Maíra de Menezes Franco

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.

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.

Biofeedback and the electromyographic activity of pelvic floor muscles in pregnant women.

BACKGROUND Maintaining continence is among the functions of the pelvic floor muscles (PFM) and their dysfunction can cause urinary incontinence (UI), which is a common occurrence during pregnancy and the puerperal period. Pelvic floor muscle training (PFMT), therefore, is important during pregnancy, although most women perform the muscle contractions unsatisfactorily. OBJECTIVES This study is an exploratory analysis of the results of three electromyographic (EMG) activity biofeedback sessions in pregnant women. METHODS The study sample included 19 nulliparous women with low risk pregnancies. The participants performed three sessions of EMG biofeedback consisting of slow and fast contractions. The average value of the normalized amplitudes of surface electromyography was used to evaluate the results. The linear regression model with mixed effects was used for statistical analysis, with the EMG data normalized by maximum voluntary contraction (MVC). RESULTS A steady increase in EMG amplitude was observed during each contraction and by the end of the biofeedback sessions, although this difference was only significant when comparing the first tonic contraction of each session (p=0.03). CONCLUSIONS The results indicate that three sessions of training with biofeedback improved PFM EMG activity during the second trimester in women with low-risk pregnancies. The effectiveness of this protocol should be further investigated in randomized controlled trials.

Avaliação da qualidade de vida e da perda urinária de mulheres com bexiga hiperativa tratadas com eletroestimulação transvaginal ou do nervo tibial

Trata-se de um ensaio clinico prospectivo comparativo que objetivou comparar os efeitos do tratamento com eletroestimulacao transvaginal (ET) e do nervo tibial (ENT) sobre a qualidade de vida (QV) e queixas de perda urinaria em mulheres com bexiga hiperativa. Participaram 42 pacientes com bexiga hiperativa ou incontinencia urinaria (IU) mista e foram divididas para tratamento com ET ou ENT. A QV foi avaliada pelo questionario de QV generico, o Medical Outcomes Study Short Form 36 (SF-36) e um questionario especifico para IU, o Incontinence Quality of Life Instrument (I-QOL). Os relatos de perdas urinarias e incomodos ocasionados foram avaliados, respectivamente, por meio do diario miccional de 24 horas e Escala Visual Analogica (EVA). O tratamento foi realizado uma vez por semana, totalizando doze semanas. O grupo da ENT teve melhora significativa em tres dominios do I-QOL, na EVA, que avaliou o grau de incomodo causado pela IU e em quatro aspectos do diario miccional. No grupo de ET houve melhora significativa de dois dominios do SF-36, tres dominios do I-QOL, na EVA e em quatro aspectos do diario. Houve melhora da QV em ambos os grupos, assim como uma diminuicao das queixas de perda urinaria, entretanto, o grupo que recebeu ET obteve melhora nos escores em dois dominios do questionario de QV generico apos o tratamento, que teve limitacao por aspectos fisicos e limitacao por aspectos emocionais. O que nao ocorreu com o grupo de ENT.

Assessment of Female Sexual Function in Pregnant Women with Gestational Diabetes Mellitus

INTRODUCTION Female sexual dysfunction is a frequent problem that may be caused by several factors, such as pregnancy and diabetes, and that can affect the womans quality of life. AIM The aim of this study was to assess the sexual function of pregnant women with gestational diabetes. METHODS This is a cross-sectional clinical study involving 88 women, among which 33 were pregnant with gestational diabetes mellitus (GDM) and 55 were with low-risk pregnancy (LRP). MAIN OUTCOME MEASURES Sexual function was assessed using the Female Sexual Function Index (FSFI), a self-applicable questionnaire validated in Portuguese. All the pregnant women answered the questionnaire between the 20th and 25th week of gestation. Data were submitted to descriptive analysis by using the SAS version 9.2 procedure PROC MEANS (SAS Institute Inc., Cary, NC, USA), whereas Students t-test was applied by using the procedure PROC TTEST (SAS Institute Inc.) at a significance level of ≤5% for all analyses. RESULTS The percentage of women presenting sexual dysfunction in each group was the following: 66.7% in Group GDM and 38.9% in the Group LRP, with significant difference between the groups (P = 0.03). However, no significant differences were found between the groups regarding sexual desire, excitement, lubrication, and pain. On the total score of FSFI, Group GDM had a score ≤26.55 (P = 0.03). CONCLUSION Diabetic pregnant women were found to have a higher incidence of sexual dysfunction as their scores were lower for all FSFI domains compared with LRP females.

