Cross-Cultural Adaptation and Validation of the ICIQ-BD for Brazilian Women With Lower Urinary Tract Symptoms.

INTRODUCTION AND HYPOTHESES: The International Continence Society recommends the International Consultation on Incontinence Questionnaire-Bladder Diary (ICIQ-BD) for the assessment, management, and monitoring of lower urinary tract symptoms (LUTS). Translation, cross-cultural adaptation and validation will establish a valid and reliable tool for Brazilian women with LUTS. METHODS: A cross-sectional study involving 101 women was carried out at the Urogynecology Outpatient Clinic in Belo Horizonte, Brazil, between August 2020 and April 2022. The process of cross-cultural adaptation and validation was executed following the ICIQ Group's protocol. Reviewed by an expert committee, the first pre-test was followed by subsequent adaptations, resulting in a second adapted version that underwent expert revisions. A second pretest was conducted, followed by cross-cultural adaptation and construct validation. Finally, the International Consultation on Incontinence Questionnaire-Bladder Diary-Brazilian Portuguese Version (ICIQ-BD-Br) underwent a validation process. RESULTS: Construct validity (IVC >0.78) and internal consistency were satisfactory (α-Cronbach coefficient 0.87-0.94). The following adjustments were made: a specific field was created to document sleep and wake times, and a printed score ranging from 0 to 4 was included in the bladder sensation column. Test-retest reliability ranged from fair to excellent for all analyzed items (Spearman correlation: 0.64-0.95). Criterion validity analysis indicated slight agreement for one of the four symptoms analyzed (nocturia k=0.32). The final version was approved by the ICIQ Group. CONCLUSIONS: The ICIQ-BD-Br has been adapted for use in Brazilian Portuguese and has exhibited robust construct validity and reliability for Brazilian women with LUTS.

Linking Pelvic Floor Muscle Function Terminology to the International Classification of Functioning, Disability and Health.

OBJECTIVE: A previous systematic review on pelvic floor muscle function (PFMF) identified a miscellaneity of terms. The lack of consensual terminology might have come from the complexity of neuromusculoskeletal function itself. This study sought to link the previously identified PFMF terms to the International Classification of Functioning, Disability and Health (ICF) terminology. METHODS: In this secondary analysis study, 10 linkage rules were applied to link 196 previously identified PFMF terms to the ICF. Two researchers performed the linking process independently. Disagreements were solved by open dialogue with a third researcher. Percentage agreement was computed for main outcome. RESULTS: A total of 184 (93.9%) PFMF terms were subsumed into the following 6 ICF terms: tone, involuntary movement reaction, control, coordination, strength, and endurance. The most frequently investigated PFMF was strength (25.5%), followed by involuntary movement reaction (22.9%), endurance (17.2%), control (14.1%), coordination (9.9%), and tone (4.2%). Only 6.2% PFMF could not be linked to ICF terminology. A wide variation of instruments/methods was used to measure PFMF. Vaginal palpation was the only method employed to measure all 6 PFMF. Percentage agreement between raters was 100%. CONCLUSIONS: Linking PFMF terminology to the ICF was feasible and valid. It allowed the identification of the most investigated PFMF and their measuring methods. ICF terminology to describe PFMF should be used since it may improve communication, data gathering, and the advance in scientific knowledge. IMPACT: Standardized terminology anchored in a theoretical framework is crucial to data gathering, communication, and dissemination of evidence-based practice. PFMF terminology based on ICF can be used to improve data pooling and communication.

Pelvic floor muscle function in women with and without urinary incontinence: are strength and endurance the only relevant functions? a cross-sectional study.

