The effectiveness of different electrical nerve stimulation protocols for treating adults with non-neurogenic overactive bladder: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Electrical nerve stimulation is a widely used treatment for overactive bladder but there is no consensus regarding the best placement of electrodes or protocols. We hypothesised that some non-implanted neurostimulation protocols would be more effective compared to others for treating urinary symptoms and improving quality of life among adults diagnosed with non-neurogenic overactive bladder. METHODS: A systematic review and meta-analyses of randomized clinical trials were performed in five electronic databases: PubMed/MEDLINE, Lilacs, CINAHL, Web of Science, and PEDro. The main outcome was urinary symptoms-frequency, nocturia, and urgency-and the secondary outcome quality of life. Some protocol characteristics were extracted, e.g., frequency, pulse width, intensity, intervention time, and electrode placement. RESULTS: Nine randomized controlled trials were included. Tibial neurostimulation showed better results than sacral neurostimulation for urge incontinence (mean difference = 1.25 episodes, 95% CI, 0.12-2.38, n = 73). On the pooled analysis, the different neurostimulation protocols-intravaginal, percutaneous tibial, and transcutaneous tibial nerve stimulation-demonstrated similar results for urinary frequency, nocturia, and urgency as well as quality of life. In general, effect sizes from meta-analyses were low to moderate. The best reported parameters for percutaneous tibial nerve stimulation were 20-Hz frequency and 200-µs width, once a week. CONCLUSIONS: There was evidence that tibial neurostimulation is more effective than sacral neurostimulation for urge incontinence symptoms among patients with non-neurogenic overactive bladder. Overall, there was no superiority of an electrical nerve stimulation electrode placement and protocol over others considering urinary symptoms and quality of life. Further studies with three-arm trials are necessary. This study was registered at PROSPERO: CRD4201810071.

Effects of myofascial reorganization associated with kinesiotherapy on chronic pain and functionality of breast cancer survivors: development of a study protocol / Efeitos da reorganização miofascial associada à cinesioterapia na dor crônica e funcionalidade de sobreviventes de câncer de mama: desenvolvimento de um protocolo de estudo

Abstract Introduction: Breast cancer is the most common type of cancer among women. Treatments can lead to complications modifying upper limbs movement patterns and generating pain and functionality loss. Kinesiotherapy and myofascial reorganization (MR) have shown positive effects reducing chronic pain and improving upper limbs function. We hypothesize that these techniques can maximize results and reduce treatment time in clinical practice. Objective: To develop a study protocol to verify whether MR associated with kinesiotherapy is more effective than isolated kinesiotherapy to treat chronic pain and upper limb dysfunction in breast cancer survivors. Methods: Participants will be divided into two groups: intervention group (myofascial reorganization + kinesiotherapy) and sham group (traditional massage + kinesiotherapy). Six treatment sessions (once a week) and three-time assessment will occur. Instruments for assessing pain and functionality will be Visual Analogue Scale, Body Pain Diagram, Disabilities of the Arm, Shoulder and Hand Questionnaire, and goniometry. Statistical analysis will be conducted based on intention-to-treat analysis. To analyze the difference of means between groups, we will use T-Student or U Mann-Whitney test. Repeated measures ANOVA will be used to check treatments effects. Significance level for all tests will be 5%. Conclusion: We believe that the developed study protocol will show that MR associated with kinesiotherapy improve chronic pain and upper limbs functionality of breast cancer survivors.

