Sensory and muscular functions of the pelvic floor in women with endometriosis - cross-sectional study.

PURPOSE: The aim of this study was to analyze the sensory and muscle functions of the pelvic floor in women with endometriosis, trying to improve overall knowledge/findings regarding pelvic floor muscle functions in patients with endometriosis. METHODS: Sample size calculated as 92 patients with endometriosis, aged between 18 and 45 years, not virgin, without other causes of pain and could not be pregnant. Patients underwent the Pelvic Floor Sensorial and Muscle Function Exam (EFSMAP). Descriptive data were recorded with mean and standard deviation, median (range), and absolute and relative frequency. The Kolmogorov-Smirnov test was used to observe the normality of quantitative variables. The significance level adopted for this study was 5%. RESULTS: Of 92 women assessed, 93.3% had pain and 75% had increased tone in the levator ani muscle; 50.4% had impaired pelvic floor relaxation with median strength of 3 by the Oxford scale and endurance of 2 s. CONCLUSIONS: The patients had a high prevalence of pain and dysfunction of the pelvic floor muscles, such as low muscle endurance and difficulty to relax. It shows that these patients should be referred to a pelvic floor physiotherapist, as soon as they have the diagnosis of endometriosis, to be assessed to prevent and/or treat pelvic floor impairments.

Acute Effect of a Half-Marathon over the Muscular Function and Electromyographic Activity of the Pelvic Floor in Female Runners with or without Urinary Incontinence: A Pilot Study.

OBJECTIVE: to verify the acute effect of running a half marathon on pelvic floor muscle (PFM) function and electromyographic (EMG) activity in female runners with and without urinary incontinence. METHODS: This is a cross-sectional pilot study. The sample was divided into two groups: runners with urinary incontinence (with UI) and runners without urinary incontinence (without UI). A semi-structured form and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were used for data collection. The EMG and PFM function were evaluated using the PERFECT method before and immediately after running a half marathon. RESULTS: A total of 14 runners were included (8 with UI; 6 without UI). Runners with and without UI did not show significant differences for EMG and PERFECT. The acute effects of the half marathon on runners without UI were reduced PFM function in terms of strength (p = 0.00), reduced endurance (p = 0.02), and reduced repetition (p = 0.03), and an increase in EMG measured by the median frequency (p = 0.02). Runners with UI showed reduced PFM function in terms of strength (p = 0.05) and repetition (p = 0.01). CONCLUSION: there was no difference in the acute effects of the half marathon on PFM function and EMG in women with and without UI.

Prevalência, conhecimento e fatores associados à incontinência urinária em mulheres estudantes de um curso de Fisioterapia / Prevalencia, conocimientos y factores asociados a la incontinencia urinaria en mujeres estudiantes de Fisioterapia / Prevalence, knowledge, and factors associated with urinary incontinence in female students of a physical therapy undergraduate course

RESUMO O objetivo deste estudo foi avaliar a prevalência, o conhecimento e os fatores associados à incontinência urinária (IU) em mulheres estudantes de um curso de fisioterapia, bem como sua qualidade de vida. Foi aplicada uma ficha de avaliação, o International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) e um questionário de conhecimento sobre a musculatura do assoalho pélvico (MAP) e a ocorrência de IU, baseado em estudo tipo conhecimento, atitude e prática (CAP). Das 248 estudantes do curso, 170 (69%) participaram do estudo. Pela ficha de avaliação, 111 (65%) relataram perda urinária. De acordo com o ICIQ-SF, 63 participantes (37%) são incontinentes, sendo que 41 (65%) dessas apresentam IU de esforço, apresentando pequena perda e com frequência de uma vez na semana ou menos, com baixo impacto na sua qualidade de vida. A maioria das participantes que relataram ter dor na relação sexual (59%) e alguns sintomas uroginecológicos e intestinais, como esforço ao urinar (92%), jato interrompido (75%), incômodo na região vaginal (73%), constipação (53%), esforço ao defecar (53%) e esvaziamento intestinal incompleto (70%), apresentou queixa de IU. Todas as que usam protetor (100%) e procuraram atendimento médico (100%) eram incontinentes. O uso de anticoncepcional foi maior em mulheres sem perda urinária (84%). O conhecimento sobre a MAP e a IU foi adquirido gradualmente com o avançar do curso. Esse resultado sugere que as mulheres que não cursam Fisioterapia não têm domínio do assunto, sendo necessário disseminar o conhecimento sobre a IU e a atuação da fisioterapia.