OBJECTIVES: To investigate if pelvic floor muscle functions (PFMFs), besides strength and endurance, are associated with the occurrence of urinary incontinence (UI) in women, and to investigate which functions predict the occurrence of UI. DESIGN: Cross-sectional study. SETTING: Public health service and community. PARTICIPANTS: Two hundred and ten women (101 with UI and 109 without UI). MAIN OUTCOME MEASURES: PFMF was investigated by the Pelvic Floor Sensory and Muscle Function Exam (Exame das Funções Sensoriais e Musculares do Assoalho Pélvico), a valid and reliable instrument that measures the following functions: tone, reaction, control (contraction), control (relaxation), coordination, strength and endurance. The International Consultation on Incontinence Questionnaire-Short Form was used to document the occurrence and type of UI. Sociodemographic and clinical data were collected through the questionnaire. Chi-squared test, Student's t-test and Mann-Whitney test were used to evaluate the association of each function with UI. Two logistic regression models tested the predictive value of each function for UI: Model a included all of the above PFMFs and Model b included all of the above PFMFs except strength and endurance. RESULTS: Most sociodemographic and clinical risk factors differed between women with UI and women without UI. On univariate analysis, tone, reaction, control (contraction), coordination, strength and endurance were found to be significantly associated (P<0.05) with the occurrence of UI. On multivariate analysis, Model a explained 69% and Model b explained 61% of the likelihood of UI, respectively. CONCLUSIONS: Besides strength and endurance, pelvic floor muscle tone, reaction, control (contraction) and coordination were significantly associated with the occurrence of UI, and should be investigated further.

Effectiveness of pelvic floor muscle training and bladder training for women with urinary incontinence in primary care: a pragmatic controlled trial.

BACKGROUND: Although the efficacy of pelvic floor muscle training (PFMT) and bladder training are well established, there is a paucity of patient centered models using these interventions to treat women with UI at primary level of health assistance in Brazil. OBJECTIVE: To investigate the effectiveness of a physical therapy intervention to treat women with UI in primary health centers. METHODS: Pragmatic non-randomized controlled trial in which women with UI from the community participated in a supervised physical therapy program consisting of bladder training plus 12 weeks of PFMT, performed either at home or in the health center. Outcome measures were amount and frequency of urine loss measured by the 24-h pad-test and the 24-h voiding diary; secondary outcome was the impact of UI on quality of life measured by the ICIQ-SF. Outcomes were measured at baseline, at the 6th and 12th weeks of the intervention and 1 month after discharge. RESULTS: Interventions reduced the amount (pad-test, p=0.004; d=0.13, 95% CI=-0.23 to 0.49) and frequency of urine loss (voiding diary, p=0.003; d=0.51, 95%CI=0.14 to 0.87), and the impact of UI on quality of life (ICIQ-SF, p<0.001; d=1.26, 95%CI=0.87 to 1.66) over time, with positive effects from the 6th week up to 1 month for both intervention setting (home and health center), and no differences between them. CONCLUSION: Interventions were effective, can be implemented in primary health centers favoring the treatment of a greater number of women who do not have access to specialized physical therapy. TRIAL REGISTRATION: RBR-8tww4y.

Cross-cultural adaptation to Brazilian Portuguese of the Activity Measure for Post-Acute Care (AM-PAC) short forms for outpatients in rehabilitation.

BACKGROUND: The Activity Measure for Post-Acute Care was developed to evaluate the limitations of activities of adult individuals with different health conditions. OBJECTIVES: To translate and cultural adapt the Activity Measure for Post-Acute Care short forms for outpatients into Portuguese-Brazilian, to verify the comprehension of the items and categories of the responses by users of the rehabilitation services and to analyze the reliability indices of the instrument. METHODS: Translation and back-translation were conducted by two independent teams. Cognitive interviews (n=2) evaluated the comprehension of the translated version among patients. Item reliability and consistency was also investigated. RESULTS: There was conceptual equivalence between the translated and original versions. For some items, the information was modified in order to attend to the measurement units used in Brazil. Comparative analyses of the translated versions chose the most appropriate term to capture the English content. The few discrepancies identified in the back-translation were solved by consensus. The cognitive interviews detected few comprehension problems, which were solved by means of repetition of the item statement and use of examples to clarify the specificity of the information. The final translated short forms of the instrument showed excellent test-retest reliability and inter-examiner reliability indices, as well as high internal consistency. CONCLUSION: The Portuguese version of the Activity Measure for Post-Acute Care short forms will provide Brazilian clinicians and researchers with an up-to-date instrument for the evaluation of functioning of adults with various clinical conditions who attend outpatient rehabilitation settings.

