Purpose: This cross-sectional descriptive study describes available pelvic floor physiotherapy (P... more Purpose: This cross-sectional descriptive study describes available pelvic floor physiotherapy (PT) services for older women with urinary incontinence (UI) in Quebec, Canada, and identifies possible affordability barriers. Methods: From September to December 2019, Quebec physiotherapists practising pelvic floor PT were invited to complete a survey on their clinical practice and perceptions of the affordability of UI treatment for older women. Results: Eighty-four of the 225 registered pelvic floor physiotherapists (37.3%) filled out the online survey. They worked a median of 32 hours/week in PT, with 15 of those hours (46.9%) in pelvic floor PT and three hours (9.8%) treating UI in older women. Only 13.0% of them offered group treatment, while 84.3% were interested in it. Most of the physiotherapists (92.2%) had met older women in their practice who had reported financial barriers to completing their pelvic floor PT treatment. Conclusions: The accessibility of UI care in Quebec appe...
Introduction Dyspareunia frequently affects women after gynecological cancer treatment. The focus... more Introduction Dyspareunia frequently affects women after gynecological cancer treatment. The focus of previous studies has been on the biomedical factors contributing to dyspareunia in this population. To our knowledge, no study has yet examined the biopsychosocial factors associated with women's experiences of dyspareunia after gynecological cancer treatment. Moreover, cancer survivors appear to refrain from seeking care despite the consequences of dyspareunia. Objective The aim of this study is to examine gynecological cancer survivors’ experiences of dyspareunia and factors influencing their care-seeking behavior. Methods A nested qualitative study was performed with the participants of a clinical trial investigating a multimodal pelvic floor physical therapy intervention. This enabled a comprehensive understanding of women's experiences and care-seeking behavior, including factors that could influence whether they seek care as well as their decision to undertake treatment...
Purpose: Urinary incontinence (UI) affects as many as 50% of women aged 60 years and older, but U... more Purpose: Urinary incontinence (UI) affects as many as 50% of women aged 60 years and older, but UI pathophysiology, specifically in elderly women, remains unclear. A better understanding of morphometric differences between continent and urinary incontinent elderly women is needed to improve the effectiveness of conservative treatment approaches. We hypothesized that morphometric differences in the pelvic floor muscles (PFM) among elderly women with and without UI could be observed using three- and four-dimensional (3D/4D) transperineal ultrasound (TPU) imaging. Method: A total of 40 elderly women (20 women with and 20 women without UI), with a mean age of 67.10 (SD 4.94) years, participated in the study. This was a case-control study in which TPU images were taken under three conditions: rest, maximal voluntary contraction (MVC), and Valsalva. Independent t-tests were conducted to compare measurements between the groups. Results: The study revealed statistically significant differen...
Objective: The aim was to investigate whether pretreatment pain characteristics, psychological va... more Objective: The aim was to investigate whether pretreatment pain characteristics, psychological variables, and pelvic floor muscle (PFM) function predict the response to physical therapy (PT) in women with provoked vestibulodynia (PVD). Materials and Methods: One hundred-five women diagnosed with PVD underwent 10 weekly sessions of individual PT comprising education, PFM exercises with biofeedback, manual therapy, and dilators. Treatment outcomes were evaluated at pretreatment, post-treatment, and 6-month follow-up and included pain intensity (numerical rating scale 0 to 10) and sexual function (Female Sexual Function Scale). Multilevel analyses were used to examine the potential predictors of response over time including pain characteristics (PVD subtype, pain duration), psychological variables (fear of pain, pain catastrophizing), and PFM function assessed with a dynamometric speculum (tone, flexibility, and strength). Results: PVD subtype and PFM tone were significant predictors of greater treatment response for pain intensity reduction. Secondary PVD (ie, pain developed after a period of pain-free intercourse) and lower PFM tone at baseline were both associated with greater reduction in pain intensity after PT and at follow-up. Among the psychological variables, fear of pain was the only significant predictor of better treatment response when assessed through improvement in sexual function, where higher fear of pain at baseline was associated with greater improvement after PT. Discussion: This study identified PVD secondary subtype, lower PFM tone, and higher fear of pain as significant predictors of better treatment response to PT in women with PVD.
