Safety and efficacy of motor imagery-based physical activity in high-risk pregnancy: A randomized controlled study.

OBJECTIVE: This study aimed to investigate the acute effects of motor imagery-based physical activity on maternal well-being, maternal blood pressure, heart rate, oxygen saturation, fetal heart rate, and uterine contractions in women with high-risk pregnancies. METHODS: This randomized controlled trial was conducted in Izmir Tepecik Education and Research Hospital from August 2023 to January 2024. Seventy-six women with high-risk pregnancies were randomized into two groups: a motor imagery group (n = 38, diaphragmatic-breathing exercise and motor imagery-based physical activity) and a control group (n = 38, diaphragmatic-breathing exercise). Maternal well-being was determined using the Numerical Rating Scale-11. Digital sphygmomanometry was used to measure maternal heart rate and blood pressure, pulse oximetry for oxygen saturation, and cardiotocography for fetal heart rate and uterine contractions. Assessments were performed pre-intervention, mid-intervention, and post-intervention. RESULTS: There were no significant differences in baseline characteristics between groups (P > 0.05). There was a significant main effect of time in terms of maternal well-being and maternal heart rate (P = 0.001 and P = 0.015). In addition, there was a significant main effect of the group on oxygen saturation (P = 0.025). The overall group-by-time interaction was significant for maternal well-beingm with an effect size of 0.05 (P = 0.041). CONCLUSION: The combination of diaphragmatic-breathing exercises and a motor imagery-based physical activity program in women with high-risk pregnancies was determined to have no adverse effects on the fetus, did not induce uterine contractions, and resulted in a significant improvement in maternal well-being and oxygen saturation. Thus, imagery-based physical activity can be used in high-risk pregnancies where physical activity and exercise are not recommended.

The effect of e-pelvic floor muscle training on symptoms in women with stress urinary incontinence: a randomized controlled trial.

The aim of this study was to investigate how e-pelvic floor muscle training (e-PFMT) affected urinary incontinence (UI) symptoms and quality of life (QoL) in women with stress urinary incontinence (SUI). Fifty-five women with SUI symptoms were randomly assigned to the intervention (n = 27) or the control (n = 28) group. Both groups were given lifestyle advice about SUI. The intervention group performed e-PFMT three days a week, one day via videoconference, and was supervised by a physiotherapist for eight weeks. UI symptoms were assessed by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), the Incontinence Severity Index (ISI), the Urinary Distress Inventory-6 (UDI-6), and QoL was assessed by the King's Health Questionnaire (KHQ) before and after intervention. After intervention, the Patient Global Impression of Improvement (PGI-I) scale was used to assess improvement, and the Visual Analogue Scale (VAS) was used to assess adherence. While the intervention group's ICIQ-UI SF, ISI, and UDI-6 scores improved (p < .001), there was no change in the control group (p > .05). Except for personal relationship limitations, all KHQ scores improved in the intervention group. The control group's role limitations and sleep/energy disturbances scores worsened. ICIQ-UI SF (p = .004), ISI (p < .001), and UDI-6 (p < .001) scores of the intervention group were improved compared to the control group. PGI-I and adherence were found to be higher in the intervention group compared to the control group. e-PFMT performed via videoconference to women with SUI, was found to be effective in improving UI symptoms and QoL as compared to lifestyle instructions only.

Menstrual health and genital hygiene status in adolescent girls and young women with cerebral palsy.

