Telehealth is effective for pelvic health physical therapy.

BACKGROUND: Telehealth utilization, largely spurred by the COVID-19 pandemic, has become popular due to convenience and access. We assessed the effectiveness of telehealth for delivering pelvic health physical therapy (PHPT) in patients with pelvic floor disorders (PFD). METHODS: In this IRB approved, cross-sectional study, 812 patients who underwent PHPT treatment by telehealth or in combination with in-person visits were surveyed. Post intervention effectiveness was analyzed using Patient Global Impression of Change (PGIC) and short form Pelvic Floor Impact Questionnaire (PFIQ-7). RESULTS: One hundred and forty-one patients, 80% female, mean (SD) age of 52 (17) completed the study. The mean number of encounters was 4.55 (4.25) with 2.81 (2.08) telehealth visits. A total of 42 (30%) patients reported no change/worse, 27 (19%) minimal, and 72 (51%) moderate/much improvement of symptoms consistent with a lower PFIQ-7 scores. Patients who reported improvement were significantly younger (p < 0.002). Age was the only independent factor that could predict response to PHPT. Patients <50 years old reported significantly more symptom improvement (p < 0.02), symptom resolution (p < 0.002), meeting personal goals (p < 0.0001), improved muscle strength, coordination, and relaxation (p < 0.05), greater satisfaction with bowel movements, and less negative impact of bowel on quality of life (p < 0.005) than older patients. Regardless of age, 89 (64%) patients preferred hybrid telehealth visits. CONCLUSION & INFERENCES: Utilizing telehealth alone or in a hybrid format combined with in-person visits for PHPT appears to be preferred by patients and associated with subjective report of improvement of symptoms. However, efficacy of telehealth interventions in older adults warrants further studies.

Developing an integrated nurse and physiotherapist-led bladder, bowel and pelvic health team.

A service redesign in 2019 led to the formation of an integrated team of nurses and physiotherapists working together to form a bladder, bowel and pelvic health team across two hospitals and the community in Lewisham and Greenwich NHS Trust. The last few years have had their challenges, but the team is now very successful and has won awards for the integration and achievements, particularly in the redesign of the containment product service. Integrating two professional groups has led to excellent team-work and smoother patient journeys.

Figure it out on your own: a mixed-method study on pelvic health survivorship care after gynecologic cancer treatments.

PURPOSE: Pelvic health issues after treatment for gynecological cancer are common. Due to challenges in accessing physiotherapy services, exploring virtual pelvic healthcare is essential. This study aims to understand needs, preferences, barriers, and facilitators for a virtual pelvic healthcare program for gynecological cancer survivors. METHODS: A multi-center, sequential mixed-methods study was conducted. An anonymous online survey (N=50) gathered quantitative data on pelvic health knowledge, opportunities, and motivation. Focus groups (N=14) explored patient experiences and consensus on pelvic health interventions and virtual delivery. Quantitative data used descriptive statistics, and focus group analyses employed inductive thematic analysis. Findings were mapped to the capability, opportunity, and motivation (COM-B) behavior change model. RESULTS: Participants reported lacking knowledge about pelvic health interventions and capability related to the use of vaginal dilators and continence care. Barriers to opportunity included lack of healthcare provider-initiated pelvic health discussions, limited time in clinic with healthcare providers, finding reliable information, and cost of physical therapy pelvic health services. Virtual delivery was seen favorably and may help to address motivational barriers related to embarrassment and frustration with care. CONCLUSION: Awareness of pelvic healthcare is lacking among people treated for gynecological cancer. Virtual delivery of pelvic health interventions is perceived as a solution to enhance access while minimizing travel, cost, embarrassment, and exposure risks. IMPLICATIONS FOR CANCER SURVIVORS: A better understanding of the pelvic health needs of individuals following gynecological cancer treatments enables the development of tailored virtual pelvic health rehabilitation interventions which may improve access to pelvic health survivorship care.

Do patients undergoing physical therapy in a rehabilitation center have a high prevalence of pelvic floor dysfunction and psychological disorders? A cross-sectional study.

