Cynthia E. Neville

Randomized Multicenter Feasibility Trial of Myofascial Physical Therapy for the Treatment of Urological Chronic Pelvic Pain Syndromes

PURPOSE We determined the feasibility of conducting a randomized clinical trial designed to compare 2 methods of manual therapy (myofascial physical therapy and global therapeutic massage) in patients with urological chronic pelvic pain syndromes. MATERIALS AND METHODS We recruited 48 subjects with chronic prostatitis/chronic pelvic pain syndrome or interstitial cystitis/painful bladder syndrome at 6 clinical centers. Eligible patients were randomized to myofascial physical therapy or global therapeutic massage and were scheduled to receive up to 10 weekly treatments of 1 hour each. Criteria to assess feasibility included adherence of therapists to prescribed therapeutic protocol as determined by records of treatment, adverse events during study treatment and rate of response to therapy as assessed by the patient global response assessment. Primary outcome analysis compared response rates between treatment arms using Mantel-Haenszel methods. RESULTS There were 23 (49%) men and 24 (51%) women randomized during a 6-month period. Of the patients 24 (51%) were randomized to global therapeutic massage, 23 (49%) to myofascial physical therapy and 44 (94%) completed the study. Therapist adherence to the treatment protocols was excellent. The global response assessment response rate of 57% in the myofascial physical therapy group was significantly higher than the rate of 21% in the global therapeutic massage treatment group (p = 0.03). CONCLUSIONS We judged the feasibility of conducting a full-scale trial of physical therapy methods and the preliminary findings of a beneficial effect of myofascial physical therapy warrants further study.

A preliminary report of musculoskeletal dysfunction in female chronic pelvic pain: A blinded study of examination findings

INTRODUCTION AND HYPOTHESIS Female chronic pelvic pain is prevalent and causes disability. Can women with self-reported chronic pelvic pain (CPP) be distinguished from pain-free women by demonstrating a greater number of abnormal musculoskeletal findings on examination? METHODS In this cross-sectional study, blinded examiners performed 9 physical exam maneuvers on 48 participants; 19 with CPP, and 29 pain-free. Frequency of positive findings between groups, total number of positive exam findings, cluster analysis, and sensitivity - specificity analyses were performed. RESULTS Women with CPP presented with significantly more abnormal findings than pain-free women. By using two examination maneuvers, examiners correctly classified women with self-reported CPP from pain-free women 85% of the time. CONCLUSIONS Abnormal findings on musculoskeletal exam are more common in women with self-reported CPP. Women with CPP might benefit from a faster time to diagnosis and improved treatment outcomes if a musculoskeletal contribution to CPP was identified earlier.

Impact of urinary incontinence on medical rehabilitation inpatients

To determine the prevalence of urinary incontinence (UI) and its association with rehabilitation outcomes in patients receiving inpatient medical rehabilitation in the United States.

Analysis of Physical Therapy Intervention Outcomes for Urinary Incontinence in Women Older Than 65 Years in Outpatient Clinical Settings

Background: Conservative interventions provided by physical therapists for the treatment of bladder control problems in adult females are strongly supported in the literature and in clinical practice guidelines. However, physical therapy (PT) intervention outcomes specifically for women older than 65 years with urinary incontinence (UI) in outpatient settings in the United States have not been extensively reported. Objectives: To provide preliminary PT intervention outcome data specific to female patients older than 65 years receiving outpatient PT for UI. Design: Preliminary retrospective analysis of a convenience sample of women 65 to 93 years of age. Methods: Women older than 65 years with UI who were referred to outpatient PT and answered “yes” to a UI screening question at intake completed 3 UI surveys (3 Incontinence Questions [3IQ], Incontinence Impact Questionnaire Short-Form [IIQ-7] and the International Consultation on Incontinence Modular Questionnaire—Urinary Incontinence [ICIQ-UI]). Patients received individualized treatment provided by a physical therapist. Physical therapists were asked to administer the surveys again during and/or after treatment. Demographic, clinical, and health-related quality of life data were collected. Frequency of UI types, UI symptoms, and impact of quality of life were analyzed. Paired samples t test was used to evaluate the change in measures between the initial survey and a follow-up survey. Results: Surveys were collected from 62 women. Significant changes in scores on 2 outcome measures (ICIQ-UI and IIQ-7) indicated significant reductions in UI symptom severity and improvements in UI-related health-related quality of life after undergoing individualized PT treatment of UI. Limitations: The study population was a convenience sample. Data on treatment interventions were not collected. Conclusions: Individualized interventions provided by physical therapists have the potential to significantly improve symptom severity and health-related quality of life in women older than 65 years with different types of UI.