Menstrual health and genital hygiene behavior in patients with cerebral palsy (CP) is underrecognized, undertreated, and negatively affects quality of life. The aim of this case-control study is to compare menstrual health and genital hygiene behaviors in adolescent girls and young women with CP to a healthy women control group. Participants were invited to study via social media tools between August 2021 and February 2022. The study included 74 adolescent girls and young women with CP and 89 healthy women. Menstrual status with semi-structured questions, menstrual symptoms with "Menstrual Symptom Questionnaire (MSQ)," genital hygiene behavior with "Genital Hygiene Behavior Scale (GHBS)" were evaluated. The control group scored significantly higher on the MSQ sub-dimensions of "negative effects somatic complaints" (r = 0.396; p < .001), "menstrual pain" (r = 0.287; p < .001), "coping methods" (r = 0.291; p < .001), and total score (r = 0.395; p < .001), as well as the GHBS sub-dimensions of "awareness of abnormal findings" (r = 0.270; p = .001) and "menstrual hygiene" (r = 0.495; p < .001) and total score (r = 0.393; p < .001). People with CP had worse genital hygiene behavior, had less menstrual symptoms, and behaved differently about the menstruation symptoms. This study focused on adolescent girls and young women with CP who cannot easily express their own experiences and concerns, emphasized that their needs should be identified by determining their menstrual health and genital hygiene behaviors.Clinical Registration Name, Registration Number, Registration Date: Menstrual Health and Genital Hygiene Status in Cerebral Palsy and NCT04985045, August 2,2021.

Examination of posture and balance in children with primary monosymptomatic nocturnal enuresis.

PURPOSE: This study aimed to examine symptom severity, posture, and balance of children with primary monosymptomatic nocturnal enuresis (PMNE) and compare to a healthy control group. METHODS: Thirty-five children with PMNE and 34 healthy children were included in this study. Physical and sociodemographic characteristics of the children were recorded. Symptom severity was assessed with a Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES), a four-day bladder diary and a seven-day bowel diary. Standing postural alignment was assessed with the Spinal Mouse device, and the sensory integration of static balance and dynamic standing balance was assessed with the Biodex Balance System SD. RESULTS: Compared to healthy controls, children with PMNE demonstrated increased symptom severity (p = 0.001), increased upright lumbar lordosis (p = 0.018) and sacral-hip angles (p = 0.029), decreased static balance in the sensory condition of unstable surface with eyes closed (p = 0.001), and decreased mediolateral dynamic balance (p = 0.049). CONCLUSION: Children with PMNE demonstrate altered postural alignment, static and dynamic postural instability, and greater symptom severity on the Vancouver NLUTD/DES than age-matched controls.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ): Validation of the Turkish version in patient with multiple sclerosis.

This study aimed to psychometrically evaluate the Turkish version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) in women with MS. The study included 130 women with MS. The Turkish linguistic validation process of the original English MSISQ-15 was performed according to standardized guidelines. Reliability analysis was evaluated with test-retest analysis and intra-class correlation (ICC). Internal consistency between the items was analyzed using the Cronbach's alpha coefficient. Item analysis results were used to assess the contribution of the items to the scale. In evaluating the validity of the scale, the relationship between the MSISQ and the Female Sexual Function Index (FSFI), the Multiple Sclerosis Quality of Life Questionnaire-54 (MSQOL-54), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PSIQ-12) was investigated. Psychometric properties were analyzed using internal consistency, test-rest reliability, construct validity, and floor-ceiling effect. The internal consistency of the Turkish MSISQ-15 was strong in terms of both sub-dimension score and the total score (Cronbach's a coefficient > 0.80). The test-retest reliability of the scale was very strong (ICC > 0.90). A medium-high correlation was found between the MSISQ-15 and the MSQOL-54, the FSFI, and the PSIQ-12 (between r = -0.448 and r = -0.798, p < 0.001, respectively). The MSISQ-15 is a comprehensive, reliable, and valid inventory to obtain information about the cause of sexual dysfunction in Turkish women with MS and to evaluate the level of sexual dysfunction. In future studies, it is recommended to examine the sensitivity of the Turkish MSISQ-15 to treatment-related changes.

Comparing the efficacy of the Knack maneuver on pelvic floor muscle function and urinary symptoms using different teaching methods: a prospective, nonrandomized study.