BACKGROUND: Prevalence of pelvic floor dysfunction (PFD) and its relationship with anxiety in a population undergoing physical therapy treatment in Rehabilitation Centers seems to have been little investigated in the literature. OBJECTIVE: 1) to investigate the prevalence of PFD, anxiety, depression; 2) to assess quality of life (QoL) in patients undergoing physical therapy in a Rehabilitation Center, 3) to compare the results by sex; and 4) to assess the relationship between PFD and anxiety, depression, and QoL. METHODS: This cross-sectional study included participants receiving physical therapy care in a Rehabilitation Center. Validated questionnaires were used to assess PFD, QoL, depression, and anxiety. The Chi-square test, Pearson's correlation coefficient, and a binary logistic regression model were used for data analysis. RESULTS: 253 participants (56.9% female) were included, 45% of them reported at least one PFD symptom. Females had higher prevalence of urinary incontinence (UI) (28% vs 14%); constipation (25% vs 10%); sexual dysfunction (75% vs 9%); anxiety (47% vs 35%); and depression (34% vs 17%) than males. A weak correlation was found between anxiety and depression with UI and sexual dysfunction for females. For all participants, poor QoL was found in physical functioning, physical role, bodily pain and emotional role. Being elderly (OR: 2.58 [1.24, 5.37]), partnered (OR: 1.82 [1.04, 3.17]), female (OR: 3.38 [1.91, 5.99]), and anxious (OR: 2.03 [1.14, 3.62]) were risk factors for reporting PFD. CONCLUSION: This study found a high prevalence of PFD symptoms in patients attending a Rehabilitation Center. All symptoms except fecal incontinence were more prevalent in females than in males. There was a weak correlation between UI with QoL and psychological disorders among females.

Pessary management practices for pelvic organ prolapse among Australian health care practitioners: a cross-sectional study.

INTRODUCTION AND HYPOTHESIS: Vaginal pessaries are a low-cost, effective treatment for pelvic organ prolapse (POP) and an alternative to surgery. Whilst traditionally pessary management (PM) has been provided by medical professionals, particularly gynaecologists, recent international studies found other professionals, including physiotherapists and nurses, may be involved. It is unknown which health care practitioners (HCPs) provide PM for POP in Australia or the distribution of services. METHODS: In a cross-sectional study design, a self-reported electronic survey investigated Australian HCPs providing PM for POP. Purposive and snowball sampling targeted HCPs, professional organisations and health care facilities. Descriptive statistics described PM in relation to HCP professional profile, PM provision and geographical location. RESULTS: There were 536 respondents (324 physiotherapists, 148 specialists, 33 general practitioners (GPs) and 31 nurses providing PM. Most worked within metropolitan regions (n = 332, 64%), 140 (27%) in rural, 108 (21%) in regional and 10 (2%) in remote areas. Most worked privately (n = 418, 85%), 153 (46%) worked publicly and 85 (17%) in both. Ring pessaries were most commonly used, followed by cube and Gellhorn. HCPs reported variable training in PM, and 336 (69%) had no mandatory workplace competency standard; however, 324 (67%) wanted further training. Women travelled long distances to access services. CONCLUSIONS: Doctors, nurses and physiotherapists provided PM in Australia. HCPs had variable training and experience in PM, with rural and remote HCPs particularly wanting further training. This study highlights the need for accessible PM services, standardised and competency-based training for HCPs, and governance structures ensuring safe care.

The RISE FOR HEALTH study: Methods for in-person musculoskeletal assessment.

OBJECTIVES: To describe the methods for the in-person musculoskeletal (MSK) assessment of the RISE FOR HEALTH (RISE) study, a population-based multicenter prospective cohort study designed to identify factors associated with bladder health (BH) conducted by the Prevention of Lower Urinary Tract Symptoms Research Consortium (PLUS). METHODS: A subset of RISE participants who express interest in the in-person assessment are screened to ensure eligibility (planned n = 525). Eligible consenting participants are asked to complete a standardized MSK assessment to evaluate core stability (four component core stability test, lumbar spine pain (seated slump test), pelvic girdle pain, (sacroiliac joint, anterior superior iliac spine, pubic symphysis tenderness, and pelvic girdle pain provocation test), hip pain (flexion, abduction, internal rotation and flexion, adduction and external rotation) and pelvic girdle function (active straight leg raise). Participants are also asked to complete the Short Physical Performance Battery to measure balance, gait speed, lower extremity strength, and functional capacity. RESULTS: Detailed online and in-person MSK training sessions led by physical therapy were used to certify research staff at each clinical center before the start of RISE in-person assessments. All evaluators exceeded the pre-specified pass rates. CONCLUSIONS: The RISE in-person MSK assessment will provide further insight into the role of general body MSK health and dysfunction and the spectrum of BH.

