Cristine Homsi Jorge Ferreira

Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometer.

OBJECTIVE To evaluate the inter-rater reliability of the modified Oxford Grading Scale and the Peritron manometer. DESIGN All participants were evaluated twice, first by one examiner and 30 days later by a second examiner. Measurements of vaginal squeeze pressure were compared with the results from the palpation test. PARTICIPANTS Nineteen women with a mean age of 23.7 years (range 21 to 28 years). RESULTS Inter-rater reliability for vaginal palpation was fair (κ=0.33, 95% confidence interval 0.09 to 0.57). Using the Peritron manometer, the difference between examiners was less than 10cmH(2)O in 11 of the 19 (58%) cases. The palpation test did not differentiate between weak, moderate, good and strong muscle contractions. This study found fair inter-rater reliability for the modified Oxford Grading Scale and moderate inter-rater reliability for the Peritron manometer. CONCLUSIONS The inter-rater reliability of vaginal squeeze pressure measurement using the Peritron manometer is acceptable and can be used in re-evaluations performed by different examiners in clinical practice. However, for research purposes, the ideal situation would be for a single examiner to assess and re-assess the subject. Vaginal palpation is important in the clinical assessment of correctness of a pelvic floor muscle contraction, but this study does not support the use of the modified Oxford Grading Scale as a reliable and valid method to measure and differentiate pelvic floor muscle strength.

Evaluation of Sexual Function in Brazilian Pregnant Women

The objective of the present study was to evaluate the sexual function of pregnant women and to identify the potential variables associated with it. The study was conducted on 137 low-risk, sexually active pregnant women who filled out the Female Sexual Function Index (FSFI) questionnaire. Although 61% of the women assessed presented an FSFI score ≤26.5, they declared that they were satisfied with the emotional proximity to their partner, with their relationship, and with their sex life. A positive association was detected between sexual dysfunction and gestational age and a report of urinary incontinence and excessive weight gain in the current pregnancy.

Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial

BACKGROUND The use of the pelvic floor muscle training for urinary incontinence treatment is well established but little is known about its effects in labor and newborn outcomes. OBJECTIVES To evaluate the effects of antenatal pelvic floor muscle training and strength in labor and newborn outcomes in low-income pregnant women. METHODS This is a randomized controlled trial that recruited forty-two nulliparous healthy pregnant women aged between 18-36 years old and able to contract the pelvic floor muscles. The participants were included in the study with 20 weeks of gestational age and had their pelvic floor muscles measured by vaginal squeeze pressure. They were randomly allocated into two groups: training group and a non-intervention control group. Then, all participants had their labor and newborn outcomes evaluated through consultation of medical records by a blinded researcher. RESULTS There were no statistically significant differences between the groups regarding gestational age at birth, type of labor, duration of the second stage of labor, total time of labor, prevalence of laceration, weight and size of the baby, and Apgar score. No correlation was observed between pelvic floor muscle strength and the second stage or the total length of labor. CONCLUSIONS This randomized controlled trial did not find any effect of pelvic floor muscle training or pelvic floor muscle strength on labor and newborn outcomes.

Is the Sexual Satisfaction of Postmenopausal Women Enhanced by Physical Exercise and Pelvic Floor Muscle Training

INTRODUCTION Physical exercise including pelvic floor muscle (PFM) training seems to improve the sexual function of women with urinary incontinence. This effect in postmenopausal women who are continent has not yet been determined. AIM The aim of this study was to assess the effect of a 3-month physical exercise protocol (PEP) on the sexual function and mood of postmenopausal women. METHODS Thirty-two sedentary, continent, sexually active women who had undergone menopause no more than 5 years earlier and who had follicle stimulating hormone levels of at least 40 mIU/mL were enrolled into this longitudinal study. All women had the ability to contract their PFMs, as assessed by vaginal bimanual palpation. Muscle strength was graded according to the Oxford Modified Grading Scale (OMGS). A PEP was performed under the guidance of a physiotherapist (M.M.F.) twice weekly for 3 months and at home three times per week. All women completed the Sexual Quotient-Female Version (SQ-F) and the Hospital Anxiety and Depression Scale (HADS) before and after the PEP. MAIN OUTCOME MEASURES SQ-F to assess sexual function, HASDS to assess mood, and OMGS to grade pelvic floor muscle strength. RESULTS Thirty-two women (24 married women, eight women in consensual unions) completed the PEP. Following the PEP, there was a significant increase in OMGS score (2.59 ± 1.24 vs. 3.40 ± 1.32, P < 0.0001) and a significant decrease in the number of women suffering from anxiety (P < 0.01), but there was no effect on sexual function. CONCLUSION Implementation of our PEP seemed to reduce anxiety and improve pelvic floor muscular strength in sedentary and continent postmenopausal women. However, our PEP did not improve sexual function. Uncontrolled variables, such as participation in a long-term relationship and menopause status, may have affected our results. We suggest that a randomized controlled trial be performed to confirm our results.

