Pelvic Floor Dysfunction in Transgender Men on Gender-affirming Hormone Therapy: A Descriptive Cross-sectional Study.

INTRODUCTION AND HYPOTHESIS: The objective of this research is to explore the effects of hormone therapy using testosterone on pelvic floor dysfunction (PFD) in transgender men. We hypothesize that PFD might be prevalent among transgender men undergoing hormone therapy. Therefore, this study was aimed at verifying the frequency of these dysfunctions. METHODS: A cross-sectional study was conducted between September 2022 and March 2023 using an online questionnaire, which included transgender men over 18 years old who underwent gender-affirming hormone therapy. Volunteers with neurological disease, previous urogynecology surgery, active urinary tract infection, and individuals without access to the internet were excluded. The questionnaire employed validated tools to assess urinary symptoms, such as urinary incontinence (UI), as well as sexual dysfunction, anorectal symptoms, and constipation. The data were analyzed descriptively and presented as frequencies and prevalence ratios with their respective confidence intervals (95% CI), mean, and standard deviation. RESULTS: A total of 68 transgender men were included. Most participants had storage symptoms (69.1%), sexual dysfunction (52.9%), anorectal symptoms (45.6%), and flatal incontinence (39.7%). Participants with UI symptoms reported moderate severity of the condition. CONCLUSIONS: Transgender men on hormone therapy have a high incidence of PFD (94.1%) and experience a greater occurrence of urinary symptoms (86.7%).

Effectiveness of Laser Acupuncture for Reducing Pain and Increasing Mouth Opening Range in Individuals with Temporomandibular Disorder: A Systematic Review and Network Meta-Analysis.

PURPOSE OF REVIEW: Laser acupuncture (LA) demonstrates promising results in the treatment of musculoskeletal disorders. However, its effects on temporomandibular disorder (TMD) are not yet fully understood. Thus, the aim of this systematic review and network meta-analysis was to assess the effectiveness of LA on pain intensity and maximum mouth opening range (MMO) related to TMD. A search was carried out in 11 electronic databases and references of included studies to locate randomized clinical trials (RCTs) that evaluated LA as a primary treatment for TMD. The risk of bias was assessed using the RoB 2 tool. Network meta-analysis was conducted on the MetaInsight platform, considering the pain intensity and counseling (C) as the outcome of reference. The GRADE system was used to assess the certainty of the evidence. RECENT FINDINGS: Five studies evaluated pain intensity, four with a high risk of bias and one with a low risk. Two studies evaluated pain intensity on palpation (one with high and one with low risk of bias), and one study with high risk of bias evaluated MMO. Laser parameters were: 690-810 nm, 40-150 mW, and 7.5-112.5 J/cm2. Occlusal splint (OS) [- 2.47; CI 95% - 3.64, - 1.30] and Physiotherapy (PT) [-2.64; CI 95% - 3.94, - 1.34] reduced pain intensity compared to C. The ranking of treatments in order of effectiveness was PT > OS > LA > C > CR (craniopuncture). The certainty of the evidence was very low or low. The data do not support the indication of LA for the treatment of TMDs and new placebo-controlled RCTs must be conducted to demonstrate its effectiveness more precisely.

Social isolation and post-weaning environmental enrichment effects on rat emotional behavior and serotonergic system.

Social isolation (SI) is related to adverse neurobehavioral effects and neurochemical changes when it occurs early in development. On the other hand, environmental enrichment (EE) is associated with a reduction in anxiety-like and depression-like behavior, as well as an increase in serotonin (5-HT) levels in the prefrontal cortex and hippocampus in rodents. This study systematically reviewed the effects of SI and EE on emotional behavior and serotonergic system components in rats after weaning. Primary experimental studies that used subgroups of rats subjected to SI, EE, and normal social conditions after weaning were considered eligible. Studies that used transgenic rodents, ex vivo studies, in vitro studies, human research, or in silico studies were ineligible. Two authors completed searches in Medline/PubMed, LILACS, Scopus, Web of Science, EMBASE, and Open Gray. The Kappa index was calculated to assess agreement between reviewers and assess study quality. The results showed that the animals exposed to EE showed better adaptation to a new environment. Furthermore, EE increased 5-HT levels in the hippocampus and prefrontal cortex of rodents. Thus, it appears that an EE during the critical period of development may reduce anxiety/depression-like behaviors, as well as increase long-term neurotransmitter response.

Cochlear radiation dose and hearing loss in patients with vestibular schwannoma undergoing radiosurgery: systematic review

Abstract Objectives: To determine the cut-off point of the cochlear radiation dose as a risk factor for hearing loss in patients with vestibular schwannoma treated with radiosurgery. Methods: A systematic review of the literature was performed without language or publication year restrictions in the MEDLINE/PubMed, EMBASE, Web of Science, LILACS/VHL and Cochrane Library databases. Studies that met the following criteria were included: 1) population: adults of both sexes who underwent radiosurgery for vestibular schwannoma treatment; 2) exposure: cochlear radiation; 3) outcome: hearing loss; 4) type of study: cohort. Two independent reviewers conducted the entire review process. The registration number in PROSPERO was CRD42020206128. Results: From the 333 articles identified in the searches, seven were included after applying the eligibility criteria. There was no standardization as to how to measure exposure or outcome in the included studies, and most studies did not present sufficient data to enable meta-analysis. Conclusion: It was not possible to determine a cut-off point for high cochlear dose that could be considered a risk factor for hearing loss.

