The effect of trunk-stabilizing muscle training in women with stress urinary incontinence: A randomized controlled trial.

INTRODUCTION: There is little evidence regarding the effect of trunk-stabilizing muscle training on the improvement of stress urinary incontinence (SUI) symptoms. OBJECTIVE: To investigate the effect of trunk-stabilizing muscle training on transabdominal ultrasonography (TAUS) and clinical urological indices, and on the quality of life (QoL) in women with SUI. DESIGN: Randomized controlled trial. SETTING: A university hospital. PARTICIPANTS: Forty-six women with SUI, ages 20-55 years, were randomly assigned to an experimental (n = 23) and control group (n = 23). INTERVENTIONS: The experimental group performed trunk-stabilization exercises according to the Sapsford protocol, whereas the control group performed pelvic floor muscle (PFM) exercises for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was bladder base displacement (BBD), assessed by TAUS during PFM contraction (PFMC), Valsalva, and abdominal curl. The secondary outcome measures were PFM strength, the severity of urinary incontinence (UI), voiding diary, and QoL, assessed by the Modified Oxford Grading System, the severity index, frequency chart, and lower urinary tract symptoms-QoL questionnaire, respectively. All variables were assessed at baseline and after 8 weeks of intervention. RESULTS: The interaction of group and time was not significant for BBD during PFMC (p = .98), Valsalva (p = .28), abdominal curl (p = .34), and secondary variables (p > .05). The main effect of time was significant in both groups for BBD during PFMC, PFM strength, the severity of UI, voiding diary, and QoL (p < .001), with effect size (d) of 0.30, 0.80, 2.05, 1.07, and 1.03 in the control; and 0.49, 0.52, 1.75, 0.66, and 0.88 in the experimental group, respectively. The main effect of the group was not significant for BBD during PFMC (p = .68), Valsalva (p = .22), abdominal curl (p = .53), and secondary variables (p > .05). CONCLUSIONS: Trunk-stabilizing muscle training and PFM exercise are equally effective in the improvement of PFM function, UI symptoms, and QoL in women with SUI. Both methods can be used interchangeably by physical therapists.

Evaluation of scapular mobilization and comparison to pectoralis minor stretching in individuals with rounded shoulder posture: A randomized controlled trial.

BACKGROUND: Rounded shoulder posture (RSP) is a common postural condition which can alter scapular position. Although, there is no consensus on the relationship between posture and musculoskeletal dysfunction, some evidence suggests a significant relationship between RSP and shoulder dysfunction. Therefore, treatment of this postural condition is important. Various treatment methods are used to correct RSP. However, the effectiveness of scapular mobilization, (SM) as a method which can alter scapular kinematics, has not been investigated. OBJECTIVE: To evaluate the effects of SM on scapular resting position in individuals with RSP, and to compare this technique to pectoralis minor self-stretching (PMS), and combined SM + PMS. METHODS: 52 healthy students (18 men and 34 women; mean age 23.67 ± 6.73 years) with RSP were randomly assigned to four groups (SM, PMS, combined SM + PMS, control). The mobilization group received SM, the stretching group performed self-PMS, and the combined group received SM + PMS. The control group received no treatment. Kinematics data to measure scapular protraction (cm), anterior tilt (°), internal rotation (°), and downward rotation (°) were captured with a motion analysis system before and after 5 sessions of group intervention. RESULTS: All variables decreased significantly post-intervention compared to baseline values (P < 0.05). Internal rotation and downward rotation decreased significantly in the intervention groups compared to the control group (P < 0.05). No significant differences were observed between the intervention groups. CONCLUSION: SM appears to be an effective technique to change scapular resting position in individuals with RSP. However, this technique was not superior to PMS or a combination of SM + PMS.

Transabdominal Ultrasound Imaging of Pelvic Floor Muscle Activity in Women With and Without Stress Urinary Incontinence: A Case-Control Study.