Resumo Introdução: O câncer de mama é o tipo de câncer mais comum entre as mulheres. Os tratamentos podem levar a complicações, modificando os padrões de movimento dos membros superiores e gerando dor e perda de funcionalidade. A cinesioterapia e a reorganização miofascial (RM) têm demonstrado efeitos positivos na redução da dor crônica e na melhora da função dos membros superiores. A hipótese do presente estudo é que essas técnicas podem maximizar os resultados e reduzir o tempo de tratamento na prática clínica. Objetivo: Desenvolver um protocolo para verificar se a RM associada à cinesioterapia é mais eficaz do que a cinesioterapia isolada no tratamento da dor crônica e disfunção do membro superior em sobreviventes de câncer de mama. Métodos: As participantes serão divididas em dois grupos: grupo intervenção (reorganização miofascial + cinesioterapia) e grupo sham (massagem tradicional + cinesioterapia). Serão realizadas seis sessões de tratamento (uma vez por semana) e três avaliações. Os instrumentos de avaliação da dor e da funcionalidade serão a Escala Visual Analógica, o Diagrama de Dor Corporal, o Questionário de Deficiências do Braço, Ombro e Mão e a goniometria. A análise estatística será realizada com base na análise de intenção de tratar. Para analisar a diferença de médias entre os grupos, serão utilizados o teste T-Student ou U Mann-Whitney. ANOVA de medidas repetidas será utilizada para verificar os efeitos dos tratamentos. O nível de significância para todos os testes será de 5%. Conclusão: Espera-se que a RM associada à cinesioterapia melhore a dor crônica e a funcionalidade dos membros superiores de sobreviventes de câncer de mama.

Pain mapping and characteristics in breast cancer survivors during task-oriented training: analysis at 3, 6, and 9 months.

PURPOSE: To evaluate the frequency and characteristics of trunk and upper limb pain in women diagnosed with breast cancer, in different movement planes, during task-oriented training (TOT) 3, 6, and 9 months after surgery. METHODS: A prospective cohort study with 20 women. The body pain diagram (BPD), VAS, and McGill questionnaire were used. The TOT consisted of 20 exercises based on the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) questionnaire. BPD overlay was performed in GIMP® image editor. The chi-square test was applied to the relationship between population characteristics and pain. Freedman's ANOVA and the Cochran's Q test were used in the comparison of pain site frequencies and intensity over time. RESULTS: In total, 297 BPDs were generated, which identified the affected upper limb as the body area with the highest frequency of pain at the three moments. However, at 9 months, the unaffected upper limb presented the same frequency as the affected limb. Radiotherapy presented a statistically significant relationship (p < 0.05) with pain at 9 months. The pain was characterized as moderate at the three moments, affective at 3 and 6 months, and sensory at 9 months. CONCLUSION: The most frequent area of pain at 3 and 6 months was the affected upper limb however, at 9 months, the unaffected upper limb presented the same frequency of pain as the affected upper limb. Pain was characterized as moderate at the three evaluation moments.

Comparison between Two Methods to Evaluate Function in Postoperative Breast Cancer Survivors.

INTRODUCTION: Treatment for breast cancer can cause adverse effects such as pain and reduced upper limb function which can affect activities of daily living. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most used tool for evaluating function in breast cancer survivors. However, some specific aspects have raised discussions about its restricted coverage, which can generate several biases. OBJECTIVE: To determine if DASH scores differed when assessed before and after task-oriented training (TOT) at 3 and 6 months after breast cancer surgery. DESIGN: Prospective cohort study. SETTING: Institutional study of 22 women assessed at 3 and 6 months after breast cancer surgery. MAIN OUTCOME MEASURES: The DASH questionnaire and TOT assessment. Two correlation tests were performed: Spearman's correlation between the total score of the two DASH scores (pre- and post-TOT) and the Kendall's tau correlation between each of the items. RESULTS: There was a moderate and excellent correlation between final DASH scores, pre- and post-TOT, at both 3 and 6 months postoperatively. However, when assessed individually, most of the DASH items were poorly correlated. There was also no agreement between the total DASH scores pre- and post-TOT as assessed by Bland-Altman plots. CONCLUSION: Both the DASH and TOT are considered useful in clinical practice to assess upper limb function, although the use of TOT in some of the DASH items may reduce memory bias and improve skills estimation.

Pain characteristics and quality of life of breast cancer survivors that return and do not return to work: an exploratory cross-sectional study.

