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Ferreira C.H.1,2, Mateus-Vasconcelos E.C.L.1,2,3, Vassimon F.I.A.1, Daniel T.1, Ribeiro A.M.1, Brito L.G.d.O.1
1University of São Paulo, Ribeirão Preto, Brazil, 2Rehabilitation Center of Clinical Hospital of the Ribeirão Preto Medical School, Ribeirão Preto, Brazil, 3Barão de Mauá University Center, Ribeirão Preto, Brazil
Background: The ability to contract the pelvic floor muscles (PFM) is required to conduct a PFM training and the prevalence of women unable to perform it is high. Although this there is gap in the literature related to the effectiveness of Physical therapy interventions to facilitate a PFM contraction in women.
Purpose: The primary aim was to evaluate the effect of intravaginal electrical stimulation (ES), vaginal palpation, vaginal palpation associated with posterior pelvic tilt in the facilitation of a voluntary PFM contraction in women; the secondary aims were to evaluate the effect of interventions on the urinary incontinence (UI), quality of life; and sexual function.
Methods: A randomized controlled clinical trial, including 132 women with PF dysfunction and PFM function 0 or 1 according to Modified Oxford Scale (MOS) submitted to eight physiotherapy sessions of intravaginal ES (GES) (n=33); vaginal palpation (GP) (n=33); vaginal palpation with posterior pelvic tilt (GPPT) (n=33); or only verbal instructions to contract the PFM (CG) (n=33). Primary outcome was assessed using the MOS. Secondary outcomes were evaluated using validated questionnaires (ICIQ-SF and FSFI) at baseline and eight weeks later. To investigate the association between categorical variables, Fisher´s exact test was used. For analysis of the questionnaires a linear mixed effect models was used. The significance level for all tests was 5%.
Results: The mean age of participants was 53.11 (± 12.56) years and mean body mass index was 29.72 (± 5.37) kg / m2.The four groups were homogenous at baseline in relation to primary and secondary outcomes. All groups showed improved ability to contract the PFM considering changes to EOM ≥ 2 in the second assessment. The percentages of change in each group were: GPPT (69.70%), GP (63.64%); GES (33.33%), CG (19.18%) - p 0.001. Compared to the CG, the results were: GPPT (OR = 10,349; 95% CI, 3.261 to 32.844), GP (OR = 7.874; 95% CI, 2.534 to 24.470) and GES (OR = 2.250; 95% CI, 0.717 to 7.056). All groups showed improvement in UI after eight weeks. The intergroup analysis showed the following results between the GES and the GP (mean difference: 3.6364; 95% CI, 0.6781 to 6.5947; p = 0.0162); between the GP and the GPPT (3.0606, 95% CI, -6.0189 to -0.1023; p = 0.0426); and between GP and CG (4.7273, 95% CI, -7.6856 to -1.7690; p = 0.0018). No intra or intergroup differences were found in relation to sexual function.
Conclusion(s): The vaginal palpation with posterior pelvic tilt and vaginal palpation were the most effective interventions facilitating a voluntary PFM contraction in women when compared to control group and electrical stimulation group. All interventions improved UI reports. The palpation group showed the best result in relation to UI. There was no improvement in sexual function.
Implications: This original study will contribute to guide the clinical decision making when electing a physical therapy intervention to facilitate a voluntary PFM contraction in women.
Funding acknowledgements: To Foundation of University Hospital of Ribeirão Preto Medical School - FAEPA
Topic: Women's & mens pelvic health
Ethics approval: Approved by Research Ethics Committee of Clinical Hospital, Ribeirão Preto Medical School, University of São Paulo (HCRP n ° 1918/2013)
All authors, affiliations and abstracts have been published as submitted.
