The Effects of Connective Tissue Manipulation in Primary Dysmenorrhea: a Randomized Placebo-Controlled Study.

The aim of this study was to identify the effects of connective tissue manipulation (CTM) in primary dysmenorrhea (PD) in a randomized, placebo-controlled design. Thirty-eight nulliparous women with PD were randomly allocated into 3 groups: CTM (n = 13), placebo therapeutic ultrasound (US) (n = 13), and control (n = 12). The primary outcome measure was the maximum and mean menstrual pain intensity at the last menstrual period on the visual analogue scale (VAS). Secondary outcome measures were menstrual symptom frequency and distress score, the number of analgesic/anti-inflammatory drugs used during the last menstrual period, and perception of improvement in dysmenorrhea severity via interventions. The chi-square test and analysis of variance were used to determine within-group and between-group differences. Statistical significance level was determined as p < 0.05. Compared with the placebo US and control groups, it was observed that menstrual pain (VAS mean and VAS maximum), menstrual symptom frequency, and distress level decreased more after treatment (T2) and the 3-month follow-up (T3) in de CTM group (p < 0.001, p = 0.001, p = 0.014, p = 0.015, respectively). There was no difference between the groups in terms of analgesic/anti-inflammatory drugs use (p > 0.05). The rate of individuals reporting perceived improvement at the end of intervention period was higher in the CTM group than in the placebo-US and control groups (p < 0.001). In the 3rd month follow-up, there was no difference between groups in the perception of improvement (p > 0.05). CTM is superior to placebo intervention and control in improving menstrual pain and other menstrual symptoms in PD in the short-term. On the other hand, when the application is terminated, this superiority seems to disappear during the follow-up period.

Psychometric Properties and Cutoff Value of the Turkish Overactive Bladder Symptom Score.

IMPORTANCE: The Overactive Bladder Symptom Score (OABSS) measures all overactive bladder (OAB) symptoms with graded answers, evaluates urgency symptoms, and reveals the subjective bladder control. However, the Turkish version and the cutoff value of the questionnaire have not yet been studied. OBJECTIVE: The aims of this study were to determine the psychometric properties of the 7-item OABSS and to estimate the cutoff value of the scale. STUDY DESIGN: This was an observational study. The internal consistency (Cronbach α) and test-retest reliability were analyzed, and exploratory factor analysis was performed. For the criterion validity, the correlations between the OABSS, the Overactive Bladder Questionnaire, the Bristol Female Lower Urinary Tract Symptoms questionnaire, and outcomes of a bladder diary were used. The cutoff value of the OABSS was analyzed by the receiver operating characteristics curve analysis. RESULTS: Participants with (n = 49) and without (n = 38) OAB were included. The internal consistency was very strong (Cronbach α = 0.95). The test-retest reliability was very strong (intraclass correlation coefficients = 0.93-0.95, P = 0.001). The percentage of explanation of the total variance was calculated as 78%. There was a strong to very strong correlation between the OABSS and the Overactive Bladder Questionnaire and Bristol Female Lower Urinary Tract Symptoms scores and outcomes of the bladder diary. The cutoff value for the OABSS was determined as 10.5. CONCLUSIONS: The Turkish OABSS was found to be a valid and reliable scale to determine OAB symptoms and severity. Those who score more than 10.5 on the questionnaire can be considered as at risk of OAB syndrome.

Contributory effects of individual characteristics on pelvic floor distress in women with pelvic floor dysfunctions.