PURPOSE: the aim of this study is two-fold: 1) to explore the pain characteristics among breast cancer survivors that return to work and do not return to work; 2) to identify the factors associated with pain on the upper quadrant of the affected side. MATERIALS AND METHODS: Sixty-two breast cancer survivors were included. Quality of life was assessed using EORTC QLQ-C30 and QLQ-BR23. Pain characteristics were assessed with a body diagram and a numeric rating scale. RESULTS: Thirty-five breast cancer survivors did not return to work. Ninety-one percent of women that did not return to work reported pain. The most frequent pain sites were the cervical spine and the axilla of the affected side. There were no significant differences in pain intensity between groups. The factors associated with pain on the upper quadrant of the affected side were perception of shoulder stiffness OR = 5.93 (1.38-44.87, 95%CI) and time since surgery of more than four years OR = 5.54 (1.36-20.97, 95% CI). CONCLUSIONS: Pain was highly prevalent among breast cancer survivors. Breast cancer survivors that returned to work presented better quality of life. Longer time since surgery and perception of shoulder stiffness were associated with pain on the upper quadrant of the affected side.Implications for rehabilitationPain is a major factor following breast cancer surgery preventing returning to work.This group reported more pain on the cervical spine and axilla of the affected side.Rehabilitation needs to focus specifically on pain management in order to improve quality of life.A multidisciplinary approach involving pain specialists and vocational support is recommended.

Functional outcomes and oncological fatigue among older cancer patients: a cross-sectional study

Abstract Aim: To characterize functional outcomes and oncological fatigue in older cancer patients, and verify the relation of these outcomes with age, number of hospitalizations, and falls within 12-months. Methods: Cross-sectional study involving 116 older adults with cancer undergoing treatment in a hospital in Santiago de Chile. Participants were assessed for independence on the activity of daily living (Barthel index), functional mobility with "timed up and go" (TUG) test, handgrip strength with a Baseline® Hydraulic Hand Dynamometer, and fatigue with Brief Fatigue Inventory. Information about the number of falls and hospitalizations from the previous 12-months was also collected. Results: 21.6% had experienced at least one fall during the previous 12-months, and 52% had been hospitalized over the same period. Handgrip strength was below the cut-off thresholds for older adults and 78.4% were classified with the risk of falls according to the TUG test. Forty-nine percent of participants experienced moderate fatigue, and 58% were dependent to perform activities of daily living. There was a correlation of TUG results with age (r = 0.204; p = 0.028). Conclusions: Older adults with cancer in our study experienced moderate fatigue, a high dependence to perform activities of daily living, especially those associated with mobility, dressing, and bladder or bowel function. Older adults with cancer are more likely to develop functional decline which leads to increased dependency or death. The data suggests they present functional impairment. Physical activity interventions would benefit this population.

Functionality and factors associated with work behaviour among Brazilian breast cancer survivors: A cross-sectional study.

BACKGROUND: Breast cancer treatments lead to several comorbidities in the upper limbs, such as pain and stiffness, hindering physical functions and the return to work. OBJECTIVE: To explore the functionality and factors associated with work behaviour among manual and non-manual Brazilian workers who have recovered from breast cancer. METHODS: This is an observational cross-sectional study involving Brazilian breast cancer survivors. The sociodemographic, work, and clinical aspects were assessed through clinical records, upper limb disability, and human functionality obtained from 62 women. Multiple and univariate logistic regressions were used to identify the association of variables on return to work, p < 0.05. RESULTS: 56.5% of women did not return to work, the mean time for returning to work was 16 months (±15.21), absenteeism from work lasted 41 months (±34.58). Modified radical mastectomy (OR = 5.13, 95% CI = 1.35 to 18.66) and moderate-to-severe disability levels in the upper limbs (OR = 6.77, 95% CI = 1.86 to 24.92) were associated with not returning to work. The loss of productivity was higher among non-manual workers (21.5%) (p = 0.040). CONCLUSIONS: The rates of not returning to work after breast cancer treatment are high. Women who did not return to work presented higher levels of disability.

