Exercise adherence to pelvic floor muscle strengthening is not a significant predictor of symptom reduction for women with urinary incontinence.

OBJECTIVE: To explore the predictors of treatment effectiveness for women with urinary incontinence (UI) receiving pelvic floor muscle (PFM) strengthening. DESIGN: Four-month cohort study. SETTING: Laboratory. PARTICIPANTS: Volunteers (N=68; mean age ± SD, 50.5±6.0y) with UI. INTERVENTION: Four-month daily PFM strengthening exercise program at home. MAIN OUTCOME MEASURES: Outcome measures included self-reported improvement, Severity Index score, 3-days diary, strength of PFM, and quality of life. The participants' recall of the amount of exercise after the 4-month exercise period was used to assess the exercise adherence. RESULTS: Fifty-one (75%) of 68 women reported that their condition improved after 4 months of exercise. There were significant reductions in Severity Index score, number of voidings per day, number of leakages per day, and impact on quality of life (P<.05). In addition, the score of PFM strength was significantly improved (P=.001). There were no significant correlations between the change score of the Severity Index and age, body mass index, parity, type of UI, duration of UI, menopausal status, and amount of exercise (all P>.10). Multiple regression analysis revealed that initial severity of symptoms and improvement of PFM strength predicted 51.3% of variance in 4-month exercise effectiveness (change score of the Severity Index). CONCLUSIONS: The effectiveness of the 4-month PFM strengthening program was influenced by the severity of symptoms and the improvement score of PFM strength instead of exercise adherence. Women who had more significant symptoms of leakage (higher score on the Severity Index at baseline) and who had more improvement of PFM strength showed more improvement of symptoms after PFM strengthening.

Can ICF model for patients with breast-cancer-related lymphedema predict quality of life?

GOAL OF WORK: The aim of the study was to investigate if the International Classification of Functioning, Disability and Health (ICF) model with clinical data from patients with breast-cancer-related lymphedema can predict their health-related quality of life (HRQL). MATERIALS AND METHODS: Sixty-one patients with breast-cancer-related lymphedema were recruited. Data were collected from records, including age, type(s) of surgery, number of dissected lymph nodes and history of radiotherapy and/or chemotherapy, duration of lymphedema, and duration between surgery and enrollment. Excessive arm volume, average arm symptom, function of upper extremity (U/E), and HRQL were assessed four times during and after patients' treatment of lymphedema. RESULTS: The ICF model accounted for 20.5% to 55.6% variance in each domain of HRQL. Activity and participation reflected by U/E function were the most important factor, significantly predicting every domain of HRQL. Among measured impairments, average arm symptom was found to be most correlated with U/E function (r = 0.590, P < 0.05). CONCLUSION: The ICF model consisting of clinical measures for patients with breast-cancer-related lymphedema can predict their HRQL. Activity and participation were the most important component. Arm symptoms rather than arm volume significantly correlated with U/E function. This might suggest that reducing arm symptoms is relatively more important while treating patients with breast-cancer-related lymphedema.

Validating the ICF core set for cerebral palsy using a national disability sample in Taiwan.

Purpose: To validate the activities and participation (d) codes of two age-specific brief International Classification of Functioning, Disability, and Health (ICF) core sets for school-aged children with cerebral palsy (CP), using national dataset of the child version of the Functioning Scale of the Disability Evaluation System (FUNDES) in Taiwan.Methods: Students with CP aged 6-17.9 years (n = 546) in the national dataset were analyzed. Items of the child version of the FUNDES were linked to the ICF d-codes and matched to two brief ICF core sets for CP. The restriction rate of the linked d-codes were calculated. Random Forest regression was applied to select the important linked d-codes for predicting school participation frequency.Results: The vast majority of the content of the Taiwanese dataset was covered by two core sets. The matched d-codes represent high restriction rates (80%) and most were important for predicting school participation. One important code, d740 (formal relationships, such as relationship with teachers), identified in this study were not included in two ICF core sets.Conclusions: Two brief ICF core sets for CP capture the majority of relevant functional information collected by the child version of the FUNDES. Some additional codes not covered in the international ICF core sets should be considered for inclusion in the revised Taiwanese version.Implications for rehabilitationCerebral palsy (CP) is the most common cause of severe physical disability in childhood. ICF core sets for CP promote a comprehensive assessment and service provision.To ensure applicability, ICF core sets for CP were validated in Taiwan using the child and youth national dataset of the child version of the Functioning Scale of the Disability Evaluation System. This study shows content validity and proposes new ICF codes additions for the Taiwanese version.Among top five ICF-based predictors for school participation frequency, four of them were consistent in both children and youth groups as d310-d350 (basic communication), d750 (informal social relationships), d820 (school education), and d710-d720, d880 and d920 (social play), which could be taken into consideration in clinical application.

Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study.