RESUMEN El objetivo de este estudio fue evaluar la prevalencia, el conocimiento y los factores asociados a la incontinencia urinaria (IU) en mujeres estudiantes de Fisioterapia, así como su calidad de vida. Se aplicó un formulario de evaluación, el International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) y un cuestionario de conocimiento sobre la musculatura del suelo pélvico (MSP) y la ocurrencia de IU, basado en un estudio de conocimiento, actitud y práctica (CAP). De las 248 estudiantes del curso, 170 (69%) participaron en el estudio. Según el formulario de evaluación, 111 (65%) reportaron pérdida urinaria. Conforme el ICIQ-SF, 63 participantes (37%) son incontinentes, y 41 (65%) de ellas tienen IU de esfuerzo, presentando una pequeña pérdida y con frecuencia de una vez a la semana o menos, con bajo impacto en su calidad de vida. La mayoría de las participantes que informaron sentir dolor en las relaciones sexuales (59%) y algunos síntomas uroginecológicos e intestinales, como esfuerzo al orinar (92%), chorro interrumpido (75%), molestias en la región vaginal (73%), estreñimiento (53%), esfuerzo al defecar (53%) y vaciamiento intestinal incompleto (70%), se quejó de IU. Las participantes que usan protectores (100%) y buscan atención médica (100%) eran incontinentes. El uso de anticonceptivos fue mayor en las mujeres sin pérdida urinaria (84%). El conocimiento sobre la MSP e IU se adquirió de manera gradual a medida que avanzaba el curso. Este resultado apunta que las mujeres que no estudian Fisioterapia no tienen dominio del tema y es necesario difundir conocimientos sobre la IU y la actuación de la fisioterapia.

ABSTRACT This study aimed to evaluate the prevalence, knowledge, factors associated with urinary incontinence (UI), and quality of life in female students enrolled in a physical therapy undergraduate course. Students had to answer a form we developed, the International Questionnaire on Incontinence Consultation - Short Form (ICIQ-SF), and a knowledge questionnaire on pelvic floor musculature (PFM) and the occurrence of UI, based on a previous knowledge, attitude, and practice (KAP) study. Out of 248 students, 170 (69%) participated in our study. According to our evaluation form, 111 women (65%) reported urinary loss at some point in their lives. According to ICIQ-SF criteria, 63 (37%) women were incontinent, 41 (65%) suffered from strain urinary incontinence, showing small urinary losses once per week or less, which slightly impacted their quality of life. Most women who have pain during sexual intercourse (59%) and some urogynecological and intestinal symptom, such as straining (92%), intermittent urination (75%), nausea (73%), constipation (53%), excessive effort (53%), and incomplete outlet (70%) also suffered from UI. All women who used pads (100%) and sought medical care (100%) were incontinent. The use of contraceptive was higher among women without UI (84%). Participants built their knowledge on PFM and UI as the course progressed. These results suggest that women who attend undergraduate courses outside physical therapy have limited knowledge about the subject. We find it necessary to spread knowledge about UI and the importance of physical therapy to prevent and treat UI.

Prevalence of primary dysmenorrhea and associated factors in adult women.

