). Fast contractions (1 second contraction with 1 second relaxation) were added after the sustained contractions, with a target of 10 reps in every set. Bladder neck position at rest and during a cough, the Valsalva maneuver, and a PFM contraction was assessed by transperineal ultrasonography before and after the intervention. There was no blinding of subjects or evaluators in this study.

Oxford Levels of Evidence: This study was a single-group pretest-posttest design - Level 3
Read more »

Adibi P, Mazdak H, Derakhshandeh A, Toghiani A. Change in functional bowel symptoms after prostatectomy: a case-control study. J Res Med Sci. 2011 February; 16(2):130-135.

2011-12-12T17:26:00.000-08:00

Pelvic Physiotherapy Think Tank

December 7, 2011

Michelle Spicka

Objective: The goal of this study was to compare the relative frequency changes in IBS symptoms in the patients who underwent prostate surgery.

Subjects: 126 patients (66 in a case group and 66 in a control group) were involved. 66 patients (33 with a TURP and 33 with an open prostatectomy) were interviewed from 3-12 months postop. 66 patients (a control group who had the same prostate symptoms but were waiting for surgery in that time period) were interviewed also. Both case and control groups were selected using convenience time-based sequential sampling from a single academic center under treatment by one urologic surgeon.

Study Design/Method: A structured interview was designed for data gathering and patients were interviewed during follow up in the clinic.

Oxford Levels of Evidence: case-control study design - Level 4

2011 Pelvic Physiotherapy Distance Journal Club Summary

2011-12-08T05:21:00.000-08:00

The Pelvic Physiotherapy Distance Journal Club started meeting this year with the intent to share research and information on the rehabilitation of patients with disorders of the pelvis, urogenital, and colorectal systems. We have had 10 meetings with the first meeting March. Meetings have covered a wide variety of topics. Outlines of December meeting will be posted soon.

I now have 91 PTs on the journal club email list. In addition, I have heard from many PTs that they have listened to the meeting on pod cast at a later time. All meeting are still available for download or you can listen right from the computer (September meeting was not recorded due to technical issues). I have collected all outlines and pod casts on one CD. Please email me at beth@bethshelly.com if you are interested in the back issues of the meetings.

A Randomized, Double Blind, Placebo Controlled Trial of Pelvic Floor Exercises in the Treatment of Genuine Stress Incontinence.

2011-11-25T08:38:00.000-08:00

This was one of the articles that was cited in the last Pelvic Physiotherapy Distance Journal club discussion on Optimizing pelvic floor muscle exercises. This article randomized 44 patients to perform home exercises of 4 second PFM exercises or 4 second hip abductor exercises.

· Both groups had 64% of patients reporting improvement (no formal outcome measure, no specifics of how much change).

· No difference in 2 groups perineometry scores – both got better – no numbers given

· Pad test better in abductor group, worse in PFM exercise group – WOW

· The really interesting point is the adherence to exercises. – on average participants did 52 exercises per week – 7 or 8 per day. I think we can all agree (including the authors) this is not enough.

Overall I would say the study design was poor and though the results are intriguing, I would have to see a better study to believe that hip abductor exercises are as effective as PFM exercises in decreasing SUI. Read for yourself.

November 9, 2011 Pelvic Physiotherapy Distance Journal Club

2011-11-10T18:12:00.000-08:00

Discussion centered on PFM exercise routines. Still more questions than answers. Check out the outlines posted on this blog. Also make sure to answer the survey about the journal club if you received the link. Next month’s meeting is December 7^th. Already planning for next year. 2012 schedule is below.

This month’s discussion

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux MC. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence. Arch Phys Med Rehabil 2010;91:1059-1063.

Dumoulin C, Glazner, C, Jenkinson D. Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence. Neurourol and Urodynam 2011;30:746-753.

Listening / downloading recordings

Meetings will be recorded so they can be shared with others who were not able to attend
https://www.freeconferencecall.com
Top right corner – “log in”
Access code – 436790

Dial-in number – (209) 647-1000

Subscriber PIN – 883352

Choose the date you want to access – you can playback or download in several formats. If you want to save it to your computer you click “wav” and choose “save” – name the file and choose the location to save it.

2012 schedule

January 11 – Cindy Neville

February 8 - No journal club this month

March 7 – Beth Shelly

April 4 – Jane O’Brien

May 9 – Ann Dunbar

June 6 – Michelle Spicka

July 11 –

August 8 –

September 5 -Ann Dunbar

October 10 – MJ Strauhal

November 7 – Beth Shelly

December 5 – Michelle Spicka

Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence.

2011-11-10T18:06:00.000-08:00

Dumoulin C, Glazner, C, Jenkinson D. Neurourol and Urodynam 2011;30:746-753.

Beth Shelly November 9, 2011

Second International Consultation on Incontinence Research Society Bristol June 2010 – experts in the field chosen to present and debate and eventually summarize selected topics.

“It is no longer a question of whether PFM training programs work but what components (including adjunct therapies) and combinations there of are most effective.” Page 752

Comparing PFM exercises for SUI to no treatment

· Women who were treated were 17 times more likely to report cure or improvement

· They experienced between 0.8 and 3 few leaks per 24 hours

· Were 5 to 16 times more likely to be continent on pad test

Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence.

2011-11-10T18:04:00.000-08:00

Dumoulin C, Bourbonnais D, Morin M, Gravel D, Lemieux MC. Arch Phys Med Rehabil 2010;91:1059-1063.

Beth Shelly November 9, 2011

Background

· Women who continue with UI 3 months post-partum have a significant risk of symptoms persisting 5 years later.