GOALS OF WORK: The purpose of this study is to compare the treatment and retention effects between standard decongestive lymphatic therapy (DLT) combined with pneumatic compression (PC) and modified DLT, in which the use of a short-stretch bandage is replaced with the use of Kinesio tape (K-tape) combined with PC. MATERIALS AND METHODS: Forty-one patients with unilateral breast-cancer-related lymphedema for at least 3 months were randomly grouped into the DLT group (bandage group, N = 21) or the modified DLT group (K-tape group, N = 20). Skin care, 30-min manual lymphatic drainage, 1-h pneumatic compression therapy, application of a short-stretch bandage or K-tape for each group, and a 20-min physical therapy exercise were given during every treatment session. Patient evaluation items included physical therapy assessment, limb size, water composition of the upper extremity, lymphedema-related symptoms, quality of life, and patients' acceptance to the bandage or tape. MAIN RESULTS: There was no significant difference between groups in all outcome variables (P > 0.05) through the whole study period. Excess limb size (circumference and water displacement) and excess water composition were reduced significantly in the bandage group; excess circumference and excess water composition were reduced significantly in the tape group. The acceptance of K-tape was better than the bandage, and benefits included longer wearing time, less difficulty in usage, and increased comfort and convenience (P < 0.05). CONCLUSIONS: The study results suggest that K-tape could replace the bandage in DLT, and it could be an alternative choice for the breast-cancer-related lymphedema patient with poor short-stretch bandage compliance after 1-month intervention. If the intervention period was prolonged, we might get different conclusion. Moreover, these two treatment protocols are inefficient and cost time in application. More efficient treatment protocol is needed for clinical practice.

Effect of pelvic-floor muscle strengthening on bladder neck mobility: a clinical trial.

BACKGROUND: Pelvic-floor muscle (PFM) strengthening has been widely used to treat people with urinary incontinence (UI). However, its effect on bladder neck position and stiffness is unknown. OBJECTIVE: The aim of the study was to investigate the effect of PFM strengthening on bladder neck mobility for women with stress UI (SUI) or mixed UI (MUI). DESIGN: This study was conducted as a single-group pretest-posttest design. SETTING: This study was conducted mainly at the Life Quality & Health Promotion Laboratory at National Taiwan University and partly in the Ultrasonography Room of the Department of Obstetrics and Gynecology at National Taiwan University Hospital. Patients Twenty-three patients (mean age=51.9 years, SD=6.1) participated in the study. INTERVENTION AND MEASUREMENTS: Each participant underwent a PFM strengthening program for 4 months. Bladder neck position at rest and during a cough, the Valsalva maneuver, and a PFM contraction was assessed by transperineal ultrasonography before and after the intervention. Severity Index score, self-reported improvement, PFM strength (force-generating capacity), and vaginal squeeze pressure were assessed for treatment effect. RESULTS: The position of the bladder neck at PFM contraction and bladder neck mobility for maximal incursion from rest to PFM contraction were elevated, with effect sizes of 0.48 and 0.84, respectively. Bladder neck position and bladder neck mobility were not changed during a cough and the Valsalva maneuver. All participants reported diminution of incontinence, and PFM strength and maximal vaginal squeeze pressure were improved after the intervention. Limitations The limitations of the present trial included the pretest-posttest design and the absence of intra-abdominal pressure measuring and exercise adherence recording. CONCLUSIONS: Four months of daily PFM strengthening can significantly improve the ability of the PFM to elevate the bladder neck voluntarily, but may not improve its stiffness during a cough and the Valsalva maneuver for women with SUI and MUI.

An alternative intervention for urinary incontinence: retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function.

This study was a randomized controlled trial to investigate the effect of treating women with stress or mixed urinary incontinence (SUI or MUI) by diaphragmatic, deep abdominal and pelvic floor muscle (PFM) retraining. Seventy women were randomly allocated to the training (n = 35) or control group (n = 35). Women in the training group received 8 individual clinical visits and followed a specific exercise program. Women in the control group performed self-monitored PFM exercises at home. The primary outcome measure was self-reported improvement. Secondary outcome measures were 20-min pad test, 3-day voiding diary, maximal vaginal squeeze pressure, holding time and quality of life. After a 4-month intervention period, more participants in the training group reported that they were cured or improved (p < 0.01). The cure/improved rate was above 90%. Both amount of leakage and number of leaks were significantly lower in the training group (p < 0.05) but not in the control group. More aspects of quality of life improved significantly in the training group than in the control group. Maximal vaginal squeeze pressure, however, decreased slightly in both groups. Coordinated retraining diaphragmatic, deep abdominal and PFM function could improve symptoms and quality of life. It may be an alternative management for women with SUI or MUI.

Reliability study of measurements for lymphedema in breast cancer patients.

OBJECTIVE: Water displacement, circumference measurement, and tissue tonometry are important methods to evaluate the status of lymphedemous limbs in breast cancer patients. The purpose of this study was to investigate the reliabilities, and define the limits for clinical change indicative of clinical improvement with respect to these three measures. DESIGN: Fourteen patients were recruited for water displacement and circumference measurement, and 17 for tissue resistance by tonometry. All had been treated for breast cancer and subsequently developed lymphedema. Two physical therapists conducted the measurements to determine intra- and interrater reliability. RESULTS: All measures had fair to excellent reliability (water displacement and circumference measurement, intraclass correlation coefficient [ICC] >0.99, P < 0.05; tissue tonometry, 0.66 < ICC < 0.88, P < 0.05). There was no systematic change in the mean for any of the measures. The variation, as determined by standard error of measurement (SEM), SEM%, smallest real difference (SRD), and SRD% was greatest for tissue tonometry. CONCLUSIONS: Water displacement and circumference measurement (but not tonometry) are reliable techniques for assessing lymphedema in clinical practice. The effect of modifying the tonometry protocol and increasing the amount of rater training should be studied to determine whether the reliability of this method can be improved.