The Development and Evaluation of the Kinesthetic Motor Imagery of Pelvic Floor Muscle Contraction Questionnaire (KMI-PFQ) in Spanish Women.

Practitioners have begun using motor imagery (MI) for preventing and treating some pelvic floor disorders. Due to requirements for imagining before performing a MI intervention and because there are few instruments available for assessing this specific ability in the pelvic floor musculature, we sought to develop and test a new MI questionnaire, the Kinesthetic Motor Imagery of Pelvic Floor Muscle Contraction Questionnaire (KMI-PFQ). We focused in this study on the development and analysis of the instrument's factorial structure and internal reliability in a participant sample of 162 healthy Spanish women (M age = 20.1, SD = 2.2 years). We developed and evaluated the KMI-PFQ's psychometric properties, finding it to have good internal consistency, with Cronbach's α = .838, ω coefficient = .839, and an intraclass correlation coefficient = .809, with two factors ("ability" and "mental effort") explaining 58.36% of response variance. The standard error of measurement was 3.58, and the minimal detectable change was 9.92. No floor or ceiling effects were identified. There was also good convergent validity as seen by statistically significant positive correlations between KMI-PFQ scores and the revised-Movement Image Questionnaire and Vividness of Visual Imagery Questionnaire. There were no statistically significant correlations between KMI-PFQ scores and the Orientation to Life Questionnaire. The KMI-PFQ is a valid and reliable instrument for measuring kinesthetic ability to feel/imagine pelvic floor muscle contractions in healthy Spanish women.

Social inequalities in the use of physiotherapy in women diagnosed with breast cancer in Barcelona: DAMA cohort.

PURPOSE: This study aimed to analyze social inequalities in the use and access of physiotherapy service and its clinical and socio-economic determinants in women diagnosed with breast cancer in the hospital network of Barcelona. METHODS: Data from 2235 women belonging to the mixed (prospective and retrospective) DAMA Cohort were analyzed, including demographic, socio-economic, clinical, and breast cancer treatment outcomes. To determine the influence of such variables on access to physiotherapy, different Poisson regression models with robust variance (obtaining Prevalence Ratios and confidence intervals) were estimated. RESULTS: Although when experiencing different chronic and acute symptoms, only between 20 and 35% of women visited physiotherapist. Two out of 3 women reported to have received insufficient information about medical care and rehabilitation. Age of women, job occupation, education level, having a mutual or private insurance, as well as outcomes related to breast cancer, appear to be factors influencing the access to physiotherapy. CONCLUSIONS: Social and economic inequalities exist on the access to physiotherapy by women diagnosed with breast cancer, which is generally low, and may clearly impact on their functional recovery. Promoting strategies to reduce social bias, as well as improve communication and patient information regarding physiotherapy may be of interest for a better health care in breast cancer diagnosed women.

Effects of therapeutic exercise in primary dysmenorrhea: an umbrella and mapping review.

PURPOSE: Primary dysmenorrhea (PD) is 1 of the most prevalent gynecologic conditions. The main aim of this umbrella review was to assess the effects of therapeutic exercise (TE) on PD. METHODS: A systematic search was carried out in PubMed, Embase, SPORTDiscus, CINAHL, and PEDro (December 10, 2022). The outcome measures assessed were menstrual pain intensity, menstrual pain duration, and quality of life. Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the advisory committee grading criteria guidelines. RESULTS: Nine systematic reviews were included. The results showed that TE, regardless of the exercise model and intensity, has a clinical effect in improving menstrual pain intensity in women with PD with moderate quality of evidence. In addition, the results showed that TE has a clinical effect in improving the duration of menstrual pain in women with PD with a limited quality of evidence. However, the results are controversial on the improvement of quality of life in women with PD with a limited quality of evidence. CONCLUSIONS: TE seems an effective option to implement in women with PD to improve the intensity and duration of menstrual pain. We cannot draw robust results for quality of life due to the low number of primary studies. More research in this field can help us establish more robust conclusions, as well as to assess whether there is one exercise model or intensity of training that is more effective than others.PROSPERO number: This review was previously registered in PROSPERO (CRD42022371428).