OBJECTIVE: This study aimed to assess the prevalence and factors associated with primary dysmenorrhea in a sample of adult women. METHODS: A cross-sectional study was carried out with women aged between 19 and 49 years from a city of northeastern Brazil. Sociodemographic, gynecological, and obstetric variables were assessed by questionnaires and interviews. Dysmenorrhea was measured by self-report, and the Numerical Pain Rating Scale measured the intensity of pain. Statistical analyses included χ2 test, ANOVA, and logistic regression. RESULTS: The average age was 33.2±9.1 years and the prevalence of primary dysmenorrhea was 56% for the whole sample. The average duration of symptoms was 2.7±1.8 days and the mean intensity was 6.1±2.6. The previous cesarean section was associated with a higher rate of primary dysmenorrhea (PR=2.33; 95%CI 1.11-4.90) when considering the whole sample. Women who aged 25-39 years and are insufficiently active had higher rates of primary dysmenorrhea (PR=5.24; 95%CI 1.08-27.31). CONCLUSION: Primary dysmenorrhea has a high prevalence in young adults, adults, and middle-aged women. Cesarean section and being physically inactive was associated with increased rates of dysmenorrhea among adult women.

Prevalence of primary dysmenorrhea and associated factors in adult women

SUMMARY OBJECTIVE: This study aimed to assess the prevalence and factors associated with primary dysmenorrhea in a sample of adult women. METHODS: A cross-sectional study was carried out with women aged between 19 and 49 years from a city of northeastern Brazil. Sociodemographic, gynecological, and obstetric variables were assessed by questionnaires and interviews. Dysmenorrhea was measured by self-report, and the Numerical Pain Rating Scale measured the intensity of pain. Statistical analyses included χ2 test, ANOVA, and logistic regression. RESULTS: The average age was 33.2±9.1 years and the prevalence of primary dysmenorrhea was 56% for the whole sample. The average duration of symptoms was 2.7±1.8 days and the mean intensity was 6.1±2.6. The previous cesarean section was associated with a higher rate of primary dysmenorrhea (PR=2.33; 95%CI 1.11-4.90) when considering the whole sample. Women who aged 25-39 years and are insufficiently active had higher rates of primary dysmenorrhea (PR=5.24; 95%CI 1.08-27.31). CONCLUSION: Primary dysmenorrhea has a high prevalence in young adults, adults, and middle-aged women. Cesarean section and being physically inactive was associated with increased rates of dysmenorrhea among adult women.

Impacts of COVID-19 on physiotherapy care for women with breast cancer / Impactos da COVID-19 nos atendimentos fisioterapêuticos a mulheres com câncer de mama

Abstract Introdution: COVID-19 has been declared a public health emergency of international concern by the World Health Organization, with a diverse clinical spectrum. Given the coronavirus prevention measures and recommendations from health authorities, there is a concern about how physiotherapy care is provided to women with breast cancer. The discontinuity of care may favor the emergence of complications, and compromise functionality, quality of care and the provision of complementary treatments. Objective: To assess the impacts of the COVID-19 pandemic on the continuity of physiotherapy care for women with breast cancer. Methods: This is a cross-sectional study. Data were collected through an online questionnaire and the population was composed of physiotherapists, of both sexes, who work in Brazil. Results: Twenty percent of the 40 participants reported no change in their work routine, 48% had their workload reduced, 12% had an increased workload, 25% were relocated to provide assistance to patients affected by COVID-19, and 20% of consultations were suspended. The greatest continuity of care was seen in hospital admissions (40%) and outpatient clinics (42%). The number of women cared for before the pandemic compared to during the restriction period declined by 72%. Conclusion: Most consultations were suspended; however, in most cases, continuity of care was guaranteed through telerehabilitation. Nevertheless, the interviewees reported clinical worsening in women after treatment was interrupted.