Hypothesis / aims of study Endometrial cancer is the sixth most prevalent cancer affecting women ... more Hypothesis / aims of study Endometrial cancer is the sixth most prevalent cancer affecting women globally (1). Its treatment frequently involves different interventions such as resection surgery and radiation therapy (RT). Between 30 to 70% of these women develop urogenital dysfunctions such as urinary incontinence after these interventions. It is plausible that these dysfunctions are associated, at least in part, to an alteration of the pelvic floor muscles functional properties. The aim of our study was to compare pelvic floor muscles (PFM) functional properties of women reporting urinary incontinence (UI) after hysterectomy and radiotherapy (RT) for endometrial cancer, to women with a history of comparable hysterectomy without UI. Additionally, to verify if exists a correlation between muscle functional properties and urogenital and bowel function. We hypothesized that the participants with UI would have significantly lower maximal strength of their PFM, higher passive resistance...
Hypothesis / aims of study Mixed urinary incontinence (UI) has been independently associated with... more Hypothesis / aims of study Mixed urinary incontinence (UI) has been independently associated with increased falls among aging community-dwelling women. However, the association between UI severity and falls is not fully understood. Thus, the aim of this study was to explore possible relationships between balance or lower extremity strength and the impact and/or severity of mixed UI in aging community-dwelling women.
Hypothesis / aims of study Recruitment is a major challenge in successfully completing any random... more Hypothesis / aims of study Recruitment is a major challenge in successfully completing any randomized control trial (RCT) as difficulties in recruitment can have an important impact on the duration of the study, its costs and more critically, can be related to trial failure [1]. Investigators are increasingly using new e-recruitment initiatives, such as Facebook advertisement. However, no studies in urogynecology have investigated or compared recruitment strategies regarding efficiency, retention, clinical characteristics and cost. The aim of this study was to compare three recruitment methods (conventional methods (ads, poster, leaflets), professional referrals and erecruitment,) for the number of patients screened/enrolled, the efficiency rate, the retention rate, the baseline characteristics of participants, and the average cost per enrolled participant.
Aims of course/workshop The aims of this workshop are: 1. To present an overview of the evidence ... more Aims of course/workshop The aims of this workshop are: 1. To present an overview of the evidence of physical therapy (PT) for urinary incontinence (UI) and to provide key information on the effectiveness of different treatment regimens. 2. To present the evidence for pelvic floor PT in the prevention and treatment of pre and postnatal UI. 3. To present the evidence for PT in the treatment of UI in the elderly women and to discuss emerging therapies such as postural and motor control strategies. 4. To present the evidence for PT in the prevention and treatment of pelvic organ prolapse (POP).
Hypothesis / aims of study To evaluate the effectiveness of individual physiotherapy treatments (... more Hypothesis / aims of study To evaluate the effectiveness of individual physiotherapy treatments (PT) in reducing urine leakage in postmenopausal, urinary incontinent women with osteoporosis or low bone density, immediately after intervention and at one year in comparison to a control group (Co). We hypothesised that participants receiving physiotherapy would have a significant reduction in the severity of urinary incontinence (UI) after intervention, and that these results would be maintained at one year.
Hypothesis / aims of study The pelvic floor muscles (PFM) are subject to considerable stretching ... more Hypothesis / aims of study The pelvic floor muscles (PFM) are subject to considerable stretching during a vaginal birth. In approximately 21 to 36% of women, this stretching will result in an avulsion injury (i.e. disconnection of the puborectalis portion from its insertion points on the pubis). It has been shown that avulsion injury significantly affects PFM morphometry resulting in a marked enlargement of the levator hiatus and an altered contractility [1]. Importantly, avulsion has also been associated with the development of urogynecologic symptoms such as pelvic organ prolapse and incontinence in the postpartum period. International clinical guidelines in agreement with meta-analysis recommend PFM physiotherapy as a first line treatment for these symptoms [2]. However, it is unclear whether women with PFM lesions as severe as a complete avulsion injury could respond to physiotherapy. The main objectives of this pilot study were 1-to evaluate the effect of physiotherapy for impr...
Hypothesis / aims of study: Urethral hypermobility and the loss of pelvic-floor muscle support ar... more Hypothesis / aims of study: Urethral hypermobility and the loss of pelvic-floor muscle support are the primary causes of female stress urinary incontinence [1]. New technologies, such as 2D ultrasound imaging, provide important information regarding the mobility of the urethra, the support and dynamic activity of the pelvic floor muscles (PFM) during an active contraction and, potentially, incontinence-producing stress, such as the stress experienced during a Valsalva maneuver and a cough. In order to quantify the kinematic parameters of the urethra and the pelvic floor muscles (PFM) during contraction and effort, this study explored the possibility of developing an automatic motion-tracking algorithm based on optical flow techniques.