Physical Therapists' Ethical and Moral Sensitivity: A STROBE-Compliant Cross-Sectional Study with a Special Focus on Gender Differences.

(1) Background: Healthcare professionals´ clinical practice, their care of patients and the clinical decision-making process may be influenced by ethical and moral sensitivity. However, such outcomes have been scarcely studied in physical therapists. This study aimed to explore ethical sensitivity and moral sensitivity in practicing physical therapists, and to compare both variables by gender. (2) Methods: Cross-sectional study. 75 physical therapists (58.7% women; average age = 34.56 (8.68) years) were asked to fill in questionnaires measuring ethical sensitivity (Ethical Sensitivity Scale Questionnaire) and moral sensitivity (Revised-Moral Sensitivity Questionnaire). (3) Results: The sample showed high ethical sensitivity (116.14 ± 15.87 over 140) and high moral sensitivity (40.58 ± 5.36 over 54). When comparing by gender, women reported significantly higher ethical sensitivity than men (p = 0.043), as well as higher scores in the following dimensions: Caring by connecting with others (p = 0.012) and Working with interpersonal and group differences (p = 0.028). However, no differences were found in moral sensitivity (p = 0.243). (4) Conclusion: Physical therapists showed high levels of ethical and moral sensitivity, whilst women reported higher ethical sensitivity than men. Understanding physical therapists´ ethical and moral sensitivity is essential to design and implement integrated education programs directed to improve the quality of care of patients in their daily clinical practice.

Sexual Perception in Spanish Female Breast Cancer Survivors. Cross-Sectional Survey.

BACKGROUND: The aim was to assess sexual perception in female breast cancer survivors and establish if women presenting with sexual dysfunctions symptoms receive pelvic floor physiotherapy or request information on treatment. METHODS: Cross-sectional survey carried out between January and March 2021. An online survey designed by the authors was structured in 3 dimensions: demographic and anthropometric data, medical data and sexual perception data. An open format survey with 23 questions available to any website visitor. The survey followed the CHERRIES guidelines. The study included 130 women who fulfilled the inclusion criteria. RESULTS: The presence of pain during sexual activity was reported in 56.92% of cases. Specifically, 40.8% reported superficial dyspareunia, which is most commonly expressed by women as a "stinging pain." Surprisingly, only 4.6% of the women had received any type of pelvic floor physiotherapy treatment or had sought information. CONCLUSIONS: Women breast cancer survivors have a negative perception of their sexuality. In addition, there is a lack of knowledge about the role of physiotherapy in sexual dysfunction, and only a small percentage of women received pelvic floor treatment or information to address their sexual dysfunction.

The effect of an abdominopelvic exercise program alone VS in addition to postural instructions on pelvic floor muscle function in climacteric women with stress urinary incontinence. A randomized controlled trial.

INTRODUCTION: Scarce literature exists regarding the influence of posture-based interventions for the treatment of stress urinary incontinence (SUI). OBJECTIVE: The aim of this randomized controlled trial with two parallel groups was to investigate whether the addition of postural instructions to a 12-week abdominopelvic exercise program is superior to an abdominopelvic exercise program alone, in terms of PFMs function and symptoms in climacteric women with SUI. METHODS: Climacteric women aged between 40-75 years old who presented with SUI were included in this parallel study (NCT03727945). Two randomized groups performing one 40-minutes session per week for 12-weeks were compared: one performing an abdominopelvic exercise program (AEP) and a second one performing the same intervention with the addition of postural instructions (AEPPI). PFMs electromyographical (EMG) activity and strength (Oxford Grading Scale) were quantified during a maximal voluntary contraction. SUI symptoms were assessed using a 3-day bladder diary. These outcomes were collected at baseline, immediately after intervention, and 3-months after the intervention. RESULTS: A total of 47 women were included in the study (AEP [n = 23], AEPPI [n = 24]). Between-group analysis showed significant differences for post-intervention EMG and strength values, showing higher values for the AEPPI compared to the AEP group. At 3-months follow-up, statistically significant differences were only obtained in strength, with higher values in the AEPPI group. No significant differences were obtained in terms of UI symptoms. CONCLUSION: A 12-session abdominopelvic exercise program supplemented with postural instructions is superior to an abdominopelvic exercise program alone in terms of PFMs function in women with SUI.