Cultural adaptation and validation of the Wexner scale in patients with anal incontinence in a Brazilian population.

INTRODUCTION AND HYPOTHESIS: Jorge and Wexner devised a questionnaire for anal incontinence (AI), known as the Wexner scale (WS). Specific validated questionnaires are essential for the assessment of symptom severity. The objective was to accomplish the cultural adaptation and validation of the Portuguese version of the WS. METHODS: The WS was validated according to the international criteria. A Brazilian version was tested, including the item "I do not understand" at the end of each question. If this answer was reported at a rate higher than 15 %, the item would be considered difficult to understand and would thus be modified. The final version of the WS and the Fecal Incontinence Quality of Life (FIQL) were completed by 50 women. Convergent validity was assessed by comparing the data from the first interview of the WS with the FIQL using Spearman's test. Reproducibility was assessed by means of a 2-week test-retest procedure using Cronbach's alpha coefficient. RESULTS: In the initial version of the questionnaire, we did not obtain a response of "I do not understand" at a rate greater than 15 % and this version was considered definitive. A significant negative relationship (r = -0.63) was found between the FIQL total score and the WS. The answers obtained on the "test-re-est" questionnaires showed a significant correlation according to the intraclass correlation coefficient (ICC). A high level of internal consistency was found, as demonstrated by a Cronbach's alpha of 0.932. CONCLUSION: The Brazilian Portuguese version of the WS is a reliable, consistent, and valid instrument.

Development of infant reaching behaviors: kinematic changes in touching and hitting.

This longitudinal study investigated the development of reaching in typical infants, from age 4 to 8 months, and described the pattern of hand kinematics underlying changes in the characteristics of infants' actions while reaching for a target. Thirteen infants were followed biweekly. Two reaching behaviors emerged during the infants' free interactions with the target, touching and hitting. Changes over time were documented for the number of movement units, straightness index, distance, peak velocity and time to peak velocity of the hand for touches and hits. We observed increases in the numbers of touches and hits and changes in hand kinematics over time; the distance traveled by the hand was greater for hitting compared to touching. These kinematic changes were specific to the movement patterns that infants adopted to reach to the target.

Treatments for invasive carcinoma of the cervix: what are their impacts on the pelvic floor functions?

Aims: Describe the impact of surgery, radiotherapy and chemoradiation in the pelvic floor functions in cervical cancer patients. Materials and Methods: A prospective study with women submitted to radical hysterectomy (RH) (n = 20), exclusive radiotherapy (RT) (n = 20) or chemoradiation (CT/RT) (n = 20) for invasive cervical cancer. Urinary, intestinal and sexual function, as well as vaginal length and pelvic floor muscle contraction were evaluated. Comparisons between groups were performed by Kruskal-Wallis and Chi-square tests (p < 0.05). Results: The groups were similar in stress urinary incontinence incidence (p = 0.56), urinary urgency (p = 0.44), urge incontinence (p = 0.54), nocturia (p = 0.53), incomplete bowel emptying (p = 0.76), bowel urgency (p = 0.12) and soilage (p = 0.43). The CT/RT group presented a higher urinary frequency (p < 0.001) and diarrhea (p = 0.025). Patients in the RH group were more sexually active (p = 0.01) and experienced less dyspareunia (p = 0.021). Vaginal length was shorter in RT group (5.5 ± 1.9cm) and CT/RT(5.3 ± 1.5 cm) than in the RH group (7.4 ± 1.1 cm) (p < 0.001). Pelvic floor muscle contraction was similar (p = 0.302). Conclusions: RT and CT/RT treatment for cervical carcinoma are more associated to sexual and intestinal dysfunctions. .