Cochlear radiation dose and hearing loss in patients with vestibular schwannoma undergoing radiosurgery: systematic review.

OBJECTIVES: To determine the cut-off point of the cochlear radiation dose as a risk factor for hearing loss in patients with vestibular schwannoma treated with radiosurgery. METHODS: A systematic review of the literature was performed without language or publication year restrictions in the MEDLINE/PubMed, EMBASE, Web of Science, LILACS/VHL and Cochrane Library databases. Studies that met the following criteria were included: 1) population: adults of both sexes who underwent radiosurgery for vestibular schwannoma treatment; 2) exposure: cochlear radiation; 3) outcome: hearing loss; 4) type of study: cohort. Two independent reviewers conducted the entire review process. The registration number in PROSPERO was CRD42020206128. RESULTS: From the 333 articles identified in the searches, seven were included after applying the eligibility criteria. There was no standardization as to how to measure exposure or outcome in the included studies, and most studies did not present sufficient data to enable meta-analysis. CONCLUSION: It was not possible to determine a cut-off point for high cochlear dose that could be considered a risk factor for hearing loss.

Eficácia E Custo-Utilidade De Intervenções Para O Tratamento Da Enurese Em Crianças E Adolescentes Sob A Perspectiva Do Sistema Único De Saúde Brasileiro: Effectiveness and Cost-Utility of Interventions for Enuresis Treatment in Children and Adolescents From the Brazilian Single Health System Perspective.

OBJECTIVES: This study aimed to estimate the cost-utility of effective interventions for enuresis treatment in children and adolescents and to calculate the incremental cost-utility ratio from the perspective of the Brazilian Unified Health System in a 1-year time horizon. METHODS: The economic analysis is in 7 stages: (1) survey of evidence of treatments for enuresis, (2) performing the network meta-analysis, (3) estimation of the probability of cure, (4) cost-utility analysis, (5) model sensitivity analysis, (6) analysis of acceptability of interventions by acceptability curve, and (7) monitoring the technological horizon. RESULTS: The association between desmopressin and oxybutynin is the therapeutic strategy with the highest probability of success in the treatment of enuresis in children and adolescents compared with placebo (relative risk [RR] 2.88; 95% confidence interval [CI] 1.65-5.04), followed by the combination therapy between desmopressin and tolterodine (RR 2.13; 95% CI 1.13-4.02), alarm (RR 1.59; 95% CI 1.14-2.23), and neurostimulation (RR 1.43; 95% CI 1.04-1.96). Combination therapy between desmopressin and tolterodine was the only 1 considered not to be cost-effective. Neurostimulation, alarm therapy, and therapy had the respective incremental cost-utility ratio values: R$5931.68, R$7982.92, and R$29 050.56/quality-adjusted life-years. CONCLUSION: Among the therapies that are on the borderline of efficiency, the combined therapy between desmopressin and oxybutynin presents the greatest incremental benefit at an incremental cost that is still feasible, given that it does not exceed the reference value of the cost-effectiveness threshold established in Brazil.

The Impact of the COVID-19 Pandemic on People With Lymphedema in an Endemic Area for Lymphatic Filariasis in Brazil.

Objectives: To investigate the repercussions of the COVID-19 pandemic on lymphedema patients from an endemic area of lymphatic filariasis. Methods: The study descriptive compared sociodemographic and clinical aspects, risk of falling and quality of life, prior and during the COVID-19 pandemic in 28 lymphedema patients, older than 18 years old and under investigation of filarial infection. For the evaluation of functional mobility, the Time Up and Go test and The Medical Outcome Study Short Form-36 Health for quality of life, was used. Results: An increase in interdigital and dermal lesions, a higher frequency of acute dermatolymphangioadenitis crises and risk of falling, worsening of quality of life in the domains of physical functioning, general health, vitality, and mental health during the pandemic was observed. Conclusion: Our findings of clinical worsening and quality of life of patients during the COVID-19 pandemic indicate the need to reinforce the goal of the Lymphatic Filariasis Program regarding the follow-up of these patients in the actions of the Global Program for the Elimination of Lymphatic Filariasis, due to the discontinuity in the care during the pandemic.

What do cochrane systematic reviews say about interventions for enuresis in children and adolescents? An overview of systematic reviews.