A Central Nervous System Focused Treatment Program for People with Frozen Shoulder: A Feasibility Study.

Background: Frozen shoulder (FS) is a highly disabling pathology of poorly understood etiology, which is characterized by the presence of intense pain and progressive loss of range of motion (ROM). The aim of this study is to evaluate the feasibility and clinical impact of a CNS-focused treatment program for people with FS. Methods: 10 subjects with primary FS received a 10-week CNS-focused intervention including sensory discrimination training and graded motor imagery techniques delivered as clinic sessions (60 min) and home therapy (30 min five times per week). Measurements were taken at baseline, after a 2-week "washout" period, after treatment, and at three months follow-up. The Shoulder Pain and Disability Index (SPADI) was the primary outcome. Secondary measures were feasibility-related outcomes, self-reported shoulder pain, active and passive range of motion, two-point discrimination threshold (TPDT), left/right judgement task (LRJT), fear-avoidance (Tampa Scale for Kinesiophobia), pain catastrophization (Pain Catastrophizing Scale), and pain sensitization (Central Sensitization Inventory). A Student's t-test was used to assess the "washout" period. A repeated measure analysis of variance (ANOVA) was used to evaluate within-subjects' differences for all outcome measures in the different assessment periods and a pairwise analysis was used to compare between the different assessment points. Statistical significance was set at p < 0.05. Results: 70% of participants completed the treatment. No significant changes were found after "washout" period except for TPDT (p = 0.02) and SPADI (p = 0.025). Improvements in self-reported shoulder pain (p = 0.028) and active shoulder flexion (p = 0.016) were shown after treatment (p = 0.028) and follow-up (p = 0.001) and in SPADI at follow-up (p = 0.008). No significant changes were observed in TPDT, LRJT, fear-avoidance, pain catastrophization, and pain sensitization. Conclusions: a CNS-focused treatment program might be a suitable approach to improve pain and disability in FS, but further research is needed to draw firm conclusions.

Prevalence and Predisposing Factors for Recurrence after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis.

Recurrence is a frequent and undesirable outcome after hallux valgus (HV) surgery. However, the prevalence of HV recurrence and the pre- and postoperatory factors associated with it have not been adequately studied. This study aimed to quantify the prevalence rate of HV recurrence and to analyze its predisposing factors. MEDLINE and EMBASE databases were systematically searched for observational studies including individuals undergoing HV surgical correction. The random-effects restricted maximum likelihood model was used to estimate the pooled effect size (correlation coefficient (r)). Twenty-three studies were included, yielding a total of 2914 individuals. Pooled prevalence of HV recurrence was 24.86% (95% confidence interval (CI), 19.15 to 30.57, I2 = 91.92%, p = 0.00). Preoperative HV angle (HVA) (r = 0.29; 95% CI, 0.14 to 0.43) and preoperative intermetatarsal angle (IMA) (r = 0.13; 95% CI, 0.00 to 0.27) showed a moderate positive relationship with recurrence. Postoperative HVA (r = 0.57; 95% CI, 0.21 to 0.94) and sesamoid position (r = 0.46; 95% CI, 0.31 to 0.60) showed strong relationships with recurrence. In conclusion, preoperative HVA, IMA, and postoperative HVA and sesamoid position are significant risk factors for HV recurrence, and the association of these factors with recurrence is affected by age.

Differences in Inter-Rectus Distance and Abdominopelvic Function between Nulliparous, Primiparous and Multiparous Women.

