Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness.

PURPOSE: We determined the efficacy and safety of pelvic floor myofascial physical therapy compared to global therapeutic massage in women with newly symptomatic interstitial cystitis/painful bladder syndrome. MATERIALS AND METHODS: A randomized controlled trial of 10 scheduled treatments of myofascial physical therapy vs global therapeutic massage was performed at 11 clinical centers in North America. We recruited women with interstitial cystitis/painful bladder syndrome with demonstrable pelvic floor tenderness on physical examination and a limitation of no more than 3 years' symptom duration. The primary outcome was the proportion of responders defined as moderately improved or markedly improved in overall symptoms compared to baseline on a 7-point global response assessment scale. Secondary outcomes included ratings for pain, urgency and frequency, the O'Leary-Sant IC Symptom and Problem Index, and reports of adverse events. We compared response rates between treatment arms using the exact conditional version of the Mantel-Haenszel test to control for clustering by clinical center. For secondary efficacy outcomes cross-sectional descriptive statistics and changes from baseline were calculated. RESULTS: A total of 81 women randomized to the 2 treatment groups had similar symptoms at baseline. The global response assessment response rate was 26% in the global therapeutic massage group and 59% in the myofascial physical therapy group (p=0.0012). Pain, urgency and frequency ratings, and O'Leary-Sant IC Symptom and Problem Index decreased in both groups during followup, and were not significantly different between the groups. Pain was the most common adverse event, occurring at similar rates in both groups. No serious adverse events were reported. CONCLUSIONS: A significantly higher proportion of women with interstitial cystitis/painful bladder syndrome responded to treatment with myofascial physical therapy than to global therapeutic massage. Myofascial physical therapy may be a beneficial therapy in women with this syndrome.

Shoulder antagonistic strength ratios during concentric and eccentric muscle actions in the scapular plane.

Reporting agonist/antagonist ratios is frequently more clinically applicable than reporting absolute strength values of single muscle groups. The purpose of this study was to measure shoulder abduction/adduction and external/internal rotation ratios in the functional scapular plane of shoulder movement. Ratios were calculated using peak and average torques during concentric and eccentric muscle actions, and ratios of healthy males and females were compared. Thirty-six, non-athletic subjects performed concentric-eccentric cycles at two angular velocities. No significant differences were observed in the ratios using peak and average torques as criterion measurements. Abduction/adduction ratios using peak torques were significantly greater during concentric than eccentric actions. External/internal rotation ratios using average torques were significantly greater during eccentric than concentric actions. External/internal rotation ratios at 180 degrees/sec were significantly greater than those at 90 degrees/sec. No significant differences were observed between male and female subjects. Ratios were higher than previously reported. This was attributed to the scapular plane testing position. The clinician should be aware that shoulder strength ratios are dependent on position and that the scapular plane may be advantageous in some cases for testing and treatment.

Validation of outcome measures in patients with patellofemoral syndrome.

This project was supported by a grant from the Physiotherapy Foundation of Canada. The purpose of this study was to determine the reliability and validity of the following outcome measures in a group of 18 patients with patellofemoral pain syndrome: the visual analog pain scale (VAS), a functional index questionnaire (FIQ), selected temporal components of gait on level walking and ascending stairs, knee joint angle on downhill walking, and electromyographic activity of the quadriceps during stair climbing. Subjects were tested at initial assessment (time 0), after 24 hours (time 1), and after clinically significant improvement, following a course of treatment (time 2). Using the intraclass correlation coefficient (r1), the VAS (r1 = 0.603) and FIQ (r1 = 0.483) exhibited poor day-to-day reliability (time 0 versus time 1). However an ANOVA between time 0 and time 2 showed them to be valid measures for detection of clinical change (p < 0.01). No differences in the gait variables were observed from time 0 to time 1 or time 2, suggesting that gait analysis may not be sensitive enough to detect changes in pain and function in this patient population. J Orthop Sports Phys Ther 1989;10(8):302-308.