· Cochrane review – PFM exercises decrease SUI

Error in terminology

“Pelvic floor physiotherapy uses graded muscle training, either alone ….” This sentence (written by physiotherapists) creates and contributes to the confusion other professional have about what we do and what it should be called. Pelvic floor physiotherapy is a treatment for the pelvic floor provided by physiotherapists. So can a nurse provide pelvic floor physiotherapy? Certainly we would say “no” but nurse can provide “graded muscle training, either alone or ….”. More appropriate alternative would be - “Pelvic floor physiotherapists use graded muscle training, either alone…”

Center for Evidenced Based Medicine

2011-11-04T06:43:00.000-07:00

The Centre for Evidence-based Medicine was established in Oxford as the first of several UK centers with the aim of promoting evidence-based health care. The CEBM provides free support and resources to doctors, clinicians, teachers and others interested in learning more about EBM.

EBM Tools section has a great deal of information

· Asking Focused Questions

· Finding the Evidence

· Critical Appraisal

· Making a Decision

· Evaluating Performance

· Designing Research

The critical appraisal section is quite good and has documents to help you review articles and understand terminology better. http://www.cebm.net/index.aspx?o=1157

Also of note is the 2011 Levels of Evidence Chart.

http://www.cebm.net/mod_product/design/files/CEBM-Levels-of-Evidence-2.1.pdf

This is a great web site.

November 9, 2011 Pelvic Physiotherapy Distance Journal Club

2011-10-28T05:51:00.000-07:00

November 9, 2011 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com
Please keep background noise to a minimum (see below for more details)

This month’s discussion

Dumoulin C, Glazner, C, Jenkinson D. Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence. Neurourol and Urodynam 2011;30:746-753.

Pelvic Physiotherapy Distance Journal Club 2011 survey

2011-10-26T09:12:00.001-07:00

The Pelvic Physiotherapy Distance Journal Club started meeting this year with the intent to share research and information on the rehabilitation of patients with disorders of the pelvis, urogenital, and colorectal systems. We have had 8 meetings with the first meeting March covering a wide variety of topics.

Date	Topics	# of callers
3-2-11	Prognostic indicators for success in PT with SUI patients Validity and reliability of digital PFM assessment	18
4-6-11	PFM activity in different positions Pelvic alignment altered by PFM spasm	12
5-4-11	Evidence of adding TrA training to PFM training Physical exam findings in CPP – comparing PT and MD results	10
6-8-11	How to critique a research study	9
7-6-11	PFM changes after PFM training Effect of abdominal and PFM tasks on pressure and bladder neck position	11
8-10-11	Pelvic girdle questionnaire Variation in anal resting pressure with various breathing techniques	11
9-7-11	Motor control patterns in ASLR in patients with and without PGP Levator trauma associated with POP	16
10-5-11	MFR feasibility study and case study	14

I now have 68 PTs on the journal club email list. In addition, I have heard from many PTs that they have listened to the meeting on pod cast at a later time. All meeting are still available for download or you can listen right from the computer (September meeting was not recorded due to technical issues).

The core group of leaders is now planning for the 2012 journal club meetings and would like your input to make the group even more usable. Please take just a few minutes to answer a quick questionnaire.

http://www.zoomerang.com/Survey/WEB22DKEET9YQ2

Thanks

Four interesting articles

2011-10-12T07:24:00.001-07:00

Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet, Volume 378, Issue 9798, Pages 1244 - 1253, 1 October 2011

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960749-6/abstract?elsca1=ETOC-LANCET&elsca2=email&elsca3=segment

15 min per day or 90 min per week of moderate exercise had a 14% reduced risk of morality. This was true across all ages, sexes, and even when cardiovascular risks were present.

http://www.ncbi.nlm.nih.gov/pubmed?term=Etiological%2C%20Diagnostic%20and%20Therapeutic%20Consideration%20of%20the%20Myofascial%20Component%20in%20Chronic%20Pelvic%20Pain.

Too bad my Spanish is not better. Full article is available but only the abstract is in English. Very interesting.

Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA 2011 Sep 28;306(12):1344-1351. Barry MJ et al. http://www.ncbi.nlm.nih.gov/pubmed/21954478

Study is not in support benefit of saw palmetto use

Management of nocturia. Faisal Rauf Khan et al. Trends in urology and men’s health. Vol 2, issue 5, 4-43, sept/ oct 2011 http://onlinelibrary.wiley.com/doi/10.1002/tre.223/pdf

Wells done summary. Full article available free.

October 5, 2011 Pelvic Physiotherapy Distance Journal Club

2011-10-09T21:03:00.000-07:00

This month’s journal club lead by Jane O’Brien focused on myofascial release and the treatment of pelvic pain. The difficulties in researching this modality are highlighted in the article presented. The case study showcases the benefits of treatment.

This month’s discussion

Fitzgerald MP, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J or Urol 2009;182:570-580.

Jane K. O’Brien , PT, MSPT. Physical Therapy Management of a Patient with Dyspareunia and Scoliosis: A Case Report. Unpublished case report using myofascial release.

Guided imagery for relaxation and healing

2011-10-06T12:36:00.001-07:00

Donna Carrico NP at Beaumont Hospital in Royal Oak Michigan has developed two CDs specifically for women with pelvic pain, interstitial cystitis or vulvodynia. Ms Carrico runs the Women’s Initiative for pelvic pain, and Sexual Health program (WISH) which provides intensive treatment for women with pelvic pain. The CDs are extremely well done and provide four different opportunities (2 on each CD). Images of healing light, restful meadow, soothing shoreline, and breathing exercises are used to encourage relaxation. Ms Carrico’s voice is very soothing and the choice of words is positive and supportive. For a donation of $15 you will receive both CDs. http://www.beaumonthospitals.com/files/imce/GuidedImageryCDOrderForm.pdf

I would recommend every woman’s health PT look into these CDs.

October 5, 2011 Pelvic Physiotherapy Distance Journal Club

2011-10-03T05:27:00.000-07:00

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com
Please keep background noise to a minimum (see below for more details)

This month’s discussion

Fitzgerald MP, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J or Urol 2009;182:570-580.

Jane K. O’Brien , PT, MSPT. Physical Therapy Management of a Patient with Dyspareunia and Scoliosis: A Case Report. Unpublished case report using myofascial release.