Pre-rehabilitation of the pelvic floor before radiation therapy for cervical cancer: a pilot study.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate pelvic floor muscle (PFM) function regarding strength, activation and incontinence, approximately 1 month before and after radiation therapy in women with cervical cancer. METHODS: This was a pilot study of 49 women with cervical cancer at stages I to III. These women attended an educational session with a physical therapist who taught them to perform preventive pelvic floor muscle exercises (PFMEs; slow and fast contractions and the "knack") at home before, during and after radiation therapy. The women received instructions for performing PFME prior to radiation therapy. The modified Oxford scale, electromyography (EMG), the International Consultation on Incontinence Questionnaire Short Form to assess urinary incontinence and two questions for faecal and gas incontinence were used. RESULTS: Twenty-eight women (57%; mean age = 44 years, range 27-66) completed the study, 21 (43%) were lost to follow-up. There was no significant change from baseline to post-radiation therapy in muscle strength, EMG records and incontinence (p > 0.05). The median of PFM strength was equal at baseline and after intervention (median = 2; IQR = 1). CONCLUSIONS: The results of this study suggest that pre-rehabilitation teaching PFMEs might be a protective factor for preserving PFM strength and preventing incontinence 1 month after radiation therapy. It is a feasible intervention.

Physical symptoms and components of labor tasks associated with upper limb disability among working breast cancer survivors.

BACKGROUND: Each year, the number of breast cancer (BC) cases increases in Brazil and worldwide. In addition, BC affects women of working age who need to resume their jobs after treatments. This is an observational, cross-sectional study that investigated the association of physical symptoms and work tasks with upper limb disability and return to work in BC survivors. METHODS: Sociodemographic, labor, clinical and surgical aspects, and physical incapacity of the upper limbs of 62 women diagnosed with BC were evaluated through a questionnaire of our own and the disability of the arm, shoulder, and hand (DASH) questionnaire. The data were analyzed by the IBM Statistical Package for Social Sciences SPSS version 20.0 and a significance of p < 0.05 was adopted. Logistic regression and odds ratio were used to verify the level of association between work tasks and pain with return to work, and multiple linear regression verified the association of physical symptoms with upper limb functionality. RESULTS: The work tasks associated with non-return to work were raising objects above the head (OR 3.64, 95% CI 1.26-10.51), lifting objects of more than 5 kg (OR 2.88, 95% CI 1.02-8.13), and loading objects of more than 5 kg (OR 3.93; 95% CI 1.14-10.07). The pain in the upper quadrant homologous to the surgery explained 64% of the variance in physical incapacity of the upper limbs. CONCLUSIONS: There is an association of labor tasks that require upper limb strength and range of motion with non-return to work, and also pain in the upper quadrant homologous to the BC with reduction in the functionality of the upper limbs.

Adherence and effectiveness of a single instruction of pelvic floor exercises: a randomized clinical trial.

INTRODUCTION AND HYPOTHESIS: In Brazil there are limited knowledge and education about preventative exercises for pelvic floor muscles (PFMs). We hypothesised that a single pelvic floor muscle exercise (PFME) session immediately postpartum would be effective in preventing urinary incontinence (UI) in a 3-month postpartum period with good adherence rates. METHODS: Two hundred two women were approached for this randomised controlled trial and randomly assigned to two groups: the control group and experimental group. The intervention comprised a visual assessment of PFM contraction, a single PFME instruction session supervised by a physical therapist, and an educational approach through distribution of brochures about home-based PFME exercises (without supervision). Involuntary urinary loss and quality of life (QoL) were evaluated using the International Consultation on Incontinence Questionnaire Short Form (main outcome). Sociodemographic and clinical information was collected. Adherence and barriers were assessed via telephone/mobile phone surveys (secondary outcomes). RESULTS: The adherence rate was 85.1%; only 37% of the women reported having some knowledge about PFME prior to participating in this study. The main barriers to PFME mentioned were forgetfulness (61.2%), lack of time (52.2%), and the need to take care of the baby (56.7%). One instruction session on postnatal PFME delivered in the immediate postpartum period was ineffective for improving urinary symptoms such as frequency of leakage (p = 0.821), amount of leakage (p = 0.746), and influence of leakage on QoL (p = 0.823). In addition, there was no difference in QoL 3 months post-partum (p = 0.872). CONCLUSIONS: Although the proposed intervention did not prevent UI symptoms, the adherence rate to PFME was high.