OBJECTIVE: To conduct an overview of Cochrane systematic reviews about treatment alternatives for children and/or adolescents with enuresis. SOURCES: An overview of Cochrane systematic reviews about interventions for enuresis in children/adolescents was developed between September/2021 and December/2021. The protocol was registered on PROSPERO and the search was conducted only in the Cochrane Library database without any restriction. Reviews involving any type of intervention for the treatment of enuresis in children/adolescents were included. The risk of bias was assessed using Risk of Bias in Systematic Reviews (ROBIS) and the quality of reviews was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). SUMMARY OF THE FINDINGS: Seven systematic reviews were identified. Based on the ROBIS assessment, all reviews were classified as low risk of bias. According to the AMSTAR-2 assessment, the three oldest systematic reviews were rated as critically low quality, one review was moderate quality, and the three most recent systematic reviews were rated as high quality. No difference was shown between alarm and desmopressin for a complete response to therapy after treatment (RR = 1.30; 95%CI: 0.92 to 1.84), but alarm use is related to a lower risk of adverse events (RR = 0.38; 95%CI: 0.20 to 0.71). There is a moderate certainty that the association between imipramine and oxybutynin is better than placebo to reduce the risk of children who do not achieve 14 consecutive dry nights after treatment (RR = 0.43; 95%CI: 0.23 to 0.78). CONCLUSIONS: There is no difference between alarm and desmopressin for enuresis treatment. However, alarm therapy had fewer adverse events than desmopressin. Moreover, combination therapy between imipramine and oxybutynin is better than placebo.

Assessment of the strength and electrical activity of the pelvic floor muscles of male-to-female transgender patients submitted to gender-affirming surgery: A case series.

AIMS: To assess the strength and electrical activity of the pelvic floor muscles (PFMs) of male-to-female transgender individuals submitted to gender-affirming surgery (GAS). METHODS: A case series study was conducted from October 2016 to August 2018. Transgender women, who were scheduled for GAS, participated in the study. The volunteers were submitted to a clinical evaluation of the PFM followed by digital palpation (PERFECT method) and electromyography in the preoperative, 15, and 30 days after GAS. They responded to the International Consultation on Incontinence Questionnaire-Urinary Incontinence (UI)-Short Form to evaluate the effect of UI on quality of life and to questions related to the urinary, anorectal, and sexual symptoms. Fifteen days after the GAS, patients were instructed to perform perineal exercises at home, twice a day. RESULTS: The study sample consisted of 15 transgender women with an average age of 30.6 (SD = 6.7) years. There was a decline in median strength and sustained muscle contraction duration (PERFECT), in the electrical muscle activity (RMSmean and RMSmax) between pre-GAS and 15 days after GAS (p < 0.05). However, there was an increase in these parameters between 15 and 30 days after GAS (p < 0.05). Moreover, six patients exhibited pre-GAS UI, which continued after surgery, with a worsening of urgency symptoms and improvement in nocturia and postmicturition leakage. CONCLUSION: Strength, sustained muscle contraction duration, and PFM electrical activity may decline 15 days after GAS, returning to pre-GAS values in the first month after surgery.

Frequência de incontinência urinária em mulheres praticantes de crossfit: um estudo transversal / Frecuencia de incontinencia urinaria en mujeres que practican crossfit: un estudio transversal / Frequency of urinary incontinence in women who practice crossfit: a cross-sectional study

RESUMO O objetivo deste estudo foi verificar a frequência de Incontinência Urinaria (IU) em mulheres praticantes de Crossfit. Realizou-se um estudo de corte transversal com mulheres que praticavam Crossfit há, pelo menos, 6 meses ininterruptos, com idade entre 18 a 35 anos e frequência de treino de, no mínimo, três vezes por semana. Foram aplicados questionários de avaliação individual compostos por dados sociodemográficas, antropométricos e esportivos, além do International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF), para identificar a presença de IU. Também por meio do ICIQ-IU-SF foram identificados a frequência e quantidade de perda de urina e interferência da IU na qualidade de vida (QV) das mulheres incontinentes. Essas mulheres também responderam a um questionário acerca da gravidade da IU. A amostra total do estudo foi de 50 mulheres, das quais 10 (20%) apresentaram IU. A maioria das mulheres incontinentes apresentou IU de gravidade moderada e de interferência leve na QV. Ademais, observou-se associação entre ter histórico de IU e apresentar IU (RP=5,33; IC95%=1,41 a 20,10). Diante do exposto, conclui-se que a frequência de IU em mulheres praticantes de Crossfit foi de 20%, sendo a IU, em sua maioria, de gravidade moderada e de leve interferência na QV.