Reviews on Pain Management

2011-09-26T05:01:00.000-07:00

Cochrane Review Tackles Acute Postoperative Pain

This review begins a process of reevaluating the effect of pain medication. It appears they are currently working on a similar paper on chronic pain which should be very interesting. Even though PTs do not prescribe pain medications, it is important for us to understand the current thoughts on usage of medications. I will be watching for more on this.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008659.pub2/abstract

http://www.medscape.com/viewarticle/749816?src=nl_topic

National Coverage Analysis (NCA) Tracking Sheet for Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain (CAG-00429N)

More review of the treatment of pain. Unfortunately this may result in loss of coverage for TENS units.

“CMS will review available evidence on the use of TENS for the treatment of chronic low back pain. We are particularly interested in receiving evidence speaking to the health outcomes attributable to the use of TENS in home settings.”

Would be good for PTs to post if you have some input / evidence.

http://tinyurl.com/TENSreview

Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women.

2011-09-23T07:22:00.000-07:00

Very interesting paper on biofeedback for PFM dysfunction. Unfortunately it does point out the argument against biofeedback – increased patient contact. Is it only the increased patient contact or does the machine add to the treatment.

Cochrane Database Syst Rev. 2011; (7):CD009252 (ISSN: 1469-493X)

Herderschee R ; Hay-Smith EJ ; Herbison GP ; Roovers JP ; Heineman MJ
Department of Obstetrics & Gynaecology Academic Medical Centre, University of Amsterdam, Kerkstraat 379b, Amsterdam, Netherlands, 1017 HW.
BACKGROUND: Pelvic floor muscle training (PFMT) is an effective treatment for stress urinary incontinence in women. Whilst most of the PFMT trials have been done in women with stress urinary incontinence, there is also some trial evidence that PFMT is effective for urgency urinary incontinence and mixed urinary incontinence. Feedback or biofeedback are common adjuncts used along with PFMT to help teach a voluntary pelvic floor muscle contraction or to improve training performance.
OBJECTIVES: To determine whether feedback or biofeedback adds further benefit to PFMT for women with urinary incontinence.To compare the effectiveness of different forms of feedback or biofeedback.
Read more »

Five Interesting Articles

2011-09-14T06:36:00.000-07:00

I receive table to contents from a number of journals each month. Here are a few I have found interesting in the past several months. Hope you find them interesting also. I would love to know what articles you are finding that are interesting. Post on the blog or email me beth@bethshelly.com

NAFC's New Health Forum

2011-09-11T08:01:00.000-07:00

NAFC recently partnered with Inspire.com to bring you a new online support community. NAFC and Inspire have created a community where members can discuss bladder and bowel health and offer support to each other.

More than just a forum where individuals can post discussion topics, Inspire is a community of members in which one can write journal entries, add friends, maintain a profile and contribute to the discussion. NAFC's support community serves as a safe place to exchange questions, stories and suggestions about bladder and bowel control problems and even make some new friends along the way.

Click here to access NAFC's New Online Support Community!

Bladder Health Awareness Campaign

2011-09-11T07:59:00.000-07:00

Recently, NAFC began its nation-wide Bladder Health Awareness campaign. With the launch of the new website, last month, NAFC now has more tools to help educate the public about bladder health. Activities throughout this campaign are channeled in a countdown to National Bladder Health Week, November 14-18, 2011.

Read the blogs, articles and news bulletins to stay up-to-date with the latest treatment and management options for bladder dysfunction. Participate in the simple suggested activities to improve your bladder health and promote this campaign to others.

Specific exercises to treat pregnancy-related low back pain in a South African population. Kluge J, Hall D, Louw Q, Theron G, Grové D. Int J Gynaecol Obstet. 2011 Jun;113(3):187-91.

2011-09-09T12:43:00.000-07:00

OBJECTIVE:

To investigate the effect of an exercise program, including specific stabilizing exercises, on pain intensity and functional ability in women with pregnancy-related low back pain.

METHODS:

Fifty women between 16 and 24 weeks of pregnancy were recruited at Tygerberg and Paarl Hospitals, Western Cape, South Africa. Twenty-six women were randomized to a 10-week exercise program and 24 were randomized as controls.

RESULTS:

Overall, the most frequent type of back pain experienced was lumbar pain (36 [72.0%]). Pain intensity (P=0.76) and functional ability (P=0.29) were comparable between the groups on study entry. In the study group, there was a significant improvement in pain intensity (P<0.01) and an improvement in functional ability (P=0.06) at the end of the study. In the control group, there were no significant changes in pain intensity (P=0.89) or functional ability (P=0.70) at the end of the study.

CONCLUSION:

A specific exercise program decreased back pain intensity and increased functional ability during pregnancy in South African women with lumbar and pelvic girdle pain.

Article supports use of exercise in decreasing pregnancy related LBP.

September 7, 2011 Pelvic Physiotherapy Distance Journal Club

2011-09-08T05:06:00.000-07:00

Discussion continues on intra-abdominal pressure adding the component of levator avulsion. Each month adds more to the picture and brings up more questions.

The group also discussed the need for more patient education on birth trauma and recovery. It was proposed that the SOWH consider another task force to develop and disseminate such a document.

Unfortunately I was not able to record this month’s call but will work on fixing that for next month. See outlines below. We will be thinking about the schedule for next year. I would like to send out a short survey to all on the journal club list. Please let us know what is working or not working for you. Looking forward to next month’s call.

This month’s discussion

Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG 2008;115:979-984.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in pain-free subjects. Spine 2008;34(1):E1-E8.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects. Spine 2009;34(9):861-870.

World Congress of Physical Therapy 2011

2011-09-05T19:45:00.000-07:00

All of the available abstracts and PowerPoint presentations from the World Congress of Physical Therapy 2011 can now be accessed online at the link below. Notice that there is a search function at the top of the page.

http://www.wcpt.org/posters_and_ppts

Abstracts and web cast for the International Contenence Society meeting just completed are also aviable on the ICS web site. More details and highlights coming soon.