Purpose: This cross-sectional descriptive study describes available pelvic floor physiotherapy (P... more Purpose: This cross-sectional descriptive study describes available pelvic floor physiotherapy (PT) services for older women with urinary incontinence (UI) in Quebec, Canada, and identifies possible affordability barriers. Methods: From September to December 2019, Quebec physiotherapists practising pelvic floor PT were invited to complete a survey on their clinical practice and perceptions of the affordability of UI treatment for older women. Results: Eighty-four of the 225 registered pelvic floor physiotherapists (37.3%) filled out the online survey. They worked a median of 32 hours/week in PT, with 15 of those hours (46.9%) in pelvic floor PT and three hours (9.8%) treating UI in older women. Only 13.0% of them offered group treatment, while 84.3% were interested in it. Most of the physiotherapists (92.2%) had met older women in their practice who had reported financial barriers to completing their pelvic floor PT treatment. Conclusions: The accessibility of UI care in Quebec appe...
Introduction Dyspareunia frequently affects women after gynecological cancer treatment. The focus... more Introduction Dyspareunia frequently affects women after gynecological cancer treatment. The focus of previous studies has been on the biomedical factors contributing to dyspareunia in this population. To our knowledge, no study has yet examined the biopsychosocial factors associated with women's experiences of dyspareunia after gynecological cancer treatment. Moreover, cancer survivors appear to refrain from seeking care despite the consequences of dyspareunia. Objective The aim of this study is to examine gynecological cancer survivors’ experiences of dyspareunia and factors influencing their care-seeking behavior. Methods A nested qualitative study was performed with the participants of a clinical trial investigating a multimodal pelvic floor physical therapy intervention. This enabled a comprehensive understanding of women's experiences and care-seeking behavior, including factors that could influence whether they seek care as well as their decision to undertake treatment...
Purpose: Urinary incontinence (UI) affects as many as 50% of women aged 60 years and older, but U... more Purpose: Urinary incontinence (UI) affects as many as 50% of women aged 60 years and older, but UI pathophysiology, specifically in elderly women, remains unclear. A better understanding of morphometric differences between continent and urinary incontinent elderly women is needed to improve the effectiveness of conservative treatment approaches. We hypothesized that morphometric differences in the pelvic floor muscles (PFM) among elderly women with and without UI could be observed using three- and four-dimensional (3D/4D) transperineal ultrasound (TPU) imaging. Method: A total of 40 elderly women (20 women with and 20 women without UI), with a mean age of 67.10 (SD 4.94) years, participated in the study. This was a case-control study in which TPU images were taken under three conditions: rest, maximal voluntary contraction (MVC), and Valsalva. Independent t-tests were conducted to compare measurements between the groups. Results: The study revealed statistically significant differen...
Objective: The aim was to investigate whether pretreatment pain characteristics, psychological va... more Objective: The aim was to investigate whether pretreatment pain characteristics, psychological variables, and pelvic floor muscle (PFM) function predict the response to physical therapy (PT) in women with provoked vestibulodynia (PVD). Materials and Methods: One hundred-five women diagnosed with PVD underwent 10 weekly sessions of individual PT comprising education, PFM exercises with biofeedback, manual therapy, and dilators. Treatment outcomes were evaluated at pretreatment, post-treatment, and 6-month follow-up and included pain intensity (numerical rating scale 0 to 10) and sexual function (Female Sexual Function Scale). Multilevel analyses were used to examine the potential predictors of response over time including pain characteristics (PVD subtype, pain duration), psychological variables (fear of pain, pain catastrophizing), and PFM function assessed with a dynamometric speculum (tone, flexibility, and strength). Results: PVD subtype and PFM tone were significant predictors of greater treatment response for pain intensity reduction. Secondary PVD (ie, pain developed after a period of pain-free intercourse) and lower PFM tone at baseline were both associated with greater reduction in pain intensity after PT and at follow-up. Among the psychological variables, fear of pain was the only significant predictor of better treatment response when assessed through improvement in sexual function, where higher fear of pain at baseline was associated with greater improvement after PT. Discussion: This study identified PVD secondary subtype, lower PFM tone, and higher fear of pain as significant predictors of better treatment response to PT in women with PVD.
