Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

Purpose: To accurately and precisely evaluate the validity and reliability of the English-language Pelvic Floor Inventories (PelFIs) administered questionnaire. Participants: Fifty female patient volunteers (ages 24 to 82 years) plus fifty female control volunteers (ages 21 to 83 years) completed the 149-item questionnaire. Results: Construct validity of the English-language PelFIs was established by quantifying the differences in prevalence of pfm dysfunction between the patient population and the control population. Very significant findings of F=10.83, p<0.0001 were found for the document as a whole. Content validity was attained by experts, and additional information gathered for further improvement of this tool. Test-retest reliability for all domains was established with ICC=0.905 and no significant differences were found between time-one and time-two. Internal consistency was obtained with significant Pearson's Correlation noted between the domains. The prevalence of co-occurrence of pfm disorders with patients presenting for treatment of a single pfm dysfunction was quantified and 100% of the patients reported symptoms in domains additional to the domain they sought treatment for. The presence of pfm dysfunction was also quantified in the control population and 94% were found to display symptoms of pelvic floor dysfunction. Conclusions: The English-language PelFIs was shown to be valid and reliable. Co-occurrence of pfm dysfunction was found to be highly prevalent.

Purpose: To accurately and precisely evaluate the validity and reliability of the English-language Pelvic Floor Inventories (PelFIs) administered questionnaire. Participants: Fifty female patient volunteers (ages 24 to 82 years) plus fifty female control volunteers (ages 21 to 83 years) completed the 149-item questionnaire. Results: Construct validity of the English-language PelFIs was established by quantifying the differences in prevalence of pfm dysfunction between the patient population and the control population. Very significant findings of F=10.83, p<0.0001 were found for the document as a whole. Content validity was attained by experts, and additional information gathered for further improvement of this tool. Test-retest reliability for all domains was established with ICC=0.905 and no significant differences were found between time-one and time-two. Internal consistency was obtained with significant Pearson's Correlation noted between the domains. The prevalence of co-occurrence of pfm disorders with patients presenting for treatment of a single pfm dysfunction was quantified and 100% of the patients reported symptoms in domains additional to the domain they sought treatment for. The presence of pfm dysfunction was also quantified in the control population and 94% were found to display symptoms of pelvic floor dysfunction. Conclusions: The English-language PelFIs was shown to be valid and reliable. Co-occurrence of pfm dysfunction was found to be highly prevalent.

Background: Radical prostatectomy is the gold-standard treatment for clinically organ-confined cancer of the prostate. However, urinary incontinence and erectile dysfunction are major clinical problems, despite advances in surgical techniques. Pelvic floor muscle training is still the first-line treatment used to restore pelvic floor or bladder function after radical prostatectomy although its role is still inconclusive. Objectives: To determine the benefit of starting pelvic floor muscle training three weeks before radical prostatectomy in order to find by the end of three months after surgery: (1) any degree of continence regained in the intervention group, measured by 24-hour and one-hour pad tests; (2) any positive improvement in the quality of life in that group. Methods: Sixty-six eligible participants were randomised into either the intervention or the control group before radical prostatectomy. The former received three weeks’ pre-operative pelvic floor muscle training from an advanced practice nurse, while the latter received only standard care. Urine loss by 24-hour pad test was compared in the two groups as the primary outcome, and the questionnaires on incontinence impact, functional assessment on prostate cancer and potency satisfaction at one, two, three and six months after surgery were compared as secondary outcomes. Results: The intervention group regained continence significantly (p=0.002) earlier than the control group at the end of three months after surgery, as measured by the 24-hour pad test. The intervention group also reported a significantly better quality of life in the questionnaire on ‘incontinence impact’ than the control group. Interestingly, the Functional Assessment of Cancer Therapy-Prostate questionnaire showed no statistical significant difference between the groups, despite significantly less urine loss in the intervention group, which also had a higher potency satisfaction score on the International Index of Erectile Function (p=0.005) by the end of three months after surgery. Discussion: The present study found that three weeks’ pre-operative pelvic floor muscle training decreased the duration and severity of incontinence after radical prostatectomy, as measured by the 24-hour pad test of urine loss (in grams). Some other studies counted the number of pads used as the comparative data between the groups; however, there might be divergent findings in different studies. In one previous study of pelvic floor muscle training initiated two to four weeks before surgery but showing no benefit, it was found that patients received only one training session before surgery without further monitoring. A limitation of present study is that participants were followed-up for six months after surgery. It is possible that a longer period, perhaps one or two years, of post-prostatectomy follow-up might provide further important information. Conclusions: This is the first comprehensive study in Hong Kong to examine the efficacy of three weeks’ pre-operative pelvic floor muscle training in reducing post-prostatectomy urinary incontinence, and to evaluate the continence-related quality of life and potency satisfaction of intervention and control groups. The results demonstrated that such training not only significantly hastens the recovery of urinary continence after surgery but also leads to a better continence-related quality of life and potency satisfaction in the intervention group. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Nursing