INTRODUCTION AND HYPOTHESIS: This study was aimed at comparing the efficacy of Knack maneuver training taught using different techniques on pelvic floor muscle (PFM) function, urinary symptoms, and perception of improvement in women with stress urinary incontinence (SUI). METHODS: We conducted a prospective nonrandomized study of 46 women with SUI. Assessments included: PFM functions (secondary outcome, SO) using a Myomed 932 EMG biofeedback device, urinary incontinence symptoms using the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form (ICIQ-SF; primary outcome), the Urogenital Distress Inventory-6 (UDI-6; SO), and the Incontinence Severity Index (ISI; SO), and perception of improvement using the Global Perceived Impact scale. The women were divided into three groups according to their preference: group 1 (Knack maneuver training with electromyography biofeedback), group 2 (Knack maneuver training with verbal instruction), and group 3 (Knack maneuver training with vaginal palpation). An education program was also given to all women individually. The training program was 1 day per week for 4 weeks. RESULTS: There was an improvement in UDI-6, ICIQ-SF, and ISI scores in all groups (p<0.05). The maximum voluntary contraction (MVC) of the PFMs increased in group 2 (p=0.002), whereas both the MVC of PFMs and PFM contraction during Valsalva increased in group 3 (p=0.011 and p=0.042). CONCLUSIONS: Regardless of the teaching methods, the Knack maneuver and education programs were effective on urinary symptoms in women with mild to moderate SUI. The Knack maneuver training with vaginal palpation and verbal instruction improved MVC of PFMs. All three different teaching methods might be used in SUI treatment programs.

Developing a shoulder pain scale for wheelchair basketball players.

BACKGROUND: Shoulder pain in wheelchair (WC) basketball players is common. Yet there was no scale to define shoulder pain. OBJECTIVE: This study was performed to develop a shoulder pain scale for WC basketball players. METHODS: A five-step procedure was followed: Identifying the feature, writing down the items and drafting the form, formulating the final form, pre-pilot-pilot implementation, and validity-reliability analyses. The final form of the scale consisted of 15 items about self-care and sport-specific activities. RESULTS: External factor analysis showed that the scale had a two-factor structure which is "Shoulder Pain during Sports" and "Shoulder Pain during Self-care Activities". Pre-rotation results of factor analysis showed that if all of the items were loaded on the first factor, it would have an eigenvalue more than 7 times larger than the eigenvalue of the second factor. Therefore, it can be concluded that the scale can be used as a one-dimensional scale. The Cronbach's Alpha values were found to be 0.94 and 0.92 for the shoulder pain factor during sports and self-care activities, respectively. Total value was found to be 0.95. The corrected item-total correlation values were all above 0.60. CONCLUSIONS: This newly developed valid, reliable scale allows assessment of the shoulder pain of WC basketball players.

The effect of pelvic organ prolapse type on sexual function, muscle strength, and pelvic floor symptoms in women: A retrospective study.

OBJECTIVE: This retrospective research was planned to investigate the effect of pelvic organ prolapse (POP) type on sexual function, muscle strength, and pelvic floor symptoms in symptomatic women. MATERIALS AND METHODS: Data on POP type and stages as assessed using the Pelvic Organ Prolapse-Quantification system of 721 women who presented to the women's health unit between 2009 and 2016 were collected retrospectively. POP types were recorded as asymptomatic, anterior, apical, and posterior compartment prolapses. Sexual function was assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short-form (PISQ-12), pelvic floor muscle strength was assessed through vaginal pressure measurement, and pelvic floor symptoms and quality of life were assessed using the Pelvic Floor Distress Inventory-20 (PFDI-20). RESULTS: Among 168 women who met the inclusion criteria, 96 had anterior compartment prolapses, 20 had apical compartment prolapses, 16 had posterior compartment prolapses, and 36 women were asymptomatic. There was no difference between the groups in their PISQ-12 total and subscales scores, PFDI-20 total and two subscale (colorectal/anal, urinary) scores, and muscle strength (p>0.05). In the Pelvic Organ Prolapse Distress Inventory-6, another subscale of PFDI-20, it was determined that there was a difference between asymptomatic women and those with anterior compartment prolapses (p=0.044) and apical compartment prolapses (p=0.011). CONCLUSION: This research found that POP type did not affect sexual function, muscle strength, and colorectal and urinary symptoms in our cohort. There were more prolapse symptoms and complaints in women with anterior and apical compartment prolapses.