Instrumentos de avaliação para os dois primeiros anos de vida do lactente / Instruments of assessment for first two years of life of infant

Introdução: a avaliação do desenvolvimento de lactentes objetiva identificar e classificar precocemente um atraso de desenvolvimento e/ou programar uma intervenção. Esta avaliação é considerada ineficiente quando realizada apenas por julgamento clínico profissional. Dessa forma existem inúmeras escalas de avaliação que podem auxiliar os profissionais neste processo, sendo necessário um maior conhecimento de suas vantagens e desvantagens. Objetivo: identificar e analisar instrumentos de avaliação do desenvolvimento infantil para lactentes de zero a dois anos de idade. Método: realizou-se busca nas principais bases de dados informatizadas, nos manuais dos instrumentos de avaliação e livros de Fisioterapia Pediátrica. Foram extraídos de cada instrumento: caracterização geral, propriedades psicométricas,pressuposto teórico que embasa o instrumento, validade para crianças brasileiras e acessibilidade para ofisioterapeuta no Brasil. Resultados: Foram selecionados os artigos referentes aos testes TIMP, DUBOWITZ, MAI, AIMS e BAYLEY-III. O TIMP apresentou os melhores índices de confiabilidade e sensibilidade para avaliação de bebês prematuros nos quatro primeiros meses de vida, contudo é sua aplicação é demorada e depende do estado emocional do lactente. DUBOWITZ é de fácil e rápida aplicação apesar de não ser muito acessível no Brasil. A literatura sugere uma reavaliação do MAI à medida que este exibe uma limitada base psicométrica e uma pobre validade de construto. A AIMS apresenta as melhores propriedades psicométricas e condições para uso clínico. A Bayley-III está entre os melhores instrumentos, pois seus dados são válidos, confiáveis e objetivos, contudo pouco utilizada no Brasil provavelmente pelo custo do material de aplicação. Conclusão: Em lactentes pré-termo o uso do TIMP apresenta as melhores propriedades psicométricas, já em lactentes de até 18 meses a AIMS é uma melhor opção, e acima desta idade a Bayley-III atinge os objetivos propostos com adequadas propriedades psicométricas.

INTRODUCTION: the developmental assessment of infants seeks to identify and classify early developmental delay and /or schedule an intervention. This assessment is considered inefficient when performed only by professional clinical judgment. Thus there are numerous assessment scales to help professionals in this process, requiring a greater knowledge of their advantages and disadvantages. OBJECTIVES: to identify and analyze instruments used for assessment of infant development from zero to two years old. METHODS: a search was made in the most important databases in the area, in the manual of the instruments used for evaluation and books of Pediatric Physical Therapy. The following data of each standardized instrument were extracted: general characteristics, psychometrics, theoretical basis of each instrument, validity of the instruments for brazilian children and accessibility of the instruments to the physiotherapist in Brazil. RESULTS: articles about TIMP, DUBOWITZ, MAI, AIMS and BAYLEY-III were selected. The TIMP presents the best indices of reliability and sensitivity for the evaluation of pre-term infants in the four first months of life, however it takes long time to apply and depends on the emotional state of the infant. DUBOWITZ is an instrument that is easy and quick to use although it is not easily found in Brazil. The literature suggests a reevaluation of the MAI instrument as it presents limited psychometric properties, especially a poor validity of construct. AIMS proved to have the best psychometric properties and conditions for clinical use. Bayley III is one the best instruments with high psychometric properties, however it is not of common use in Brazil probably because of the high cost of its application kit. CONCLUSION: for pre-term infants up to 4 months the TIMP seems to be the instrument of choice, but for longer follow-up up to 18 months, AIMS is the best option, and above this age the Bayley-III scale is adequate as it presents very good psychometric properties.