September 7, 2011 Pelvic Physiotherapy Distance Journal Club

2011-08-24T04:23:00.000-07:00

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com
Please keep background noise to a minimum (see below for more details)

This month’s discussion

Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG 2008;115:979-984.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in pain-free subjects. Spine 2008;34(1):E1-E8.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects. Spine 2009;34(9):861-870.

Stuge B, Garrett A, Jenssen H, Grotle M: The Pelvic Girdle Questionnaire: A Condition-Specific Instrument for Asssessing Activity Limitations and Symptoms in People with Pelvic Girdle Pain. Phys Ther. 2011;91:1-11.

2011-08-12T06:05:00.000-07:00

August 10, 2011 Michelle Spicka

Objective: The objective of this study was to develop a condition-specific measure, the Pelvic Girdle Questionnaire (PGQ), for sue during pregnancy and postpartum.

Introduction:

1) In general, literature does not make a clear distinction between pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) but there is growing evidence that PGP disorders comprise a distinct subgroup with a unique clinical presentation and a need for specific management.

a. For adequate evaluation of interventions, reliable and valid outcome measures are needed

2) Outcome measures that have been validated for LBP are not necessarily the most appropriate ones for PGP

a. The Pregnancy Mobility Index (van de Pol, et al 2006) has activity items that are based on literature research and clinic experience but does not include the views of patients.

b. Current outcome measures may not adequately capture the specific problems and consequences that patients describe, and there is a discrepancy between patients’ scores and their feedback.

3) This study was designed to develop a condition-specific measure for use both during pregnancy and postpartum in research and clinical practice. After the application of Rasch analysis, the final questionnaire was assessed for test-retest reliability and construct validity.

Benetti TH, Santos MF, Mergulhao MEA, Fagundes JJ, Ayrizono MJS, Coy CSR: Variation of the Anal Resting Pressure Induced by Postexpiratory Apnea Effort in Patients with Constipation. Arq Gastroenterol 2011; 48(1):30-5.

2011-08-12T06:01:00.000-07:00

August 10, 2011 Michelle Spicka

Objective:

To analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced post-expiratory apnea in subjects with secondary constipation.

Introduction:

1. Functional evacuation disorders that lead to constipation are not completely understood (dyskinesia of the pelvic floor) but functional change is common (though underestimated) as a cause of chronic constipation and studies report that 50% of individuals suffer from constipation.

a. Dyskinesia of the pelvic floor is characterized by difficulty initiating the evacuation and

sensation of incomplete evacuation secondary to failure of relaxation of the puborectal and external anal sphincter or contraction of those muscles during evacuation.

b. The observation that the Valsalva, used by some patients at the end of the evacuation effort, could be an aggravating favor of constipation led to this study to compare this variable with apnea after forced expiration.

c. Patients with dyskinesia of the pelvic floor tend to have decreased rectal sensitivity and muscular incoordination during the act of evacuation, showing an unconscious paradoxical contraction, exacerbated by the Valsalva.

August 10, 2011 Pelvic Physiotherapy Distance Journal Club

2011-08-12T05:58:00.000-07:00

We had continued discussions of the effect of intra-abdominal pressure on the PFM. More questions, some new ideas, lots of stimulating discussion. Check out the pod cast. Outlines of the talks are posting in this blog with links to more articles and references.

This month’s discussion

Stuge B, Garrett A, Jenssen H, Grotle M: The Pelvic Girdle Questionnaire: A Condition-Specific Instrument for Asssessing Activity Limitations and Symptoms in People with Pelvic Girdle Pain. Phys Ther. 2011;91:1-11.

Benetti TH, Santos MF, Mergulhao MEA, Fagundes JJ, Ayrizono MJS, Coy CSR: Variation of the Anal Resting Pressure Induced by Postexpiratory Apnea Effort in Patients with Constipation. Arq Gastroenterol 2011; 48(1):30-5.

Continue the discussion on LinkedIn group - Pelvic Physical Therpay Distance Journal Club
http://www.linkedin.com/groups?gid=3997188&trk=hb_side_g

August 10, 2011 Pelvic Physiotherapy Distance Journal Club

2011-07-29T08:14:00.000-07:00

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com
Please keep background noise to a minimum (see below for more details)
Call will begin promtpy at 8:30 EST

This month’s discussion

New links to FDA alert on POP mesh

2011-07-26T05:14:00.000-07:00

The FDA has posted three new links with information on the surgical complications of mesh for the treatment of POP. This is creating quite a stir. Check it out.
http://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM262760.pdf
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/UroGynSurgicalMesh/default.htm

Would be great to hear the reaction from MDs.

FDA: Surgical placement of mesh to repair pelvic organ prolapse poses risks

2011-07-23T06:49:00.000-07:00

On July 13, 2011 the FDA posted a news release and an alert on the risks of mesh in the treatment of pelvic organ prolapse (POP). Link to the news release using the title of this post or the link below This is a quick summary and includes this statement by the FDA.

“The FDA issued a safety communication in 2008 due to increasing concerns about adverse events associated with the transvaginal placement of mesh. Since then, the number of adverse events has continued to climb. From 2008 to 2010, the FDA received 1503 adverse event reports associated with mesh used for POP repair, five times as many as the agency received from 2005 to 2007.”

The full alert can be found at http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm It includes recommendations for healthcare providers and recommendations for patients. It does suggest consideration of non-surgical options but does not list any specific non-surgical treatments.

Sherrie Palm from the Association for Pelvic Organ Prolapse Support has posted another side of the story which is also important to consider. http://pelvicorganprolapsesupport.org/library/sherrie_palm_articles I would expect other medical professional groups will also formally respond. Will be interesting to see the results of the meeting in September.

REFERENCES for Sherrie's post

https://www.augs.org/AboutAUGS/MediaCenter/PressReleases/PelvicFloorDisordersWillImpactasManyasOne/tabid/491/Default.aspx .

http:www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm262752.htm.2011;July 13 .

http://www.intelihealth.com/IH/ihtPrint/WSIHW000/333/8988/14066249.html .

http:www.ehow.com/about_5660232_hernia-mesh-complications.html

http://www.modernmom.com/article/statistics-on-complications-of-cosmetic-surgery .