Turkish adaptation of the Pelvic Organ Prolapse Symptom Score and its validity and reliability.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to adapt the Pelvic Organ Prolapse Symptom Score (POP-SS) into Turkish and evaluate its reliability and validity. METHODS: The POP-SS was adapted into Turkish by following the steps of the intercultural adaptation process. One hundred and three women with symptomatic or asymptomatic pelvic organ prolapse (POP) completed the Turkish POP-SS and other valid and reliable Turkish tools for POP: Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), Colorectal-Anal Distress Inventory 8 (CRADI-8), Urinary Distress Inventory 6 (UDI-6), Pelvic Floor Distress Inventory 20 (PFDI-20), and Pelvic Organ Prolapse Impact Questionnaire 7 (POPIQ-7). Pelvic Organ Prolapse Quantification (POP-Q) system was also used to assess pelvic support, and patients were divided into three groups based on POP-Q scores. Cronbach's alpha was used to determine internal consistency, and intraclass correlation coefficient (ICC) was estimated for test-retest reliability. POP-SS validity was assessed by using the Spearman rank correlation and Kruskal-Wallis analyses. The underlying scale structure was determined by exploratory factor analysis. RESULTS: The POP-SS scale had high internal consistency (Cronbach's alpha = 0.705) and test-retest reliability (ICC = 0.981; p < 0.001). Among groups, there was statistically significant differences in POP-SS scores. POP-SS scores were also significantly correlated with POPDI-6 (r = 0.830), CRADI-8 (r = 0.525), UDI-6 (r = 0.385), PFDI-20 (r = 0.752), and POPIQ-7 (r = 0.690) (p < 0.001). Two factors were identified by exploratory factor analysis. CONCLUSIONS: The Turkish version of POP-SS is a valid and reliable tool for Turkish women with POP.

Reliability and validity of a Turkish version of the Global Pelvic Floor Bother Questionnaire.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to translate the Global Pelvic Floor Bother Questionnaire (GPFBQ) into Turkish and to assess its validity and reliability. METHODS: The Turkish adaptation of the GPFBQ was created by following the stages of the intercultural adaptation process. A test-retest interval of 1 week was used to assess the reliability, which was examined by the intraclass correlation coefficient. The validity of the GPFBQ was assessed and compared with the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) using Spearman's rank correlation coefficients. For construct validity, confirmatory factor analysis was performed. RESULTS: A total of 131 women, whose mean age was 46.83 years, were included in the study. The test-retest reliability of the GPFBQ was excellent (0.998, p < 0.0001). The GPFBQ correlated significantly with the PFDI-20 (r = 0.860, p = 0.00) and PFIQ-7 (r = 0.802, p = 0.00). Confirmatory factor analysis was performed to determine construct validity, and it was found that it had four dimensions. CONCLUSIONS: The Turkish version of the GPFBQ is a valid and reliable tool for assessing the symptoms of bother and severity in Turkish-speaking women with pelvic floor dysfunction.

The effect of parity on pelvic floor muscle strength and quality of life in women with urinary incontinence: a cross sectional study.

[Purpose] The purpose of this study was to analyze the pelvic floor muscle (PFM) activity after vaginal birth, and the effect of parity on PFM strength and quality of life (QoL) in women with urinary incontinence. [Subjects and Methods] Patients (n=241) who gave birth vaginally and experienced urinary incontinence were divided into three groups: group 1 consisted of women having 1-3 children, group 2 consisted of women having 4-6 children, and group 3 consisted of women having more than 6 children. All patients underwent detailed examination of the PFM. The Turkish version of the self-administered Incontinence Quality of Life Instrument (I-QoL) questionnaire was used to evaluate the effects of stress urinary incontinence on participants' QoL. [Results] Comparison of PFM strengths showed a significant intergroup difference. Group 1 showed significantly higher PFM strength scores than those of groups 2 and 3. I-QoL scores related to stress incontinence showed a significant intergroup difference. As number of deliveries increased, quality of life decreased. Comparison of PFM strengths and I-QoL scores related to stress incontinence showed a significant intergroup difference. [Conclusion] Increasing the awareness of PFM training in women will reduce potential postpartum incontinence due to a weak PFM strength; and will increase quality of life.