Manual Therapy as Treatment for Chronic Musculoskeletal Pain in Female Breast Cancer Survivors: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this systematic review was to investigate the effectiveness of manual therapy (MT) for chronic musculoskeletal pain (CMP) in the upper limbs and thorax of female breast cancer survivors and to investigate the changes in the quality of life and function of these patients. METHODS: Systematic searches were performed in the databases MEDLINE/PubMed, Cumulative Index of Nursing and Allied Health/EBSCO, Web of Science, and Physiotherapy Evidence Database, through March 2018, to identify randomized controlled trials investigating whether MT was effective to treat CMP pain in female breast cancer survivors (PROSPERO number CDR42017074175). RESULTS: The database searches retrieved 1562 titles, and after screening, 5 papers were included for full analysis. The manual therapy techniques described in the included studies involved myofascial induction, myofascial release, classic massage, ischemic compression of trigger points, and myofascial therapy. A meta-analysis, using a fixed-effects model, found that MT decreased CMP intensity (standardized mean difference: 0.32; 95% CI 0.06-0.57), but no significant difference was observed in quality of life after the MT intervention in comparison with a control condition (standardized mean difference: 0.14; 95% CI 0.17-0.46). CONCLUSION: Current evidence suggests that MT is considered effective for treating CMP in the upper limbs and thorax of female breast cancer survivors.

Physical symptoms and working performance in female breast cancer survivors: a systematic review.

PURPOSE: The aim of this systematic review was to summarize and systematize the information about physical symptoms and its relation with work activity on female Breast Cancer Survivors (BCS). METHODS: A systematic search was performed on the databases MEDLINE/PubMed (via National Library of Medicine), SCOPUS (Elsevier), Web of Science (Thomson Reuters Scientific) and CINAHL with full text (EBSCO), including papers about physical impairments experienced by female workers who have had breast cancer. RESULTS: The search retrieved 238 studies, and another 5 were identified in the articles' references, totaling 243 papers. After removing duplicates and applying the inclusion criteria and a full text reading, 13 articles were included for qualitative analysis. Concerning physical limitations, most complaints were related to the elevation of upper limbs, carrying heavy objects, driving and holding manual movements. The most referred symptoms were breast/arm pain, fatigue, lymphedema, reduced range of motion and weakness in the upper limbs, scar tissue adherence in the breast/axilla and paresthesia in the arm/breast. CONCLUSION: These symptoms and physical limitations led to the difficulty or impossibility of performing work tasks, which also diminished work productivity, as well as the increase in time to return to work. The present results suggest higher unemployment rates and the need for modifying work conditions. Implication for Rehabilitation Health professionals should include risk assessment at daily routine to identify possible sources of physical impairments for upper limbs. Provide the support and orientations according to personal and job characteristics of the patient. Focus the aims of treatment over upper limbs impairments, reducing the prevalence and the gravity of symptoms.

Implicações das cirurgias de câncer de mama nas atividades profissionais / Breast cancer surgery effect over professional activities

