Jessica McKinney

Musculoskeletal pain in gynecologic surgeons.

OBJECTIVE To describe the prevalence of musculoskeletal pain and symptoms in gynecologic surgeons. DESIGN Prospective cross-sectional survey study (Canadian Task Force classification II-2). SETTING Virtual. All study participants were contacted and participated via electronic means. PARTICIPANTS Gynecologic surgeons. INTERVENTIONS An anonymous, web-based survey was distributed to gynecologic surgeons via electronic newsletters and direct E-mail. MEASUREMENTS AND MAIN RESULTS There were 495 respondents with complete data. When respondents were queried about their musculoskeletal symptoms in the past 12 months, they reported a high prevalence of lower back (75.6%) and neck (72.9%) pain and a slightly lower prevalence of shoulder (66.6%), upper back (61.6%), and wrist/hand (60.9%) pain. Many respondents believed that performing surgery caused or worsened the pain, ranging from 76.3% to 82.7% in these five anatomic regions. Women are at an approximately twofold risk of pain, with adjusted odds ratios (OR) of 1.88 (95% confidence interval [CI], 1.1-3.2; p = .02) in the lower back region, OR 2.6 (95% CI, 1.4-4.8; p = .002) in the upper back, and OR 2.9 (95% CI, 1.8-4.6; p = .001) in the wrist/hand region. CONCLUSION Musculoskeletal symptoms are highly prevalent among gynecologic surgeons. Female sex is associated with approximately twofold risk of reported pain in commonly assessed anatomic regions.

Ergonomics in the Operating Room: Protecting the Surgeon

STUDY OBJECTIVE To review elements of an ergonomic operating room environment and describe common ergonomic errors in surgeon posture during laparoscopic and robotic surgery. DESIGN Descriptive video based on clinical experience and a review of the literature (Canadian Task Force classification III). SETTING Community teaching hospital affiliated with a major teaching hospital. SUBJECTS/AUDIENCE Gynecologic surgeons. INTERVENTION Demonstration of surgical ergonomic principles and common errors in surgical ergonomics by a physical therapist and surgeon. MEASUREMENTS AND MAIN RESULTS The physical nature of surgery necessitates awareness of ergonomic principles. The literature has identified ergonomic awareness to be grossly lacking among practicing surgeons, and video has not been documented as a teaching tool for this population. Taking this into account, we created a video that demonstrates proper positioning of monitors and equipment, and incorrect and correct ergonomic positions during surgery. Also presented are 3 common ergonomic errors in surgeon posture: forward head position, improper shoulder elevation, and pelvic girdle asymmetry. Postural reset and motion strategies are demonstrated to help the surgeon learn techniques to counterbalance the sustained and awkward positions common during surgery that lead to muscle fatigue, pain, and degenerative changes. CONCLUSION Correct ergonomics is a learned and practiced behavior. We believe that video is a useful way to facilitate improvement in ergonomic behaviors. We suggest that consideration of operating room setup, proper posture, and practice of postural resets are necessary components for a longer, healthier, and pain-free surgical career.

Pelvic Floor Physical Therapy as Primary Treatment of Pelvic Floor Disorders With Urinary Urgency and Frequency-Predominant Symptoms.

Objective To assess the efficacy of pelvic floor physical therapy (PFPT) as primary treatment of urinary urgency and frequency symptoms Methods We conducted a prospective cohort study of women with urinary urgency and frequency symptoms. Participants underwent PFPT once or twice per week for 10 weeks. Symptom improvement was assessed by validated questionnaires (Pelvic Floor Distress Inventory-Short Form 20 and Patient Global Impression of Improvement), voiding diaries, and subjective measures. Results Fifty-seven participants enrolled; 21 (36.8%) withdrew or completed less than 5 weeks of PFPT. Thirty-one (54.4%) of the remaining 36 participants completed 10 weeks of PFPT. The mean age of the study group (n = 36) was 48.9 ± 15.0 years. The primary diagnoses were overactive bladder syndrome (n = 24, 66.7%) and painful bladder syndrome (n = 12, 33.3%). Women attended a median of 14.0 (interquartile range [IQR], 8.0–16.0) PFPT visits over a median of 11.9 weeks (IQR, 10.0–18.1). At baseline, the median Pelvic Floor Distress Inventory-Short Form 20 score was 79.2 (IQR, 53.1–122.9), and decreased to 50.0 (IQR, 25.0–88.5; P < 0.001) after PFPT; the urinary and prolapse symptom subscales both decreased significantly. Participants reported a decrease from a median of 10.0 voids per day to 8.0 (P < 0.001). On the Patient Global Impression of Improvement, 62.5% of women reported that they were “much better” or “very much better.” Conclusions The PFPT with myofasical release techniques improves urinary symptoms while avoiding medications and more invasive therapies. The high dropout rates suggest that motivation or logistic factors may play a significant role in the utilization and success of this treatment option.

