Culture, teams, and organizations: A qualitative exploration of female nurses' and midwives' experiences of urinary symptoms at work.

AIM: To explore nurses' and midwives' experiences of urinary symptoms at work. BACKGROUND: Lower urinary tract symptoms are common in female nurses and midwives. There is limited understanding of the relationship between urinary symptoms, bladder health practices, and work. DESIGN: Qualitative design providing in-depth exploration of nurses' and midwives' experiences of urinary symptoms at work through focus group discussions. METHODS: Twelve focus groups were held July-September 2016 with 96 Registered Nurses and midwives working at two tertiary-referral hospitals in urban New South Wales, Australia. A semi-structured question schedule was used. An inductive process guided thematic analysis of data using a socioecological framework of health behaviours. RESULTS: Nurses' and midwives' experiences of urinary symptoms at work primarily relate to delaying voiding. This practice is explained by a work culture of "patient-first" care at expense of self-care, relationships in the nursing team, demands of the nursing role, and inadequacy of workplace amenities. The first two themes reflect cultural and social caring dilemmas central to nursing. The second two themes identify issues with workforce management and physical workplace environments. CONCLUSION: Nurses' and midwives' urinary symptoms and behaviours in response to sensory cues for bladder emptying are dependent on several socioecological influences. Occupational health initiatives in the workforce are required to break cultural norms that deter self-care and to promote work environments that support healthy bladder practices. Workforce management and physical workplace environments are key influences on nurses' timely and dignified access to amenities.

Delaying voiding, limiting fluids, urinary symptoms, and work productivity: A survey of female nurses and midwives.

AIM: To examine the relationships between workplace bladder practices, urinary symptoms, and work productivity. DESIGN: Cross-sectional observational survey. METHODS: Surveys were distributed June-November 2016 to at least 600 female nurses and midwives at three urban hospitals in New South Wales, Australia. Nurses self-reported restricted workplace access to toilets, delaying voiding, limiting of fluid intakes and urinary symptoms at work. Logistic modelling was used to examine whether nurses' bladder practices impaired their time management, ability to concentrate or perform physical demands. RESULTS: Of 353 useable surveys, one in five nurses (22.4%; N = 79) reported restricted access to toilets at work, most (77.1%; N = 272) delayed voiding and one in four (26.9%; N = 95) limited fluid intakes to delay voiding at work. Almost half the sample had urinary symptoms at work (46.7%; N = 165); delaying voiding increased the likelihood of impaired mental concentration and limiting fluid intakes increased the likelihood of impaired time management. CONCLUSION: As workplace access to toilets and related bladder practices are modifiable, associated urinary symptoms and productivity loss may be preventable. IMPACT: Nurses' often experience restricted accesses to amenities due to job demands and workplace environments. The impact of nurses' poor bladder practices in the workplace is not known. In this study most nurses delayed voiding and many purposefully limited fluid intakes at work. These behaviours impacted a nurse's ability to manage time and/or concentrate at work. Results have implications for nurses' personal health, the design of workplace environments, workforce management, occupational health policy, and patient care.

Prevalence and associated factors of urinary leakage among women participating in the 45 and Up Study.

AIMS: The study was undertaken to investigate the prevalence of urinary leakage and its associated factors among a sample of females aged 45 years and over in New South Wales. METHODS: Data were obtained from the 45 and Up Study wherein urinary leakage is identified as women who reported being troubled by leaking urine. At baseline, 143 096 females (2006-2009) and 59 060 females in the follow-up survey (2012-2015) were included in the analysis. We estimated the prevalence, and identified the factors associated with urinary leakage using logistic regression models. RESULTS: The prevalence of urinary leakage was 44.0% at baseline and 44.6% at the first follow-up survey. Among women who reported urinary leakage at baseline, 21.2% reported urine leakage once a week or less and 13.1% four or more times per week. Increasing age, abnormal BMI, back pain, anxiety, depression, and psychological distress were associated with greater odds of women reporting urinary leakage. Asian ancestry and being unemployed was associated with a lower risk for urinary incontinence. CONCLUSION: Findings from this analysis estimate that approximately one in two women aged 45 years and older will most likely experience urinary leakage. The associated factors could serve as screening indicators for urinary leakage.