[{"text": "Introdução: O câncer de mama representa 25% de todos os tipos de câncer, sendo o de maior incidência na\r\npopulação feminina. Com o avanço dos tratamentos e diagnósticos precoces, as taxas de sobrevida têm aumentado e tal contexto reflete nos afastamentos laborais, tendo em vista que a maioria das mulheres se encontra em idade produtiva. Os principais motivos responsáveis pelos afastamentos do trabalho são as complicações físicas decorrentes do tratamento cirúrgico. Objetivo: Objetivou-se investigar as implicações cirúrgicas do tratamento do câncer de mama na atividade profissional, caracterizar o número de afastamentos laborais e investigar a relação entre o tipo de cirurgia nos afastamentos do trabalho e seus principais motivos. Método: Estudo transversal envolvendo 74 mulheres diagnosticadas com câncer de mama. Para a coleta dos dados, foi utilizada uma entrevista semiestruturada, que abordou as questões clínico-cirúrgicas, os dados sociodemográficos, o comportamento laboral e o tratamento fisioterapêutico. Os dados foram organizados no Microsoft Excel mediante frequências e o teste de qui-quadrado, sendo considerado p ≤ 0,05. Resultados: O lado esquerdo foi o mais acometido pela doença (51%), a cirurgia radical modificada do tipo Madden foi a mais comum (50%) e 93,2% submeteram-se à linfadenectomia axilar. As complicações operatórias\r\nmais frequentes foram dor, problemas cicatriciais, alteração da sensibilidade, limitação da ADM, linfedema e\r\nseroma. Apenas 58% delas fizeram fisioterapia e 60% afastaram-se das atividades profissionais, 23% abandonaram o trabalho, 26% modificaram as funções do trabalho e 14% se aposentaram por motivo de doença. Conclusão: Este estudo sugere a existência de uma relação direta do tratamento sobre os afastamentos laborais.", "_i": "pt"}, {"text": "Introduction: Breast cancer is responsible for 25% of all cancers and is the most prevalent in the female\r\npopulation. Due to treatment advances and early diagnoses, survival rates have improved, however this condition impacts work absenteeism due to the productive age of these women. The main factors responsible for work absenteeism are physical complications due to surgical treatment. Objective: The aim of this study is to investigate the effects of surgical breast cancer treatments on occupation, to characterize the degree of work absenteeism and to investigate the type of relation between surgical technique and absenteeism's main causes. Method: Cross-sectional study with 74 women diagnosed with breast cancer. A semi-structured interview was used to collect information regarding surgical and clinical aspects, sociodemographic data, work behavior and physical therapy treatments. The data was organized on Microsoft Excel and analyzed by frequency and chi-squared test. The significance level considered was p ≤ 0.05. Results: Breast cancer was most common on the left side (51%), Madden modified radical\r\nmastectomy was the most common (50%) and lymph node resection was present in 93.2% of cases. The most frequent post-surgery complications were pain, problems with scarring, sensitivity alterations, ROM limitation, lymphedema and seroma. Only 58% of women were treated with physical therapy and 60% withdrew from professional activities, 23% abandoned work, 26% changed their work role and 14% retired due to the disease. Conclusion: The present study suggests the existence of a direct relation between treatment and work absenteeism.", "_i": "en"}]

Psychometric properties of the Female Sexual Function Index in the visual analogue scale format.

The Female Sexual Function Index (FSFI) is the gold standard for evaluating female sexual function, yet it has not been validated in a visual analogue scale (VAS) format. The aim of the present study was to assess the psychometric properties of the FSFI applied to the VAS. METHODS: The study was conducted in three phases. In Phase 1, the instrument was adapted by two independent researchers, generating two versions, which were evaluated by a committee of six experts. The FSFI-VAS, resulting from this first phase, was used in a pilot study with 45 women. In Phase 2, the FSFI-Likert (original format) and FSFI-VAS questionnaires were administered to 246 women recruited to the study. Tests of reproducibility (test-retest/phase 3), internal consistency, discriminant validity and construct validity were applied. RESULTS: In Phase 1, the pilot study showed that there were no doubts and difficulties completing the FSFI-VAS. In Phase 2, the Spearman rank (validity) test showed high correlation between the total scores on the FSFI-Likert and FSFI-VAS (0.87). The results of the internal consistency test were between 0.66 and 0.88, and the results of the construct validity test indicated a good value (0.73). The discriminant validity test was also appropriate. In Phase 3, the lowest intraclass correlation coefficient value was 0.81. CONCLUSION: The FSFI-VAS has internal consistency, construct validity, discriminant validity and reproducibility adequate to assess female sexual dysfunction in young women.

Prevalence of female sexual dysfunction in Brazil: A systematic review.

The aim of this systematic review is to investigate the prevalence of female sexual dysfunction in the Brazilian population. This is a systematic review conducted in July 2016 in which four databases were searched: MEDLINE/Pubmed, Scopus, LILACS, and Cinahl. Two investigators extracted the primary data, which were fully analyzed, and applied the inclusion/exclusion criteria. The search found 113 results, and 20 of them compounded the scope of this study. Only four of the studies showed good methodology quality. The main diagnostics criteria used were validated questionnaires specific for sexual function assessment. Regarding the variation of prevalence values, female sexual dysfunction ranged from 13.3% to 79.3% of the studied population, while this value for changes in sexual desire ranged from 11% to 75%, arousal from 8% to 68.2%, lubrication from 29.1% to 41.4%, orgasm from 18% to 55.4%, and satisfaction from 3.3% to 42%; sexual activity frequency ranged from 55.8% to 78.5%, dyspareunia from 1.2% to 56.1%, and pleasure modifications was not addressed. Beside the divergences among studies, there is still a high prevalence of female sexual dysfunction in Brazil.