It is important for PTs to know about this discussion and the resultant regulations or recommendations. Would be nice if this resulted in more conservative treatment!!!

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm262752.htm

Behavioral Therapy With or Without Biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy UI a randomized controlled study

2011-07-20T05:20:00.000-07:00

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

2011-07-19T10:00:00.000-07:00

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.

2011-07-17T14:07:00.000-07:00

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.

2011-07-11T06:12:00.000-07:00

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.

2011-07-11T06:09:00.001-07:00

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

July 6, 2011 Pelvic Physiotherapy Distance Journal Club

2011-07-11T06:07:00.000-07:00

This month’s call created a great deal of discussion about intra-abdominal pressure, what we know and what we don’t know. Additional articles were referenced and evidence was discussed. We have also gone international with the addition of Helena Frawley PT from Australia on the call. Outlines will be posted on this blog in the next two posts. This would be a recording to listen to right from the computer, downloaded on your IPod, or burn a cd. Stay tuned for more stimulating discussion next month Aug 10, 2011.

This month’s discussion

Junginger B, Baessler K, Sapsford R, Hodges P. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J 2010 21:69-77.

Hoff Braekken I, Majida M, Engh ME, Bo K. Morphological changes after pelvic floor muscle training measured by 3-dimentional ultrasonography A randomized controlled trial. Ob Gyn 2010 115(2):317-324.

July 6, 2011 Pelvic Physiotherapy Distance Journal Club

2011-06-29T19:19:00.000-07:00

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com

This month’s discussion

Junginger B, Baessler K, Sapsford R, Hodges P. Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck. Int Urogynecol J 2010 21:69-77.

Hoff Braekken I, Majida M, Engh ME, Bo K. Morphological changes after pelvic floor muscle training measured by 3-dimentional ultrasonography A randomized controlled trial. Ob Gyn 2010 115(2):317-324.

Physical therapy reimbursement on National Public Radio

2011-06-10T10:33:00.000-07:00

This past week (June 6, 2011) National Public Radio aired a story limited reimbursement and its impact on PT care. It is quite good and brings to light an issue that hits pelvic PTs hard as we can only see one patient at a time. It is relatively short but worth reading / listening to. Bravo to NPR.

http://www.npr.org/2011/06/06/135385837/high-costs-limited-care-a-pain-for-therapy-patients

June 8, 2011 Pelvic Physiotherapy Distance Journal Club

2011-06-10T10:26:00.000-07:00

We had a good group Wednesday night for the research discussion. Outline provided by Pam Downey was already emailed to the journal club members and will not be posted here. Pam is working on a check sheet that can be used to review articles as you read them. That will be posted when available. The call was 70 minutes and packed with good information about how to read a research paper. The recording is available for download if you were not on the call or if you want to listen to it again. Ann has already picked articles for the July 6^th call. I am sure it will be another stimulating conversation. Schedule for the rest of the year is below. Have a great summer.

Critiquing a Research Study by Pam Downey

June 8, 2011 Pelvic Physiotherapy Distance Journal Club

2011-06-02T19:16:00.000-07:00

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com

This month’s discussion - Critiquing a Research Study by Pam Downey

Neurourology and urodynamics vol 30, issue 1 and 4 2011

2011-05-31T05:07:00.000-07:00

Neurourology and urodynamics vol 30, issue 1 2011

Reference values for the nocturnal bladder capacity index – this paper adds to the complexity possible with measured voided volume diaries. I highly recommend having patient measure volumes and calculating nocturnal polyuria or low bladder capacity if possible.

Protracted postpartum urinary retention – This is very important for the acute postpartum patient. Second stage of labor and vacuum were significant independent risk factors. Complete resolution should occur within 28 days.

Eight interesting articles

2011-05-27T07:03:00.000-07:00

Review of Physical Therapy Journal March

This month’s issue has three articles that caught my eye. Maybe you have some input.

Utilization and clinical outcomes of out patient physical therapy for Medicare beneficiaries with musculoskeletal conditions – very interesting – worth reading
Depressive symptoms, anatomical region, and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain. – higher depression in women and those with chronic pain. Depression “contributed additional variance” to pain intensity. Our patients fall into this category and it is important to recognize the influence of depression.
Responsiveness to change of 10 physical tests used for patients with back pain

Vaginismus on Discovery/TLC television

2011-05-23T06:00:00.001-07:00

Some of you may have already seen this but thought it was worth posting again. It aired on TLC April 3, 2011. http://www.womentc.com/content.php?keyword=Media&ArticleID=138

This version is without commercials and takes about 22 minutes. It is very well done and quite accurate except for insurance coverage. The treatment described includes simultaneous treatment by a PT and a psychologist. I do not have experience with the billing of co-treatments. I do separate PT treatments and do receive coverage by most insurances under the code muscle spasm. I am sure many of you have the same experience.

I have read their book Private Pain. It is a good book for supporting patients as it has many testimonials about the impact of vaginismus and the success of the treatment. The treatments are not described. I would be happy to offer private or group distance learning on the physical therapy treatment of vaginismus. Certainly there is a range of severity and many patients have success with primary physical treatment. Email me if you are interested beth@bethshelly.com

Evidence of Benefit of Transverse Abdominus Training Alone or in Combination with Pelvic Floor Muscle Training to Treat Female UI: A Systematic Review.

2011-05-15T07:56:00.000-07:00

Introduction:

PFMT is recommended for first line of treatment of SUI and Mixed UI (50 RCTs). Due to synergistic activity between TrA and PFM with normal trunk activities, it is theorized that one can train TrA to enhance PFMT. The authors reviewed journal publications to find evidence to support TrA training alone or in combination with PFMT for treatment of SUI and mixed UI in women to determine if current clinical practice should be replaced with new model or if current practice should change.

Sapsford et al dispute several issues in this study via a letter to the editor. Their comments are listed in bold.

