An ideal e-health system for pelvic floor muscle training adherence: Systematic review.

BACKGROUND: Nowadays, Pelvic Floor Muscle Training (PFMT) is a first line, level 1 evidence-based treatment for urinary incontinence (UI), but adherence to PFMT is often problematic. Today, there are several mobile applications (mApps) for PFMT, but many lack specific strategies for enhancing adherence. AIMS: To review available mApps for improvement of adherence to PFMT, and to introduce a new App so called iPelvis. METHODS: Review study all available mApps for PFMT and relevant literature regarding adherence by electronic search through the databases Pubmed, Embase, CINAHL, LILACS, PEDro, and Scielo. Based on these results, development of a mApp, called "iPelvis" for Apple™ and Android™ systems, implementing relevant strategies to improve adherence. RESULTS: Based on the current adherence literature we were able to identify 12 variables helping to create the optimal mApp for PFMT. None of the identified 61 mApps found for Android™ and 16 for Apple™ has all these 12 variables. iPelvis mApp and websites were constructed taking into consideration those 12 variables and its construct is now being subject to ongoing validation studies. CONCLUSION: MApps for PFMT are an essential part of first-line, efficient interventions of UI and have potentials to improve adherence, in case these respect the principles of PFMT, motor learning and adherence to PFMT. iPelvis has been constructed respecting all essential variables related to adherence to PFMT and may enhance the effects of UI treatment.

Ginástica hipopressiva como recurso proprioceptivo para os músculos do assoalho pélvico de mulheres incontinentes / Hypopressive gymnastics as resource for perineal proprioception in women with urinary incontinence

Introdução: Está amplamente descrito na literatura que as mulheres com e sem disfunção do assoalho pélvico apresentam grande dificuldade em realizar a contração adequada dos músculos perineais.A Ginástica Hipopressiva poderia facilitar o entendimento da correta contração uma vez que supostamente promove contração reflexa dos músculos do assoalho pélvico (MAP) durante sua realização.Objetivo: Avaliar a função dos MAP antes e após protocolo de exercícios hipopressivos para melhora da propriocepção perineal em mulheres com incontinência urinária de esforço (IUE). Métodos:Foram incluídas 14 mulheres com IUE que se submeteram a protocolo de três sessões individuais, com conteúdo padronizado,que incluiu o aprendizado dos exercícios hipopressivos em etapas.Após este período de aprendizado, as pacientes se submeteram a12 semanas de exercícios domiciliares, com sessões mensais com o fisioterapeuta. A cada sessão, as pacientes apresentavam diário de exercícios preenchido para mensuração da aderência ao tratamento.A função dos MAP foi mensurada antes e após o tratamento por meio de palpação bidigital, utilizando-se a escada de Oxford, o endurance muscular e o número de contrações rápidas. Resultados:Houve melhora em todos os parâmetros de função muscular avaliados:Oxford (p = 0,0005); endurance (p = 0,0001) e número de contrações rápidas (p < 0,0001). Conclusão: Houve aumento da função muscular do assoalho pélvico após prática de exercícios hipopressivos para melhora da propriocepção perineal.

Introduction: It is widely reported in the literature that womenwith and without pelvic floor dysfunction have great difficulty inperforming adequate contraction of the perineal muscles. Hypopressive Gymnastics could facilitate the correct understanding ofcontraction since that supposedly promotes reflex contraction of thepelvic floor muscles (PFM) during its implementation. Objective: Toevaluate the function of PFM before and after hypopressive exercise protocol to improve perineal proprioception in women with stress urinary incontinence (SUI). Methods: Were included 14 women with SUI who underwent a protocol of 3 individual sessions with standardized content, which included learning of the hypopressive exercises in stages. After this learning period, patients underwent12 weeks of home exercise, with monthly sessions with the physiotherapist.At each session, the patients presented daily exercisesjournal to measure adherence. The role of PFM was measuredbefore and after treatment by bidigital palpation, using the Oxfordscale, muscular endurance and the number of rapid contractions. Results: Was observed improvement in all evaluated parameters of muscle function: Oxford (p = 0.0005), endurance (p = 0.0001)and number of rapid contractions (p < 0.0001). Conclusion: Wasobserved increased pelvic floor muscle function after hypopressive exercise for improving perineal proprioception.