Resumo Introdução: A COVID-19 trata-se de uma situação de emergência de saúde pública de importância interna-cional, cujo espectro clínico é diverso. Levando em consideração as medidas de prevenção ao coronavírus e as recomendações das autoridades de saúde, surge a preocupação de como estão os atendimentos fisiotera-pêuticos a mulheres com câncer de mama, já que sua descontinuidade pode favorecer o aparecimento de complicações, prejuízos na funcionalidade, na qualidade de vida e na realização de tratamentos complementares. Objetivo: Avaliar os impactos da pandemia de COVID-19 na continuidade dos atendimentos fisioterapêuticos a mulheres com câncer de mama. Métodos: Trata-se de uma pesquisa transversal. Os dados foram coletados por meio de questionário on-line e a população foi composta por fisioterapeutas que atuam em território brasileiro. Resultados: De um total de 40 participantes, 20% relataram não ter sofrido alteração na rotina de trabalho, 48% tiveram a carga horária reduzida, 12% sofreram aumento de carga horária, enquanto 25% foram realocadas de setor para prestar assistência aos acometidos pela COVID-19. Vinte por cento dos atendimentos foram suspensos, sendo os locais com maior continuidade na assistência os de internação hospitalar (40%) e ambulatórios (42%). Quanto ao número de mulheres atendidas antes da pandemia em comparação ao número durante o período de restrição, houve uma queda de 72%. Conclusão: Verificou-se suspensão da maior parte dos atendimentos, no entanto, em sua maioria, a continuidade da assistência foi garantida através de teleatendimento. Não obstante, os entrevistados relataram piora clínica no quadro das mulheres após o período de suspensão do tratamento.

Association among dysmenorrhea and activity limitation and participation restrictions in adult women: a cross-sectional study, Brazil -2017.

BACKGROUND: The present study aims to analyse if dysmenorrhea is associated with activity limitations and participation restrictions in experencied by adult women. METHODS: This is a cross-sectional study carried out with adult women recruited from primary health services in Brazil between 2016 and 2017. Dysmenorrhea was measured via a self-report and the activity limitation and participation restrictions was assessed by the World Health Disability Assessment Schedule (WHODAS2.0). Pain and level of physical activity were assessed, respectively, by the numerical pain rating scale and International Physical Activity Questionnaire (IPAQ), short version. Associations between groups, dysmenorrhea and without dysmenorrhea (WD), were analysed by the median difference, Mann Whitney test, effect size measures and 95 % confidence interval. Statistical significance was p <0.05. RESULTS: The prevalence of dysmenorrhea was 54 %. The pain lasted an average of three days or more (66 %). The average pain intensity, in the crisis period, was 6.1 ± 2.6, women who presented severe pain complaints were associated with considerable difficulties in their domains of mobility (p = 0.003; 2 = 0.115), participation (p = 0.030; 2 = 0.063) and total score (p = 0.012; 2 = 0.086), with a moderate effect size for all variables. CONCLUSIONS: Severe dysmenorrhea was associated with higher scores of disabilities assessed by the WHODAS 2.0, especially in mobility, and participation domains.

Perineal trauma in nulliparous women and its associated factors / Laceração perineal em nulíparas e seus fatores associados

INTRODUCTION: Perineal trauma is an important complication for women after giving birth. OBJECTIVE: To evaluate the prevalence of perineal trauma and its associated factors in nulliparous. METHODS: A retrospective cohort study was carried out, through the analysis of the medical records of women with singleton pregnancy who achieved vaginal birth of a live infant, in 2017, in a maternity hospital. Data collection involved information about demographic, obstetric, and clinical data from nulliparous women, and infant birthweight. Univariate and multivariate logistic analyses were performed to verify the association of perineal trauma with the variables assessed, with significant variables remaining in the model (p<0.05), through a stepwise strategy. RESULTS: A total of 326 medical records were analyzed. The percentage of perineal trauma was 60%. In the multivariate analysis, the use of oxytocin increased the chance of perineal trauma by 730%. In addition, the adoption of squatting position and hands and knees decreased the chances of perineal trauma by 81% and 97%, respectively, in comparison with those who adopted the lithotomy position, during the second stage labor. CONCLUSION: The rate of perineal laceration was high, but the severity was low. The use of oxytocin is associated with the presence of trauma and the squatting position and hands and knees, especially, have contributed to the protection of the perineum.