Sexual function and quality of life in gynecological cancer pre- and post-short-term brachytherapy: a prospective study.

PURPOSE: To evaluate the sexual function and quality of life pre- and post-gynecological cancer treatment with high-dose rate brachytherapy in the short term. METHODS: This is a descriptive and prospective study involving 20 women diagnosed with gynecological cancer aged between 18 and 70 years, resident in Florianopolis and the surrounding region. We used the Quality of Life Questionnaire Core-30 (QLQ-C30) 3.0 to assess quality of life pre- and post-brachytherapy treatment and the Female Sexual Function Index (FSFI) to assess sexual function. RESULTS: Regarding quality of life, significant worsening was observed for the items loss of appetite (p = 0.002) and diarrhea (p = 0.045) from pre- to post-brachytherapy treatment, whereas constipation (p = 0.013) improved. For sexual function, the statistical difference was found exclusively in the domain of lubrication reduction (p = 0.046). Only nine women were sexually active before and after brachytherapy treatment. CONCLUSIONS: There was a worsening of quality of life in comparing pre- and post-evaluations related to gastrointestinal symptoms over a period equivalent to 40 days. Regarding sexual function, lack of lubrication was identified in short-term post-gynecological cancer brachytherapy.

Processo de recuperação físico-emocional no pós-câncer ginecológico

Introdução: O câncer ginecológico é uma doença que abrange as malignidades do colo uterino, dos ovários, do endométrio e da vagina ou vulva, sendo considerado um problema de saúde pública, visto que há declínio na qualidade de vida (QV). Objetivo: Identificar as implicações físico-emocionais e comparar a qualidade de vida na pré e na pós-braquiterapia. Método: Estudo prospectivo com abordagem qualiquantitativa. Foi realizado no Centro de Pesquisas Oncológicas e foram avaliadas 20 mulheres sobreviventes do câncer ginecológico entre 18 e 70 anos (49,55 ± 16,98). Utilizou-se o instrumento EORTC QLQ ­ C30 para avaliar a QV e a entrevista semiestruturada com perguntas acerca da problemática. Resultados: As características sociodemográficas demonstraram predominância no diagnostico de câncer de colo de útero, com estadiamento tipo IIB. Com relação à qualidade de vida, observou-se diferença significativa após a braquiterapia nos itens Constipação (p= 0,027) e Diarreia (p= 0,004). Os domínios função física, emocional, cognitiva, social e desempenho de papéis tiveram decréscimo das funções. Os temas construídos a partir da análise das verbalizações foram: 1) alterações físicas: a) lidando com a dor e o sofrimento; b) enfrentando as dificuldades físicas; 2) alterações emocionais: a) superando a ansiedade, medo, angústia e depressão; b) enfrentando as implicações emocionais, e 3) alterações físico-emocionais. Conclusão: As implicações emocionais proporcionam um impacto importante na resposta física. As alterações no estado de saúde em geral e na qualidade de vida destas mulheres após a braquiterapia determinam a necessidade de readequar práticas cotidianas estimuladas por multiprofissionais da saúde.

Atuação da fisioterapia nas disfunções sexuais femininas: uma revisão sistemática / Physical therapy in sexually dysfunctional women: a systematic review