RESUMEN El objetivo de este estudio fue evaluar la frecuencia de incontinencia urinaria (IU) en mujeres que practican crossfit. Se realizó un estudio transversal con mujeres que habían practicado crossfit, como mínimo, durante 6 meses ininterrumpidos, con edades entre 18 y 35 años y una frecuencia de entrenamiento de al menos tres veces por semana. Se aplicaron cuestionarios de evaluación individual que constó de datos sociodemográficos, antropométricos y deportivos, además del International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF) para identificar la presencia de IU. También se identificaron la frecuencia y cantidad de pérdida de orina y la interferencia de la IU en la calidad de vida (CV) de las mujeres con incontinencia utilizando el ICIQ-IU-SF. Esas mujeres también respondieron a un cuestionario sobre la gravedad de la IU. La muestra total del estudio se compuso de 50 mujeres, de las cuales 10 (20%) tenían IU. La mayoría de las mujeres con incontinencia presentaban IU de gravedad moderada e interferencia mínima en la CV. Además, se observó una asociación entre haber presentado antecedentes de IU y tener IU (RP=5,33; IC95%=1,41 a 20,10). Se concluye que la frecuencia de IU en mujeres que practican crossfit fue del 20%, y que la IU se presentó, en su mayoría, de gravedad moderada y de interferencia mínima en la CV de ellas.

ABSTRACT The aim of this study was to determine the frequency of urinary incontinence (UI) in women who practice crossfit. This was a cross-sectional study with women aged between 18 and 35 years, who had been practicing crossfit for at least six months without interruption, and at least three times a week. Individual assessment questionnaires were used, composed of sociodemographic, anthropometric and exercise data, as well as the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF) to identify the presence of UI. The frequency and amount of urine loss and UI interference in quality of life (QoL) were also identified via ICIQ-IU-SF. These women also responded to a questionnaire about the severity of UI. The total sample of the study was 50 women, of whom 10 (20%) had UI. Most incontinent women had moderate UI and mild interference in QoL. Moreover, we observed an association between having UI history and presenting UI (PR=5.33, 95% CI=1.41 to 20.10). Given the above, we concluded that the frequency of UI in female crossfit athletes was 20%, with UI being mostly of moderate severity and mild interference in QoL.

"Posterior Tibial Nerve" or "Tibial Nerve"? Improving the reporting in health papers.

AIMS: The primary objective of this study is to identify which term is the most appropriate to use according to anatomical nomenclature: "posterior tibial nerve" or "tibial nerve." Furthermore, this paper intends to show how the use of these terms in papers indexed in important health databases is numerous and to describe the anatomical characteristics of such nerve, to improve future scientific publications. METHODS: This is a descriptive study about the importance of standardizing the use of the terms "posterior tibial nerve" and "tibial nerve" and its anatomy. It comprises three phases: the first is a search in the main databases to identify the use of the terms "posterior tibial nerve" and "tibial nerve." The second phase refers to the consultation of international anatomical terminology to identify the most appropriate term to refer to the nerve, while the third phase is related to the study of the anatomy of this nerve. RESULTS: The term "tibial nerve" is more commonly used, but the use of the term "posterior tibial nerve" is still very substantial. According to international anatomical terminology, the correct term is "tibial nerve," which is a branch of the sciatic nerve. CONCLUSIONS: "Tibial nerve" is the term standardized by international anatomical terminology. The use of terms in accordance with Terminologia Anatomica is important to facilitate the process of teaching and learning, as well as to improve the reporting and interpretation of papers regarding health, and the evidence-based clinical practice.

Measurement properties of the Brazilian version of the Motor Assessment Scale, based on Rasch analysis.

PURPOSE: To cross-culturally adapt and verify the measurement properties of the Brazilian version of the Motor Assessment Scale (MAS). METHODS: The process of cross-cultural adaptation followed standardized procedures. Construct validity of the MAS was investigated using Rasch analysis (n = 100), whereas inter-rater and test-retest reliabilities were evaluated using Kappa coefficients and Bland and Altman plots (n = 52). RESULTS: The MAS demonstrated satisfactory measurement properties. The Kappa coefficients for the inter-rater and test-retest reliabilities were 0.73 (ranging from 0.79 to 1.00) and 0.82 (ranging from 0.86 to 1.00), respectively. The Bland and Altman plots showed adequate inter-rater and test-retest agreements. No ceiling or floor effects were observed and only one item exhibited misfit to the Rasch model expectations. Item 4 "sitting to standing" exhibited marginal misfit (infit MnSq = 1.44; Zstd = 2.6), but it did not affect the unidimensionality of the scale. CONCLUSIONS: The MAS demonstrated good indicators of validity and reliability to be used for the assessment of motor function of individuals with stroke within clinical and research contexts. Implications for rehabilitation The Motor Assessment Scale is a performance-based scale for the assessment of motor function of individuals with stroke, based on a task-oriented approach. The Motor Assessment Scale has shown good clinical utility indicators dues to its quick administration, objectivity, and clinical relevance as a functional predictor. The Motor Assessment Scale showed good indicators of validity and reliability to be used within clinical and research contexts for the evaluation of motor function of individuals after stroke.

Efficacy of proprioceptive neuromuscular facilitation compared to other stretching modalities in range of motion gain in young healthy adults: A systematic review.