INTRODUÇÃO: Laceração perineal é uma complicação importante para mulheres pós-parto. OBJETIVO: Avaliar a prevalência de laceração perineal e seus fatores associados em primíparas. MÉTODOS: Foi realizado um estudo de coorte retrospectivo, através da análise dos prontuários de mulheres que pariram no ano de 2017, em uma maternidade da cidade. Durante a coleta de dados foi utilizada uma lista de checagem e um formulário para retirar informações sobre dados obstétricos, sociodemográficos e clínicos das mulheres e o peso do recém-nascido. Em seguida foram formuladas tabelas para determinação da associação entre as variáveis independentes e a presença de laceração. Logo após, foi feita a análise de regressão logística múltipla para identificar as variáveis mais fortemente associadas à laceração perineal. RESULTADOS: Um total de 326 prontuários foram analisados. O percentual de laceração perineal foi de 60%. Na análise multivariada, o uso de oxitocina aumentou a chance de laceração perineal em 730%. Além disso, a posição de cócoras e de quatro apoios diminuíram a chance de laceração perineal em 80% e 97%, respectivamente, em comparação com as mulheres que adotaram a posição de litotomia, durante o segundo período do parto. CONCLUSÃO: A taxa de laceração perineal encontrada foi alta, mas a gravidade foi baixa. O uso de ocitocina está associado com a presença de laceração perineal e a posição de cócoras e de quatro apoios contribuem para a proteção do períneo.

Is Constipation Associated with Worse Functioning in Adult Women? A Cross-Sectional Study.

OBJECTIVE: The aim of this study is to analyze the relationship between intestinal constipation and functioning in adult women living in a municipality in the interior of northeast Brazil. MATERIALS AND METHODS: This is a cross-sectional study conducted with 195 adult women in the city of Santa Cruz-RN. Constipation was diagnosed using the Rome III criteria. Functioning was measured through WHODAS 2.0. Social conditions, habits and lifestyle were also investigated. Inferential analysis was performed using the chi-squared test and the Mann-Whitney U-test, and the effect size was determined by eta squared (η2). Multivariate analysis was performed using multiple linear regression to analyze the relationship between the WHODAS total score and constipation, being adjusted by covariates with p≤0.20 in the bivariate. A statistical significance level of p<0.05 was considered. RESULTS: Most of the participants in this study were aged 19 to 39 years (69.7%) and had an income of up to 1 minimum monthly salary (79.5%). WHODAS scores showed that women with constipation had more disability in the cognitive (p <0.001), mobility (p <0.002), self-care (p <0.001), and participation (p <0.001) domains, as well as the total score (p <0.001). After multiple linear regression analysis, the total WHODAS score remained associated with constipation (p <0.001), in which this condition increases the score by nine points. CONCLUSION: The results of this study show that there is a reduction in functioning associated with the presence of constipation in adult women, mainly affecting the cognition, mobility, self-care and participation domains, in addition to the total score.

PREVALENCE AND FACTORS ASSOCIATED WITH CONSTIPATION IN PREMENOPAUSAL WOMEN: A COMMUNITY-BASED STUDY.

BACKGROUND: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature. OBJECTIVE: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil. METHODS: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered. RESULTS: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation. CONCLUSION: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.

Prevalência e fatores associados à constipação em mulheres na pré-menopausa: um estudo de base comunitária / Prevalence and factors associated with constipation in premenopausal women: a community-based study

ABSTRACT BACKGROUND: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature. OBJECTIVE: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil. METHODS: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered. RESULTS: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation. CONCLUSION: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.

RESUMO CONTEXTO: A constipação intestinal é caracterizada por problemas relacionados à evacuação, e apresenta alta prevalência no gênero feminino. Essa condição tem demonstrado efeitos negativos no desenvolvimento das atividades diárias, causando prejuízos no bem-estar físico e emocional dos indivíduos que são diagnosticados com ela. Estudos que investiguem quais prejuízos à saúde a constipação intestinal pode ocasionar são escassos na literatura. OBJETIVO: Este estudo teve como objetivo verificar a prevalência e os fatores associados à constipação intestinal em mulheres na pré-menopausa residentes no nordeste do Brasil. MÉTODOS: Estudo transversal realizado no Nordeste do Brasil. Participaram 195 mulheres adultas e de meia idade. Condições sociais, hábitos e estilo de vida, aspectos clínicos e história obstétrica foram investigados. A constipação foi diagnosticada através dos Critérios de Roma III. A análise multivariada foi conduzida através da Regressão de Poisson com variância robusta, para analisar a relação entre constipação intestinal e variáveis independentes. Considerou-se o nível de significância estatística de P≤0,05. RESULTADOS: A maioria das mulheres estava na faixa etária de 25 a 39 anos (49,2%) e possuía renda de até um salário mínimo (79,5%). A prevalência da constipação intestinal foi de 35,4%. No modelo final da regressão multivariada, os aspectos clínicos hemorroidas (P<0,01), dor (P<0,001) e ardor (P<0,01) ao evacuar e disfunção sexual (P<0,03) permaneceram associados à constipação. CONCLUSÃO: O presente estudo encontrou uma prevalência significativa de constipação entre mulheres na pré-menopausa e fatores clínicos como hemorroidas, dor e ardor na evacuação, e disfunção sexual se associaram a constipação intestinal.