OBJECTIVE: To determine individual characteristics (i.e. sociodemographic and medical, obstetric and gynecological, and musculoskeletal and anthropometric parameters) for greater pelvic floor distress (PFD). METHODS: A cross-sectional study was performed in 253 women with pelvic floor dysfunction. PFD was assessed using the Pelvic Floor Distress Inventory-20 (PFDI-20). The score of Urogenital Distress Inventory-6 (UDI-6) was used to perform secondary analyses. Sociodemographic, medical, and obstetric & gynecological parameters were recorded. Waist and hip circumferences and pelvic diameters were measured as anthropometric parameters. Pearson test, t-test, and linear regression analyses were conducted with a significance level of 0.05. RESULTS: Education level (r = -0.23, p < .001; r = -0.24, p < .001), number of vaginal births (r = 0.15, p = .012; r = 0.12, p = .048), total vaginal birth weight (r = 0.15, p = .021; r = 0.16, p = .019), and Body Mass Index (r = 0.12, p = .043; r = 0.16, p = .007) were significantly correlated with the higher PFDI-20 and UDI-6 scores. The maternal age at the first vaginal birth (r = -0.13, p = .049) and pelvic antero-posterior diameter (r = 0.17, p = .013) were also significantly correlated with higher UDI-6 score. Linear regression analyses revealed that younger age (Beta coefficient (ß) = -1.10, p = .005), greater symptom duration (ß = 2.28, p = .001), the presence of chronic cough/constipation (ß = 25.72, p = .001), and increased total vaginal birth weight (ß = 2.38, p = .030) were associated with the greater PFDI-20 score. Increased pelvic antero-posterior diameter (ß = 0.88, p = .049) was a contributory factor for the greater UDI-6 score. CONCLUSION: This study showed that younger age, chronic cough/constipation, higher total vaginal birth weight, greater symptom duration, and pelvic antero-posterior diameter can be contributors of greater PFD. We suggest further longitudinal studies that better reveal the causal relationship between individual characteristics and PFD.

Musculoskeletal and anthropometric factors associated with urinary incontinence in pregnancy.

INTRODUCTION: Urinary incontinence (UI) is a common pelvic floor dysfunction in pregnancy. The relationship between biomechanical changes and pregnancy-related UI has not been fully elucidated. OBJECTIVE: To investigate the association of various musculoskeletal and anthropometric changes in pregnancy that affect gestational UI. METHODS: The study was conducted with 275 pregnant women. Ninety-three, 110 and 72 women were in first, second and third trimesters, respectively. Incontinence Impact Questionnaire for UI, Urogenital Distress Inventory-Short Form and Incontinence Severity Index were applied. Lumbar lordosis measurement was performed by Baseline Bubble Inclinometer while diastasis recti abdominis (DRA) measurement was carried out by finger-width method. Manual muscle test for rectus abdominis and right and left external oblique abdominal muscles, and Benign joint hypermobility test with Beighton scoring method were also applied as musculoskeletal measurements. Tape measurement at the waist, umbilical and hip levels, caliper with bi-iliac and bi-trochanteric diameters were also recorded as anthropometric measurements. RESULTS: Significant associated factors for UI were: umbilical DRA (OR = 1.57; p = .012); rectus abdominis muscle strength (values of 3 and below, OR = 1.2; p = .014); umbilical environment (OR = 1.1; p = .029); bi-iliac diameter (OR = 1.1; p = .05;) and bi-trochanteric diameter (OR = 1.3; p = .05), respectively. CONCLUSION: Changing musculoskeletal and anthropometric characteristics of pregnant women should be taken into consideration in UI follow-up during pregnancy.

Trimester-based changes in urogenital symptoms and their impact on the quality of life in pregnant women: A preliminary report.