The accessibility of pelvic health physiotherapy for adolescents with persistent pelvic pain: a qualitative framework analysis.

BACKGROUND: Physiotherapy, with a specific focus on pelvic health, is one service used in the multidisciplinary management of adolescent persistent pelvic pain (PPP). However, there has been little investigations into the accessibility of physiotherapy for adolescents with PPP. OBJECTIVE: This qualitative study aimed to detail the experiences of adolescents with PPP accessing a tertiary hospital physiotherapy service. METHODS: Two focus groups included six adolescent females diagnosed with PPP that had either a) been referred and attended the physiotherapy clinic (n = 5), or b) been referred to physiotherapy but yet to attend their appointment (n = 1 plus one support person). Focus group transcripts were deductively thematically analyzed according to four domains from the patient-centered healthcare accessibility framework. RESULTS: The domain of 'Approachability and ability to perceive' was impacted by limited information and poor patient health literacy. 'Acceptability and ability to seek' was hindered by adolescent mental health struggles and failures of previous PPP management. 'Availability and accommodation, and ability to reach' was influenced by lengthy referral processes, and reliance on familial support for transport. 'Acceptability and ability to engage' was facilitated by engaging clinicians and group environments, however, adolescents became dependent on physiotherapy for pain management. CONCLUSION: Physical, social, and environmental factors influence the accessibility of physiotherapy for adolescents with PPP. Healthcare services should consider the specific needs of adolescents with PPP for optimizing accessibility.

"We don't talk about it enough": Perceptions of pelvic health among postpartum women in rural communities.

PURPOSE: A descriptive qualitative study was conducted to explore perceptions and experiences related to pelvic health in the postpartum period among a cohort of women residing in communities with less than 50,000 residents. METHODS: A semi-structured interview approach guided by the Theory of Planned Behavior was used. Postpartum individuals (<6 months since childbirth) were interviewed in the fall/winter of 2021-2022. RESULTS: Specific to individuals' attitudes toward pelvic health, women viewed Kegels as an important component to improving pelvic health but had a negative attitude toward their own pelvic health, often identifying their pelvic floor as "weak." The subjective norms influencing a woman's perception were typically, a positive influence by family/friends and the Internet, although the Internet was viewed as an insufficient resource. Healthcare providers were noted as an infrequent and ineffective resource for education and support in the postpartum period. Finally, women's perceived behavioral control to manage their pelvic health was influenced by limited knowledge of pelvic health and time, and a desire for more education from their primary care provider and geographical barriers. CONCLUSION: Innovative strategies are needed to support postpartum women's pelvic health within rural communities. Primary care providers may benefit from the development of "quick tips" by specialists, such as women's health physical therapists, to optimize pelvic health discussions with their postpartum patients. Education interventions targeted toward postpartum women in rural communities should focus on strategies that address the geographic barriers identified while still providing individualized care. Options, such as webinars, telehealth, and text message interventions, could be considered.

Covid-19, pelvic health, and women's voices: A descriptive study.

Objective: To examine how the pandemic affected women with pelvic dysfunction. Methods: A Survey Monkey™ online questionnaire on how the pandemic and Covid-19 infection affected women's pelvic problems, exercise, and weight. A free text box captured their comments. Results: Six hundred and forty-seven women took part. Bladder control 265 (41%), prolapse 240 (37%), pelvic pain 40 (6%), sexual dysfunction 27 (4%), faecal incontinence 19 (3%) and other symptoms 56 (9%) were women's main pelvic problems. Symptoms were unchanged for 331 (51%), worse for 243 (38%), and improved for 60 (10%). Weight was gained by 290 (45%), unchanged by 243 (38%), and lost by 114 (17%). Exercise levels were unchanged, worse, or better in 33% each. Access to medical appointments and date for surgery were difficult for 235 (36.5%) and 38 (6%) women respectively. Sixty-six (10.3%) women reported Covid-19 infection: the distribution of pelvic problems and changes through the pandemic, weight and exercise patterns, and difficulty accessing a date for surgery or healthcare were similar to those not contracting infection. Sexual dysfunction was the main new or worsening problem, featuring 13 women (18%). Seventy women - 16 postnatal, and 54 with a pre-existing pelvic problem commented. Five core themes were identified. Difficulty accessing healthcare review, mental health impact and physiotherapy services especially affected delivered women: lifestyle alterations and conservative treatment tools were prominent in women with a pre-existing problem. Conclusions: Pelvic floor dysfunction adversely affected women's mental health in the pandemic through limiting their ability to exercise. Furthermore, the pandemic exposed the fact that female pelvic health services are not readily available to those in need: many women particularly postnatally received no care. Sexual dysfunction was a feature of recovery from Covid infection in this study.