The objective of this study was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) on range of motion (ROM) gain in young healthy adults. We performed a systematic review of randomized controlled trials and quasi-randomized trials, including young healthy adults. The interventions were: PNF compared with different PNF techniques, control, other muscle stretching exercises and musculoskeletal manipulations. The outcome measures were: articular ROM and adverse effects. The final number of included studies was 46, involving 1,864 adults. There was difference on ROM comparing assisted hold-relax (HR) on diagonal plane to control, based on very low-quality evidence. There was also difference on ROM comparing assisted HR to self-HR; self-contract-relax (CR) to control; assisted CR contract to control; and assisted HR contract to control, based on low-quality evidence. Moderate-quality evidence shows that results differ between self HR and control (SMD: 0.95; 95%CI 0.03, 1.86; I249%; P = 0.16) in terms of ROM gain. When performing the other comparisons, the results were based on low or very low-quality evidence and do not allow to state if PNF is more or less effective than other stretches for improving ROM in healthy young adults. No adverse effects were mentioned.

Factors associated with temporomandibular dysfunction in the elderly: an integrative literature review / Fatores associados à disfunção temporomandibular em pessoas idosas: uma revisão integrativa da literatura

Abstract Objective: To identify the factors associated with temporomandibular dysfunction among elderly persons. Method: An integrative literature review was carried out, evaluated by scientific publications indexed in five databases: MEDLINE/PubMed, SCOPUS, WEB OF SCIENCE, CINAHL and LILACS, without date or language restrictions. The adapted Newcastle-Ottawa Scale was used to evaluate the articles. Results: Of the 888 articles from the databases, four were considered eligible for this review. Risk of bias analysis classified one article as low risk and the other as intermediate risk. Conclusion: The factors associated with temporomandibular dysfunction in the elderly indicated by the studies were: female gender, age between 60-70 years, a low income, suffering from tinnitus, dizziness, depression, headache or bruxism; experience temporomandibular joint palpation, masticatory and cervical muscle pain, a low number of teeth and the use of complete dentures.

Resumo Objetivo: Identificar os fatores associados à disfunção temporomandibular em pessoas idosas. Método: Trata-se de revisão integrativa da literatura, em que foram avaliadas publicações científicas indexadas em cinco bases de dados: MEDLINE/PubMed, SCOPUS, WEB OF SCIENCE, CINAHL e LILACS, sem restrição temporal ou de idioma. Os artigos foram avaliados pelo instrumento The Newcastle-Ottawa Scale adaptado. Resultados: Dos 888 artigos provenientes das bases de dados, quatro foram considerados elegíveis para esta revisão. Segundo a análise do risco de viés, um artigo foi classificado como de baixo risco e os demais como de risco intermediário. Conclusão: Os fatores associados à disfunção temporomandibular em pessoas idosas indicados nos estudos foram: ser do sexo feminino, ter idade entre 60-70 anos, ser de baixa renda, apresentar zumbido, tontura, depressão, cefaleia ou bruxismo; ter dor à palpação da articulação temporomandibular, músculos mastigatórios e cervicais, número de dentes reduzido e fazer uso de próteses totais.

Multiparity, age and overweight/obesity as risk factors for urinary incontinence in pregnancy: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Multiparity, age and high body mass index (BMI) are the most widely investigated factors associated with urinary incontinence (UI) during pregnancy. We hypothesized that multiparity, age 35 years or older and high BMI (prepregnancy and during pregnancy) are risk factors for the occurrence of UI in pregnant women. METHODS: Searches were done on MEDLINE/PubMed (1966-2017), LILACS/BIREME (1982-2017), CINAHL/Ebsco (1981-2017) and Scopus/Elsevier (1950-2017). The following criteria were used for study eligibility: (1) population: low-risk pregnant women in any trimester and without age restriction; (2) exposure factors: multiparity (≥ 2 deliveries), age 35 years or older and high BMI (overweight and obesity); (3) outcome: UI during pregnancy; (4) study design: cohort, case-control or cross-sectional studies that used multivariate logistic analysis. Two independent reviewers performed the entire systematic review process. Data extraction of each article was done and, when possible, included in a meta-analysis. Risk of study bias was assessed by NOS and quality of evidence by GRADE. A significance level of p ≤ 0.05 was adopted. The PROSPERO registration number was CRD42014013193. RESULTS: Of 1176 articles identified through searches, 13 were included after screening and application of eligibility criteria. Very low quality of evidence shows that multiparity (OR = 2.09; 95% CI: 1.07 to 4.08), age 35 years or older (OR = 1.53; 95% CI: 1.45 to 1.62) and overweight and obesity during pregnancy (OR = 1.53; 95% CI: 1.28 to 1.83) are risk factors for UI in pregnancy. CONCLUSIONS: The exposure factors investigated are risk factors for UI in pregnancy based on a very low quality of evidence.

Abdominal and pelvic floor electromyographic analysis during abdominal hypopressive gymnastics.