Prevalence of urinary incontinence in high-impact sports athletes and their association with knowledge, attitude and practice about this dysfunction.

OBJECTIVE: To evaluate the prevalence of urinary incontinence (UI) in female athletes practising high-impact sports and its association with knowledge, attitude and practice (KAP). DESIGN: Observational study. METHODS: A semi-structured evaluation form, KAP survey and the International Consultation on Incontinence Questionnaire - Short Form were used. Univariate and multivariate analyses were performed to verify the association of UI with KAP, sociodemographic, gynaecological and sports-related variables, with significant variables remaining in the model (p < .05), through a stepwise strategy. RESULTS: The prevalence of UI in 118 athletes was 82 (70%), of which 19 (23%) had pure stress UI, 19 (23%) had pure urgency UI and 44 (54%) had mixed UI; with 50 (61%) athletes losing urine during training and 37 (45%) during competitions. Regarding the KAP survey, 37 athletes (31%) demonstrated adequate knowledge, 63 (53%) adequate attitude and zero adequate practice. In the multivariate analysis, a sports practice time of over 8 years and dyspareunia presented significant values, with odds ratios (OR) of 2.66 and 2.99, respectively. Knowledge was significantly associated with UI (OR 0.43). UI had a slight impact on QOL. CONCLUSIONS: There is a high prevalence of UI yet low levels of adequate knowledge and practice regarding the occurrence of UI in sports, with sports practice time over 8 years and dyspareunia factors predisposing female athletes to UI by 2.7 and 3 times, respectively. Athletes with adequate knowledge were 57% less likely to develop UI.

Frequency and associated factors of axillary web syndrome in women who had undergone breast cancer surgery: a transversal and retrospective study.

BACKGROUND: Breast cancer is the most common malignancy among women. Surgical treatment is an essential part of therapy, which still includes chemotherapy, radiotherapy and hormone therapy. The increase in early cancer detection and less aggressive treatment has made longer survival rates possible for women with this neoplasia. Morbidities after treatment have subsequently aroused particular interest in the scientific community in order to minimize their effects and provide increased quality-of-life for these patients. The present study aimed at investigating one of these morbidities: axillary web syndrome, which occurs after axillary surgical management. METHODS: From December 2011 to September 2012, according to the inclusion and exclusion criteria, 97 patients, who had been surgically treated for breast cancer, were enrolled, interviewed, and submitted to a specific physical exam. An investigation of the axillary cords, characteristic of this syndrome, was performed in all patients. RESULTS: The axillary web syndrome was diagnosed in 28.86% of the women. Higher risk of triggering the syndrome has been associated with younger age (21.7%), longer time between first treatment and data collection (29.3%), greater number of resected lymph nodes (149.7%) and surgical management medical teams (113.2%). CONCLUSIONS: One can conclude that axillary web syndrome was associated with younger age, greater time elapsed since surgery, surgical management of medical staff and number of resected lymph nodes. Further studies are needed to review prior-to-surgery and post-operative follow-up, to properly assess the effects of surgery in the axilla on homeostatic balance, not only in the ipsilateral upper limb, but also assess their compensatory consequences throughout the body.

Effectiveness of physical therapy for pregnancy-related low back and/or pelvic pain after delivery: a systematic review.