Urinary incontinence, work, and intention to leave current job: A cross sectional survey of the Australian nursing and midwifery workforce.

AIMS: To determine the prevalence and severity of urinary incontinence (UI) in a group of female nurses and midwives, and to examine the relationship between UI, work and intention to leave current job. METHODS: An electronic survey "Fit for the future" was distributed to nurses and midwives in NSW, Australia between May 2014 and February 2015. UI was investigated using the International Consultation on Incontinence UI-Short Form. Examined work characteristics included: work role, location, setting, contract, shift, job satisfaction, and plans to leave current job. Logistic regression modelling was performed to determine whether the severity of UI had an independent effect on intention to leave. RESULTS: Of 5041 survey responses, 68.5% answered the question on urine leakage. Of the included female sample (n = 2,907) the prevalence of UI was 32.0% (95% CI: 30-34%): of these 40.5% experienced moderate and 4.4% "severe or very severe" symptoms. UI was more likely to be reported in nurses or midwives working part-time or days only (not shifts). Those with "severe or very severe UI" were more likely to indicate an intention to leave at 12 months (OR: 2.68; 95% CI: 1.18-6.06) than those with slight or moderate symptoms, after accounting for age, body mass index, parity, pelvic organ prolapse, anxiety, depression, work contract, shift, and job satisfaction. CONCLUSIONS: UI is a condition of high prevalence and significant severity in female nurses and midwives. In this workforce, severe UI was associated with intentions related to future employment.

A systematic review of prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups.

AIM: To investigate the prevalence and impact of symptoms of pelvic floor dysfunction in identified workforce groups. BACKGROUND: Productivity of workforce groups is a concern for ageing societies. Symptoms of pelvic floor dysfunction are associated with ageing and negatively influence psychosocial health. In the general population, lower urinary tract symptoms negatively influence work productivity. DESIGN: A systematic review of observational studies. DATA SOURCES: Electronic searches of four academic databases. Reference lists were scanned for relevant articles. The search was limited to English language publications 1990-2014. REVIEW METHODS: The Centre for Reviews and Dissemination procedure guided the review method. Data extraction and synthesis was conducted on studies where the workforce group was identified and the type of pelvic floor dysfunction defined according to accepted terminology. Quality appraisal of studies was performed using a Joanna Briggs Institute critical appraisal tool. RESULTS: Twelve studies were identified of variable quality, all on female workers. Nurses were the most frequently investigated workforce group and urinary incontinence was the most common subtype of pelvic floor dysfunction examined. Lower urinary tract symptoms were more prevalent in the studied nurses than related general populations. No included study investigated pelvic organ prolapse, anorectal or male symptoms or the influence of symptoms on work productivity. CONCLUSION: Lower urinary tract symptoms are a significant issue among the female nursing workforce. Knowledge of the influence of symptoms on work productivity remains unknown. Further studies are warranted on the impact of pelvic floor dysfunction subtypes in workforce groups.

Assessing the effectiveness of decision aids for decision making in prostate cancer testing: a systematic review.

BACKGROUND: Prostate cancer is a leading disease affecting men worldwide. Conflicting evidence within the literature provides little guidance to men contemplating whether or not to be screened for prostate cancer. This systematic review aimed to determine whether decision aids about early detection of prostate cancer improve patient knowledge and decision making about whether to undergo prostate-specific antigen testing. METHODS: Medline, EMBASE, CINAHL, PsychINFO, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment databases up until March 2014 were searched. All included randomised controlled trials were assessed for methodological quality. Clinical selection and assessment heterogeneity among studies prevented the pooling of data for meta-analyses. Descriptive analyses of all included studies and comparison were performed. RESULTS: A total of 13 randomised controlled trials met the inclusion criteria. Significant heterogeneity was present for the design and implementation of decision aids including comparative interventions and outcomes. Eight studies were of a low methodological quality, with the remaining five of medium quality. Improvements in patient knowledge following use of a decision aid were demonstrated by 11 of the 13 included studies. Seven of 10 studies demonstrated a reduction in decisional conflict/distress. Three of four studies demonstrated no difference between a decision aid and information only in reducing decisional uncertainty. Three of five studies demonstrated an increase in decisional satisfaction with use of a decision aid. CONCLUSIONS: Decision aids increase patient knowledge and confidence in decision making about prostate cancer testing. Further research into effective methods of implementation is needed. Copyright © 2015 John Wiley & Sons, Ltd.