BACKGROUND: This study is aimed to determine the trimester-based changes in urogenital symptoms and their impact on the quality of life in pregnant women. MATERIALS AND METHODS: Fifty-one pregnant women participated in this study. Self-reported symptom-based questionnaires, Urogenital Distress Inventory-Short Form (UDI-6), Incontinence Severity Index (ISI), and Incontinence Impact Questionnaire (IIQ-7) were administered to determine urogenital symptoms, incontinence severity, and the quality of life in all participants in the first, second, and third trimesters. The findings obtained were analyzed with the Friedman and Spearman tests. RESULTS: Irritative (urgency and frequency) and stress incontinence symptoms showed statistically significant changes (p < 0.05), whereas obstructive and genital pain/discomfort symptoms did not significantly change (p > 0.05) according to the scores of UDI-6 subscales over the trimesters. There were negative, weak-moderate correlations between stress incontinence symptoms and IIQ-7 in the first, second, and third trimester. There was a negative, moderate correlation between irritative symptoms and IIQ-7 only in the third trimester, but there were not any correlations between the other urogenital symptoms and IIQ-7 (p > 0.05). In the prepregnancy period, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) occurred in 9.8% and 7.8% of the patients, respectively, whereas there were no women with mixed urinary incontinence (MUI) preconceptionally. The presence of SUI, UUI, and MUI were 13.7%, 7.8%, and 0% in the first, 26%, 9.8%, and 3.9% in the second, and 41.2%, 27.5%, and 13.7% in the third trimester, respectively. ISI scores showed statistically significant changes in the first, second, and third trimesters of women with SUI, UUI, and MUI (p < 0.05). Statistically significant differences were also found in UDI-6 and IIQ-7 scores obtained from all three trimester evaluations of pregnant women with SUI, UUI, and MUI (p < 0.05). CONCLUSIONS: Urogenital symptoms associated with urinary incontinence such as frequency, urgency, and stress incontinence were found to be increased over the course of the three trimesters of the pregnancy and the quality of life was negatively affected. Special care is essential for urinary incontinence during antenatal care.

Complex Decongestive Therapy in the Physical Therapist Management of Rosacea-Related Edema (Morbus Morbihan Syndrome): A Case Report With a New Approach.

OBJECTIVE: The aim of this case report was to describe the use of complete decongestive therapy (CDT) with a new approach in the management of a male with facial edema related to Morbus Morbihan Syndrome (MMS). METHODS: An 18-year-old male with MMS after acne treatment was the subject of this case report. Volume assessment was performed with distance measurements of the facial area using standard reference points, the overflow method, and the measurement of the percentage of subdermal fluid. Participant-reported symptoms of lymphedema (feeling of swelling and tightness) and body image perception were evaluated with the visual analogue scale, and the severity of anxiety was evaluated with the State and Trait Anxiety Inventory. In addition, the participant's perception of improvement was determined using a Likert-type scale. Evaluations were performed at baseline, week 4 (during the treatment), and week 8 (immediately after treatment). CDT was applied to the participant in a total of 24 sessions, 3 d/wk for 8 weeks. RESULTS: Compared with the baseline measurement, the facial distances (tragus-mental cavity, tragus-mouth corner, mandibula-nasal canal, mandibula-internal orbita, mandibula-external orbita, mental cavity-internal orbita, mental cavity-mandibula, right-left tragus, and hairline in the forehead-mental cavity), the volume, and the percentage of subdermal fluid of facial area were decreased at the week 4 and 8 measurements. The anxiety score, participant reports of feelings of swelling and tightness, and body image perception improved after the 8 weeks of treatment compared with baseline. CONCLUSION: This case report described the use of CDT in treating edema and participant symptoms in an individual with facial lymphedema related to MMS. Body image and level of anxiety improved.

Psychometric properties of the Turkish version of the Pregnancy Sexual Response Inventory.

PURPOSE: The purpose of this study was to adapt the Pregnancy Sexual Response Inventory (PSRI) into Turkish and to determine the psychometric properties for pregnant women. METHODS: A total of 139 pregnant women were included in the study. The psychometric features of the questionnaire were analyzed in terms of internal consistency, test-retest reliability, content and criterion validity. The Turkish version of the PSRI and the Female Sexual Function Index (FSFI) was completed by the pregnant women. Criterion validity was tested by measuring the correlations between the total and subscale scores of the PSRI and the FSFI. RESULTS: The test-retest reliability of the Turkish PSRI was found to be moderate to very strong (ICC = 0.57-0.96, p < 0.001). The internal consistency [Cronbach's alpha (α) coefficient] was found to be 0.65-0.70 before pregnancy and 0.73-0.80 during pregnancy. The criterion validity of the PSRI was supported by moderate to strong correlations between the subscales of the FSFI (desire, arousal, orgasm, satisfaction, pain) and the subscales of the PSRI-during pregnancy (r = 0.59, r = 0.45, r = 0.64, r = 0.53, r = 0.41, p < 0.001, respectively). The total score of the PSRI was significantly correlated with the total score of the FSFI (r = 0.71, p < 0.001). CONCLUSION: The results of this study showed that the Turkish version of the PSRI has valid and reliable properties for assessing sexuality and sexual response during pregnancy.