The purpose of this study was to investigate the reliability of three different electromyography (EMG) detection systems commonly used to acquire EMG data from the pelvic floor muscles (PFM) at rest, during maximum voluntary contractions (MVCs) and during a coughing task. Twelve nulliparous women between the ages of 24 and 40 participated in the study. EMG data were recorded from each side of the pelvic floor using surface (Femiscan™ and Periform™ vaginal probes), and fine-wire electrodes while subjects performed three repetitions of each task in supine and in standing. RMS amplitudes of baseline and peak PFM activity were computed from the data acquired during the MVC and the coughing tasks. The peak RMS amplitudes from the cough data were also normalized to each subject’s MVC and report as a percent of their maximum voluntary electrical activation (% MVE). Signal to noise ratio (SNR) was calculated for each task. Comparisons were made between the RMS amplitudes and SNR recorded from each side of the PFM. Between-trial and between-day reliability was determined using a variety of measures including intraclass correlation coefficients (ICC), coefficients of variation (CV) and mean absolute difference (MAD). The reliability of the different devices was compared using the MAD normalized to average signal amplitude (nMAD). The results indicated that the EMG data recorded from the right and left sides of the PFM were different, therefore the EMG data acquired from each side of the pelvic floor were analyzed separately. Between-trial reliability assessed by ICC was good for all the devices (left and right average ICC(3,1) = 0.80 – 0.96); the CVs supported these findings (average CV = 12.4 – 17.1%) Between-day reliability was poor and inconsistent across all devices as tasks. When the cough data were normalized however, the between-day RMS amplitudes were very consistent (79.5 – 90.2% MVE). Each device recorded consistent activation amplitudes within a given day. Between-day reliability results indicate that EMG data recorded on separate days with these instruments should not be compared unless data can be normalized. Clinicians and researchers are cautioned to normalize their data if day-to-day comparisons in EMG amplitude are to be made using data recorded with these devices. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2007-12-14 17:31:34.552

Many women with pelvic floor disorders (PFDs) suffer in silence; unaware there is a medical explanation for their symptoms. Limited research on their perspectives living with these conditions was the underlying reason for this phenomenological study. Semi-structured, in-depth interviews were conducted with at least one vaginal delivery and a PFD diagnosis by a medical professional required for all participants. Subjects' ages ranged from 29 to 57, with the mean age of 41.3 years. The four major themes that emerged were (a) pregnancy-related issues, (b) interaction with family and friends, (c) relationships with significant others, and (d) interactions with healthcare professionals. All of the women visited multiple health care specialists, with the average period being 12 years from their first symptoms to diagnosis. Participants shared they did not discuss their symptoms with friends and/or partners hoping the problems would resolve on their own. Further studies on the personal experiences of women living with PFD are essential not only for the quality of prenatal care, but to encourage more women to seek help and improve their overall quality of life.

Feci quod potui: Fa ciant meliora potentes ( I did what I could, allow others to do better) Inscriptions on graduation dissertations in old Russia.This work began with a search for the pubo-recto-analis muscle at the instigation of Professor J.H. Louw. Requests followed from surgeons and urologists for information about, and demonstration of, structure related to the pelvic floor in infants and adults, these encouraged me to go more and more deeply into the anatomy of this region in Man. I found that welding of viscera to their fascial,muscular and bony environs is not described in current textbooks. The absence of clear-cut boundaries between some of the muscles, in areas where they are contiguous,is likewise never emphasised. The beautiful drawings in atlases and textbooks have a comforting way of reassuring us that all has been revealed about the pelvic floor and its viscera. However, when the time-consuming expedient of removing the superior fascia of the levator had already yielded dividends,in that failure to do this, had led generations of anatomists to misrepresent the commonest form of the origin of the pubo-coccygeus, it seemed worthwhile to pursue the fascia,muscles and terminal viscera and their nerves, in order to fully understand their complex interwoven relationships. The unusual electrical activity of the musculature was especially intriguing and demanded an explanation. My findings,many of which fully corroborate the findings of others, led me to a consideration of the factors which combine to produce the remarkably efficient functioning of intestinal and genito-urinary outlet mechanisms. It then appeared essential to adopt a correlative approach. Accordingly I have aimed to present a selective account of the soft tissues of the pelvis and perineum which is comprehensive and I hope useful. From it certain aspects,which appear of primary importance,should emerge clearly.