Physical exam findings by physical therapists compared with physicians of musculoskeletal factors in women with chronic pelvic pain Journal of the Section on Women's Health, Sept- Dec 2010, pp73-79

2011-05-15T07:51:00.000-07:00

Introduction: PTs and physiatrist have extensive MS training. Purpose was to compare ability of physiatrist and PTs ability to differentiate women with CPP from those without it.

Methods:

48 non pregnant women aged 18-55, mean age 35, CCP group and non pain group

4 blinded examiners (2 MD, 2 PT), 1 MD and 1 PT would see pt 30 minutes apart and do the MS exam maneuvers. Goal was to diagnosis / identify CPP. This is quite different from evaluating a patient to determine a PT plan of care.

Celebrate Women's Health Week May 8-14

2011-05-13T12:11:00.000-07:00

I guess they have a “week” for everything. Great to hear there is a Women’s Health week. This was posted on the APTA newsletter. “On Wednesday, the Pennsylvania House of Representatives unanimously adopted HR 277, recognizing the role of physical therapists in promoting the health of women.” I am always excited to hear women’s health PT being recognized in main stream medicine. A step forward HAY!!!! http://www.apta.org/PTinMotion/NewsNow/2011/5/13/HR277/

Single blind, randomized controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women

2011-05-10T05:38:00.000-07:00

Bo K, Talseth T, Holme I. Single blind, randomized controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999, 318:487-493.

Subjects: 107 females 24 to 70 yo

Groups – 6 months of treatment

PFM exercises – 8 to 12 contractions TID with weekly PT visits
Electrical stimulation – intermittent, 50 Hz, 30 min qd, monthly PFM re eval, instructed not to do PFM contractions
Vaginal cones – 20 min per day, monthly PFM re eval
Control – given pads

Neurourology and Urodynamics (vol 29, issue 8) - 2010 winter issue

2011-05-02T06:07:00.000-07:00

This issue, as usual, has a number of very interesting papers. The editorial gives an update on the journal itself. Time to print is decreasing and the number of pages will be increased this year.

Pelvic floor muscle training in the treatment of lower urinary tract dysfunction in women with multiple sclerosis (Lucio) This RTC is supportive of PFM exercises in patient with MS. Treatment group received pressure biofeedback treatment twice per week for 12 weeks. They were asked to perform 30 long holds and 3 minutes of fast twitch exercises 3 times per day without feedback. Unfortunately the PERFECT scale was used to measure muscle function – not very reliable. Even so, post treatment measurements showed improvements in endurance, number of repetitions and fast twitch contractions with little change in “power” a trend that I see clinically with many patient populations.

Journal on Women’s Health PT Vol 34 #3, Sept/ Dec 2010

2011-04-29T07:30:00.000-07:00

As usual another issue packed with thought provoking, and interesting information. I have just received the Spring issue and working hard to keep the flow of information timely. Many a probably way ahead of me and have already read this issue. I would love to hear your comments. The major feature is posters and platforms from CSM. Many good research projects are represented. I am looking forward to the full papers.

The editorial is on ambiguity and the use of treatments that (in the editor’s opinion) are not evidence based such as visceral mobilization and craniosacral therapy. I certainly cannot argue with the lack of evidence in these particular areas (and others in women’s health). And I would suggest therapist continue to PUBLISH some level of evidence on these treatments. In addition I think that only providing treatments that have been fully studied will limit patient success. They did not stop using penicillin just because they did not understand how it works. I believe some of my patients fail orthopedic PT because the therapist only considered treatments with extensive evidence. My treatment includes some of those treatments and often results in success when others fail. Certainly I would not charge insurance and keep seeing the patient if my treatments were not changing their symptoms – whether I am using evidence based treatments or those with less evidence. Variety is good.

May 4, 2011 Pelvic Physiotherapy Distance Journal Club

2011-04-25T17:20:00.000-07:00

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com

This month’s articles

Neville C, et al. Physical Exam Findings by Physical Therapists Compared with Physicians of Musculoskeletal Factors in Women with Chronic Pelvic Pain. Journal of Section on Women’s Health, Sept-Dec 2010, pp 73-79

Bo K, et al. Evidence of Benefit of Transverse Abdominus Training Alone or in Combination with Pelvic Floor Muscle Training to Treat Female UI: A Systematic Review. Neurology and Urodynamics 28:368-373 (2009).

Sapsford, Hodges and Smith. Retort: Letter to the Editor, Neurology and Urodynamics 29: 800-801 ( 2010)

Recent articles of interest

2011-04-20T06:45:00.000-07:00

The following is a list of articles that pelvic PTs may be interested in from the first part of 2011. I found them interesting. Hope they are interesting to you also.

BJU International

Volume 107, Issue 8 Page i - 1019

The long-term efficacy of sacral neuromodulation in the management of intractable cases of bladder pain syndrome: 14 years of experience in one centre (pages 1258–1264)
Jerzy B. Gajewski and Ali A. Al-Zahrani
Article first published online: 30 SEP 2010 | DOI: 10.1111/j.1464-410X.2010.09697.x

Free Resources for Pelvic Physical Therapists

2011-04-16T16:10:00.000-07:00

I have been on the look out for free stuff and have an expanded list. Some things have been posted before and some are new. I would love to hear what you have found for free.

International Continence Society - has posted 4 on line courses. These are available free of charge to members and provide a great wealth of information. http://www.icsoffice.org/eLearning/Home.aspx Classes are 1 to 3 hours. Titles include: Brain and bladder, Headache in the pelvis – chronic pelvic pain, Overactive bladder – do we need a new paradigm?, urodynamic equipment – limitations and challenges.

PT Journal Collections – Women’s Health

2011-04-16T16:07:00.000-07:00

The following is a list of 19 articles published in Physical Therapy Journal from 1988 to 2010 that are public access. In fact all PTJ articles are public access one year after publication. These are wonderful resources for learning and marketing.

Summary of Physical Therapy Journal April 2011

2011-04-11T15:40:00.000-07:00

Quick input on 5 of the PTJ articles for this month. It's a quick read.

