Mara Regina Knorst

Clinical profile, quality of life and depressive symptoms of women with urinary incontince attending a university hospital

OBJECTIVES To describe the characteristics of urinary incontinence (UI) and to evaluate its impact on health-related quality of life (QOL) and depressive symptoms in women referred for physical therapy at a university hospital. METHODS A descriptive cross-sectional study with demographic data collection related to UI. All women were evaluated through examination and also through depression and QOL questionnaires. RESULTS Forty-eight women were evaluated (53.8±10.9 years), 47.9% with mixed UI (MUI), 39.6% with stress UI (SUI) and 12.5% with urge UI (UUI). In 50% of the cases the urinary loss lasted between 3.3 and 10 years. There was no significant difference in the pelvic floor muscle strength among the different types of UI (P>0.05). Depressive symptoms were detected in 37% of the women. Changes in the QOL were observed in all three groups of women with UI. According to the Kings Health Questionnaire (KHQ), women with MUI presented more compromised health perception and greater physical, social, daily activity and personal relationship limitations (P<0.05). The women with MUI presented a worse health perception (P<0.05) according to the WHOQOL-Bref. CONCLUSION Depressive symptoms were detected in more than a third of the women whose quality of life was adversely affected and the greatest impact was observed in the patients with MUI.

Qualidade de vida de idosos com incontinência urinária

Objective: To assess the prevalence of urinary incontinence (UI) in an elderly citizen sample in Porto Alegre, RS, as well as to determine whether there is a difference in the quality of life between incontinent and continent people. Materials and Methods: A crosscut survey with 509 elderly citizens. Barthel’s Index and a closed question were used to evaluate the UI and WHOQOL-Bref. Data were analyzed by SPSS 11.5. The study was carried out according to Resolution 196/96-CNS/MS. Results: Analyzing the Barthel’s Index, 24% presented UI; among women, 29.4% and 10.3% among men. In the single question, 50% have mentioned UI. There was an association between sex and incontinence, prevailing the women (p<0.001), and between UI and the quality of life global assessment and health (p<0.05). The results confirm the findings of other surveys. Conclusion: The quality of life and health are better among the continent subjects. Planning and investment in therapeutic interventions, with interdisciplinary approaches, are essential to improve the quality of life in such population group.

Physical therapy intervention in women with urinary incontinence associated with pelvic organ prolapse

BACKGROUND Urinary incontinence (UI) is a prevalent condition that affects women of all ages. Pelvic organ prolapse in conjunction with UI is a common occurrence. OBJECTIVE To assess the effect of pelvic prolapse on the outcome of physical therapy treatment for women with UI. METHODS The study included 48 women aged between 35 and 78 years who underwent anamnesis and measurement of pelvic floor strength (bi-digital test and perineometry). The physical therapy intervention consisted of transvaginal electrical stimulation and pelvic floor exercise for up to 15 weekly sessions. RESULTS The majority of the women had normal delivery and 2.6±1.5 children (range=0-7). Pelvic prolapse was observed in 72.4% of the women who had normal delivery, in 100% of those who had cesarean section, and in 77.8% of those who had both normal and cesarean deliveries. 48% of the women had mixed UI, 39.5% had stress UI, and 12.5% had urge UI. The duration of symptoms varied from 2 to 28 years (7.9±5.3). In the participants with and without prolapse, a significant difference was observed in the pre- and post-treatment comparisons for the pelvic floor muscles. The pre- and post-treatment perineometry showed a significant increase only in the women with prolapse (p=0.048). 87.5% of the participants became continent. CONCLUSIONS The physical therapy treatment was effective in treating and/or curing the symptoms of UI, whether or not associated with pelvic prolapse, regardless of the clinical type of incontinence. Clinical Trial Registration (Brazilian Clinical Trial Registry): RBR-3p5s66.