Turkish version of the Rotator Cuff Quality of Life questionnaire in rotator cuff-impaired patients.

PURPOSE: To date, the "Rotator Cuff Quality of Life" (RC-QOL) measure has not been translated into Turkish. The aim of this study was to perform a cross-cultural adaptation of the questionnaire and determine the reliability and reproducibility of the "Turkish version of the RC-QOL" (Tur-RC-QOL) questionnaire on Turkish-speaking patients. METHODS: The translation followed an established forward-and-backward translation procedure. Thirty Turkish-speaking, rotator cuff-impaired patients were enrolled in the study. The validity of the Tur-RC-QOL was assessed and compared with the "Shoulder Pain and Disability Index" (SPADI) and the "Western Ontario Rotator Cuff Index" (WORC) using Pearson's correlation coefficients. A test-retest interval of 2 days was used to assess the reliability. Internal consistency was tested by Cronbach's alpha, relative reliability with "intraclass correlation coefficient" (ICC), and absolute reliability using the formula for the "standard error of measurement" (SEM). RESULTS: The Cronbach's alpha scores were high for the total scores and subheadings of the Tur-RC-QOL, in the range of 0.83-0.98. Excellent test-retest reliability scores were found for the total score and for all parts of the Tur-RC-QOL, with the exception of "Part E". The ICC score for Part E was relatively lower than other parts (ICC = 0.71), and the SEM score was relatively higher (17.92 %). The Pearson correlation coefficients for the Tur-RC-QOL were high for SPADI (r = 0.90, p < 0.001) and WORC (r = 0.85, p < 0.001). CONCLUSIONS: This study demonstrates that the Tur-RC-QOL is a reliable and valid instrument to assess the quality of life of rotator cuff-impaired patients. LEVEL OF EVIDENCE: III.

A comparison between stabilization exercises and pelvic floor muscle training in women with pelvic organ prolapse.

OBJECTIVE: This study aimed to compare the effectiveness of stabilization exercises and pelvic floor muscle training in women with stage 1 and 2 pelvic organ prolapse. MATERIALS AND METHODS: In a total 38 women with pelvic organ prolapse whose average age was 45.60 years, pelvic floor muscles were evaluated with electromyography, and prolapse with pelvic organ prolapse quantification system, and the quality of life with prolapse quality of life questionnaire. Afterwards, the subjects were divided into two groups; stabilization exercise group (n=19) and pelvic floor muscle training group (n=19). Stabilization exercise group were given training for 8 weeks, 3 times a week. Pelvic floor muscle training group were given eight-week home exercises. Each group was assessed before training and after eight weeks. RESULTS: An increase was found in the pelvic muscle activation response in the 2 groups (p≤0.05). There was no difference in EMG activity values between the groups (p>0.05). A difference was found in the values Aa, Ba and C in subjects of each group (p≤0.05), and the TVL, Ap, Bp and D values of subjects in pelvic floor muscle training group (p≤0.05) in the before and after pelvic organ prolapse quantification system assessment, however, no difference was found between the groups (p≤0.05). A positive difference was found in the effect of prolapse sub parameter in each of the two groups, and in general health perception sub parameter in subjects of stabilization exercise group (p<0.05) in the prolapse quality of life questionnaire. CONCLUSIONS: It was concluded that both training programs increased the pelvic floor muscle strength, provided a decline in prolapse stages. Stabilization exercise has increased general health perception unlike home training, thus, these exercises can be added to the treatment of women with prolapse.

Is cesarean section a real panacea to prevent pelvic organ disorders?