Instrumentos de avaliação para os dois primeiros anos de vida do lactente / Instruments of assessment for first two years of life of infant

Introdução: a avaliação do desenvolvimento de lactentes objetiva identificar e classificar precocemente um atraso de desenvolvimento e/ou programar uma intervenção. Esta avaliação é considerada ineficiente quando realizada apenas por julgamento clínico profissional. Dessa forma existem inúmeras escalas de avaliação que podem auxiliar os profissionais neste processo, sendo necessário um maior conhecimento de suas vantagens e desvantagens. Objetivo: identificar e analisar instrumentos de avaliação do desenvolvimento infantil para lactentes de zero a dois anos de idade. Método: realizou-se busca nas principais bases de dados informatizadas, nos manuais dos instrumentos de avaliação e livros de Fisioterapia Pediátrica. Foram extraídos de cada instrumento: caracterização geral, propriedades psicométricas,pressuposto teórico que embasa o instrumento, validade para crianças brasileiras e acessibilidade para ofisioterapeuta no Brasil. Resultados: Foram selecionados os artigos referentes aos testes TIMP, DUBOWITZ, MAI, AIMS e BAYLEY-III. O TIMP apresentou os melhores índices de confiabilidade e sensibilidade para avaliação de bebês prematuros nos quatro primeiros meses de vida, contudo é sua aplicação é demorada e depende do estado emocional do lactente. DUBOWITZ é de fácil e rápida aplicação apesar de não ser muito acessível no Brasil. A literatura sugere uma reavaliação do MAI à medida que este exibe uma limitada base psicométrica e uma pobre validade de construto. A AIMS apresenta as melhores propriedades psicométricas e condições para uso clínico. A Bayley-III está entre os melhores instrumentos, pois seus dados são válidos, confiáveis e objetivos, contudo pouco utilizada no Brasil provavelmente pelo custo do material de aplicação. Conclusão: Em lactentes pré-termo o uso do TIMP apresenta as melhores propriedades psicométricas, já em lactentes de até 18 meses a AIMS é uma melhor opção, e acima desta idade a Bayley-III atinge os objetivos propostos com adequadas propriedades psicométricas.(AU)

INTRODUCTION: the developmental assessment of infants seeks to identify and classify early developmental delay and /or schedule an intervention. This assessment is considered inefficient when performed only by professional clinical judgment. Thus there are numerous assessment scales to help professionals in this process, requiring a greater knowledge of their advantages and disadvantages. OBJECTIVES: to identify and analyze instruments used for assessment of infant development from zero to two years old. METHODS: a search was made in the most important databases in the area, in the manual of the instruments used for evaluation and books of Pediatric Physical Therapy. The following data of each standardized instrument were extracted: general characteristics, psychometrics, theoretical basis of each instrument, validity of the instruments for brazilian children and accessibility of the instruments to the physiotherapist in Brazil. RESULTS: articles about TIMP, DUBOWITZ, MAI, AIMS and BAYLEY-III were selected. The TIMP presents the best indices of reliability and sensitivity for the evaluation of pre-term infants in the four first months of life, however it takes long time to apply and depends on the emotional state of the infant. DUBOWITZ is an instrument that is easy and quick to use although it is not easily found in Brazil. The literature suggests a reevaluation of the MAI instrument as it presents limited psychometric properties, especially a poor validity of construct. AIMS proved to have the best psychometric properties and conditions for clinical use. Bayley III is one the best instruments with high psychometric properties, however it is not of common use in Brazil probably because of the high cost of its application kit. CONCLUSION: for pre-term infants up to 4 months the TIMP seems to be the instrument of choice, but for longer follow-up up to 18 months, AIMS is the best option, and above this age the Bayley-III scale is adequate as it presents very good psychometric properties.(AU)

Quality of life in women with vulvar cancer submitted to surgical treatment: a comparative study.