Factors Related to Primary Dysmenorrhea in Turkish Women: a Multiple Multinomial Logistic Regression Analysis.

This study aimed to evaluate the factors related to the severity of menstrual pain in Turkish women with primary dysmenorrhea (PD). The study included 504 women with PD aged 18 years or older. A Visual Analogue Scale (VAS), a self-developed structured questionnaire, the International Physical Activity Questionnaire-Short Form (IPAQ-SF), State and Trait Anxiety Inventory, Beck Depression Inventory, and Nottingham Health Profile (NHP) were used to measure outcomes. Multiple multinomial logistic regression analysis was used to determine the factors related to the severity of menstrual pain. In this model, categorical menstrual pain severity levels (mild, moderate, and severe) were considered as dependent variables and the category of "severe menstrual pain" was determined as the reference category. p value less than 0.05 was considered statistically significant. The individuals were divided into 3 groups according to their VAS scores: mild-pain group (n = 132, 26.19%), moderate-pain group (n = 189, 37.50%), and severe-pain group (n = 183, 36.30%). BMI increase (OR = 1.10 and OR = 1.09), decreased chocolate consumption (OR = 1.88), menstruation duration (OR = 2.48) and menstrual pain duration (OR = 1.33 and OR = 1.61), and increased physical activity level (OR = 1.10) were found to increase the tendency to have less severe pain. The positive family history (OR = 0.35), a decrease in the age of menarche (OR = 0.47), the presence of irregular menstruation (OR = 0.36), and decreased quality of life (OR = 0.98 for NHP pain and emotional reaction) were found to be associated with a reduced likelihood of less severe pain (p < 0.05). In Turkey as well as in the rest of the world, PD is an important public health problem and many factors are associated with menstrual pain in Turkish women.

The Reliability and Validity of the Turkish Version of the Lymphedema Life Impact Scale in Patients With Breast Cancer-Related Lymphedema.

BACKGROUND: Health-related quality of life is measured to detect the influence of lymphedema on physical, functional, and social aspects of life in patients with breast cancer-related lymphedema (BCRL). OBJECTIVE: This study aimed to perform the psychometric evaluation of the Lymphedema Life Impact Scale (LLIS) in Turkish patients with BCRL. METHODS: Patients with BCRL (n = 78) filled out the Turkish LLIS, Lymphedema Quality of Life, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and Quick Disability of Arm, Shoulder and Hand scales. Breast cancer survivors without BCRL (n = 35) completed only the Turkish LLIS. Psychometric properties were analyzed with the internal consistency, test-rest reliability, construct, criterion, and discriminant validity. RESULTS: The internal consistency of the Turkish LLIS was strong (Cronbach's α coefficient >.70). Test-retest reliability was strong to very strong (intraclass correlation coefficients from 0.88 to 0.93; P < .001). Similar to the original structure of the scale, exploratory factor analysis identified 3 factors. Criterion validity was supported by moderate to strong correlations between the LLIS, Lymphedema Quality of Life, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and quick Disability of Arm, Shoulder and Hand. There were significant differences in the total and subscale scores of the LLIS between participants with and without BCRL (P < .05). CONCLUSIONS: The present study provided the evidence to confirm reliability and clinical validity of the Turkish LLIS. IMPLICATIONS OF PRACTICE: The Turkish LLIS is a reliable and valid condition-specific scale to measure the physical, functional, and psychological aspects of health-related quality of life in patients with BCRL.

The Reliability and Validity of the Turkish Kaiser Physical Activity Survey for Pregnant Women.