Purpose To evaluate the pelvic floor health knowledge base and presence of pelvic floor dysfunction (PFD) in women working in an office environment, and whether this knowledge significantly increases following a pelvic floor health education session and a re-education session. To assess whether this knowledge-acquisition leads to significant decrease in PFD. Participants Female volunteers (N=161), ages 18-69 years, were randomly allocated to Groups A, B or C. Methods Online surveys were completed by all groups on three occasions and included validated tools (Prolapse and Incontinence Knowledge Quiz, Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire-7) plus sexual function and pelvic floor muscle (PFM) exercise items. On completion of the baseline survey, an education session was given to Groups A and B only (Group C represented the controls). Following this, all participants completed the second survey. Two months later, to allow time for efficacy for the PFM exercises, a re-education presentation was given to Group A only, followed by the final survey administered to all. Analysis Of the 161 volunteers, 16 failed to complete all study requirements, leaving 145 questionnaires (Groups A and B n=48, Group C n=49) available for analysis using ANOVA and Descriptive Analysis. Results The knowledge base of the participants receiving the education showed highly significant improvement compared to the control group, and again for those receiving the re-education session. Although only 14% stated that they had PFD, the surveys revealed that 96% of the participants had PFD. The groups receiving the PFM exercise education and strategies to encourage healthier bladder and bowel habits showed significant decrease in PFD symptoms and increase in QoL. Education was successful in producing highly significant increases in knowledge, importance and commitment toward PFM exercise. Conclusion This study is unique as it evaluated pelvic floor health knowledge and presence of PFD of presumably healthy women within an office setting in contrast to patients seeking PFD medical attention. While further research is required, it is clear that low pelvic floor health knowledge was associated with high prevalence of PFD. Further, as knowledge/awareness significantly increased following education, so did QoL, while PFD significantly decreased.

Purpose To evaluate the pelvic floor health knowledge base and presence of pelvic floor dysfunction (PFD) in women working in an office environment, and whether this knowledge significantly increases following a pelvic floor health education session and a re-education session. To assess whether this knowledge-acquisition leads to significant decrease in PFD. Participants Female volunteers (N=161), ages 18-69 years, were randomly allocated to Groups A, B or C. Methods Online surveys were completed by all groups on three occasions and included validated tools (Prolapse and Incontinence Knowledge Quiz, Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire-7) plus sexual function and pelvic floor muscle (PFM) exercise items. On completion of the baseline survey, an education session was given to Groups A and B only (Group C represented the controls). Following this, all participants completed the second survey. Two months later, to allow time for efficacy for the PFM exercises, a re-education presentation was given to Group A only, followed by the final survey administered to all. Analysis Of the 161 volunteers, 16 failed to complete all study requirements, leaving 145 questionnaires (Groups A and B n=48, Group C n=49) available for analysis using ANOVA and Descriptive Analysis. Results The knowledge base of the participants receiving the education showed highly significant improvement compared to the control group, and again for those receiving the re-education session. Although only 14% stated that they had PFD, the surveys revealed that 96% of the participants had PFD. The groups receiving the PFM exercise education and strategies to encourage healthier bladder and bowel habits showed significant decrease in PFD symptoms and increase in QoL. Education was successful in producing highly significant increases in knowledge, importance and commitment toward PFM exercise. Conclusion This study is unique as it evaluated pelvic floor health knowledge and presence of PFD of presumably healthy women within an office setting in contrast to patients seeking PFD medical attention. While further research is required, it is clear that low pelvic floor health knowledge was associated with high prevalence of PFD. Further, as knowledge/awareness significantly increased following education, so did QoL, while PFD significantly decreased.

Regular physical activity is a recognised factor in the promotion of lifelong health. Exercise during pregnancy has been more accepted lately, and research shows that exercise during pregnancy is safe and beneficial, as opposed to the general view a few years ago when exercise during pregnancy was considered dangerous for both mother and fetus. It is likely that exercise plays a crucial role for women's health in postpartum as at any other time during her life. However, exercise after pregnancy is not a well­studied field and there are uncertainties about how exercise postpartum should be performed. This fact contributes to that an estimated 75% of women in postpartum reports that they want more information about lifestyle related factors such as diet, physical activity and exercise. The aim of the present study was to investigate how well exercise­advise given to women postpartum match with current research. To investigate this, a survey was made. Seven midwifes responded to how they advise and supervise women when it comes to exercise postpartum. The results shows that a majority of midwifes are unsure of how exercise should be performed, and the advise given does not always match with current research. The present study indicates that more research and education concerning exercise postpartum is needed.