Investigating the Efficacy of an 18-Week Postpartum Rehabilitation and Physical Development Intervention on Occupational Physical Performance and Musculoskeletal Health in UK Servicewomen: Protocol for an Independent Group Study Design.

BACKGROUND: Postpartum women are at an increased risk of pelvic floor dysfunction, musculoskeletal injury, and poor psychological health and have reduced physical fitness compared to before pregnancy. There is no formal, evidence-based rehabilitation and physical development program for returning UK servicewomen to work following childbirth. OBJECTIVE: This study aims to examine the efficacy of a rehabilitation and physical development intervention for returning postpartum UK servicewomen to occupational fitness. METHODS: Eligible servicewomen will be assigned to a training or control group in a nonrandomized controlled trial 6 weeks after childbirth. Group allocation will be based on the location of standard pregnancy and postpartum care. The control group will receive standard care, with no prescribed intervention. The training group will start an 18-week core and pelvic health rehabilitation program 6 weeks post partum and a 12-week resistance and high-intensity interval training program 12 weeks post partum. All participants will attend 4 testing sessions at 6, 12, 18, and 24 weeks post partum for the assessment of occupational physical performance, pelvic health, psychological well-being, quality of life, and musculoskeletal health outcomes. Occupational physical performance tests will include vertical jump, mid-thigh pull, seated medicine ball throw, and a timed 2-km run. Pelvic health tests will include the Pelvic Organ Prolapse Quantification system, the PERFECT (power, endurance, repetitions, fast, every contraction timed) scheme for pelvic floor strength, musculoskeletal physiotherapy assessment, the Pelvic Floor Distress Inventory-20 questionnaire, and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms. Psychological well-being and quality of life tests will include the World Health Organization Quality of Life questionnaire and the Edinburgh Postnatal Depression Scale. Musculoskeletal health outcomes will include body composition; whole-body areal bone mineral density; tibial volumetric bone mineral density, geometry, and microarchitecture; patella tendon properties; muscle architecture; muscle protein and collagen turnover; and muscle mass and muscle breakdown. Data will be analyzed using linear mixed-effects models, with participants included as random effects, and group and time as fixed effects to assess within- and between-group differences over time. RESULTS: This study received ethical approval in April 2019 and recruitment started in July 2019. The study was paused in March 2020 owing to the COVID-19 pandemic. Recruitment restarted in May 2021. The results are expected in September 2022. CONCLUSIONS: This study will inform the best practice for the safe and optimal return of postpartum servicewomen to physically and mentally demanding jobs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04332757; https://clinicaltrials.gov/ct2/show/NCT04332757. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32315.

Point of care ultrasound in pelvic health: scope of practice, education and governance for physiotherapists.

Pelvic health and pelvic floor dysfunction have wide-reaching implications across a range of patient groups. Placing ultrasound imaging into the hands of assessing and treating clinicians (i.e. point of care ultrasound, PoCUS) can provide a step change in clinical effectiveness and efficiency. Pelvic floor dysfunction is managed by one or more members of a multi-disciplinary team that includes physiotherapists. Physiotherapists' involvement includes diagnosis, patient education, identifying shared treatment goals, using rehabilitative strategies and empowering patients through self-management. Drawing upon existing publications in this area and applying framework principles, the authors propose a clinical and sonographic scope of practice for physiotherapists as part of supporting the consolidation and expansion of pelvic health PoCUS. Education and governance considerations are detailed to ensure the robust and safe use of this modality. Alongside empowering the use of ultrasound imaging by clinicians such as physiotherapists in the UK and internationally, we provide clarity to other members of the care pathway and ultrasound imaging professionals.