Comparison between measurements obtained with three different perineometers

OBJECTIVE: To analyze the results obtained in the evaluation of intra-vaginal pressure using three different brands of perineometers in nulliparous volunteers. MATERIALS AND METHODS: Twenty nulliparous women with no anatomical alterations and/or dysfunction of the pelvic floor were enrolled in our study. All the women had the ability to voluntarily contract their PFM (Pelvic Floor Muscles), as assessed by digital palpation. The intra-vaginal pressure was assessed using three different brands of perineometer (Neurodyn Evolution™, SensuPower™ and Peritron™). Each volunteer was evaluated on three alternate days by a single examiner using a single brand of perineometer on each day. In the assessment, the volunteers were required to pull (contract) their PFM in and up as strongly as possible 3 times and to sustain the contraction for 5 seconds, with an interval of 30 seconds between each pull. For the statistical analysis, a concordance correlation coefficient was used to compare the values that were obtained with each brand of perineometer. RESULTS: A moderate concordance (0.51) was found between the results from the Peritron™ and Neurodyn™ perineometers, a fair concordance (0.21) between the Peritron™ and SensuPower™ brands and a poor concordance (0.19) between the Neurodyn™ and SensuPower™ brands. CONCLUSION: The concordance of the measurements of the intra-vaginal pressure ranged from poor to moderate, suggesting that perineometers of different brands generate different results.

Massage reduced severity of pain during labour: a randomised trial.

QUESTION Does massage relieve pain in the active phase of labour? DESIGN Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. PARTICIPANTS 46 women pregnant at ≥ 37 weeks gestation with a single fetus, with spontaneous onset of labour, 4-5cm of cervical dilation, intact ovular membranes, and no use of medication after admission to hospital. INTERVENTION Experimental group participants received a 30-min lumbar massage by a physiotherapist during the active phase of labour. A physiotherapist attended control group participants for the same period but only answered questions. Both groups received routine perinatal care. OUTCOME MEASURES The primary outcome was pain severity measured on a 100mm visual analogue scale. Secondary outcomes included the Short Form McGill Pain Questionnaire, pain location, and time to analgesic medication use. After labour, a blinded researcher also recorded duration of labour, route of delivery, neonatal outcomes, and the participants satisfaction with the physiotherapist during labour. RESULTS At the end of the intervention, pain severity was 52mm (SD 20) in the experimental group and 72mm (SD 15) in control group, which was significantly different with a mean difference of 20mm (95% CI 10 to 31). The groups did not differ significantly on the other pain-related outcome measures. Obstetric outcomes were also similar between the groups except the duration of labour, which was 6.8hr (SD 1.6) in the experimental group and 5.7hr (SD 1.5) in the control group, mean difference 1.1hr (95% CI 0.2 to 2.0). Patients in both groups were satisfied with the care provided by the physiotherapist. CONCLUSION Massage reduced the severity of pain in labour, despite not changing its characteristics and location.

Physiotherapy treatments for breast cancer-related lymphedema: a literature review