Managing chronic nonspecific LBP with a sensorimotor retraining approach – This one is worth reading - sounds like it will help abdominal patients also. It is modeled after Moseley’s treatment of RSD in the extremities but applied to the back. Includes sensory training and motor training. The technique is very well described, seems it would be possible to try with patients. I will report if I find a patient to try it on - Let me know if you do.

April 6, 2011 Pelvic Physiotherapy Distance Journal Club

2011-04-07T18:45:00.000-07:00

No technical difficulties and a lot of good discussion this month. Thanks to all who contributed (10 callers). I think we all have more questions than answers. Check out the recordings and outlines below.

This month’s articles

Bendova P, Ruzicka P, Peterova V, Fricova M, Springrova I. MRI-based registration of pelvic alignment affected by altered pelvic floor muscle characteristics. Clinical Biomechanics 2007;22:980-987.

Sapsford et al. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil 2008;89:1741-1747.

Listening / downloading recordings

Meetings will be recorded so they can be shared with others who were not able to attend
https://www.freeconferencecall.com
Top right corner – “log in”
Access code – 436790
Dial-in number – (209) 647-1000
Subscriber PIN – 883352
Choose the date you want to access – you can playback or download in several formats. If you want to save it to your computer you click “wav” and choose “save” – name the file and choose the location to save it.

ICS eLearning center

2011-04-06T07:28:00.000-07:00

The International Continence Society has posted 4 on line courses. These are available free of charge to members and provide a great wealth of information. This is an active ICS project with more courses being developed. Check back here for new courses. At the bottom of the page other resource links are also provided.

April 6, 2011 Pelvic Physiotherapy Distance Journal Club

2011-03-28T19:04:00.000-07:00

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com

This month’s articles

Bendova P, Ruzicka P, Peterova V, Fricova M, Springrova I. MRI-based registration of pelvic alignment affected by altered pelvic floor muscle characteristics. Clinical Biomechanics 2007;22:980-987.

Sapsford et al. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil 2008;89:1741-1747.

How Can Doulas Improve the Musculoskeletal Health of Childbearing Women?

2011-03-23T18:47:00.000-07:00

This handout was used during two recorded lectures for a local group of Doulas. I have posted them here as a resource for others. I hope you find them useful. Recordings (reference # 5 and 6) can be downloaded or listened to in the same location as the journal club recordings.

https://www.freeconferencecall.com
Top right corner – “log in”
Access code – 436790
Dial-in number – (209) 647-1000
Subscriber PIN – 883352
Choose the date you want to access – you can playback or download in several formats. If you want to save it to your computer you click “wav” and choose “save” – name the file and choose the location to save it.

Doulas have a unique position

· Ability to interact with healthy women who are interested in being healthy

· Prenatal and post partum visits

· Many opportunities but 2 very important

Avoiding long term low back pain (LBP) and pelvic girdle pain (PGP) associated with pregnancy and delivery
Maximizing the function of the pelvic floor muscle (PFM)

Physical Therapy Journal Updates – December 2010 and January 2011

2011-03-21T06:07:00.000-07:00

Physical therapist management of chronic prostatitis / chronic pelvic pain syndrome. Van Alstyne LS, Harrington KL, Haskvitz EM. Phys Ther 2010;90(12):1795-1806.

This is a great addition to the evidence for pelvic PT. It is a very well done case study of 2 men with CPPS. This article can be used for marketing / insurance justification itself and has many other articles sited which could also be helpful. The authors have done a very good job of summarizing the literature on CPPS dx, sx, tests, and rx. Both patients improved significantly within 12 visits and had complete resolution of symptoms on one year follow up.

Pelvic PT Pelvic Floor Muscle Examination

2011-03-10T19:02:00.000-08:00

Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standard terminology of the international continence society. Slieker-ten Hove 2009.
Below is a table outlining the parts of a PFM evaluation

The PRAFAB-Questionnaire

2011-03-10T18:56:00.001-08:00

This outcomes measure seems to be used a lot in the Netherlands. It was sited in the Netherlands practice guidelines for urinary incontinence and in the article discussed 3/9/11 “Prognostic indicators for poor short term outcome of physiotherapy intervention in women with SUI”. In the article discussed they used the first 3 questions as the Leak Severity Scale (LS) with a possible high score of 12 and low score of 3. A change of more than 4 was considered recovery / success. http://www.gezondheidstoestand.nl/files/E_Hendriks_Minimal_important_change_van_de_PRAFAB.pdf

http://www.ncbi.nlm.nih.gov/pubmed/17563109

March 9, 2011 Pelvic Physiotherapy Distance Journal Club

2011-03-10T18:53:00.000-08:00

A good first try. After two rocky spots in the beginning we did manage to get through a stimulating discussion of the two listed articles. We had 18 total callers. Just a reminder that we are not taking attendance. We are happy for all who can join in the discussion or just listen and hope others will access the recording at a later time. The following is an outline of the two articles. Please see the end of this post for information on listening to the recordings and future journal club meetings.

This month’s articles

Hendriks, EJM et al. Prognostic indicators of poor short term outcome of physiotherapy intervention in women with stress urinary incontinence. Neurourol and Urodynam. 2010, 29:336-343.

Slieker-ten Hove MCP et al. Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standard terminology of the international continence society. Neurourol and Urodynam 2009, 28:295-300.

Listening / downloading recordings

Meetings will be recorded so they can be shared with others who were not able to attend
https://www.freeconferencecall.com
Top right corner – “log in”
Access code – 436790

Dial-in number – (209) 647-1000

Subscriber PIN – 883352

Choose the date you want to access – you can playback or download in several formats. If you want to save it to your computer you click “wav” and choose “save” – name the file and choose the location to save it.

Section on Women’s Health – CSM update 2011

2011-03-06T06:38:00.000-08:00

It has been about a month since CSM in New Orleans (Feb 8 to 5, 2011). As usual the meeting was a great success with awesome educational programming, a wonderful exhibit hall, productive networking, and a bit of fun on the side. This year was a bit different for me as I did not have loads of meetings and was able to really get the flavor of CSM from all angles. I do not have the final numbers but I did hear we continue each year to have higher attendance. This year over 8,000 attended. Thanks to all the volunteers who make CSM such a great success.