Mobilidade funcional em idosos institucionalizados e não institucionalizados

INTRODUCTION: Falls are a major cause of morbidity and mortality in old age, with consequences ranging from minor injuries to death. The measure of functional mobility can be used to predict the risk of falls and to measure the result of interventions that seek to reduce it. OBJECTIVES: To assess and compare a functional mobility measure in elderly people living in the community and in a long stay institution (LSI), and determine its relation to age and sex in the different places of residence. MATERIALS AND METHOD: This observational, analytical and cross-sectional study used data from two other observational studies carried out in the city of Porto Alegre, Brazil. A total of 413 elderly people took part in this study; out of those 72 were institutionalized (average age = 80.9 ± 8.1years) and 341 lived in the community (69.8 ± 7.5 years). The Timed Up and Go Test (TUG) was used to evaluate the degree of functional mobility. RESULTS: No statistical difference was found in the TUG mean values presented by the genders, both in the community (p>0.05) and in the LSI (p>0.05). Institutionalized men and women showed significantly higher TUG mean than those living in the community (p<0.01). A significant difference was detected between the TUG means, when compared in terms of age group (p = 0.003). CONCLUSION: Functional mobility decreases with age in men and women, but does not differ between the sexes. Elderly people living in the community were faster than the institutionalized ones and therefore had a lower risk of falls. It is clear that there is a need for interventions that help both groups improve their mobility and reduce the risk of falls.

Fisioterapia em oncologia mamária: qualidade de vida e evolução clínico funcional

Purpose: to assess physiotherapy intervention impact on quality of life and functional evolution of women who underwent clinical treatment of breast cancer. Methods: almost-experimental study of the type before and after, carried out from March to June of 2009. We have included 10 patients subjected to surgical treatment of breast cancer and who underwent adjuvant treatment. We performed functional evaluation and a quality life questionnaire application, and a intervention protocol proposal with stretching and exercises training since resistance, strength and resistance strength by 8 weeks, supervised by the physiotherapist and home orientation. Results: the proposal with the protocol early implementation with exercises for the comorbidities prevention related to breast câncer treatment helped in clinical and functional parameters improvement. There was no quality of life decline even with the systemic treatment. There was parameters improvement related to satisfaction with health, the ability to daily activities perform, ability to work satisfaction and satisfaction with themselves. Conclusion: the physical therapy must start early and this protocol promoted quality of life maintenance and improved functional capacity of these women.

The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence

OBJECTIVE To assess the effect of a weekly, short-term physical therapy intervention on the pelvic floor muscles and urinary incontinence (UI) among patients of the public health system. METHOD Quasi-experimental before-and-after study. Clinical history and function evaluation were performed using perineal bidigital maneuvers and perineometry. The intervention consisted of transvaginal electrical stimulation and pelvic floor kinesiotherapy. Data were analyzed using the paired t test or Wilcoxon signed-rank test, Pearson product-moment correlation coefficient or Spearmans rank correlation coefficient. A value of P<0.05 was considered significant. RESULTS Eight-two women 55.1±10.9 years-old were evaluated. Mixed urinary incontinence (MUI), stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were observed in 52.4%, 36.6% and 11%, respectively. The length of UI was 6.0 years (3.0-10). Approximately 13.64 physical therapy sessions were held on average. There was no difference in perineometry measurements following the intervention (40.6±24.1 versus 41.7±25.4, P=0.098). Muscle function significantly increased (P<0.01) in the bidigital maneuver. The patients reported being continent or satisfied with the treatment in 88.9% of cases. CONCLUSIONS The results demonstrated an increase in muscle function and the attainment of urinary continence or treatment satisfaction in most cases.

Avaliação da qualidade de vida antes e depois de tratamento fisioterapêutico para incontinência urinária