OBJECTIVE: Transabdominal ultrasound (TAU) is an easy and noninvasive way to evaluate and retrain pelvic floor muscle (PFM) function. The purpose of this study was to compare PFM activity in women with and without urinary incontinence (UI) by measuring bladder base displacement (as a marker for PFM activity) using TAU during PFM contraction, Valsalva's maneuver, and abdominal curl. METHODS: Sixty-three women, aged 20-55 years, volunteered to participate in this cross-sectional study: 21 were continent and 42 had UI (21 stress urinary incontinence [SUI] and 21 mixed urinary incontinence [MUI]). Mean bladder base displacement in millimeters was measured to evaluate differences between the three groups (continent, SUI, and MUI) and also between the continent and UI groups during the performance of each maneuver. RESULTS: No significant differences were seen between the three groups in bladder base elevation during PFM contraction (P > 0.05). Descent of the bladder base during Valsalva's maneuver and abdominal curl was significantly greater in women with SUI and MUI than in women in the continent group (P < 0.05). Comparison of the continent and UI groups showed no significant differences in elevation of the bladder base during PFM contraction, while descent of the bladder base was significantly greater in women with UI than in women in the continent group during Valsalva's maneuver and abdominal curl (P < 0.05). CONCLUSION: TAU indicated that bladder base descent was greater in women with SUI and MUI than those in the continent group during the performance of maneuvers that increased intra-abdominal pressure. This effect may be due to decreased PFM performance in women with urinary incontinence.

The effect of aerobic exercises among women with mild and moderate irritable bowel syndrome: A pilot study.

BACKGROUND: Irritable Bowel Syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort. Although patients with IBS are commonly recommended to increase their physical activity, after reviewing the literature, it was found that no study has assessed the effect of aerobic exercises on the severity of symptoms and quality of life in patients with IBS. Therefore the aim of the present study was to evaluate the effect of aerobic exercises with treadmill on the severity of symptoms and quality of life among women with mild and moderate IBS. METHODS: Twenty women with mild and moderate IBS were randomly assigned into two groups of treadmill exercise (10 participants) and control (10 participants). The treadmill group had six weeks (30 min, three sessions per week) of aerobic exercises on treadmill. The control group continued their usual daily activities. RESULTS: After six weeks of aerobic exercises on a treadmill a significant improvement was observed in the severity of IBS symptoms (p ≤ 0.001) and IBS quality of life (p = 0.001) in the treadmill group compared to the control group. Also in the treadmill group, the severity of symptoms and quality of life demonstrated a significant improvement after the intervention compared to before the intervention (p ≤ 0.001). No significant difference was observed in the severity of symptoms and quality of life in the control group before and after the study (p > 0.05).

Reliability and Validity of the Quality of Life Questionnaire in Iranian Patients with Lower Urinary Tract Symptoms.

OBJECTIVES: The aim of this study is to evaluate the psychometric properties of the Iranian version of the Quality of Life (QoL) questionnaire in patients with urinary incontinence (UI). METHODS: The English questionnaire on lower urinary tract symptoms was initially translated into Persian, and then back-translated into English. Final modifications were made after testing the questionnaire on Iranian patients with UI. To validate the translated questionnaire, the following tests were undertaken: content/face validity, internal consistency/reliability and construct validity. RESULTS: The Lower Urinary Tract Symptoms Quality of Life (LUTS-QoL) questionnaire showed good internal consistency, content validity, and criterion validity, as measured by correlation with scores on the Short-Form 36 Health Survey (SF-36). Cronbach's alpha coefficient was 0.951, indicating a high internal consistency. Concerning criterion validity, correlations between the LUTS-QoL and subscales of the SF-36 were 0.563-0.193. The highest correlation was found between the LUTS-QoL and the social function subscale of the SF-36. CONCLUSION: The Iranian version of the LUTS-QoL questionnaire is a valid and robust instrument that can be used reliably in clinical settings and in research.