The aim of this work was to investigate the effectiveness of physical therapy for the treatment of low back pain (LBP) and pelvic girdle pain (PGP) related to pregnancy after delivery. A systematic review of studies published since 1985 in the databases Medline, PEDro, SciELO, SCOPUS, LILACS, and the Cochrane Library was made. Studies that focused on postpartum LBP or PGP, without being related to pregnancy or in other non-pregnant patients, were excluded, as were papers addressing LBP or PGP indicating radiculopathy, rheumatism, or any other serious disease or pathologic condition. In accordance with the exclusion criteria and duplicate articles, of the 105 articles retrieved only six were considered for quality assessment with the PEDro Scale. Among these six papers, two were follow-ups, such that only four trials were included in this review. All trials used exercise for motor control and stability of the lumbopelvic region, but with different intervention approaches. The study affording the best evidence used individual guidance and adjustments given by the physiotherapists. Nevertheless, this systematic review was inconclusive and showed that more randomized clinical trials, with good quality, are needed.

Alterações vasculares resultantes da abordagem cirúrgica da axila: uma revisão da literatura / Vascular disorders after axillary surgery: a literature review

Introdução: O câncer de mama é considerado um problema de saúde pública. No Brasil, como ainda predominam os diagnósticos nos estágios avançados, cirurgias extensas e dissecções axilares ainda são muito utilizadas. Tais procedimentos podem levar a uma variedade de problemas clínicos,normalmente relacionados à etiologia vascular, que têm impacto funcional. Objetivos: Analisar as alterações linfovasculares sob os aspectos histopatológicos, anatômicos, linfocintilográficos e funcionais, decorrentes da abordagem cirúrgica da axila. Métodos: A revisão da literatura foi realizada a partir das bases de dados LILACS, PubMed e BIREME, via descritores DeCS/MeSH, tendo a busca sido feita entre os meses de setembro a outubro de 2011. Resultados: Os estudos que avaliaram os aspectos histopatológicos tiveram a trombose dos vasos linfáticos como o achado em comum. Naqueles que avaliaram os aspectos linfocintilográficos, ficou evidenciado a presença de um fluxo linfático retrógrado, além do surgimento, do ponto de vista anatômico demonstrado pela linfocintilografia, devias linfáticas colaterais. Outro estudo, que avaliou os aspectos funcionais, observou que a captação do radiofármaco usado, na axila, foi mais lenta em pacientes com esvaziamento axilar nas situações de repouso e exercício. Conclusões: A maioria dos estudos atesta importantes alterações vasculares que se estabelecem após a cirurgia da axila, em todos os aspectos pesquisados. Tais alterações podem permanecer por anos, resultando em transtornos clínicos aparentes como déficit de força, linfedema, síndromeda rede axilar, dentre outros, cujas origens, no sistema vascular, ainda carecem de maior atenção.

Introduction: Breast cancer is considered a public health problem. In Brazil, as still predominate inadvanced diagnostics, extensive surgery and axillary dissections are still widely used. Such procedures may lead to a variety of clinical problems, normally related to the etiology vascular, with functional impact. Objectives: To analyze the linfovasculares changes under histopathological, anatomical, functional and lymphoscintigraphic aspects, resulting from the surgical approach of the axilla. Methods: The literature review was performed from the databases LILACS, PubMed and BIREME, by DeCS/MeSH. The search was made between the months September-October 2011. Results: The studies that assessed the histopathological aspects had thrombosis of lymphatic vessels as found in common. In those studies that evaluated aspects lymphoscintigraphic, evidenced the presence of a retrograde lymphatic flow, besides the appearance of collateral lymphatic pathways shown by lymphoscintigraphy. Another study that evaluated the functional aspects, noted that the uptake of the radiopharmaceutical used, in the armpit, was slower in patients with axillary lymph node dissection in situations of rest and exercise. Conclusions: Most studies attest importante vascular changes that take place after surgery of axilla in all aspects analyzed. Such changes may persist for years, resulting in clinical disorders such apparent strength deficit, lymphedema, axillary web syndrome, among others, which origins in the vascular system, still require further attention.