Inter-rater reliability study of the Peritron™ perineometer in pregnant women

ABSTRACT Objective: To assess the inter-rater reliability of two raters for the mean and single maximal value of three vaginal maximum voluntary contractions (MVCs) using the Peritron™ perineometer for study participants in the first and second trimesters of pregnancy. Participants: Thirty-six low-risk pregnant women. Methods: The assessments were done by two different examiners with an interval of 2 to 7 days. For statistical analysis, the concordance correlation coefficient (CCC) and Bland–Altman limits of agreement were used. Results: For the overall sample, good reliability of 0.80 was found analyzing the mean of three MVCs and for the single maximal value (CCC = 0.79). Good reliability was found for the mean of three MVCs (0.81 and 0.78) for the first and second trimesters, respectively. Good reliability of 0.89 was found in the first trimester and a moderate reliability of 0.70 for the second trimester when analyzing the single maximal value of three MVCs. Conclusion: Good inter-rater reliability was found for the overall sample and first trimester of pregnancy for both mean values and single maximal values of the three MVCs. A good and moderate reliability was respectively found in the second trimester in analyzing the mean and single maximum values of three MVCs.

Pelvic floor muscle training increases pelvic floor muscle strength more in post-menopausal women who are not using hormone therapy than in women who are using hormone therapy: a randomised trial

QUESTION Are there differences in the effectiveness of pelvic floor muscle training on pelvic floor muscle strength and urinary incontinence symptoms in postmenopausal women who are and are not using hormone therapy? DESIGN Randomised, controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis. PARTICIPANTS Ninety-nine postmenopausal women, 38 of whom were using daily systemic oestrogen/progestogen therapy. INTERVENTION The experimental group (n=51) received an intensive supervised pelvic floor muscle training protocol, and the control group (n=48) received no intervention. The randomisation was stratified by hormone therapy use. OUTCOME MEASURES Change in pelvic floor muscle strength assessed with manometry at 12 weeks. Prevalence and severity of urinary incontinence symptoms were assessed using questionnaires. RESULTS Eighty-eight women provided data that could be included in the analysis. Pelvic floor muscle training increased pelvic floor muscle strength by 8.0 cmH2O (95% CI 3.4 to 12.6) in women not using hormone therapy and by -0.9 cmH20 (95% CI -6.5 to 4.8) in women using hormone therapy (interaction p=0.018). A sensitivity analysis showed that the greater training effect in women who were not using hormone therapy was still apparent if the analysis was conducted on percentage change in strength rather than absolute change in strength. There was also a significantly greater effect of training in women not using hormone therapy on prevalence of urinary incontinence symptoms (ratio of odds ratios=7.4; interaction p=0.028). The difference in effects on severity of urinary incontinence symptoms was not statistically significant (interaction p=0.37). CONCLUSION Pelvic floor muscle training increases pelvic floor muscle strength more in women who are not using hormone therapy than in women using hormone therapy. TRIAL REGISTRATION ClinicalTrials.gov NCT02549729. [Ignácio Antônio F, Herbert RD, Bø K, Rosa-e-Silva ACJS, Lara LAS, Franco MdM, Ferreira CHJ (2018) Pelvic floor muscle training increases pelvic floor muscle strength more in post-menopausal women who are not using hormone therapy than in women who are using hormone therapy: a randomised trial. Journal of Physiotherapy 64: 166-171].