This quasi experimental study analyzed the influence of a physical therapy intervention on the quality of life (QoL) of women with urinary incontinence (UI) and its effectiveness for urinary loss. Took part in this study 55 women (35 to 87 years) with a clinical diagnosis of UI who underwent an anamnesis and had the function of their pelvic floor muscles (PFMF; bidigital test) and their QoL measured (Kings Health Questionnaire - KHQ). Up to 15 weekly sessions were carried out with endovaginal electrical stimulation and perineal exercises. Once the participants reported not losing urine or expressed the desire to stop the treatment, it was terminated, regardless of the number of sessions undertaken. After treatment, the bidigital test and the KHQ were repeated and the participants were asked if they considered themselves to be continent, satisfied with the treatment or not improved. Most participants were aged between 51 and 60 years, underwent vaginal delivery with episiotomy and had prolapse. Most had mixed UI, followed by stress UI. The situations when the urinary loss most commonly occurred were coughing and sneezing, which happened mostly in jets. There was a significant improvement in all of the KHQ domains, except the general health perception. After the intervention, 90.9% of the women said that they were continent or satisfied with the treatment. The physical therapy intervention resulted in improved QoL and it was effective for containing the urinary loss.Correspondence to: Mara Regina Knorst – Avenida Ipiranga, 6.681, Predio 12, sala 803 – CEP: 90619-900 – Porto Alegre (RS), Brasil – E-mail: mknorst@pucrs.br Presentation: jul. 2012 – Accepted for publication: jul. 2013 – Financing source: none – Conflict of interests: nothing to declare – Approval at the Ethics Committee n. 06/03194. AbstrAct | This quasi experimental study analyzed the influence of a physical therapy intervention on the quality of life (QoL) of women with urinary incontinence (UI) and its effectiveness for urinary loss. Took part in this study 55 women (35 to 87 years) with a clinical diagnosis of UI who underwent an anamnesis and had the function of their pelvic floor muscles (PFMF; bidigital test) and their QoL measured (King’s Health Questionnaire — KHQ). Up to 15 weekly sessions were carried out with endovaginal electrical stimulation and perineal exercises. Once the participants reported not losing urine or expressed the desire to stop the treatment, it was terminated, regardless of the number of sessions undertaken. After treatment, the bidigital test and the KHQ were repeated and the participants were asked if they considered themselves to be continent, satisfied with the treatment or not improved. Most participants were aged between 51 and 60 years, underwent vaginal delivery with episiotomy and had prolapse. Most had mixed UI, followed by stress UI. The situations when the urinary loss most commonly occurred were coughing and sneezing, which happened mostly in jets. There was a significant improvement in all of the KHQ domains, except the general health perception. After the intervention, 90.9% of the women said that they were continent or satisfied with the treatment. The physical therapy intervention resulted in improved QoL and it was effective for containing the urinary loss.

Quality of life assessment before and after a physical therapy intervention for urinary incontinence

This quasi experimental study analyzed the influence of a physical therapy intervention on the quality of life (QoL) of women with urinary incontinence (UI) and its effectiveness for urinary loss. Took part in this study 55 women (35 to 87 years) with a clinical diagnosis of UI who underwent an anamnesis and had the function of their pelvic floor muscles (PFMF; bidigital test) and their QoL measured (Kings Health Questionnaire - KHQ). Up to 15 weekly sessions were carried out with endovaginal electrical stimulation and perineal exercises. Once the participants reported not losing urine or expressed the desire to stop the treatment, it was terminated, regardless of the number of sessions undertaken. After treatment, the bidigital test and the KHQ were repeated and the participants were asked if they considered themselves to be continent, satisfied with the treatment or not improved. Most participants were aged between 51 and 60 years, underwent vaginal delivery with episiotomy and had prolapse. Most had mixed UI, followed by stress UI. The situations when the urinary loss most commonly occurred were coughing and sneezing, which happened mostly in jets. There was a significant improvement in all of the KHQ domains, except the general health perception. After the intervention, 90.9% of the women said that they were continent or satisfied with the treatment. The physical therapy intervention resulted in improved QoL and it was effective for containing the urinary loss.Correspondence to: Mara Regina Knorst – Avenida Ipiranga, 6.681, Predio 12, sala 803 – CEP: 90619-900 – Porto Alegre (RS), Brasil – E-mail: mknorst@pucrs.br Presentation: jul. 2012 – Accepted for publication: jul. 2013 – Financing source: none – Conflict of interests: nothing to declare – Approval at the Ethics Committee n. 06/03194. AbstrAct | This quasi experimental study analyzed the influence of a physical therapy intervention on the quality of life (QoL) of women with urinary incontinence (UI) and its effectiveness for urinary loss. Took part in this study 55 women (35 to 87 years) with a clinical diagnosis of UI who underwent an anamnesis and had the function of their pelvic floor muscles (PFMF; bidigital test) and their QoL measured (King’s Health Questionnaire — KHQ). Up to 15 weekly sessions were carried out with endovaginal electrical stimulation and perineal exercises. Once the participants reported not losing urine or expressed the desire to stop the treatment, it was terminated, regardless of the number of sessions undertaken. After treatment, the bidigital test and the KHQ were repeated and the participants were asked if they considered themselves to be continent, satisfied with the treatment or not improved. Most participants were aged between 51 and 60 years, underwent vaginal delivery with episiotomy and had prolapse. Most had mixed UI, followed by stress UI. The situations when the urinary loss most commonly occurred were coughing and sneezing, which happened mostly in jets. There was a significant improvement in all of the KHQ domains, except the general health perception. After the intervention, 90.9% of the women said that they were continent or satisfied with the treatment. The physical therapy intervention resulted in improved QoL and it was effective for containing the urinary loss.