INTRODUCTION: Abdominal hypopressive gymnastics appeared as an alternative to traditional abdominal exercises to promote abdominal muscles strength without overloading the pelvic floor muscles (PFM). To determine the activation level of abdominal muscles and PFM and the posture influence in the level of activation in these muscles during abdominal hypopressive gymnastics, we used surface electromyography in young and healthy multipara women. METHODS: This is an observational study with eutrophic nulliparous women aged between 18 and 35 years, with abdominal skinfold less than or equal to 3 cm and active or irregularly active physical activity. Surface electromyography was used for rectus abdominis, external oblique, transversus abdominal/internal oblique (TrA/IO) and PFM assessment in the supine, quadruped and orthostatic (upright standing) positions during abdominal hypopressive gymnastics using normalized electromyographic (%EMG) data. We also analyzed the difference in activation between each muscle and between muscles and positions. RESULTS: Thirty women were evaluated and the mean age was 25.77 years (SD 3.29). The group formed by the TrA/IO muscles and the PFM showed higher %EMG in all the positions assessed, followed by the external oblique and rectus abdominis muscles. A comparison of %EMG of each muscle between the different positions showed differences only in rectus abdominis between the supine and quadruped (p = 0.001) and supine and orthostatic positions (p = 0.004), and in TrA/IO between the supine and orthostatic (p = 0.023) and orthostatic and quadruped positions (p = 0.019). CONCLUSIONS: The results suggest that abdominal hypopressive gymnastics can activate the abdominal muscles and PFM and the position do not have influence on electromyographic activation level of the PFM and external oblique.

Efficacy of the whole-body vibration for pain, fatigue and quality of life in women with fibromyalgia: a systematic review.

PURPOSE: To determine the quality of evidence on the use of whole-body vibration (WBV) in controlling pain, fatigue and quality of life in women with fibromyalgia. METHODS: The search involved MEDLINE/PubMed, LILACS, CINAHL, CENTRAL and PEDro, without temporal or language restriction. The terms "fibromyalgia" and "whole-body vibration" were used. Trials (randomized or quasi-randomized) that compared a group of women with fibromyalgia who received WBV to a control group with no intervention were included. The quality of evidence was assessed using the GRADE system. The quantitative evaluation by meta-analysis was also used, whenever possible. RESULTS: Three studies were included. Regarding the outcome pain, it has not been possible to assess the magnitude of effect of treatment. The result of the outcome fatigue showed no difference between the groups after the proposed intervention (Mean Difference: 0.01; 95% CI: -0.11 to 0.09). The meta-analysis for the outcome quality of life showed a small difference between groups, favoring the WBV group (Standard Mean Difference: 0.4943; p = 0.05; 95% CI: 0.0045 to 0.9841). CONCLUSIONS: The results, based on very low quality of evidence, were inconclusive regarding pain, and showed no clinically important effects on the control of fatigue and improvement of quality of life. Implications for rehabilitation There is no evidence to support the use of whole-body vibration for pain treatment of women with fibromyalgia. The use of whole-body vibration in women with fibromyalgia showed no clinically important effects in the control of fatigue and improvement of quality of life.

Electromyographic assessment of women's pelvic floor: What is the best place for a superficial sensor?

AIMS: To compare the electromyographic signal of different surface electrodes and to identify the channel that presents the highest level of electromyographic activity through the mean and peak of Root Mean Square (RMS). METHODS: Thirty healthy women participated in this study. Each woman completed three collections (on different days) of electromyographic data. Three maximal voluntary contractions of the pelvic floor muscles were requested. The electromyographic signal was recorded by intravaginal probe and surface electrodes placed on the perianal region and on the region immediately below the labia majora. To analyze the signal, an epoch of 500 ms was selected during the second contraction. The Kruskal-Wallis test followed by a post hoc Mann-Whitney test was used to compare means and to identify differences. The Bland-Altman method was used to verify the agreement between the measurements. A significance level of P ≤ 0.05 was adopted. RESULTS: There was agreement only between the measurements from perianal electrodes and intravaginal probe. Furthermore, there was no difference between the perianal electrodes and intravaginal probe in RMS mean (P = 0.225) and RMS peak (P = 0.315). However, these electrodes locations presented greater values than the electrodes in the region immediately below the labia majora (RMS mean: P < 0.001; P = 0.016. RMS peak: P < 0.001; P = 0.02). CONCLUSIONS: The intravaginal probe and the surface electrodes in perianal region are equivalent for healthy nulliparous women. The choice must be done according to the values and preferences of the patient.

Efeitos da pompage associada ao exercício aeróbico sobre dor, fadiga e qualidade do sono em mulheres com fibromialgia: um estudo piloto / Los efectos de la pompage con ejercicios aeróbicos en el dolor, fatiga y en la calidad de sueño de mujeres con fibromialgia: un estudio piloto / Effects of pompage associated with aerobic exercises on pain, fatigue, and sleep quality in female patients with fibromyalgia: a pilot study