Hypothesis / aims of study Endometrial cancer is the sixth most prevalent cancer affecting women ... more Hypothesis / aims of study Endometrial cancer is the sixth most prevalent cancer affecting women globally (1). Its treatment frequently involves different interventions such as resection surgery and radiation therapy (RT). Between 30 to 70% of these women develop urogenital dysfunctions such as urinary incontinence after these interventions. It is plausible that these dysfunctions are associated, at least in part, to an alteration of the pelvic floor muscles functional properties. The aim of our study was to compare pelvic floor muscles (PFM) functional properties of women reporting urinary incontinence (UI) after hysterectomy and radiotherapy (RT) for endometrial cancer, to women with a history of comparable hysterectomy without UI. Additionally, to verify if exists a correlation between muscle functional properties and urogenital and bowel function. We hypothesized that the participants with UI would have significantly lower maximal strength of their PFM, higher passive resistance...
Hypothesis / aims of study Mixed urinary incontinence (UI) has been independently associated with... more Hypothesis / aims of study Mixed urinary incontinence (UI) has been independently associated with increased falls among aging community-dwelling women. However, the association between UI severity and falls is not fully understood. Thus, the aim of this study was to explore possible relationships between balance or lower extremity strength and the impact and/or severity of mixed UI in aging community-dwelling women.
Hypothesis / aims of study Recruitment is a major challenge in successfully completing any random... more Hypothesis / aims of study Recruitment is a major challenge in successfully completing any randomized control trial (RCT) as difficulties in recruitment can have an important impact on the duration of the study, its costs and more critically, can be related to trial failure [1]. Investigators are increasingly using new e-recruitment initiatives, such as Facebook advertisement. However, no studies in urogynecology have investigated or compared recruitment strategies regarding efficiency, retention, clinical characteristics and cost. The aim of this study was to compare three recruitment methods (conventional methods (ads, poster, leaflets), professional referrals and erecruitment,) for the number of patients screened/enrolled, the efficiency rate, the retention rate, the baseline characteristics of participants, and the average cost per enrolled participant.
Aims of course/workshop The aims of this workshop are: 1. To present an overview of the evidence ... more Aims of course/workshop The aims of this workshop are: 1. To present an overview of the evidence of physical therapy (PT) for urinary incontinence (UI) and to provide key information on the effectiveness of different treatment regimens. 2. To present the evidence for pelvic floor PT in the prevention and treatment of pre and postnatal UI. 3. To present the evidence for PT in the treatment of UI in the elderly women and to discuss emerging therapies such as postural and motor control strategies. 4. To present the evidence for PT in the prevention and treatment of pelvic organ prolapse (POP).
Hypothesis / aims of study To evaluate the effectiveness of individual physiotherapy treatments (... more Hypothesis / aims of study To evaluate the effectiveness of individual physiotherapy treatments (PT) in reducing urine leakage in postmenopausal, urinary incontinent women with osteoporosis or low bone density, immediately after intervention and at one year in comparison to a control group (Co). We hypothesised that participants receiving physiotherapy would have a significant reduction in the severity of urinary incontinence (UI) after intervention, and that these results would be maintained at one year.
Hypothesis / aims of study The pelvic floor muscles (PFM) are subject to considerable stretching ... more Hypothesis / aims of study The pelvic floor muscles (PFM) are subject to considerable stretching during a vaginal birth. In approximately 21 to 36% of women, this stretching will result in an avulsion injury (i.e. disconnection of the puborectalis portion from its insertion points on the pubis). It has been shown that avulsion injury significantly affects PFM morphometry resulting in a marked enlargement of the levator hiatus and an altered contractility [1]. Importantly, avulsion has also been associated with the development of urogynecologic symptoms such as pelvic organ prolapse and incontinence in the postpartum period. International clinical guidelines in agreement with meta-analysis recommend PFM physiotherapy as a first line treatment for these symptoms [2]. However, it is unclear whether women with PFM lesions as severe as a complete avulsion injury could respond to physiotherapy. The main objectives of this pilot study were 1-to evaluate the effect of physiotherapy for impr...
Hypothesis / aims of study: Urethral hypermobility and the loss of pelvic-floor muscle support ar... more Hypothesis / aims of study: Urethral hypermobility and the loss of pelvic-floor muscle support are the primary causes of female stress urinary incontinence [1]. New technologies, such as 2D ultrasound imaging, provide important information regarding the mobility of the urethra, the support and dynamic activity of the pelvic floor muscles (PFM) during an active contraction and, potentially, incontinence-producing stress, such as the stress experienced during a Valsalva maneuver and a cough. In order to quantify the kinematic parameters of the urethra and the pelvic floor muscles (PFM) during contraction and effort, this study explored the possibility of developing an automatic motion-tracking algorithm based on optical flow techniques.
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