Urinary incontinence in elderly women from Porto Alegre: its prevalence and relation to pelvic floor muscle function

El objetivo de este estudio es evaluar la prevalencia del relato de perdida urinaria en mujeres mayores residentes en el municipio de Porto Alegre (RS-Brasil), y determinar la relacion entre la incontinencia urinaria (IU) y la funcion muscular del piso de la pelvis (FMPP). Participaron 270 mujeres mayores (60-92 anos) las cuales provenian de una muestra poblacional, que relataron (n= 115; 69,1±7,8 anos) o no (n=155; 67,7±7,9 anos) perdida urinaria. Las mayores que informaron IU fueron interrogadas cuanto a: la duracion de la perdida urinaria, la cantidad de orina perdida (gotas, jet o completa) y las situaciones en las que perdian orina. De este total, 178 aceptaron ser sometidas a una revision de la FMPP a traves de la perineometria y del test bidigital. La prevalencia de mayores que informaron IU (57,4%) fue significativamente mayor, siendo que la situacion aislada de perdida urinaria mas comun fue la incapacidad de llegar al bano a tiempo (26,1%), lo que se produjo principalmente en gotas (52,3%). La duracion de la IU mostro un promedio de tres anos. Las mayores con IU presentaron FMPP significativamente mas baja que la de las que no tenian IU, independientemente de la forma de medicion (perineometria o test bidigital). Por lo tanto, es posible concluir que, en esta muestra, la IU tuvo alta prevalencia y se asocio con una mas baja FMPP. Considerando estos resultados y teniendo en cuenta el conocimiento disponible en la literatura sobre el impacto de la IU en la salud y calidad de vida de las personas, asi como el bajo costo de su evaluacion y su tratamiento, se sugiere que el manejo y cuidado de esta disfuncion sean hechos en la Atencion primaria de Salud.

La incontinencia urinaria en mujeres mayores de Porto Alegre: su prevalencia y su relación con la función muscular del piso de la pelvis

El objetivo de este estudio es evaluar la prevalencia del relato de perdida urinaria en mujeres mayores residentes en el municipio de Porto Alegre (RS-Brasil), y determinar la relacion entre la incontinencia urinaria (IU) y la funcion muscular del piso de la pelvis (FMPP). Participaron 270 mujeres mayores (60-92 anos) las cuales provenian de una muestra poblacional, que relataron (n= 115; 69,1±7,8 anos) o no (n=155; 67,7±7,9 anos) perdida urinaria. Las mayores que informaron IU fueron interrogadas cuanto a: la duracion de la perdida urinaria, la cantidad de orina perdida (gotas, jet o completa) y las situaciones en las que perdian orina. De este total, 178 aceptaron ser sometidas a una revision de la FMPP a traves de la perineometria y del test bidigital. La prevalencia de mayores que informaron IU (57,4%) fue significativamente mayor, siendo que la situacion aislada de perdida urinaria mas comun fue la incapacidad de llegar al bano a tiempo (26,1%), lo que se produjo principalmente en gotas (52,3%). La duracion de la IU mostro un promedio de tres anos. Las mayores con IU presentaron FMPP significativamente mas baja que la de las que no tenian IU, independientemente de la forma de medicion (perineometria o test bidigital). Por lo tanto, es posible concluir que, en esta muestra, la IU tuvo alta prevalencia y se asocio con una mas baja FMPP. Considerando estos resultados y teniendo en cuenta el conocimiento disponible en la literatura sobre el impacto de la IU en la salud y calidad de vida de las personas, asi como el bajo costo de su evaluacion y su tratamiento, se sugiere que el manejo y cuidado de esta disfuncion sean hechos en la Atencion primaria de Salud.