Scoping review of adherence promotion theories in pelvic floor muscle training - 2011 ICS state-of-the-science seminar research paper i of iv.

AIMS: This paper, the first of four emanating from the International Continence Society's 2011 State-of-the-Science Seminar on pelvic-floor-muscle training (PFMT) adherence, aimed to summarize the literature on theoretical models to promote PFMT adherence, as identified in the research, or suggested by the seminar's expert panel, and recommends future directions for clinical practice and research. METHODS: Existing literature on theories of health behavior were identified through a conventional subject search of electronic databases, reference-list checking, and input from the expert panel. A core eligibility criterion was that the study included a theoretical model to underpin adherence strategies used in an intervention to promote PFM training/exercise. RESULTS: A brief critique of 12 theoretical models/theories is provided and, were appropriate, their use in PFMT adherence strategies identified or examples of possible uses in future studies outlined. CONCLUSION: A better theoretical-based understanding of interventions to promote PFMT adherence through changes in health behaviors is required. The results of this scoping review and expert opinions identified several promising models. Future research should explicitly map the theories behind interventions that are thought to improve adherence in various populations (e.g., perinatal women to prevent or lessen urinary incontinence). In addition, identified behavioral theories applied to PFMT require a process whereby their impact can be evaluated.

2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar.

AIMS: To summarize the findings and "expert-panel" consensus of the State-of-the-Science Seminar on pelvic floor muscle training (PFMT) adherence held prior to the 41st International Continence Society scientific meeting, Glasgow, 2011. METHODS: Summaries of research and theory about PFMT adherence (based on a comprehensive literature search) were presented by subject experts at the 2011 Seminar to generate discussion and guidance for clinical practice and future research. Supplemental research, post-seminar, resulted in, three review papers summarizing: (1) relevant behavioral theories, (2) adherence measurement, determinants and effectiveness of PFMT adherence interventions, and (3) patients' PFMT experiences. A fourth, reported findings from an online survey of health professionals and the public. RESULTS: Few high-quality studies were found. Paper I summarizes 12 behavioral frameworks relevant to theoretical development of PFMT adherence interventions and strategies. Findings in Paper II suggest both PFMT self-efficacy and intention-to-adhere predict PFMT adherence. Paper III identified six potential adherence modifiers worthy of further investigation. Paper IV found patient-related factors were the biggest adherence barrier to PFMT adherence. CONCLUSION: Given the lack of high-quality studies, the conclusions were informed by expert opinion. Adherence is central to short- and longer-term PFMT effect. More attention and explicit reporting is needed regarding: (1) applying health behavior theory in PFMT program planning; (2) identifying adherence determinants; (3) developing and implementing interventions targeting known adherence determinants; (4) using patient-centred approaches to evaluating adherence barriers and facilitators; (5) measuring adherence, including refining and testing instruments; and (6) testing the association between adherence and PFMT outcome.

Pelvic floor health: a concept analysis.