El cancer de seno es el segundo tipo de cancer mas comun entre las mujeres. La cirugia es parte del proceso terapeutico en la prevencion de la diseminacion de la enfermedad, sin embargo, puede ser causa de algunas complicaciones como el linfedema. La fisioterapia contribuye para su tratamiento con diferentes tecnicas que vienen siendo desarrolladas a lo largo de los anos. El objetivo de esta revision sistematica de la literatura es presentar las modalidades fisioterapeuticas aplicadas en el tratamiento del linfedema. La revision bibliografica fue efectuada en libros textos y en las bases de datos LILACS, PubMed y SciELO, en el periodo de 1951 a 2009. Entre los recursos fisioterapeuticos utilizados en el tratamiento del linfedema estan la terapia compleja descongestiva (TCD), compresion neumatica (CN), estimulacion electrica de alto voltaje (EVA) y laserterapia. Los trabajos analizados muestran que los resultados son mejores con las tecnicas combinadas. La TCD es el protocolo mas utilizado, y su asociacion con la CN se muestra eficaz. Las nuevas tecnicas EVA y laser presentan resultados satisfactorios.Breast cancer is the second most frequent cancer among women. Surgery is part of the therapeutic process to prevent metastases, but it can also cause some complications, including lymphedema. Physiotherapy contributes to its treatment, using different techniques that have been developed over the years. This systematic literature review aims to present physiotherapy modalities applied for lymphedema therapy. The literature review was conducted using textbooks and Lilacs, Pubmed and Scielo databases, from 1951 to 2009. Physiotherapy resources used for lymphedema treatment include complex decongestive therapy (CDT), pneumatic compression (PC), high voltage electrical stimulation (HVES) and laser therapy. The analyzed literature shows that better results are obtained with combined techniques. CDT is the most used protocol, and its association with PC has demonstrated efficacy. The new techniques HVES and laser present satisfactory results.

Reflexões sobre as bases conceituais que fundamentam a construção do conhecimento acerca da lombalgia na gestação

Low back pain is a problem that is faced by 50% of pregnant women and causes important social trouble. In spite of this, the problem is considered to be normal and is expected during pregnancy, which has contributed to the lack of prophylactic and relief measures. This work aims at understanding the historical and conceptual bases that have given rise to such naturalization as outlined by midwifery and by using world literature indexed on the topic from 1987 to 1997 as a theoretical framework. We have apprehended that a deterministic view related to this issue is supported by the biomedical model. Therefore, the adoption of effective solutions requires the incorporation of a new paradigm.A lombalgia na gestacao acomete cerca de 50% das gestantes, causando importantes transtornos sociais. Apesar disso, ela vem sendo considerada como uma ocorrencia normal e ate esperada na gravidez, o que tem contribuido para a falta de adocao de medidas profilaticas e de alivio. Buscamos neste trabalho compreender as bases conceituais historicas que originaram esta naturalizacao, usando como recorte a obstetricia e como referencia a literatura mundial sobre o tema indexada de 1987 a 1997. Apreendemos que a visao determinista relacionada ao problema respalda-se no modelo biomedico. Assim, a adocao de solucoes efetivas requer a incorporacao de um novo paradigma.Low back pain is a problem that is faced by 50% of pregnant women and causes important social trouble. In spite of this, the problem is considered to be normal and is expected during pregnancy, which has contributed to the lack of prophylactic and relief measures. This work aims at under standing the historical and conceptual bases that have given rise to such naturalization as outlined by midwifery and by using world literature indexed on the topic from 1987 to 1997 as a theoretical framework. We have apprehended that a deterministic view related to this issue is supported by the biomedical model. Therefore, the adoption of effective solutions requires the incorporation of a new paradigm.

Does pelvic floor muscle training improve female sexual function? A systematic review.

Introduction and hypothesisWe performed a review of the literature reporting on the effects of pelvic floor muscle training (PFMT) on female sexual function (SF).MethodsPubmed (from 1946 to December 2014), Ovid Medline (from 1946 to December 2014), CINAHL (from 1937 to December 2014), PsycINFO (from 1805 to December 2014), Scopus and Cochrane Central Register of Controlled Trials were searched by two independent reviewers. Randomised controlled trials (RCTs) investigating the impact of PFMT on women’s SF published in English were included. Methodological quality was scored using the PEDro scale. Data were analysed qualitatively and interpreted.ResultsA total of 1341 women were included in the eight RCTs covered by this review. The studies were published between 1997 and 2014. Methodological scores were between 4 and 7. The sample included derived from heterogeneous populations of women. In only one study was SF the primary outcome measure. Pelvic floor dysfunction was an inclusion criterion in the majority of studies. Most studies reported a significant improvement in SF score after PFMT between control and intervention groups.ConclusionsAlthough most studies indicated an improvement of at least one sexual variable in women with pelvic floor dysfunction, and one study demonstrated an improvement in SF in postpartum women selected independently of their continence status, the results need to be interpreted with caution. High-quality RCTs specifically designed to investigate the impact of PFMT on women’s SF are required.

High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: A randomized, controlled trial

Aim:  We evaluated the effectiveness of high‐frequency transcutaneous electrical nerve stimulation (TENS) as a pain relief resource for primiparous puerpere who had experienced natural childbirth with an episiotomy.