RESUMO O objetivo da pesquisa foi avaliar os efeitos da pompage como terapia complementar a exercícios aeróbicos e de alongamento sobre dor, fadiga e qualidade do sono em mulheres com fibromialgia. Para isso, 23 mulheres com esse diagnóstico foram alocadas aleatoriamente nos grupos: Experimental (GE, n=13) e Controle (GC, n=10), e em seguida foram avaliadas através do Questionário McGill de Dor, Questionário de Fadiga de Chalder e Inventário do Sono. Durante 12 semanas, duas vezes por semana, o GE realizou pompage, exercícios aeróbicos e alongamentos, enquanto o GC fez apenas exercícios aeróbicos e alongamentos. A avaliação foi repetida após 6 e 12 semanas. Ocorreram perdas amostrais, resultando em 15 indivíduos (GE, n=7/GC, n=8). Na análise estatística, utilizou-se ANOVA para medidas repetidas, seguido do teste t para amostras independentes em que houve diferença significativa (p ≤ 0,05). Houve redução significativa do escore da dimensão mista do Questionário McGill de Dor após 12 semanas no GE comparado ao GC. Nos outros aspectos avaliados de dor, fadiga e qualidade do sono, não foram observadas alterações significativas. Assim, sugere-se que a pompage como terapia complementar a exercícios aeróbicos e de alongamento não apresentou efeitos benéficos importantes para mulheres com fibromialgia, uma vez que houve melhora em apenas uma das dimensões de dor avaliadas. Estudos com amostras maiores são necessários para uma análise mais consistente dos desfechos investigados.

RESUMEN Para evaluar los efectos de la pompage como terapia complementaria a los ejercicios aeróbicos y de estiramiento en el dolor, fatiga y en la calidad de sueño de mujeres con fibromialgia (MF), se dividieron veintitrés mujeres con este diagnóstico en grupos al alzar: Grupo Experimental (GE, n=13) y Grupo Control (GC, n=10). Después les aplicaron el Cuestionario de dolor McGill, el Cuestionario de fatiga de Chalder y el Inventario del sueño. Durante 12 semanas, dos veces a la semana, el GE hizo pompage, ejercicios aeróbicos y estiramientos, mientras que el GC solo hizo ejercicios aeróbicos y estiramientos. Se repitió la evaluación después de 6 y 12 semanas. La cantidad de participantes redujo para 15 (GE, n=7, GC, n=8). En el análisis estadístico se empeló la ANOVA para medidas iguales, la prueba t para las muestras independientes, en las cuales presentaron diferencias significantes (p ≤ 0,05). En la puntuación de dimensión mixta del Cuestionario de dolor McGill tras 12 semanas presentó reducción significativa en el GE comparado al GC. En los demás ítems evaluados, dolor, fatiga y calidad de sueño, no se observaron diferencias significantes. Así que la pompage como terapia complementaria a ejercicios aeróbicos y de estiramiento no presentó efectos relevantes en mujeres con FM, debido a que solamente uno de los ítems de dolor evaluados ha presentado mejora. Son necesarios estudios con muestras más grandes para un análisis más detenido de los ítems evaluados.

ABSTRACT Aiming at evaluating the effects of pompage as a complementary therapy to aerobic exercises and stretching on pain, fatigue, and sleep quality in women with fibromyalgia, 23 women with this diagnosis were allocated randomly in the groups: Experimental (EG, n = 13) and Control (CG, n = 10). Subsequently, they were assessed using McGill Pain Questionnaire, Chalder Fatigue Questionnaire, and Sleep Inventory. For 12 weeks, twice a week, the EG made pompage, aerobic exercises, and stretching, while the CG only aerobic exercises and stretching. Evaluation was repeated after 6 and 12 weeks. We had sample losses totaling 15 individuals (EG, n=7/CG, n=8). We used ANOVA for repeated measurements in the statistical analysis, followed by the T test for independent samples with significant differences (p≤0.05). There was a significant reduction of McGill Pain Questionnaire joint score after 12 weeks in the EG compared with CG. There were not significant changes in other aspects evaluated for pain, fatigue and sleep quality. Therefore, we suggest that pompage as a complementary therapy to aerobic exercises and stretching did not have beneficial effects on women with fibromyalgia, since there was improvement in only one aspect of the pain evaluated. Studies with larger samples are necessary for a more consistent analysis of the results investigated.

Repercussão da dor da cintura pélvica na funcionalidade de gestantes avaliadas através da versão brasileira do Pelvic Girdle Questionnaire (PGQ-Brasil): estudo transversal / La repercusión del dolor pélvico en la funcionalidad de embarazadas evaluadas desde la versión brasileña del Pelvic Girdle Questionnaire (PGQ-Brasil): estudio transversal / Repercussion of pelvic girdle pain on pregnant women's functionality evaluated through the Brazilian version of the Pelvic Girdle Questionnaire (PGQ-Brazil): a cross-sectional study