Urinary incontinence symptoms and impact on quality of life in patients seeking outpatient physical therapy services

ABSTRACT Objective: The objective of this study was to examine the frequency and types of urinary incontinence (UI) in patients seeking outpatient physical therapy for neuro-musculoskeletal conditions. Design: Retrospective cross-sectional analysis. Patients: A convenience sample of patients that positively responded to a UI screening question was included in this study. Methods: Data were collected for age, sex, and primary treatment condition classified into one of the following (i.e., urinary dysfunction, fecal dysfunction, pelvic pain, spine, neurological disorders, or extremity disorders); UI type (i.e., mixed, urge, stress, or insensible); UI symptom severity; and quality of life (QoL) impact. Main outcome measures: Frequency of UI type, symptom severity, health-related quality of life (HRQoL) impact, and pad use were compared between treatment groups. Results: The mean age of the sample (n = 599) was 49.8 years (SD = 18.5) and 94.7% were female. The urinary dysfunction group comprised 44.2% of the total sample, followed by the spine group with 25.7% and pelvic pain with 17.2%. The urinary dysfunction group scored significantly higher on UI symptom severity and impact on QoL compared to the pelvic pain and spine groups, but not compared to the extremity disorders, fecal dysfunction, or neurological disorder group. Conclusion: These preliminary data indicate that UI is a condition afflicting many individuals who present to outpatient physical therapy beyond those seeking care for UI. We recommend using a simple screening measure for UI and its impact on HRQoL as part of a routine initial evaluation in outpatient physical therapy settings.

Randomized Multicenter Pilot Trial Shows Benefit of Manual Physical Therapies in Treatment of Urologic Chronic Pelvic Pain

23 demonstrated the ability to correctly perform the AHE was 5 of the 30 (16.7%) with a mean percent thickness change of the TrA at rest compared to activation of 99.6, SD (25.4) (group 1), compared to 62.4, SD (38.9) for the 25 subjects who were not able to correctly perform the AHE (group 2). The average ODI scores were 1.6, SD (2.6) for group 1 and 2.6, SD (4.0) for group 2. The average BMI of the women in group 1 was 24, SD (4.6), compared to 25, SD (3.0) for group 2. The average number of pregnancies was 2 for both groups. Zero women in group 1 reported a history of LBP prior to pregnancy, compared to 4 in group 2. The average days from delivery at the time of participation in the study was 39, SD (14.9) in group 1, compared to 34, SD (12.2) in group 2. Weight gain averages were 11 kg, SD (3.5) for group 1 and 13.2 kg, SD (4.5) for group 2. The average minutes/week of moderate exercise reported by group 1 was 61, SD (41.6) compared to 121, SD (88.3) for group 2. All subjects in both groups had current pain ratings of <2. Conclusions: The majority of the women in the study were not able to correctly activate the TrA during the AHE despite having no or a low level of pregnancy related low back pain (LBP). A program which teaches women the AHE early after childbirth may be beneficial in improving motor control deficits in this patient population regardless of pain level. Further research is needed comparing women with and without pregnancy related LBP. Clinical Relevance: To the authors knowledge this is the first study to show a decreased muscle performance of the lateral abdominal muscles in women early after childbirth. Improving the muscle performance of the TrA early after childbirth may be beneficial in improving spine stability and avoidance of injuries. This information would be useful for physical therapists in designing both prenatal and postnatal rehabilitation programs.