As disfunções sexuais femininas (DSFs) são consideradas um problema de saúde pública pela Organização Mundial da Saúde (OMS). Consistem em inúmeras desordens, como distúrbio da excitação feminina, distúrbio do desejo sexual hipoativo, transtorno sexual do orgasmo feminino, dispareunia e vaginismo. As DSFs são detectadas em 67,9% das mulheres no mundo e estão presentes em 50% das asiáticas, em 30 a 50% das americanas e em 30% das brasileiras. Objetivo: Revisar sistematicamente a literatura sobre as diferentes técnicas de fisioterapia utilizadas no tratamento das DSFs. Métodos: Realizou-se uma busca sistemática, nas bases de dados EMBASE, PEDro e MedLine, de artigos publicados até junho de 2013, através da combinação entre palavras e descritores de tratamentos fisioterapêuticos e disfunções sexuais femininas. Foram excluídos os artigos sobre disfunção sexual masculina, estudos pilotos, papers ou projetos multicêntricos, que não estivessem disponíveis na íntegra ou duplicados em outra base de dado. Após a seleção final dos estudos, foi verificada a pontuação dos ensaios clínicos randomizados na Escala de Avaliação PEDro. Resultados: 11 artigos foram incluídos e, destes, seis passaram para a avaliação qualitativa na Escala PEDro. Este estudo seguiu a estruturação metodológica do PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). Todos os estudos encontrados utilizaram questionários para avaliar os efeitos da intervenção fisioterapêutica nas DSFs. Foi verificado um total de cinco tipos de intervenções diferentes: cinesioterapia (exercícios de Kegel e treinamento muscular do assoalho pélvico - TMAP), terapia cognitivo-comportamental (CGBT), biofeedback, eletroterapia (TENS - eletroestimulação transcutânea e US - ultrassom terapêutico) e terapia manual. As limitações encontradas nesta revisão sistemática foram referentes a não disponibilização dos artigos na íntegra e à baixa qualidade metodológica dos estudos. Conclusão: Todos os estudos mostraram melhora na função sexual após intervenção fisioterapêutica. Não há um consenso sobre a intervenção com melhores resultados, no entanto, a cinesioterapia através do TMAP mostrou-se vantajosa por ser de fácil aplicação, baixo custo, aprendizado imediato e promover resultados duradouros em um curto período de tempo. No entanto, existem lacunas metodológicas que ainda precisam ser preenchidas para determinar o tratamento fisioterapêutico eletivo para as DSFs, assim como definir a melhor dosagem, o protocolo a ser seguido, a duração desta terapia, aliados ao melhor custo-benefício

The World Health Organization (WHO) considers Female Sexual Dysfunctions (FSDs) to be a public health issue. There are a multitude of disorders such as female sexual arousal disorder, hypoactive sexual desire disorder, orgasmic disorder, dyspareunia, and vaginismus. FSDs are detected in 67.9% of the women in the world and are present in 50% of Asians, in 30-50% of Americans, and in 30% of Brazilians. Objective: To systematically review the literature on the different physiotherapy techniques used in the treatment of FSDs. Methods: A systematic search was conducted in the databases EMBASE, PEDro, and MedLine in data as recent as June 2013, by combining words and descriptors of physical therapy treatments and female sexual dysfunctions. Excluded from review were articles concerning male sexual dysfunction, pilot studies, multicentric papers of projects, and those which were either not available in their entirety or were duplicated in another database. After the selection of studies was complete, the randomized clinical trials were scored on the PEDro Evaluation Scale. Results: Eleven articles were included, six of which went on to be qualitatively evaluated on the PEDro scale. The present study followed the methodological structure of PRISMA (Statement for Reporting Systematic Reviews and Meta-Analyses of Studies). All studies found used questionnaires to assess the effects of physical therapy on FSDs. A total of five different types of interventions were verified: kinesiotherapy (Kegel exercises and pelvic floor muscle training - PFMT), Cognitive behavioral therapy (CBT), biofeedback, electrotherapy (transcutaneous electrical stimulation - TENS, and therapeutic ultrasound - US), and manual therapy. The limitations found in this systematic review were related to the unavailability of the articles in full and the low methodological quality of the studies. Conclusion: All studies showed improvements in sexual function after physical therapy intervention. There is no consensus on any intervention with better results; however, kinesiotherapy using PFMT proved to be advantageous because of its easy application, low cost, easy learning curve, and lasting results achieved in a short period. However, there are methodological shortcomings that still need to be dealt with to determine the most suitable physical therapy treatment for FSDs, as well as defining the best dosage, the protocol to be followed, and the duration of therapy, as well as the best cost-benefit