Widening of the inter-rectus distance (IRD) is highly prevalent among postpartum women and can lead to dysfunction of abdominopelvic muscles. The aim of this study was to evaluate the differences in IRD and abdominopelvic function between nulliparous, primiparous and multiparous women. A cross-sectional study was conducted on 75 women (25 nulliparous, 25 primiparous and 25 multiparous at 6 months postpartum). The participants underwent ultrasound assessment under three conditions (at rest, abdominal draw-in maneuver (ADIM) and curl-up) at two locations (2 cm above and 2 cm below the umbilicus). Furthermore, abdominopelvic muscle function was determined by prone, supine and side bridge tests. In all conditions and locations, the IRD were significantly higher (p < 0.05) in the primiparous and multiparous women than in the nulliparous. The multiparous women presented greater (p > 0.05) IRD at rest and during ADIM compared to the primiparous women. Regarding abdominopelvic muscle function, differences were only significant (p < 0.05) between the nulliparous with primiparous women in prone and supine conditions. These findings suggest that parity influences IRD: women at 6 months postpartum present greater IRD compared to nulliparous women; multiparous women present greater IRD at rest and during the activation of deep abdominal muscles than primiparous women; and primiparous women exhibit worse abdominopelvic muscle function than nulliparous women.

Postural Sensorimotor Control on Anorectal Pressures and Pelvic Floor Muscle Tone and Strength: Effects of a Single 5P® LOGSURF Session. A Cross-Sectional Preliminary Study.

Pelvic floor dysfunction (PFD) is a functional condition present most frequently in women. Despite pelvic floor muscle training being considered by the International Continence Society (ICS) as the first-line treatment in uncomplicated urinary incontinence, other more comprehensive postural methods as 5P® LOGSURF have emerged. This preliminary cross-sectional study explores the effects of a single 5P® LOGSURF session on pelvic floor muscle (PFM) tone and strength (MVC), resting anal tone, intrarectal pressure, and deep abdominal muscles activation. Thirty women were included (11 without PFD and 19 with PFD). Primary outcome measures were PFM tone, PFM MVC and resting anal tone and secondary measures outcomes were intrarectal pressure and deep abdominal activation. All outcome measures were collected before, throughout and after a single 30' 5P® LOGSURF session. The findings from this study suggest that PFM tone (PFD group: p = 0.09, d = 0.72; non-PFD group: p = 0.003, d = 0.49) and PFM MVC (PFD group: p = 0.016; non-PFD group: p = 0.005) decreased in both groups after a single 5P® LOGSURF session, with a medium effect size for women with PFD. Contrarily, deep abdominal muscle MVC increased (PFD group: p < 0.001; non-PFD group: p = 0.03). Intrarectal pressure and resting anal tone decreased in both groups throughout the session. These results suggest that 5P® LOGSURF method may be interesting if is performed by women with mild symptoms of PFD or healthy women to achieve a decrease in PFM tone in women who manifested pain to intracavitary techniques or practices. Further research with higher sample sizes and long-term are necessary for generalizing.

Add-On Effect of Postural Instructions to Abdominopelvic Exercise on Urinary Symptoms and Quality of Life in Climacteric Women with Stress Urinary Incontinence. A Pilot Randomized Controlled Trial.

The aim of this study was to investigate the add-on effect of postural instructions to an abdominopelvic exercise program on incontinence urinary symptoms (UI symptoms) and quality of life (QoL) in climacteric women with stress urinary incontinence (SUI). A randomized controlled trial was performed with a total of 40 climacteric women with SUI aged between 46 and 75 years old. Participants were randomly assigned to two groups: a group performing an abdominopelvic exercise program (AEP) (n = 20) and a group performing abdominopelvic exercise with the addition of postural instructions (AEPPI) (n = 20). Primary outcome measures were UI symptoms, UI impact and QoL related to UI (UI-QoL), measured by 48 h Pad Test and International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF), which were assessed at baseline, post-intervention and 3 months follow-up. Secondary outcome was patient's satisfaction measured by the 100-point Visual Analogic Scale (VAS) only after the intervention. Between-groups differences were observed in terms of UI-QoL immediately after intervention. Within-groups differences were observed between baseline to 3 months follow-up and between post-intervention to 3 months follow-up in AEPPI group (p < 0.05) for UI-QoL and UI impact. UI symptoms were improved in both groups between baseline to 3-months follow-up (p < 0.05). Patient's satisfaction was higher in the AEPPI group (p < 0.05). The addition of postural instructions to an abdominopelvic exercise program improves UI impact to QoL and patients' satisfaction in women with SUI.