AIM: To report an analysis of the concept 'pelvic floor health'. BACKGROUND: 'Pelvic floor health' is a term used by multiple healthcare disciplines, yet as a concept is not well defined. DESIGN: Rodger's evolutionary view was used to guide this analysis. DATA SOURCES: Academic literature databases and public domain websites viewed via the Internet search engine Google. REVIEW METHODS: Literature in English, published 1946-July 2014 was reviewed. Websites were accessed in May 2014, then analysed of presentation for relevance and content until data saturation. Thematic analysis identified attributes, antecedents and consequences of the concept. RESULTS: Based on the defining attributes identified in the analysis, a contemporary definition is offered. 'Pelvic floor health' is the physical and functional integrity of the pelvic floor unit through the life stages of an individual (male or female), permitting an optimal quality of life through its multifunctional role, where the individual possesses or has access to knowledge, which empowers the ability to prevent or manage dysfunction. CONCLUSION: This analysis provides a definition of 'pelvic floor health' that is based on a current shared meaning and distinguishes the term from medical and lay terms in a complex, multifaceted and often under-reported area of healthcare knowledge. This definition provides a basis for theory development in future research, by focusing on health rather than disorders or dysfunction. Further development of the meaning is required in an individual's social context, to ensure a contemporaneous understanding in a dynamic system of healthcare provision.

Biofeedback for treatment of chronic idiopathic constipation in adults.

BACKGROUND: Biofeedback therapy has been used to treat the symptoms of people with chronic constipation referred to specialist services within secondary and tertiary care settings. However, different methods of biofeedback are used within different centres and the magnitude of suggested benefits and comparable effectiveness of different methods of biofeedback has yet to be established. OBJECTIVES: To determine the efficacy and safety of biofeedback for the treatment of chronic idiopathic (functional) constipation in adults. SEARCH METHODS: We searched the following databases from inception to 16 December 2013: CENTRAL, the Cochrane Complementary Medicine Field, the Cochrane IBD/FBD Review Group Specialized Register, MEDLINE, EMBASE, CINAHL, British Nursing Index, and PsychINFO. Hand searching of conference proceedings and the reference lists of relevant articles was also undertaken. SELECTION CRITERIA: All randomised trials evaluating biofeedback in adults with chronic idiopathic constipation were considered for inclusion. DATA COLLECTION AND ANALYSIS: The primary outcome was global or clinical improvement as defined by the included studies. Secondary outcomes included quality of life, and adverse events as defined by the included studies. Where possible, we calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for dichotomous outcomes and the mean difference (MD) and 95% CI for continuous outcomes. We assessed the methodological quality of included studies using the Cochrane risk of bias tool. The overall quality of the evidence supporting each outcome was assessed using the GRADE criteria. MAIN RESULTS: Seventeen eligible studies were identified with a total of 931 participants. Most participants had chronic constipation and dyssynergic defecation. Sixteen of the trials were at high risk of bias for blinding. Attrition bias (4 trials) and other potential bias (5 trials) was also noted. Due to differences between study populations, the heterogeneity of the different samples and large range of different outcome measures, meta-analysis was not possible. Different effect sizes were reported ranging from 40 to 100% of patients who received biofeedback improving following the intervention. While electromyograph (EMG) biofeedback was the most commonly used, there is a lack of evidence as to whether any one method of biofeedback is more effective than any other method of biofeedback. We found low or very low quality evidence that biofeedback is superior to oral diazepam, sham biofeedback and laxatives. One study (n = 60) found EMG biofeedback to be superior to oral diazepam. Seventy per cent (21/30) of biofeedback patients had improved constipation at three month follow-up compared to 23% (7/30) of diazepam patients (RR 3.00, 95% CI 1.51 to 5.98). One study compared manometry biofeedback to sham biofeedback or standard therapy consisting of diet, exercise and laxatives. The mean number of complete spontaneous bowel movements (CSBM) per week at three months was 4.6 in the biofeedback group compared to 2.8 in the sham biofeedback group (MD 1.80, 95% CI 1.25 to 2.35; 52 patients). The mean number of CSBM per week at three months was 4.6 in the biofeedback group compared to 1.9 in the standard care group (MD 2.70, 95% CI 1.99 to 3.41; 49 patients). Another study (n = 109) compared EMG biofeedback to conventional treatment with laxatives and dietary and lifestyle advice. This study found that at both 6 and 12 months 80% (43/54) of biofeedback patients reported clinical improvement compared to 22% (12/55) laxative-treated patients (RR 3.65, 95% CI 2.17 to 6.13). Some surgical procedures (partial division of puborectalis and stapled transanal rectal resection (STARR)) were reported to be superior to biofeedback, although with a high risk of adverse events in the surgical groups (wound infection, faecal incontinence, pain, and bleeding that required further surgical intervention). Successful treatment, defined as a decrease in the obstructed defecation score of > 50% at one year was reported in 33% (3/39) of EMG biofeedback patients compared to 82% (44/54) of STARR patients (RR 0.41, 95% CI 0.26 to 0.65). For the other study the mean constipation score at one year was 16.1 in the balloon sensory biofeedback group compared to 10.5 in the partial division of puborectalis surgery group (MD 5.60, 95% CI 4.67 to 6.53; 40 patients). Another study (n = 60) found no significant difference in efficacy did not demonstrate the superiority of a surgical intervention (posterior myomectomy of internal anal sphincter and puborectalis) over biofeedback. Conflicting results were found regarding the comparative effectiveness of biofeedback and botulinum toxin-A. One small study (48 participants) suggested that botulinum toxin-A injection may have short term benefits over biofeedback, but the relative effects of treatments were uncertain at one year follow-up. No adverse events were reported for biofeedback, although this was not specifically reported in the majority of studies. The results of all of these studies need to be interpreted with caution as GRADE analyses rated the overall quality of the evidence for the primary outcomes (i.e. clinical or global improvement as defined by the studies) as low or very low due to high risk of bias (i.e. open label studies, self-selection bias, incomplete outcome data, and baseline imbalance) and imprecision (i.e. sparse data). AUTHORS' CONCLUSIONS: Currently there is insufficient evidence to allow any firm conclusions regarding the efficacy and safety of biofeedback for the management of people with chronic constipation. We found low or very low quality evidence from single studies to support the effectiveness of biofeedback for the management of people with chronic constipation and dyssynergic defecation. However, the majority of trials are of poor methodological quality and subject to bias. Further well-designed randomised controlled trials with adequate sample sizes, validated outcome measures (especially patient reported outcome measures) and long-term follow-up are required to allow definitive conclusions to be drawn.