OBJECTIVES: To investigate the occurrence and severity of lymphoedema of the lower extremities (LLE), quality of life (QoL), and urinary and sexual dysfunction in women with vulvar cancer submitted to surgical treatment. STUDY DESIGN: Twenty-eight patients with vulvar cancer submitted to vulvectomy and inguinofemoral lymphadenectomy and 28 healthy, age-matched women (control group) were evaluated. The occurrence and severity of LLE were determined by Miller's Clinical Evaluation. QoL, urinary function and sexual function were assessed by the EORTC QLQ-C30, SF-ICIQ and FSFI questionnaires, respectively. The differences between groups and correlations were assessed using Student's t-test, Chi-squared test, Mann-Whitney U-test and Spearman's rho test. RESULTS: The groups were similar in terms of marital status, educational status, menopausal status, hormone therapy and height. The occurrence and severity of LLE were higher in women with vulvar cancer compared with the control group (p<0.001 and p = 0.003, respectively). A significant association was found between the severity of LLE and advanced age (p = 0.04), and the severity of LLE and higher body mass index (BMI; p = 0.04) in patients with vulvar cancer. In the patients with vulvar cancer, there was a significant correlation between the severity of LLE and worse QoL in the following domains: physical, cognitive, emotional, social, fatigue, pain, sleep and financial questions (p < 0.05). There was no difference in urinary function between the two groups (p = 0.113). Age and number of deliveries were the only variables associated with the occurrence of urinary incontinence (p = 0.01). Urinary incontinence was present in women with a mean age of 74.9 ± 4.6 years and a mean of 7.3 ± 1.3 normal deliveries. There was no difference between the groups in terms of the sexual function. Multivariate analysis showed an association between sexual function and age (p = 0.01), and sexual function and being in a stable relationship (p=0.02). CONCLUSION: Patients submitted to vulvectomy or inguinofemoral lymphadenectomy for vulvar cancer are at higher risk of developing LLE compared with healthy, age-matched women. This has a negative effect on QoL, but does not interfere with urinary or sexual function.

Educação de funcionárias de unidade básica de saúde acerca da atenção fisioterapêutica na incontinência urinária: relato de experiência / Education of employees of primary health care unit about physical therapy in urinary incontinence: report of experience

A incontinência urinária (IU) é um problema de saúde pública, devendo ser abordada em centros de saúde (CS). A educação dos profissionais é necessária para que saibam prestar assistência às usuárias. O objetivo deste estudo foi relatar a experiência do projeto "Cuidar de Quem Cuida", desenvolvido em CS para educar funcionárias acerca da IU. O programa foi realizado na forma de uma dinâmica teórico-prática com duração de 2 horas, sendo que as 28 participantes foram divididas em 2 grupos. Cada grupo participou do programa em dias diferentes de forma que as atividades usuais do CS puderam ser mantidas. Foram discutidos os tipos de IU, fatores de risco, possibilidades terapêuticas e medidas preventivas, destacando-se o cuidado com os hábitos urinários e intestinais e o treinamento dos músculos do assoalho pélvico (MAP). Após sua realização, as participantes relataram que passaram a desenvolver hábitos urinários saudáveis e realizar exercícios para os MAP. Observou-se aumento do número de usuárias referenciadas para a Fisioterapia. Assim, o programa instrumentalizou as funcionárias a desenvolver o autocuidado e identificar necessidade de assistência às usuárias. Esta abordagem poderá ser efetiva em outros serviços como um primeiro passo na implantação de assistência fisioterapêutica a mulheres com IU nos CS.

Urinary incontinence (UI) is considered a public health problem that should be firstly approached in the primary care units (PCU). Educational programs target to professionals who work in these units are a key component in the management of this condition. The aim of this study was to report the experience of the "Caring for Who Cares", a project developed in a PCU aimed at educating employees about UI. The educational program was carried out as a dynamic, with theoretical and practical character, lasting 2 hours. The 28 participants were divided into 2 groups. Each group participated in the program on different days so that the usual activities of the PCU could be maintained. Issues such as types of UI, risk factors, preventive and therapeutic measures, especially urinary and bowel habits and pelvic floor muscle (PFM) training, were discussed. The participants reported being more attentive to their urinary habits after the educational program; some of them had incorporated exercises for the PFM. There were also an increasing number of users referred to the physiotherapy care service. Therefore, the project successfully educated the employees of the PCU for their own care and allowed the implementation of UI preventative and treatment programs in this unit. This experience may be helpful to other professionals when implementing the physical therapy assistance for women with UI in PCU.