Development of a core set of outcome measures for OAB treatment

Introduction and hypothesisStandardized measures enable the comparison of outcomes across providers and treatments giving valuable information for improving care quality and efficacy. The aim of this project was to define a minimum standard set of outcome measures and case-mix factors for evaluating the care of patients with overactive bladder (OAB).MethodsThe International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group (WG) of leading clinicians and patients to engage in a structured method for developing a core outcome set. Consensus was determined by a modified Delphi process, and discussions were supported by both literature review and patient input.ResultsThe standard set measures outcomes of care for adults seeking treatment for OAB, excluding residents of long-term care facilities. The WG focused on treatment outcomes identified as most important key outcome domains to patients: symptom burden and bother, physical functioning, emotional health, impact of symptoms and treatment on quality of life, and success of treatment. Demographic information and case-mix factors that may affect these outcomes were also included.ConclusionsThe standardized outcome set for evaluating clinical care is appropriate for use by all health providers caring for patients with OAB, regardless of specialty or geographic location, and provides key data for quality improvement activities and research.

Pelvic Floor Muscle Evaluation Findings in Patients With Urinary Incontinence

Objective:We hypothesized that there are differences in the pelvic floor physical therapy (PFPT) assessment findings between those with and without urinary incontinence; findings differ among patients with stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI). Study Design:This was a retrospective cohort study of women referred to PFPT for a pelvic floor disorder between January 2009 and January 2011. Background:Although the literature supports the role of PFPT for treatment of female urinary incontinence (UI), there is sparse literature on the correlation between pelvic floor muscle (PFM) assessment findings and UI. Methods and Measures:The initial myofascial assessment—Manual Muscle Test (MMT), PFM tone, lengthening, and relaxation—was compared among women referred to PFPT for UUI, SUI, and MUI as well as non-UI pelvic floor dysfunction. A standardized scale was used for each assessment. Results:A total of 297 women were referred for PFPT. Urinary incontinence was identified in 217 women: 53 (25%) SUI, 35 (16%) UUI, and 129 (59%) MUI. Women without UI had significantly higher MMT scores (P ⩽ 0.001), whereas MMT was decreased in all groups with UI. The UUI group had significantly lower MMT scores (P ⩽ 0.005) when compared with other UI groups. Up to 83% of women without UI had normal PFM tone, whereas less than 10% of patients with UI had normal PFM tone. Conclusions:PFM evaluation identifies dysfunction unique to UI and specific incontinence subtypes. Patients may benefit from targeted PFPT to address these symptoms.

Analysis of a pilot program to implement physical therapy for women with gynecologic fistula in the Democratic Republic of Congo

To describe components of a physical therapy pilot program for women with gynecologic fistula, and to report prospective data from the first 2 years of program implementation.

Physical Therapy for Female Pelvic Pain

The purpose of this chapter is to discuss the role of physical therapy in the management of women with pelvic pain disorders. Pelvic pain is a costly, prevalent, yet poorly understood condition, found to disproportionately affect women 4:1 [1]. Annual healthcare costs in the US are estimated in excess of

Musculoskeletal Pain and Disorders among Gynecologic Surgeons

880 million for physician visits alone, and nearly three billion when out-of pocket expenses and mental health visits are included [2]. Prevalence of pelvic pain is found to be similar to prevalence rates of asthma and low back pain [3], and the 3-month prevalence of chronic pelvic pain is estimated at 24% [4]. The majority of prevalence studies of pelvic pain have excluded women with vulvar pain disorders, as well as women who were pregnant or who had been pregnant within the past year. Therefore, the prevalence of all pelvic pain conditions is likely greater than that commonly cited in the literature. For example, an investigation by Harlow and Stewart identified a 16% lifetime prevalence of unexplained chronic vulvar pain, equating to approximately 14 million US women; a much higher prevalence than that found in earlier studies [5]. This high prevalence of female pelvic pain and the changing healthcare landscape are contributing to the now widely accepted and promoted concept of a multidisciplinary and collaborative approach to diagnosis and treatment that includes physicians of multiple specialties, physical therapists, and mental health professionals [6, 7].