Prevalence correlates and impact of fecal incontinence among older women.

BACKGROUND: Fecal incontinence is a common problem that has been associated with anatomic, physiological, and medical conditions. There are very few data on the factors associated with fecal incontinence in elderly women. OBJECTIVES: We aimed to determine the factors associated with fecal incontinence via a population-based survey in a large cohort of elderly Australian women. DESIGN AND SETTING: Data from a large longitudinal population-based study of elderly Australian women aged 82 to 87 years were analyzed. PATIENTS: Participants were 5560 women (aged 82-87 years) who participated in the Australian Longitudinal Study on Women's Health; 4815 women responded to questions relating to fecal incontinence. MAIN OUTCOME MEASURES: Fecal incontinence was defined as leakage of liquid and/or solid stool at least once per month over the past 12 months. Self-reported medical conditions and lifestyle factors as well as demographic factors were recorded. RESULTS: The prevalence of fecal incontinence was 10.4% (95% CI, 9.6-11.3) (n = 510). The prevalence was significantly higher among institutional- versus community-dwelling women (14.1% vs 9.7%; p = 0.0002). Univariately, lifestyle factors including fruit intake and fluid intake, along with a range of comorbidities, were associated. However, independent factors for fecal incontinence among community-dwelling women included diabetes mellitus (OR, 1.51; 95% CI, 1.14-2.01; p = 0.004), depression (OR, 1.84; 95% CI, 1.30-2.62; p = 0.001), urinary incontinence (OR, 2.29; 95% CI, 1.83-2.86; p < 0.0001), and osteoarthritis (OR, 0.73; 95% CI, 0.57-0.94; p = 0.013). Among institutional-dwelling women, however, we found urinary incontinence (OR, 4.43; 95% CI, 2.83-6.93; p < 0.0001) and poorer general health (OR, 0.98; 95% CI, 0.97-0.99; p = 0.003) to be independently associated. LIMITATIONS: This is a cross-sectional study, which prevents making conclusions about the cause and effect of observed correlations. CONCLUSIONS: The independent factors associated with fecal incontinence in this population do not appear readily modifiable, and many previously identified risk factors may not be important in the elderly women with fecal incontinence.