The results of a 24-h pad test in Brazilian women.

INTRODUCTION AND HYPOTHESIS: The International Continence Society (ICS) adopted 1.3 g as the normative value for the 24-h pad test. We hypothesized that this cutoff value may not be valid for women who live in countries with high temperatures. METHODS: We documented the 24-h pad test values of continent women in Brazil and investigated the factors that can influence in vaginal humidity. RESULTS: The sample consisted of 257 participants. The temperatures ranged from 19°C to 27.8°C. The median increase in the weight of the pad was 1.9 g (1.4-3.0 g, 95th percentile 4.4 g). Pad test results differed significantly between pre- and postmenopausal women (p = 0.026). There was a significant difference in the pad weights of women who use hormone therapy (p = 0.003). CONCLUSIONS: The value of the 24-h pad test established by the ICS was not valid for the investigated sample. Environmental conditions, menopausal status, and use of hormone therapy can interfere with the values of the pad test.

Disfunções de assoalho pélvico em atletas / Pelvic floor dysfunction in athletes

Disfunções do assoalho pélvico são condições que acometem mulheres em idades variadas, porém aquelas que se encontram no período do climatério, assim como as multíparas, são as mais suscetíveis. Entretanto, há relatos na literatura de jovens nulíparas que apresentam sintomas de disfunções nesta região, tais como a incontinência urinária e a anal durante a prática de esportes. Essas condições podem levar ao abandono da atividade física e comprometer a qualidade de vida. Com o intuito de conhecer a ocorrência das disfunções do assoalho pélvico e seus fatores etiológicos em atletas jovens e nulíparas, foi feita uma revisão da literatura. Foram consultadas as bases de dados BVS e PubMed nos últimos dez anos. Os resultados dos estudos revisados indicaram alta prevalência de disfunções do assoalho pélvico entre atletas, muitas delas nulíparas. A incontinência urinária é a disfunção do assoalho pélvico mais documentada e acomete principalmente atletas que praticam atividades consideradas de alto impacto, como trampolim e paraquedismo. As condições que desencadeiam as disfunções do assoalho pélvico em mulheres jovens e nulíparas ainda não estão completamente elucidadas, alterações extrínsecas ou genéticas do tecido conjuntivo frouxo e atividades que envolvem longos saltos são as hipóteses mais frequentes. Apenas um estudo foi encontrado documentando a prevalência das disfunções do assoalho pélvico entre atletas envolvendo os sistemas intestinal e sexual, além do urinário

Pelvic floor dysfunctions are conditions that affect women in various ages, however those in the climacteric period, as well as the multiparous are more susceptible to it. However, there are studies in the scientific literature reporting the occurrence of urinary incontinence during sports among young and nuliparous women. Such conditions can lead to a withdrawn from physical activity compromising the quality of life. A literature review in PubMed and in VHL databases, within the last ten years, was done in order to understand the occurrence of symptoms suggestive of pelvic floor dysfunctions other than urinary incontinence, such as anorectal or sexual dysfunction, and their etiological factors in young and nulliparous athletes. Results indicated a high prevalence of urinary incontinence among athletes, who were engaged in high-impact activities such as trampoline, and skydiving. The conditions that contribute to the urinary incontinence etiology in young and nulliparous women are still not fully understood, extrinsic or genetic changes in loose connective tissue and activities involving long jumps are the most common hypotheses to this condition. Other than urinary tract symptoms, it was found only one study documenting pelvic floor disorders involving the intestinal and sexual systems in such population