RESUMO Com o objetivo de analisar a repercussão da dor da cintura pélvica na funcionalidade de gestantes, foi realizado um estudo transversal envolvendo mulheres grávidas, com idade entre 18 e 30 anos e diagnóstico clínico de dor da cintura pélvica relacionada à gravidez (DCPG). Foram coletados dados clínicos, seguidos da aplicação do Pelvic Girdle Questionnaire versão brasileira (PGQ-Brasil). Participaram do estudo 105 gestantes, das quais 62,9% eram multíparas. O diagnóstico mais frequente foi o de síndrome sacroilíaca unilateral. Quanto ao aparecimento da dor, 45,7% relataram que a dor ocorria durante os movimentos e as atividades que apresentaram maior limitação eram ficar sentada, em pé e andar por mais de 60 minutos. A média da dor na Escala Visual Analógica (EVA) foi 6,59 (1,8 DP), considerada dor moderada. As gestantes com síndrome da cintura pélvica apresentaram uma média de 54,86 (22,39 DP) para o escore total do PGQ-Brasil, as com síndrome sacroilíaca unilateral, 31,11 (17,37 DP) e com síndrome sacroilíaca bilateral 40,32 (17,46 DP). Quando comparada a média de dor entre as síndromes mediante a EVA, a síndrome da cintura pélvica apresentou a maior média (7,67; 1,72 DP), seguida pela síndrome sacroilíaca bilateral (6,86; 1,95 DP) e síndrome sacroilíaca unilateral (6,21; 1,72 DP). Ao correlacionar a média da EVA com o escore total do PGQ-Brasil, observou-se uma correlação positiva (r=0,458, p=0,01), indicando que quanto maior a dor, maior a incapacidade da gestante. Dessa forma, os achados sugerem que a DCPG pode acarretar diversos níveis de incapacidade e afetar diretamente a funcionalidade das gestantes.

RESUMEN A fin de evaluar la repercusión del dolor pélvico en la funcionalidad de embarazadas, se realizó un estudio transversal con mujeres embarazadas, entre 18 y 30 años de edad y diagnosticadas clínicamente con dolor pélvico en el embarazo (DPE). Se recolectaron datos clínicos, después de aplicado la versión brasileña del Pelvic Girdle Questionnaire (PGQ-Brasil). Han participado del estudio 105 embarazadas, de las cuales 62,9% eran multíparas. El diagnóstico más común fue el síndrome sacroilíaco unilateral. Al respecto de la aparición del dolor, un 45,7% dijeron que este dolor ocurría en movimientos y las actividades que les presentaban una mayor limitación eran estar sentada, de pie y caminar por más de 60 minutos. El promedio del dolor en la escala visual analógica (EVA) fue de 6,59 (1,8 DP), considerado un dolor moderado. Las embarazadas con el síndrome pélvico presentaron el promedio de 54,86 (22,39 DP) para la puntuación total del PGQ-Brasil, las con síndrome sacroilíaco unilateral 31,11 (17,37 DP) y con síndrome sacroilíaco bilateral 40,32 (17,46 DP). Al compararse el promedio de dolor entre los síndromes utilizando la EVA, el síndrome pélvico presentó el promedio mayor (7,67; 1,72 DP), enseguida del síndrome sacroilíaco bilateral (6,86; 1,95 DP) y del síndrome sacroilíaco unilateral (6,21; 1,72 DP). Al correlacionarse el promedio de EVA con la puntuación total del PGQ-Brasil, se ha observado una correlación positiva (r=0,458, p=0,01), que muestra que cuanto mayor es el dolor, mayor será la incapacidad de la embarazada. De esta manera, los resultados mostraron que el DPE puede resultar en diversos niveles de incapacidad y puede afectar directamente a la funcionalidad de las embarazadas.

ABSTRACT To analyze the impact of pelvic girdle pain on pregnant women's functionality, a cross-sectional study involving pregnant women, aged between 18 and 30 years, with a clinical diagnosis of pregnancy-related pelvic girdle pain (PGPP) was performed. Clinical data were collected followed by the application of the Brazilian version of the Pelvic Girdle Questionnaire (PGQ-Brazil). One hundred and five pregnant women participated, of which 62.9% were multiparous. The most frequent diagnostic was the unilateral sacroiliac syndrome. About the onset of pain, 45.7% of them reported that pain occurred on movement and the activities that had greater limitation were sitting, standing, and walking for more than 60 minutes. The average pain according to the Visual Analog Scale (VAS) was 6.59 (SD 1.8), considered a moderate pain. Pregnant women with pelvic girdle syndrome had a mean of 54.86 (SD 22.39) for the total score of PGQ-Brazil; with unilateral sacroiliac syndrome, 31.11 (SD 17.37); and bilateral sacroiliac syndrome, 40.32 (SD 17.46). When the average pain was compared among the groups assessed by the VAS, the pelvic girdle syndrome had the highest average pain (7.67; SD 1.72), followed by bilateral sacroiliac syndrome (6.86; SD 1.95), and the unilateral sacroiliac syndrome (6.21; SD 1.72). By correlating the average VAS with the total score of PGQ-Brazil, there was a positive correlation (r=0.458, p=0.01), indicating that the greater the pain, the greater the level of disability of the pregnant woman. The findings suggest that PGPP may result in different levels of disability, which may directly affect the pregnant women's functionality.