Impact of neck dissection on scapular muscle function: a case-controlled electromyographic study.

OBJECTIVE: To assess the dynamic activity of scapular muscles in patients with accessory nerve dysfunction after neck dissection surgery, compared with both their unaffected side and with age- and sex-matched controls. DESIGN: A case-control investigation. SETTING: Physiotherapy department of a hospital. PARTICIPANTS: Two groups of 10 participants were recruited. One group consisted of neck dissection patients with demonstrated clinical signs of accessory nerve injury. The second group was composed of matched healthy individuals. INTERVENTIONS: Surface electromyographic activity of the upper trapezius, middle trapezius, rhomboid major, and serratus anterior muscles was compared dynamically during scapular strengthening exercises. MAIN OUTCOME MEASURES: Electromyographic activity comparisons were made between the neck dissection affected side, the neck dissection unaffected side, and the matched healthy control side. Raw data and data expressed as a percentage of maximal voluntary isometric contraction were compared. RESULTS: The neck dissection affected side demonstrated significantly less upper trapezius and middle trapezius muscle activity compared with the neck dissection unaffected side and matched control group. The neck dissection unaffected side had significantly less upper trapezius muscle activity than the matched control group. CONCLUSIONS: Trapezius muscle activity is significantly reduced in accessory nerve shoulder dysfunction as a result of neck dissection, both in the affected and unaffected sides. This needs to be considered in the rehabilitation of this patient group.

Balance outcomes from two small rural hospitals.

OBJECTIVES: To describe predicted and measured balance changes in patients receiving physiotherapy in two rural hospitals, and to explore the relationship among balance at discharge, carer availability and patients' discharge destination. DESIGN: Prospective measurement study. SETTING: Two rural Australian hospitals. PARTICIPANTS: Eighty-nine inpatients with a median age of 84. MAIN OUTCOME MEASURES: Berg Balance Scale (BBS) on admission and the treating physiotherapist's estimate at admission of individual patient's discharge BBS. Follow-up measures included discharge BBS, carer availability after discharge and patient discharge destination. RESULTS: Although change in measured balance of study participants had wide variability, balance measured by the BBS displayed a statistically and clinically significant improvement. A strong relationship was found between balance scores and discharge destination. However, no relationship was found between carer availability and discharge destination. Physiotherapists' estimates of discharge BBS displayed an average error of 7/56. CONCLUSIONS: The strong relationship between measured balance and discharge destination in these elderly study participants suggests that maximising their balance might minimise admissions to nursing home. The high variability of measured balance change suggests outcomes are difficult to predict. The study results suggest that premature assessment of patient's suitability for nursing home placement should be avoided. The accuracy of physiotherapist's estimates of discharge BBS suggests that greater weight might be placed on their input to facilitate the discharge planning process.

Living with urinary incontinence: a longitudinal study of older women.

BACKGROUND: urinary incontinence carries major social burden and considerable costs for health care systems. OBJECTIVE: the aim of this study was to investigate changes in continence status among a large cohort of older women, and to identify factors associated with incidence of incontinence in later life. SUBJECTS: participants of the Australian Longitudinal Study of Women's Health (ALSWH), aged 70-75 years in 1996 and who have completed four health surveys over the past 10 years. METHODS: continence status across four survey periods, spanning 9 years, were defined according to women's reports of 'leaking urine' at each survey. Generalised estimating equation (GEE) models were used in longitudinal analyses of the factors associated with changing continence status over time. RESULTS: this study presents longitudinal data on the prevalence and incidence of incontinence from a large cohort of older women, over 9 years of follow-up. Over this time, 14.6% (95% CI 13.9-15.3) of the women in the study who had previously reported leaking urine 'rarely' or 'never' developed incontinence, and 27.2% (95% CI 26.2%, 28.3%) of women participating in Survey 4 (S4) in 2005 reported leaking urine 'sometimes' or 'often' at that survey, with women being twice as likely to report incontinence at S4 as they were 6 years earlier. Longitudinal models demonstrated the association between incontinence and dementia (P < 0.001; OR = 2.34; 95% CI 1.64, 3.34), dissatisfaction with physical ability (P < 0.001; OR = 1.70; 95% CI 1.52, 1.89), falls to the ground (P <0.001; OR = 1.23; 95% CI 1.13, 1.33), BMI (P < 0.001; OR = 2.18; 95% CI 1.70, 2.80 for obese), constipation (P < 0.001; OR 1.46; 95% CI 1.34-1.58), urinary tract infection (P < 0.001; OR 2.07; 95% CI 1.89-2.28), history of prolapse (P