Influência da posição de parto vaginal nas variáveis obstétricas e neonatais de mulheres primíparas / The influence of vaginal birth position on obstetric and neonatal variables in primiparous women

OBJETIVOS: determinar a prevalência de fatores obstétricos associados à posição de parto vaginal (PPV) - vertical ou horizontal; investigar correlações entre PPV e fatores obstétricos, bem como sua influência sobre as características neonatais. MÉTODOS: foi realizado um estudo de corte transversal. A amostra foi composta por 176 mulheres primíparas que realizaram parto vaginal, entre julho/2006 e fevereiro/2007. Foi investigada a correlação entre PPV e as seguintes variáveis obstétricas: ocorrência e grau de laceração perineal espontânea, episiotomia, sutura perineal, uso de ocitocina e instrumentação cirúrgica. Os neonatos foram classificados quanto à idade gestacional, peso, estatura, perímetro cefálico e Apgar 1º e 5º minutos. Teste qui quadrado foi aplicado para investigar correlação entre PPV e variáveis obstétricas e o teste t-student para investigar a influência da PPV nas características neonatais. RESULTADOS: não foi observada correlação entre PPV e sutura perineal, laceração perineal, uso de ocitocina, episiotomia e utilização de instrumentação cirúrgica (uso de fórceps ou vácuo-extrator). Houve correlação entre PPV e episiotomia e maior prevalência de episiotomia na posição horizontal. Não houve influência da PPV nas características neonatais. CONCLUSÕES: houve maior ocorrência de episiotomia na posição de parto horizontal, embora ambas as posições de parto tenham sido satisfatórias para os neonatos.

OBJECTIVES: to determine the prevalence of obstetric factors associated with vaginal birth posi tion (VBP)-vertical or horizontal; to investigate correlations between VBP and obstetric factors and neonatal characteristics. METHODS: a cross-sectional study was carried out. The sample comprised 176 primiparous women who had given birth vaginally, between july 2006 and february 2007. The correlation was investigated between VBP and the following obstetric variables: occurrence and severity of spontaneous perineal lacerations, episiotomy, perineal suture, the use of oxytocin and surgical instruments. The newborns were characterized according to gestational age, weight, height, head circumference and one-and five-minute Apgar. The chi-squared test was used to inves tigate the correlation between VBP and obstetric vari ables and Student's t-test to investigate differences in neonatal characteristics according to VBP. RESULTS: no association was found between VBP and perineal suture, perineal laceration, the use of oxytocin, episiotomy or the use of surgical instru ments (forceps or vacuum-extractor). There was a correlation between VBP and episiotomy and a greater prevalence of episiotomy for the horizontal position. VBP had no influence on the characteristics of the newborn. CONCLUSIONS: episiotomy was more prevalent in cases of horizontal birth position, although both birth positions are satisfactory as far as the newborn is concerned.

Efficacy of ankle-foot orthoses on gait of children with cerebral palsy: systematic review of literature.

PURPOSE: To perform a literature review evaluating the quality of current research on the influence of ankle-foot orthoses (AFOs) on gait in children with cerebral palsy (CP). METHODS: A qualitative systematic review of intervention studies including the following words/phrases in the title/abstract: children with CP, AFO, gait and inferential statistical analysis, and outcomes related to gait. Databases searched included PubMed, Cochrane Library, PEDro, OTSeeker, Lilacs, and Scielo. Level of evidence was graded using the PEDro Scale. RESULTS: Two between-group and 18 within-group studies met the inclusion criteria indicating a low level of evidence. Between-group studies each scored 4 on the PEDro Scale, and 17 within-group studies scored 3 and 1 scored 2, indicating low quality. Standard terminology for AFOs was not used and only 6 studies described functional status using appropriate instruments. CONCLUSIONS: Studies using high quality methods are still needed to support evidence-based decisions regarding the use of AFOs for this population.