INTRODUCTION AND HYPOTHESIS: The aim of this study is to compare the pelvic floor muscle strength after vaginal delivery vs. after cesarean section. METHODS: Five groups of 50 cases each were designated as follows: nullipara (control group), spontaneous vaginal delivery (SVD), repeat SVD (SVD-R), cesarean section (CS), and repeat CS (CS-R). Perineometric measurements, stress urinary incontinence (SUI) symptoms, pelvic organ prolapse quantification examinations, and Incontinence-Specific Quality of Life Questionnaire (IQOL) were evaluated. RESULTS: In all delivery groups, pelvic muscle strength was significantly lower than the control group (65.10 ± 15.69, 56.29 ± 17.39, 54.28 ± 20.08, 56.82 ± 17.62, and 57.92 ± 16.45 (cm H(2) ± SD) for the control, SVD, SVD-R, CS, and CS-R groups, respectively; p < 0.05). However, no significant difference was found among the delivery groups. There were significant differences in SUI symptoms between the control (2%) and SVD-R (26%) groups and between the SVD (10%) and SVD-R groups (p < 0.001 and p = 0.037, respectively). No statistically significant correlations between IQOL and perineometric measurements were noted (r = 0.097 and p = 0.598). CONCLUSIONS: Pregnancy increases postpartum muscle weakness independent of the mode of delivery. Increased SUI symptoms are associated with vaginal delivery.

The use of extracorporeal magnetic innervation for the treatment of stress urinary incontinence in older women: a pilot study.

PURPOSE: Stress urinary incontinence (SUI) is a major health problem that has substantial and important effects on health-related quality of life. In recent years, extracorporeal magnetic innervation (ExMI) has become a preferred method of treatment in urinary incontinence. This study presents the effects of ExMI treatment on pelvic floor muscle strength, urinary symptoms, incontinence conditions and quality of life of older women with SUI. METHODS: A total of 13 patients between the ages of 61 and 69 (mean 65.23 ± 2.8 years) were treated for SUI with ExMI. The following parameters were investigated: urinary symptoms, pelvic floor electromyographic (EMG) activity, 1-h pad test, incontinence conditions utilizing visual analog scale (VAS) and quality of life using Turkish version of the Urogenital Distress Inventory (UDI-6) and the Incontinence Quality of Life Instrument (I-QoL). All assessments were conducted at baseline and at the end of the study. Treatment lasted for 20 min, twice a week and for a total of 6 weeks. RESULTS: The urinary symptoms and incontinence conditions decreased after the ExMI treatment sessions. The pad test results indicated a reduction in urine loss (p = 0.016). EMG values were improved (p = 0.005). Scores of I-QoL, UDI-6 and VAS were reduced after the treatment, respectively (p = 0.002), (p = 0.002) and (p = 0.006). CONCLUSION: Extracorporeal magnetic innervation can be considered as it is an alternative, non-invasive and painless treatment method with good compliance for treatment of SUI in older patients.

Shoulder pain: a comparison of wheelchair basketball players with trunk control and without trunk control.

The purpose of this study was to compare shoulder pain between wheelchair basketball players with trunk control and wheelchair basketball players without trunk control. Players were evaluated according the International Wheelchair Basketball Federation (IWBF) classification system. The study group comprised 60 wheelchair basketball players, who were rated according to the International Wheelchair Basketball Federation classification system. Players were divided into two groups according to their trunk control. Study participants completed an anonymous survey that included demographic data, medical history data, and the Wheelchair User's Shoulder Pain Index (WUSPI). There was no statistically significant difference between the two groups based on the number of years of wheelchair use, active sport years, weekly working hours, and weekly training hours (p> 0.05). Statistically significant differences were found between wheelchair basketball players with trunk control and wheelchair basketball players with trunk control with respect to the duration of their disability, the daily number of transfers made to wheelchair, and Performance Corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI) score (p< 0.05). The total PC-WUSPI score was higher among players without trunk control (p< 0.05). Study findings suggest that the shoulder pain of wheelchair basketball players must be analyzed. Trunk stabilization is the key factor affecting the function of the shoulder and is of primary importance for appropriate loading of the shoulder joint's many forms of articulation.