A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Physical Therapy.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy].

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy].

Purpose: To investigate the incidence of urinary incontinence (UI) and relationship between UI and health related quality of life (HRQOL) of postpartum Bangladeshi women. Problem Statement: There are no studies comparing HRQOL with incidence and impact of UI amongst Bangladeshi women who have had cesarean section (CS) and those with normal vaginal delivery (NVD). Methods: Prospective, cross sectional, correlational design (n=94) of postpartum Bangladeshi women, ages 18-44, with history of one or more obstetrical deliveries within the last three years. Implemented at the Center for Rehabilitation of the Paralyzed (CRP) in Bangladesh. Subjects completed the Bengali version of the SF-36 and IIQ-7. Results: Six subjects were eliminated from the study because of co-morbidity exclusion factors. Eight subjects were excluded secondary to "mixed birth mode" (MBM). UI incidence was reported at 45% (n=39/86) total, 44% CS (n=18/41), and 47% (n=21/45) for NVD. IIQ-7 scores and UI presence showed strong correlations in both CS (rho=.729, 84, p<.001) and NVD (rho=.874, 84, p<.001). The highest impact of UI was reported in the CS group. One sample t-test reported significant differences for the sample when compared with the age equivalent norms for the SF-36 domain and component scores (p =.05-.001). Women in the 35-44 age group reported higher UI incidence and decreased HRQOL scores on the SF-36 and IIQ-7. Significant differences in HRQOL were reported for women with "pelvic/abdominal pain" and "UI" compared to those without "pain" or without "UI" and strong inverse correlations (rho=.597-.853) were reported for subjects with "pain" on the SF-36 domains (p=.001). The MBD group (n=8) reported UI incidence at 74% (n= 6/8), and pelvic/abdominal pain at 63% (n=5/8). Conclusion: No significant difference between birth modes was found in UI and HRQOL measures. A significant decrease in HRQOL for women during the postpartum period compared to age related norm scores was reported. Report of abdominal/pelvic pain and presence of UI were directly related to HRQOL in this study. Future research in this population should address pelvic and abdominal pain and "mixed birth mode" impact on QOL and UI in a larger sample using a longitudinal design.

Strengthening exercises for the lumbar extensor musculature represent the most common form of exercise therapy employed by physical therapists in clinical management of adults with chronic low back pain (CLBP). Despite the popularity of lumbar extensor strengthening exercises, the dose response relationship for lumbar extensor strengthening exercise in the clinical management of CLBP is not well established and specific guidelines to assist physical therapists in the prescription of lumbar extensor strengthening exercises for this population have not been fully developed. The primary aim of this investigation was to contribute to the understanding of the dose response relationship for lumbar extensor strengthening exercise in the clinical management of adults with CLBP. This objective was achieved by conducting a retrospective analysis of medical records from a cohort of adults with CLBP who completed a structured protocol of physical therapist supervised lumbar extensor strengthening exercises over a 5 year period at a hospital based outpatient rehabilitation center. After controlling for heterogeneity in baseline demographic and clinical characteristics, the results of the statistical analysis procedures suggested that performance of the exercise protocol once weekly for 12 weeks was associated with clinically meaningful improvements in pain intensity, perceived disability, and lumbar extensor function. There was insufficient evidence to conclude that higher training frequencies were necessarily associated with better clinical outcomes. The adults with CLBP most likely to benefit from the structured protocol of lumbar extensor strengthening exercises were those individuals who demonstrated the greatest deficits in lumbar extensor function during their baseline performance testing procedures.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy].

A formal dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy].

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy].

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy].