Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the Vulvovaginal Symptoms Questionnaire.

OBJECTIVE: The aims of this study were to perform a cross-cultural adaptation of the Vulvovaginal Symptoms Questionnaire (VSQ) into Brazilian Portuguese (VSQ-Br) and evaluate its measurement properties (structural validity, construct validity, internal consistency, and reliability). METHODS: Cross-cultural adaptation was conducted through the translation, synthesis, and back-translation of the VSQ-Br. Subsequently, 314 women completed the Pelvic Floor Impact Questionnaire, Pelvic Floor Disorders Inventory, Medical Outcomes Study 36-Item Short-Form Health Survey, and VSQ-Br. Seven to 10 days later, participants completed the VSQ-Br for the second time. Data were submitted for confirmatory factor analysis. Cronbach α was used to verify internal consistency, and construct validity was assessed using Pearson correlation coefficient ( r ). Reliability was calculated using the intraclass correlation coefficient. RESULTS: Confirmatory factor analysis showed that the questions were grouped into four domains (symptoms, emotions, life impact, and sexual impact). The model showed good fit (>0.95). The Cronbach α in this study was 0.85, reflecting adequate internal consistency. Adequate reliability was confirmed, with an intraclass correlation coefficient total score of 0.80. The VSQ-Br had a weak correlation with the pelvic domain of the Pelvic Floor Disorders Inventory, the pelvic organ prolapse domain of the Pelvic Floor Impact Questionnaire, and pain, vitality, and the social aspect domains of the Medical Outcomes Study 36-Item Short-Form Health Survey. CONCLUSIONS: The VSQ-Br was validated and had acceptable measurement properties for assessing vulvovaginal symptoms in Brazilian women.

Heart rate variability dynamics in women with urinary incontinence: a systematic review.

INTRODUCTION AND HYPOTHESIS: Sympathetic and parasympathetic pathways of the autonomic nervous system (ANS) regulate the lower urinary tract. The aim of the present study was to synthesize the evidence regarding ANS regulation in women with urinary incontinence (UI) evaluated through heart rate variability (HRV). METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Five databases were researched in April 2021 (PubMed, CINHAL, Scopus, Web of Science and Cochrane Library) and included cross-sectional studies in full-length publications in the English language. Studies assessed the HRV during bladder filling (group A) and after voiding (group B). The Joanna Briggs Institute (JBI) checklist was applied for methodological quality assessment purposes. RESULTS: A total of 920 articles were identified and 5 studies were included. Most studies analyzed the HRV by linear indexes. Studies from group A (n = 2) presented fair methodological quality; one study from group B (n = 3) showed fair methodological quality (Im et al. Korean J Urol. 51:183, 2010) whereas the others presented high methodological quality. One study from group A found an increase in both modulations between women with overactive bladder (OAB) versus women with stress UI, whereas a decrease was reported between incontinent and continent women. Studies from group B showed a decreased sympathetic and parasympathetic modulation in AOB with detrusor overactivity (DO), whereas one study found an increase in both modulations in women with OAB compared with stress UI. CONCLUSION: Parasympathetic and sympathetic modulation increased during bladder filling and rest in UI with OAB associated or not with DO. Both modulations decreased during bladder filling in incontinent women and during rest in OAB.

Cross-cultural adaptation and measurement property analysis of the Brazilian Portuguese version of the Three Incontinence Questionnaire.

INTRODUCTION AND HYPOTHESIS: The differential diagnosis of urinary symptoms may allow health professionals to establish a therapeutic objective and to choose the appropriate treatment for the patient's complaint. The aim of this study was to cross-culturally adapt the Three Incontinence Questionnaire (3IQ) into Brazilian Portuguese (3IQ-Br) and to analyze test-retest reliability, construct, and criterion validity in women. METHODS: The cross-cultural adaptation of the 3IQ-Br included forward-translation, back-translation, and consensus among an expert committee. Participants with and without urinary incontinence (UI) completed the 3IQ-Br, King's Health Questionnaire (KHQ), and Questionnaire for Female Urinary Incontinence Diagnosis (QUID-Br). Only women with UI answered 3IQ-Br after 7-10 days. Test-retest reliability and construct validity were analyzed using the Cohen linear kappa (k). The 3IQ-Br accuracy was analyzed using the area under the curve (AUC) of the receiver-operating characteristic (ROC) curve, considering the sensitivity and specificity to correctly classify women with and without UI. RESULTS: The reliability of each question from the 3IQ-Br was considered substantial in the test-retest. The agreement among 3IQ-Br, QUID-Br, and KHQ was almost perfect for UI diagnosis (k > 0.8). The 3IQ-Br was considered to have good accuracy in distinguishing women with UI considering the KHQ (AUC 0.83, 95% confidence interval [CI] 0.78 to 0.87, p < 0.001), and fair to the QUID-Br (AUC 0.73, 95% CI 0.68 to 0.78; p < 0.001). CONCLUSIONS: The results of this study showed that this version of the 3IQ-Br has acceptable measurement properties for identifying and differentiating UI symptoms in Brazilian women.

Intravaginal electrical stimulation associated with pelvic floor muscle training for women with stress urinary incontinence: study protocol for a randomized controlled trial with economic evaluation.

INTRODUCTION: Pelvic floor muscle training (PFMT) exercises and neuromuscular electrical stimulation (NMES) are described as conservative interventions to prevent or treat female stress urinary incontinence (SUI). However, it has not been described yet the effect of PFMT associated to intravaginal NMES which evaluated the cost-effectiveness and cost-utility of treating. AIMS: To evaluate the effects of intravaginal NMES associated with the PFMT protocol on urinary loss and quality of life in women with SUI and to evaluate the cost-effectiveness and cost-utility and pelvic floor muscle in women with SUI. METHODS: Randomized controlled trial study with economic evaluation. Inclusion criteria are woman (biological), aged ≥ 18 years old and with a report of SUI ≥ once/week. Exclusion criteria are presence of vaginal or urinary infection, virginity, being in the gestational or puerperium period, or neurological disease. Participants will undergo physical therapy assessment and intervention: anamnesis, pelvic floor muscle assessment by vaginal palpation and manometry (PeritronTM), questionnaires (Short-Form 6 Dimensions-Brazil (SF-6D), King's Health Questionnaire (KHQ) and King´s Health Questionnaire for Scoring Algorithm), health costs, and voiding diary. Participants will be randomly allocated into 3 groups: CG (control group), IG 1 (intervention group 1, PFMT), and IG2 (intervention group 2, PFMT + NMES). The statistical analysis will be performed by intention to treat, and multivariate analysis of mixed effects will be used to compare outcomes. Effect size measurements will be calculated and will be provided by Cohen's d test. A significance level of 5% will be adopted. Additionally, the incremental cost-effectiveness and incremental cost-utility ratios will be used. DISCUSSION: This protocol can corroborate with the literature in order to identify the effect of techniques, based on the possibility of confirming the hypothesis that the NMES associated with PFMT performed concurrently will be the best treatment option; considering the effectiveness, cost-effectiveness, and cost-utility analysis, it will be used as an option for optimization of the treatment of SUI. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-6gtzg4 . Registered on September 3, 2019.

Is there an association of lifestyle habits, anxiety, and depression between incontinent and continent women during COVID-19 pandemic?

Urinary incontinence (UI) is directly correlated with the risk of death and negatively affects the quality of life of women. During the COVID-19 pandemic, women had to adapt their lifestyles to get accustomed to the restrictive measures. The present study aimed to investigate the association between lifestyle habits, anxiety, and depression symptoms during the COVID-19 pandemic between incontinent and continent women. Seventy-seven Brazilian participants aged >18 years were assessed through semi-structured telephonic interviews from July to August 2020. The interview included a questionnaire to investigate lifestyle habit changes and two questions from the King's Health Questionnaire (KHQ) to identify the presence of UI and the Hospital Anxiety and Depression Scale (HADS). Women were allocated into two groups according to their answers to the KHQ: incontinent and continent. The chi-square test was applied, the significance level was set at 5%. Significant differences were found between groups regarding the habit to study and the time spent talking to relatives/friends (p < .05). Neither anxiety nor depression symptoms showed a significant association between the groups. It seems that women with UI changed specific lifestyle habits during the COVID-19 pandemic compared to continent women, while anxiety and depression symptoms did not differ between the groups.

Is there agreement between the preference of examiner and women for unidigital and bidigital vaginal palpation? A qualitative study.