AUA IC Guidelines

2011-03-04T09:54:00.000-08:00

http://tinyurl.com/AUA-IC-guidelines

The American Urological Association released the first version of Clinical Guidelines for Interstitial Cystitis / Painful Bladder Syndrome (IC/PBS) on March 1, 2011. This landmark document was created by 14 well know and respected professionals including one nurse practitioner (Diane Newman), one PhD, and one dietician. In addition they solicited input from 84 peer reviews. I had the honor of submitting input to the draft document in May 2010. The documents reviews literature and makes recommendations for diagnosis and treatment of IC/PBS including treatments that should not be offered. Diagnostic procedures suggested are primarily related to history and physical with urodynamics and cystoscope only offered in complex conditions. Treatment suggestions are divided into 7 groups.

March 9, 2011 Pelvic Physiotherapy Distance Journal Club

2011-03-02T07:20:00.000-08:00

Time - 8:30 PM EST for one hour

FreeConfrenceCall.com

209-647-1000 access code 436790#
Email Beth if you are having trouble accessing the call - beth@bethshelly.com

This month’s articles – attached to this email

Hendriks, EJM et al. Prognostic indicators of poor short term outcome of physiotherapy intervention in women with stress urinary incontinence. Neurourol and Urodynam. 2010, 29:336-343.

The Royal Dutch Society for Physical Therapy (KNGF) translated evidence-based guidelines

2011-02-28T18:25:00.000-08:00

The Netherlands physiotherapists have done a great job at compiling evidenced based PT guidelines including on for SUI. This is the protocol used for the Hendrick's article we are discussing next week on the Pelvic Physiotherapy Distance Journal Club. It is another validation of our role in the treatment of SUI. I have not looked at any of the other guidelines but might be something else interesting on this site.
https://www.kngfrichtlijnen.nl/654/KNGF-Guidelines-in-English.htm

Contact me if you are interested in being part of the Pelvic Physiotherapy Distance Journal Club. It is a free, phone based, discussion of the literature. beth@bethshelly.com

New Continence Devices from Verity Medical Ltd

2011-02-25T07:30:00.000-08:00

As usual CSM provided a wealth of knowledge and experiences. I plan to post several blogs highlighting the conference. Those how know me, know I spend a lot of time in the exhibit hall. Not for the free stuff (although there was a larger than usual variety of pens and sticky notes this year) but for the contacts. Visiting with the vendors allows me to stay up on new devices, new books, new courses, and new products. Thus was the case this year at the Verity Medical booth. This company was started by Nigel Verity in the late 90s in the UK. Nigel has been in the business of creating EMG machines for many years previously working with Thought Technology. I had the pleasure of trying the Nutrac™ Pelvator which is being distributed in the

by American Imex. This is a home electrical stimulation for the PFM. I used it myself and felt the most comfortable PFM contraction I have felt from any ES device. I have not used it on patients but plan to experiment more. I would encourage others to also use this device with their patients. It has many built-in continence programs, a few custom options and a pain relief mode.

Agency for Healthcare Research and Quality - Diagnosis and Comparative Effectiveness of Treatments for Urinary Incontinence in Adult Women

2011-02-18T17:02:00.000-08:00

It has been 14 years since the last government guidelines on UI where published. These guidelines are now open for discussion until MARCH 2nd. It seems very important for PT to give input. I have not yet reviewed the document but the table for contents is very complete and behavioural treatments are reviewed. I would be interested in what others think. Check it out at this link.
http://tinyurl.com/AHRQguidlines2011

The Journal of Sexual Medicine Volume 8, Issue 2 Page 335 - 633

2011-02-08T06:48:00.000-08:00

A great issue with several articles women’s health PTs might be interested in. Here are a few.

Resident Education and Training in Female Sexuality: Results of a National Survey (pages 361–366)
Apurva B. Pancholy, Linda Goldenhar, Angela N. Fellner, Catrina Crisp, Steve Kleeman and Rachel Pauls
Article first published online: 8 DEC 2010 | DOI: 10.1111/j.1743-6109.2010.02117.x

91.5% report less than 5 hrs lecture on female sexual dysfunction
19.6% report often screening patients for sexual dysfunction
82.8% felt confident obtaining a sexual history
54.7% felt able to perform a physical exam for sexual function
55.1% had cared for women with dyspareunia
16.7% had cared for women with vaginismus
34 to 56% rarely or never suggest “ancillary therapy” such as counseling and meds – we need to do a better job at educating MD students on our role.

ttmed Urology – Timely Topics in Medicine

2011-02-05T07:03:00.000-08:00

This is a wonderful resource and entirely free. The site has a wealth of information and I am sure you could spend hours searching a reading. Urology is a huge topic and (in my opinion) more than 75% of urology topics are of little to no interest to Pelvic PTs. Focus is mainly on cancer, surgery, and drugs and although we should know some about these topics, in-depth knowledge is not necessary for good clinical practice. My hope is to do some of the searching for you and provide direction to interesting information. Most of the information on this site is meant to be viewed on the site – most are not able to be downloaded or saved to your computer. However, articles can be printed and some podcasts are downloadable.

Welcome

2011-02-05T06:59:00.000-08:00

Welcome to the first posting of the Pelvic Physiotherapy Blog. As I post many are getting ready to head south (hopefully for warmer weather) to attend the Combined Section Meeting of the American Physical Therapy Association (Feb 8 to 12, 2011 in New Orleans, LA). This meeting is packed with big name, international speakers like Diane Lee, Paul Hodges, David Wise, Sarah Meeks, and many others. Remember to download handouts before the meeting at the APTA web site (link below – I hope). Watch this blog for a review of highlights.

This blog is a work in progress. Expect to find summaries of research related to Pelvic Physiotherapy. Please join in the discussion. Also check my web site www.bethshelly.com for free stuff and course information. Let the journey begin and always be joyful.

APTA CSM information and handouts