Musculoskeletal Dysfunction in Female Chronic Pelvic Pain: A Blinded Study of Examination Findings

20 strength, endurance and flexibility was observed post circuit training using a modified push-up test and sit and reach test (p<0.05). However, statistical significance was not seen in the other physical tests: curl-up, body fat percentage and in Baecke’s Questionnaire. Conclusions: Circuit training may be a helpful strategy for peri and postmenopausal women who experience menopausal symptoms and decreased QOL. Future larger clinical trials of various forms of circuit training are recommended to further define the long term benefits of exercise. Clinical Relevance: As the baby boomer generation ages, a large number of women are entering the menopause transition. Our patients may be affected by the symptoms associated with menopause and these symptoms may be impacting the patient’s recovery. We as clinician may also be involved in preparing health and wellness programs for our patients. Incorporating a comprehensive exercise program (e.g., circuit training) into a woman’s lifestyle has the potential to improve her overall health and wellbeing.

Comparison of PT and MD Findings of Physical Examination of Patients With and With-out Chronic Pelvic Pain

16 1 to 9), ovulatory phase (days 10-14) or luteal phase (days 15-28) of the menstrual cycle as determine by “ferning” pattern on dried samples of salvia and confirmed by color change of test band of urine. Subjects were subsequently tested on the next two phases and continued to track their menstrual cycle during balance testing. Subjects performed the six conditions of the Sensory Organization Test (SOT)protocol and the Functional Limitations Test(FLT) protocol; single leg stance, walking, tandem walk, step quick turn, step up and over and forward lunge on the Balance Master® system. Results: Descriptive statistics: means, standard deviation and ranges, were determined for equilibrium and composite scores of SOT and postural sway for FLT. ANOVA was employed for the effect of menstrual cycle phase on equilibrium and composite scores and postural sway responses. Pearsons’ Correlation coefficient was employed to examine correlation of composite equilibrium score and postural sway score responses and anthropomorphic measures of height and weight. Conclusions: Differences were noted in the composite score of SOT during the luteal phase, when increased estradiol levels may reduce ligamentous strength. Differences were noted during the step up and over test during luteal phase and forward lunge test during the follicular phase, which is characterized by lower levels of estrogen. Clinical Relevance: While fluctuations of hormone during the menstrual cycle may place females at risk for injuries due to changes in postural control and balance performance, SOT or FLT may not identify individuals at risk for injury as these test evaluate postural and balance response that are anticipatory rather than reactionary. The use of salvia and urine sample tests are less invasive measure to determine menstrual cycle phases, but may not identify the distinct serum hormonal levels to assess risk for injury.

Impact of Urinary Incontinence on Rehabilitation Outcomes in Inpatient Rehabilitation Facilities

16 1 to 9), ovulatory phase (days 10-14) or luteal phase (days 15-28) of the menstrual cycle as determine by “ferning” pattern on dried samples of salvia and confirmed by color change of test band of urine. Subjects were subsequently tested on the next two phases and continued to track their menstrual cycle during balance testing. Subjects performed the six conditions of the Sensory Organization Test (SOT)protocol and the Functional Limitations Test(FLT) protocol; single leg stance, walking, tandem walk, step quick turn, step up and over and forward lunge on the Balance Master® system. Results: Descriptive statistics: means, standard deviation and ranges, were determined for equilibrium and composite scores of SOT and postural sway for FLT. ANOVA was employed for the effect of menstrual cycle phase on equilibrium and composite scores and postural sway responses. Pearsons’ Correlation coefficient was employed to examine correlation of composite equilibrium score and postural sway score responses and anthropomorphic measures of height and weight. Conclusions: Differences were noted in the composite score of SOT during the luteal phase, when increased estradiol levels may reduce ligamentous strength. Differences were noted during the step up and over test during luteal phase and forward lunge test during the follicular phase, which is characterized by lower levels of estrogen. Clinical Relevance: While fluctuations of hormone during the menstrual cycle may place females at risk for injuries due to changes in postural control and balance performance, SOT or FLT may not identify individuals at risk for injury as these test evaluate postural and balance response that are anticipatory rather than reactionary. The use of salvia and urine sample tests are less invasive measure to determine menstrual cycle phases, but may not identify the distinct serum hormonal levels to assess risk for injury.