Urinary incontinence is associated with an increase in falls: a systematic review.

QUESTION: Is urinary incontinence associated with falls in community-dwelling older people? DESIGN: A systematic review and meta-analysis of observational studies investigating falls and urinary incontinence. PARTICIPANTS: Community-dwelling older people. OUTCOME MEASURES: Falls rather than fracture or injury, and any type of urinary incontinence. RESULTS: Odds ratios of nine studies were included in the meta-analysis. The odds of falling were 1.45 (95% CI 1.36 to 1.54) in the presence of any type of urinary incontinence. The odds of falling were 1.54 (95% CI 1.41 to 1.69) in the presence of urge incontinence. The odds of falling were 1.11 (95% CI 1.00 to 1.23) in the presence of stress incontinence. The odds of falling were 1.92 (95% CI 1.69 to 2.18) in the presence of mixed incontinence. CONCLUSION: Urge urinary incontinence, but not stress urinary incontinence, is associated with a modest increase in falls. Falls prevention programs need to include an assessment of incontinence and referral for interventions to ameliorate the symptoms of urge incontinence.

No association between previous Caesarean-section delivery and back pain in mid-aged Australian women: an observational study.

QUESTION: Is there an association between Caesarean section and back pain over the longer term? DESIGN: Secondary analysis of data from the Australian Longitudinal Study on Women's Health. PARTICIPANTS: The mid-aged cohort of women within the Australian Longitudinal Study on Women's Health aged 54 to 59 years (n = 9146). OUTCOME MEASURES: Data were included from women who answered the question regarding back pain. Data were extracted on whether they had given birth and, if so, whether it was by Caesarean section. Then, data on confounding variables (such as arthritis, asthma, osteoporosis, hysterectomy, ovaries removed, and repair of prolapsed vagina, bladder or bowel, menopause, smoking) were also extracted. RESULTS: After adjusting for confounding factors, women who delivered by Caesarean section had the same odds (OR 1.03, 95% CI 0.81 to 1.31) of having back pain as women who had not had a birth. CONCLUSION: Previous delivery by Caesarean section is not associated with increased back pain in mid-aged Australian women.

Urinary stress incontinence and overactive bladder symptoms in older women.

Urinary incontinence - the accidental leaking of urine - is a major problem in Australia and has a significant impact on quality of life, affecting the social, psychological, physical and financial aspects of living. The prevalence of urinary incontinence is significantly higher in women than in men. While urine loss itself is a devastating symptom, older women are also likely to suffer lower urinary tract symptoms associated with the overactive bladder syndrome such as urgency, frequency, mixed incontinence and nocturia which are reported more frequently in older women. These symptoms disrupt activities of daily living as well as seriously disturbing sleep and general health status. Conservative nurse interventions have been shown to be effective in the management of these symptoms. Simple assessment tools suitable for use by primary level clinicians and conservative management strategies are discussed within the paper.

Australian football players experiencing groin pain exhibit reduced subscale scores of Activities of Daily Living and Sport and Recreation on the HAGOS questionnaire: A case-control study.