INTRODUCTION AND HYPOTHESIS: The International Continence Society recommends vaginal palpation as a method for assessing pelvic floor muscle (PFM) function. Our aim was to analyze the agreement between preferences of examiner and participants according to unidigital and bidigital vaginal palpation during PFM assessment. The second aim was to investigate qualitatively women's perception of vaginal palpation. METHODS: Maximal voluntary contractions (MVCs) were requested during both types of vaginal palpation and were classified by the Modified Oxford Scale (MOS). Examiner and participants answered if they had preferences regarding vaginal palpation. Women answered qualitatively what they felt during the assessment. Cohen's linear kappa (κ) evaluated the agreement after allocation of the women with a weaker and stronger MVC and qualitative analysis was performed by transcription considering age range (18-35; 36-59; ≥60 years). RESULTS: Agreement was almost zero for women with weaker and stronger MVC at unidigital (κ = 0.06 and κ = -0.12) and bidigital vaginal palpation (κ = 0.008 and κ = 0.005). Participants associated bidigital palpation with more perception and an easier way of contracting the PFMs. Women between 36 and 59 years associated unidigital palpation with a harder but comfortable way of contracting the PFMs. Subjects aged ≥60 years associated bidigital palpation with an uncomfortable, harder way of contracting PFM, with less space into the vagina. CONCLUSIONS: Agreement between preferences was almost zero neither between women with a weaker and stronger PFM contraction, nor between the types of vaginal palpation. Bidigital palpation increased women's perception, made the contraction easier, and was associated with less space in the vaginal canal and less comfort.

Reliability of the PERFECT scheme assessed by unidigital and bidigital vaginal palpation.

INTRODUCTION AND HYPOTHESIS: The aim of the present study was to evaluate the inter- and intra-rater reliability of the PERFECT scheme assessed by uni- and bidigital vaginal palpation in young nulligravid women. METHODS: Forty healthy women [median age 22 (19-34) years] were evaluated by unidigital vaginal palpation by both Examiners A and C, while the other 40 participants [median age 23.5 (19-35) years] were assessed by Examiners B and C by bidigital vaginal palpation. Inter- and intra-rater reliability of all items of the PERFECT scheme were evaluated: P = power (Modified Oxford Scale); E = endurance; R = repetitions; F = fast contractions. Cohen's linear weighted kappa (κw) was used to assess the reliability of the power, while the intraclass correlation coefficient (ICC) was applied for the other items. A priori sample size calculation found that 40 participants would be adequate. RESULTS: Inter-rater reliability of unidigital palpation was considered fair for power (κw = 0.34) and poor for other items (ICC < 0.50); bidigital inter-rater reliability was considered moderate (power: κw = 0.57; endurance: ICC = 0.53; fast contractions: ICC = 0.65, respectively) and low (repetitions: ICC = 0.27). Intra-rater reliability was substantial for power (κw = 0.73 and 0.62), moderate for fast contractions (ICC = 0.63 and 0.51) and poor for repetitions (ICC < 0.50), respectively, for uni- and bidigital palpation. Endurance showed poor (ICC < 0.50) and moderate (ICC = 0.61) reliability for uni- and bidigital palpation. CONCLUSIONS: The PERFECT scheme carried out by bidigital vaginal palpation presents higher reliability when two examiners carry out the physical examination. When one examiner is responsible for PFM assessment, both types of palpation are recommended for evaluation of power and fast contraction; endurance should be evaluated using bidigital palpation. Examiners should be careful during the assessment of repetition of sustained contractions because inter- and intra-reliabilities for both types of palpation were classified as poor.

Intra- and inter-rater reliability of urethral mobility measurement by ultrasound in women: a cross-section study.

INTRODUCTION AND HYPOTHESIS: To verify the intra- and inter-rater reliability of urethral mobility measurement evaluated by ultrasound (US). METHODS: This is a reliability study realized according to Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. Twenty-one nulliparous women (25.5 ± 3.3 SD years) were volunteers. Two examiners (E1 and E2) performed the measurement of urethral mobility at rest and Valsalva on the same day. Three measurements were recorded for each moment and the mean of them were used for analysis. To perform the analysis, bladder mobility was calculated using the following equation: [Formula: see text], where "x" is the vertical distance, "y" is the horizontal distance from the dorsocaudal margin of the pubic symphysis, "V" is the Valsalva maneuver, and "R" means rest. The intraclass correlation coefficient (ICC) was calculated considering: ICC ≥ 0.75, excellent; 0.40 ≤ ICC <0.75, satisfactory; ICC < 0.40, poor, with a significance level of 5% and 95% confidence interval. RESULTS: The intra-rater reliabilities of E1 and E2 were considered excellent between the two evaluations, with ICC 0.98 (p < 0.0001) for the E1 and 0.84 (p < 0.0001) for E2. The inter-rater reliability was considered excellent (ICC = 0.83). CONCLUSIONS: Both intra- and inter-rater reliabilities of urethral mobility measurement were considered to have excellent agreement.