Assessing Engagement With Patient-Generated Health Data Recording and Its Impact on Health Behavior Changes in Multicomponent Interventions: Supplementary Analysis.

BACKGROUND: The use and sharing of patient-generated health data (PGHD) by clinicians or researchers is expected to enhance the remote monitoring of specific behaviors that affect patient health. In addition, PGHD use could support patients' decision-making on preventive care management, resulting in reduced medical expenses. However, sufficient evidence on the use and sharing of PGHD is lacking, and the impact of PGHD recording on patients' health behavior changes remains unclear. OBJECTIVE: This study aimed to assess patients' engagement with PGHD recording and to examine the impact of PGHD recording on their health behavior changes. METHODS: This supplementary analysis used the data of 47 postpartum women who had been assigned to the intervention group of our previous study for managing urinary incontinence. To assess the patients' engagement with PGHD recording during the intervention period (8 weeks), the fluctuation in the number of patients who record their PGHD (ie, PGHD recorders) was evaluated by an approximate curve. In addition, to assess adherence to the pelvic floor muscle training (PFMT), the weekly mean number of pelvic floor muscle contractions performed per day among 17 PGHD recorders was examined by latent class growth modeling (LCGM). RESULTS: The fluctuation in the number of PGHD recorders was evaluated using the sigmoid curve formula (R2=0.91). During the first week of the intervention, the percentage of PGHD recorders was around 64% (30/47) and then decreased rapidly from the second to the third week. After the fourth week, the percentage of PGHD recorders was 36% (17/47), which remained constant until the end of the intervention. When analyzing the data of these 17 PGHD recorders, PFMT adherence was categorized into 3 classes by LCGM: high (7/17, 41%), moderate (3/17, 18%), and low (7/17, 41%). CONCLUSIONS: The number of PGHD recorders declined over time in a sigmoid curve. A small number of users recorded PGHD continuously; therefore, patients' engagement with PGHD recording was low. In addition, more than half of the PGHD recorders (moderate- and low-level classes combined: 10/17, 59%) had poor PFMT adherence. These results suggest that PGHD recording does not always promote health behavior changes.

Urinary Incontinence and Its Association with Physical and Psycho-Cognitive Factors: A Cross-Sectional Study in Older People Living in Nursing Homes.

Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in five Spanish NHs. UI (measured with Minimum Data Set 3.0), sociodemographic, and health-related variables were collected. Chi-square (or Fisher's) or Student's t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6-77.2) in incontinent (n = 45, mean age 84.04, SD = 7.7) and continent (n = 23, mean age 83.00, SD = 7.7) groups. UI was significantly associated with frailty (PR = 1.84; 95%CI 0.96-3.53), faecal incontinence (PR = 1.65; 95%CI 1.02-2.65), anxiety (PR = 1.64; 95%CI 1.01-2.66), physical performance (PR = 1.77; 95%CI 1.00-3.11), and cognitive state (PR = 1.95; 95%CI 1.05-3.60). Statistically significant differences were found between incontinent and continent NH residents for limitations in activities of daily living (ADL), mobility, quality of life, sedentary behaviour, and handgrip strength. It can be concluded that two out of three of the residents experienced UI, and significant associated factors were mainly physical (sedentary behaviour, frailty, physical performance, ADL limitations, mobility, faecal incontinence, and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety, and quality of life).

Development of a multinational, multidisciplinary competency framework for physiotherapy training in pessary management: an E-Delphi study.

INTRODUCTION AND HYPOTHESIS: Vaginal support pessaries are intravaginal devices designed to relieve symptoms of pelvic organ prolapse, but they can cause serious medical complications if not managed well. Physiotherapists are well placed to manage pessaries, but there are no guidelines on the training required for competency in pessary management (PM). METHODS: A scoping review of current literature on PM training was conducted to develop draft competency standards, which were reviewed by a multidisciplinary focus group. Using e-Delphi methodology, a multidisciplinary and multinational expert panel then refined the standards. Three rounds of e-Delphi online surveys were conducted, with individual participant feedback and one videoconference to discuss items that did not reach consensus. Consensus was set at 80% agreement and stability measured using kappa coefficient. RESULTS: Pessary training competency standards, developed by 29 experts, covered three key domains including: (1) prerequisite knowledge and understanding; (2) entrustable professional activities; (3) pessary-specific standards under ten key roles. Consensus was reached on all 73 (100%) competency standards and stability demonstrated for 95.9% of standards. There was no attrition of expert panel participants through the e-Delphi rounds. CONCLUSIONS: This e-Delphi study provides the first, robust recommendations on training standards for physiotherapists in PM. These competency standards will provide clinicians with a self-assessment tool, and educators and training institutions with a benchmark in training for PM, which should improve options and reduce risk for women with prolapse being managed with a pessary.

Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice.

BACKGROUND: Pelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education. OBJECTIVES: My study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM). METHOD: Various databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements. RESULTS: My study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another. CONCLUSION: Biomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice. CLINICAL IMPLICATIONS: Incorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.

Urinary symptoms in women with faecal incontinence.

AIM: Faecal incontinence (FI) is estimated to affect 8.9% of women in the United States, with a significant impact on quality of life. Our aim was to compare urinary symptoms in patients with and without FI with different degrees of severity. METHODS: This prospective cohort of women presented for care at a pelvic floor disorder centre between May 2007 and January 2019. We excluded women with a history of bowel resection, prior history of pelvic organ prolapse surgery or existing prolapse symptoms reported by the patient during intake. The primary outcome was the presence of urinary symptoms in women with and without FI by validated questionnaires. A logistic regression model for association of urinary symptoms with FI was performed, adjusting for age, smoking, diabetes, prior hysterectomy and irritable bowel syndrome. RESULTS: A total of 2932 met inclusion criteria, and of these 1404 (47.89%) reported FI. In the univariate analysis, patients with FI were more likely to have urgency urinary incontinence (P = 0.01) or mixed urinary incontinence (P < 0.001), report nocturnal enuresis (P < 0.001) or have leakage of urine during sex (P < 0.001). In an adjusted model, FI was associated with concurrent stress (adjusted OR 1.28, P = 0.034), urgency (adjusted OR 1.52, P < 0.001) and mixed incontinence (adjusted OR 1.94, P < 0.001). CONCLUSION: In women with pelvic floor disorders, the presence of FI is associated with a higher prevalence of urinary incontinence. Pelvic floor specialists should assess urinary incontinence symptoms along with the presence and severity of FI to provide comprehensive care and guide appropriate therapy.

Menstruation: science and society.

Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Menstrual health is an integral part of overall health because between menarche and menopause, most women menstruate. Yet for tens of millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social well-being. Enhancing our understanding of the underlying phenomena involved in menstruation, abnormal uterine bleeding, and other menstruation-related disorders will move us closer to the goal of personalized care. Furthermore, a deeper mechanistic understanding of menstruation-a fast, scarless healing process in healthy individuals-will likely yield insights into a myriad of other diseases involving regulation of vascular function locally and systemically. We also recognize that many women now delay pregnancy and that there is an increasing desire for fertility and uterine preservation. In September 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a 2-day meeting, "Menstruation: Science and Society" with an aim to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field." Experts in fields ranging from the evolutionary role of menstruation to basic endometrial biology (including omic analysis of the endometrium, stem cells and tissue engineering of the endometrium, endometrial microbiome, and abnormal uterine bleeding and fibroids) and translational medicine (imaging and sampling modalities, patient-focused analysis of menstrual disorders including abnormal uterine bleeding, smart technologies or applications and mobile health platforms) to societal challenges in health literacy and dissemination frameworks across different economic and cultural landscapes shared current state-of-the-art and future vision, incorporating the patient voice at the launch of the meeting. Here, we provide an enhanced meeting report with extensive up-to-date (as of submission) context, capturing the spectrum from how the basic processes of menstruation commence in response to progesterone withdrawal, through the role of tissue-resident and circulating stem and progenitor cells in monthly regeneration-and current gaps in knowledge on how dysregulation leads to abnormal uterine bleeding and other menstruation-related disorders such as adenomyosis, endometriosis, and fibroids-to the clinical challenges in diagnostics, treatment, and patient and societal education. We conclude with an overview of how the global agenda concerning menstruation, and specifically menstrual health and hygiene, are gaining momentum, ranging from increasing investment in addressing menstruation-related barriers facing girls in schools in low- to middle-income countries to the more recent "menstrual equity" and "period poverty" movements spreading across high-income countries.