OBJECTIVES: To report normative responses to the HAGOS questionnaire for Australian football players and to determine whether any of the HAGOS questionnaire sub scales can differentiate players with and without groin pain. DESIGN: Case-control. SETTING: Clinical setting. PARTICIPANTS: Professional (n = 66) and semi-professional (n = 9) Australian football (AF) players with current groin pain (n = 16) and controls (n = 57) without current groin pain. MAIN OUTCOME MEASURE: The HAGOS subscales were compared between players with and without groin pain using the Wilcoxon rank-sum test with effect sizes (ES) calculated. Floor and ceiling effects were examined. A post-hoc factor analysis was undertaken. RESULTS: Participants with current groin pain showed lower Physical Function of Daily Living (PFDL) and Physical Function in Sport and Recreation (PFSR) subscale scores (p < 0.05, ES: 0.77 and 0.90 respectively). Any groin pain (current and/or historical) lowered the Pain and Quality of Life (QOL) subscale scores (p < 0.05, ES: 0.38 and 0.72 respectively). Factor analysis showed 8 significant factors with one main factor identified representing items describing forceful activities (Eigenvalue = 18.02, Proportion = 0.49). CONCLUSIONS: The HAGOS can distinguish AF players with current groin pain in the PFDL and PFSR subscales but not in the other four subscales. Any current or historical groin pain lowers scores on the QOL and Pain sub scales. LEVEL OF EVIDENCE: Aetiology, Individual Case-Control Study, Level 3b.

Do Australian Football players have sensitive groins? Players with current groin pain exhibit mechanical hyperalgesia of the adductor tendon.

OBJECTIVES: This is the first study to evaluate the mechanical sensitivity, clinical classifications and prevalence of groin pain in Australian football players. DESIGN: Case-control. METHODS: Professional (n=66) and semi-professional (n=9) Australian football players with and without current or previous groin injuries were recruited. Diagnoses were mapped to the Doha Agreement taxonomy. Point and career prevalence of groin pain was calculated. Pressure pain thresholds (PPTs) were assessed at regional and distant sites using handheld pressure algometry across four sites bilaterally (adductor longus tendon, pubic bone, rectus femoris, tibialis anterior muscle). To assess the relationship between current groin pain and fixed effects of hyperalgesia of each site and a history of groin pain, a mixed-effect logistic regression model was utilised. Receiver Operator Characteristic (ROC) curve were determined for the model. RESULTS: Point prevalence of groin pain in the preseason was 21.9% with a career prevalence of 44.8%. Adductor-related groin pain was the most prevalent classification in the pre-season period. Hyperalgesia was observed in the adductor longus tendon site in athletes with current groin pain (OR=16.27, 95% CI 1.86 to 142.02). The ROC area under the curve of the regression model was fair (AUC=0.76, 95% CI 0.54 to 0.83). CONCLUSIONS: Prevalence data indicates that groin pain is a larger issue than published incidence rates imply. Adductor-related groin pain is the most common diagnosis in pre-season in this population. This study has shown that hyperalgesia exists in Australian football players experiencing groin pain indicating the value of assessing mechanical pain sensitivity as a component of the clinical assessment.

Maximizing shoulder function after accessory nerve injury and neck dissection surgery: A multicenter randomized controlled trial.

BACKGROUND: Shoulder pain and dysfunction after neck dissection may result from injury to the accessory nerve. The effect of early physical therapy in the form of intensive scapular strengthening exercises is unknown. METHODS: A total of 59 neck dissection participants were prospectively recruited for this study. Participants were randomly assigned to either the intervention group (n = 32), consisting of progressive scapular strengthening exercises for 12 weeks, or the control group (n = 29). Blinded assessment occurred at baseline, and at 3, 6, and 12 months. RESULTS: Three-month data were collected on 52 participants/53 shoulders. Per-protocol analysis demonstrated that the intervention group had statistically significantly higher active shoulder abduction at 3 months compared to the control group (+26.6°; 95% confidence interval [CI] 7.28-45.95; p = .007). CONCLUSION: The intervention is a favorable treatment for maximizing shoulder abduction in the short term. The effect of the intervention compared to usual care is uncertain in the longer term.