BACKGROUND: Evaluation of physical activity by condition-specific surveys provides more accurate results than generic physical activity questionnaires. The aim of this study was to investigate the reliability and validity of the Kaiser Physical Activity Survey (KPAS) in Turkish pregnant women. METHODS: In the translation and cultural adaptation of the KPAS, the 6-phase guidelines recommended in the literature were followed. The study included a total of 151 pregnant women who were assessed using the Turkish version of KPAS, the Pregnancy Physical Activity Questionnaire, and the SenseWear Pro3 Armband. To determine the test-retest reliability, the KPAS was reapplied after 7 days. The psychometric properties of KPAS were analyzed with respect to internal consistency, test-retest reliability, and concurrent validity. RESULTS: Cronbach α coefficient indicating the internal consistency of the Turkish KPAS was found to be .60 to .80, showing moderate reliability. The intraclass correlation coefficient for test-retest reliability was very strong (intraclass correlation coefficient: .96-.98). The total KPAS scores were found to be moderately correlated with the total Pregnancy Physical Activity Questionnaire score and the total energy expenditure value on the SenseWear Pro3 Armband. CONCLUSIONS: This study showed that KPAS is a valid and reliable instrument for evaluating physical activity in Turkish pregnant women in different aspects.

Effects of vaginal tampon training added to pelvic floor muscle training in women with stress urinary incontinence: randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: We evaluated whether vaginal tampon training (VTT) combined with pelvic floor muscle training (PFMT) results in better outcomes than PFMT alone for treating stress urinary incontinence (SUI). METHODS: This was a randomized, controlled study. Patients were allocated to either the combined program, consisting of PFMT and VTT over 12 weeks [PFMT and VTT group (n = 24)] or to PFMT alone [PFMT group (n = 24)]. The primary outcome measure was self-reported improvement, while secondary outcome measures were severity of incontinence, quality of life (QoL), urinary parameters, and pelvic floor muscle strength (PFMS) and endurance (PFME). Values were analyzed with Friedman, Mann-Whitney U, Wilcoxon, and chi-square tests. RESULTS: Between-group analysis showed no statistically significant differences in self-reported improvement, severity of incontinence, symptom distress score, PFMS, PFME, urinary parameters, and all domains of QoL scores, except social limitations, at weeks 4, 8, and 12 (p > 0.05). However, the increase in PFMS and PFME between baseline and week 12 and earlier improvement was significantly greater in the PFMT and VTT than in the PFMT group (both p < 0.05) CONCLUSION: Short-term results demonstrated that PFMT with and without VT exercises had similar effectiveness on the symptoms of SUI and QoL.

Cultural adaptation and validation of the Turkish CONTILIFE: a quality of life questionnaire for urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The objective of the present study was to adapt the CONTILIFE, a quality-of-life questionnaire, into Turkish and to reveal its psychometric properties in women suffering from stress urinary incontinence (SUI). METHODS: Ninety-eight patients with a symptom of SUI participated in the study and filled out the Turkish CONTILIFE. Cronbach's alpha (α) and intraclass correlation coefficients (ICCs) were evaluated for the internal consistency and test-retest reliability, respectively. Exploratory factor analysis was performed to determine the underlying structure. Criterion validity was analyzed using the correlation coefficients between the total and subscale scores of the CONTILIFE and King's Health Questionnaire (KHQ), the Incontinence Impact Questionnaire-7 (IIQ-7), and the Urinary Distress Inventory-6 (UDI-6). RESULTS: Internal consistency was found to be strong to very strong (Cronbach's α: 0.90-0.96). Test-retest reliability was very strong (ICCs = 0.91-0.98, p < 0.001). Exploratory factor analysis revealed five significant factors, explained by 74% of the total variance. Total scores on the CONTILIFE were significantly correlated with the KHQ subscales (r = -0.43 - -0.81), IIQ-7 (r = -0.89), UDI-6 (r = -0.66), and ISI (r = -0.66); (p < 0.01). CONCLUSION: The Turkish CONTILIFE is a valid and reliable tool to determine the influence of SUI on health-related quality of life in Turkish women.