Responsiveness of Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) after pelvic floor muscle training in women with stress and mixed urinary incontinence.

OBJECTIVE: To evaluate the responsiveness of Brazilian-Portuguese version of Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) after pelvic floor muscle training (PFMT) in women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). STUDY DESIGN: This is an observational study with 72 women (51.8 ± 11.9SD years) with SUI (n = 33) and MUI (n = 39). Participants answered PFDI-20 and PFIQ-7 before and after PFMT, which consisted of a 12 weeks protocol supervised by a physiotherapist once a week with 30 min of a duration. Wilcoxon test, effect size (ES) and standardized response mean (SRM) were performed on baseline and after three months. RESULTS: We found a significant reduction in PFDI-20 and PFIQ-7 after PFMT (p < 0.001), except for Pelvic Organ Prolapses Distress Inventory (POPDI-16), Colorectal-Anal Impact Questionnaire (CRAIQ-7) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7). The responsiveness of both questionnaires was considered moderate for PFDI-20 (ES = 0.49; SEM = 0.61; p < 0.0001) and PFIQ-7 (ES = 0.51; SEM = 0.52; p < 0.0001). CONCLUSIONS: PFDI-20 and PFIQ-7 Brazilian Portuguese version presented moderate responsiveness in women with SUI and MUI who performed a PFMT.

Intra- and inter-rater reliability of post-void residual bladder volume with ultrasound.

INTRODUCTION AND HYPOTHESIS: The purpose of the present study was to test the intra- and inter-rater reliability of the measurement of post-void residual bladder volume using ultrasound. METHODS: Two evaluators performed three measurements of the height, width, and length of the empty bladder using ultrasound. The voiding residual volume was calculated using the equation: volume = length × width × height × 0.52. Intraclass correlations (ICC) were calculated considering: ICC ≥ 0.75 excellent, 0.40 ≤ ICC < 0.75 satisfactory, and ICC <0.40 poor, with a significance level of 5% and analysis of confidence intervals (95% CI). RESULTS: Twenty women participated, with an average age of 27.95 ± 3.15 years. The inter-rater ICCs for height, width, and length were 0.96 (CI 0.89-0.98), 0.88 (CI 0.71-0.95), and 0.84 (CI0.60-0.94) respectively. For the intra-rater ICCs, the values were 0.97 (CI 0.95-0.99), 0.98 (CI 0.96-0.99), and 0.97 (CI 0.94-0.99) for evaluator 1 and 0.99 (CI 0.97-0.99), 0.97 (CI 0.94-0.99), and 0.95 (CI 0.90-0.98) for evaluator 2, for height, width, and length, respectively. The residual inter-test volume was 0.96 (CI 0.90-0.99) and the intra-test volume was 0.99 (CI 0.97-0.99). All analyses presented p < 0.0001. CONCLUSIONS: The intra- and inter-rater reliability for both the post-void residual volume and measurement of the bladder dimensions showed excellent agreement.

Effects of virtual dance exercise on skeletal muscle architecture and function of community dwelling older women.

OBJECTIVES: The aim of this study was to analyze the effects of virtual dance exercise on skeletal muscle architecture and function in community-dwelling older women. METHODS: Forty-two moderately active older women participated in this study and chose to join either the control group (CG; n=20; 70.3 ± 5.6 years) or exercise group (EG; n=22; 69.3 ± 3.7 years). Participants in the CG maintained their lifestyle and those in the EG performed group dance exercise using Dance Central game for Xbox 360® and Kinect for 40 min, 3 times/week, for 12 weeks. The primary outcomes were: ankle plantar flexion and dorsiflexion peak torque (PT), medial gastrocnemius muscle thickness (MT), fascicle length (FL), and pennation angle (PA). The secondary outcomes were: lower limbs range of motion (ROM), calf circumference (CC), 6 m customary gait speed, and handgrip strength. Data were analyzed using an ANOVA mixed model test (p<0.05). RESULTS: EG participants improved plantar flexion PT at 60°/s (16.3%; p<0.01), MT (8.7%; p<0.01) and ankle dorsiflexion ROM (5.1%; p=0.04) when compared to baseline, and exhibited enhanced CC values compared to CG (1.7%; p=0.03). CONCLUSIONS: Virtual dance exercise can be recommended to increase muscle mass. Moreover, ankle plantar flexion strength and dorsiflexion ROM gains may contribute to improve functionality and fall avoidance in moderately active older women.