Pre-Licensure Inter-Professional Perspectives: Pelvic Health Physiotherapy.

Purpose: In this study, we examined knowledge and perspectives pertaining to pelvic health physiotherapy among medical, midwifery, nursing, and physician assistant students at McMaster University. Moreover, we identified opportunities to improve knowledge translation to facilitate inter-professional education in urogynecological care. Method: A cross-sectional design was created to distribute an online survey to participants using a modified Dillman approach. The survey assessed areas of clinical interest in, knowledge of the scope of practice of, and regulations governing pelvic health physiotherapy in specific, in addition to clinical applications. Fisher's exact and Kruskal-Wallis tests were used to assess statistical significance. Results: A total of 90% of the participants incorrectly indicated that internal digital exams could be delegated to physiotherapy assistants, and 50% believed that Kegel exercises were appropriate for all presentations of pelvic floor dysfunction. Moreover, when prompted to select conditions that could be treated by pelvic health physiotherapists, only 2% of the participants selected the correct conditions. Conclusions: Knowledge in all four programmes about the scope of practice, authorized activities, and application of pelvic health physiotherapy is inadequate. To foster the optimal integration of urogynecology into the relevant health science curriculums, enhanced inter-professional education, inclusive of pelvic health physiotherapy knowledge, appears to be needed.

Objectif : examiner les connaissances et les points de vue relatifs à la physiothérapie pelvienne des personnes étudiant pour devenir médecins, sages-femmes, infirmières ou auxiliaires médicales à l'université McMaster; établir des possibilités d'améliorer l'application des connaissances pour faciliter l'enseignement interprofessionnel en soins urogynécologiques. Méthodologie : les chercheurs ont créé un sondage transversal en ligne au moyen de la méthode de Dillman modifiée. Ce sondage évaluait les secteurs d'intérêt clinique, les connaissances sur le champ d'exercice et les applications cliniques de la physiothérapie pelvienne, de même que la réglementation s'y rapportant. Ils ont utilisé la méthode exacte de Fisher et le test de Kruskal-Wallis pour évaluer la signification statistique des résultats. Résultats : au total, 90 % des participants ont indiqué à tort que les examens digitaux internes pouvaient être délégués à des assistants-physiothérapeutes et 50 % croyaient que les exercices de « Kegel ¼ convenaient à toutes les présentations des dysfonctions pelviennes. De plus, lorsqu'on les invitait à sélectionner des affections qui pouvaient être traitées par des physiothérapeutes pelviens, seulement 2 % des participants choisissaient les bonnes. Conclusion : les connaissances sont insuffisantes dans les quatre programmes à l'égard du champ d'exercice, des activités autorisées et de l'application de la physiothérapie pelvienne. Pour favoriser l'intégration optimale de l'urogynécologie aux programmes pertinents en sciences de la santé, il semble nécessaire d'améliorer l'enseignement interprofessionnel, y compris les connaissances sur la physiothérapie pelvienne.

Physical Therapy Treatment of Pelvic Pain.

Physical therapists offer a valuable service in the treatment of chronic pelvic pain (CPP). Physical therapists are trained in functional restoration of the whole body. The physical therapist is in the unique position to assess and treat CPP in restoration of transitional movement ease and tolerance for improved functional control with the ultimate goal of wellness. It is imperative that pelvic floor muscle overactivity, underactivity, or a combination there of is accurately assessed and treated to avoid exacerbation of symptoms. The physical therapist has treatment options to restore the function with education in independent management of CPP.

[Pelvic Health: Healthcare Needs From Medical and Women Perspectives].

The pelvis, one of the most important cavities in the human body, is involved in human reproduction health. The pelvis changes in females with age and reproduction-related changes in hormones. Women generally lack sufficient knowledge regarding their pelvic-health needs and feel embarrassed to seek pelvic-health-related medical advice. Conversely, medical care related to women's health focuses mainly on maternal health and cancer prevention. When facing the challenges of pelvic floor dysfunction, surgical procedures are the most common treatment modality. The present article aims to define pelvic health and to compare the differences in perspective on this issue between the medical and women. Lastly, suggestions for pelvic healthcare that focus on women's needs are made.