Assessment of the bearing-down manoeuvre in pregnancy and detection of paradoxical levator ani muscle contraction using 2D transperineal ultrasound and vaginal palpation: a concurrent validity and inter-rater reliability study.

OBJECTIVE: To examine the concurrent validity and inter-rater reliability of vaginal palpation as a measure of the quality of the bearing-down manoeuvre (BDM) and the detection of a paradoxical levator ani muscle contraction (LAM) in pregnant women, compared with 2D transperineal ultrasound (TPUS). DESIGN: Concurrent validity and inter-rater reliability study. SETTING: Physiotherapy clinic. POPULATION: Twenty pregnant women in their third trimester. METHODS: The anterior posterior diameter (APD) was measured during the BDM using TPUS by one experienced physiotherapist. An APD that shortened by >2 mm from rest was described as LAM shortening, an APD that moved by 0-2 mm was described as no change and an APD that lengthened by >2 mm was described as LAM lengthening. Vaginal palpation described the LAM during the BDM as no movement, shortening or lengthening. Participants were allowed two attempts and the best attempt was measured. MAIN OUTCOME MEASURES: APD using TPUS and the assessor's subjective description of LAM during the BDM using vaginal palpation. RESULTS: TPUS detected more paradoxical LAM contractions during the BDM than palpation. Agreement between vaginal palpation and TPUS assessment for BDM was poor. The Fleiss kappa coefficients were 0.457 (90% CI 0.16-0.71) between TPUS and one assessor and 0.326 (90% CI 0.01-0.6) between TPUS and the other assessor. In addition, inter-rater reliability was poor between observers palpating the BDM, with a Fleiss kappa coefficient of 0.375 (90% CI 0.13-0.64). CONCLUSIONS: This study did not find vaginal palpation of the BDM in pregnant women to have concurrent validity or inter-rater reliability. Clinicians should be aware of potential inaccuracies when palpating the BDM, and, where possible, seek an assessment via TPUS.

International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction.

INTRODUCTION: The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research. METHODS: This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent. RESULTS: A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated. CONCLUSION: A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.

Transcutaneous Tibial Nerve Stimulation in the Management of Overactive Bladder: A Scoping Review.

OBJECTIVE: Overactive bladder (OAB) is a condition that has physical, social, psychosocial, and financial impacts. Transcutaneous tibial nerve stimulation (TTNS) is a modality that stimulates the nerve root fibers of L5-S3, the same spinal segments of the parasympathetic nervous system as the bladder. This scoping review aims to identify current literature available on the feasibility and outcomes of TTNS as a first-line treatment option for OAB. MATERIALS AND METHODS: A scoping review of six electronic data bases was performed to identify full-text articles from 2015 that explored the impact of TTNS on OAB and bladder dysfunction in people aged >18 years. RESULTS: A total of 15 articles met the inclusion criteria. TTNS was compared with sham treatment, parasacral stimulation, pelvic floor muscle training (PFMT), anticholinergic medication, and percutaneous tibial nerve stimulation (PTNS). Heterogeneity in treatment application and parameters existed, with variations in treatment duration, frequency of use, and treatment settings such as pulse width (µs) and frequency (Hz). Results indicated that TTNS has efficacy equal to PFMT and PTNS in the management of OAB; however, it is not as efficacious as anticholinergic medication. CONCLUSIONS: TTNS is a promising first-line management option for people with OAB, particularly in the older population and for those with neurogenic bladder. It can provide symptomatic relief from urinary incontinence, frequency, urgency, and nocturia, while avoiding the bothersome side effects of more invasive or pharmaceutical therapies. Heterogeneity in treatment parameters limits generalizability and translation of the most appropriate clinical application and should be considered in future trials.

Predictors of self-perceived cultural responsiveness in entry-level physiotherapy students in Australia and Aotearoa New Zealand.

BACKGROUND: Ensuring physiotherapy students are well prepared to work safely and effectively in culturally diverse societies upon graduation is vital. Therefore, determining whether physiotherapy programs are effectively developing the cultural responsiveness of students is essential. This study aimed to evaluate the level of self-perceived cultural responsiveness of entry level physiotherapy students during their training, and explore the factors that might be associated with these levels. METHODS: A cross sectional study of physiotherapy students from nine universities across Australia and Aotearoa New Zealand was conducted using an online self-administered questionnaire containing three parts: The Cultural Competence Assessment tool, Altemeyer's Dogmatism scale, and the Marlowe-Crowne social desirability scale- short form. Demographic data relating to university, program, and level of study were also collected. Data was analysed using one-way ANOVA, t-tests and multiple regression analysis. RESULTS: A total of 817 (19% response rate) students participated in this study. Overall, students had a moderate level of self-perceived cultural responsiveness (Mean (SD) = 5.15 (0.67)). Fewer number of weeks of clinical placement attended, lower levels of dogmatism, and greater social desirability were related to greater self-perceived cultural responsiveness. Additionally, fourth year undergraduate students perceived themselves to be less culturally responsive than first and second year students (p < 0.05). CONCLUSIONS: These results provide educators with knowledge about the level of self-perceived cultural responsiveness in physiotherapy students, and the factors that may need to be assessed and addressed to support the development of culturally responsive practice.

Pre-Operative Pelvic Floor Muscle Training--A Review.

The use of pelvic floor muscle training has been well established for the management of post-prostatectomy incontinence. In recent years, it has been hypothesized that because the severity and period of incontinence are not predictable pre-operatively, it makes sense to teach all men the new motor skill of correct pelvic floor muscle activation before surgery. This review is based on literature found through computerized and manual searches on available databases. Included were any studies that looked at the effect of adding pelvic floor muscle training pre-operatively and comparing them to the effect of not having pre-operative pelvic floor muscle exercises. Pre-operative pelvic floor muscle training was found to be effective in reducing the time to continence as well as the severity of incontinence in only four studies. Adding biofeedback or electrical stimulation was not found to change the outcomes.

Psychometric Properties of the Translated Spanish Version of the Vaginal Penetration Cognition Questionnaire: A Preliminary Work for Validation.

(1) Background: To develop an instrument in Spanish to assess beliefs and feelings about vaginal penetration and assess its psychometric properties. (2) Methods: This study translated and adapted the Vaginal Penetration Cognition Questionnaire into Spanish, and a total of 225 women who suffered from Genito-Pelvic Pain/Penetration Disorder were included in the study. The psychometric properties, including construct, convergent and discriminant validity, test-retest reliability, and internal consistency of the translated version were assessed. (3) Results: The Spanish version of the Vaginal Penetration Cognition Questionnaire is a valid, reliable, and consistent tool to assess beliefs and thoughts about vaginal penetration in women suffering from Genito-Pelvic Pain/Penetration Disorder. The exploratory factor analysis yielded four domains that explained 62.5% of the variance. Convergent and discriminant validity was also confirmed. Test-retest reliability was high, with an intraclass correlation coefficient value of 0.90, a standard error of measurement of 4.21, and a minimal detectable change of 11.66 points. Every domain also showed good internal consistency levels, with Cronbach's α values ranging from 0.84 to 0.89. (4) Conclusion: The Spanish version of the Vaginal Penetration Cognition Questionnaire is a valid, reliable, and consistent tool to assess vaginal penetration cognition in women suffering from Genito-Pelvic Pain/Penetration Disorder.

While allied health students prefer face-to-face clinical placement, telehealth can support competency development: results from a mixed-methods study.

Introduction: Student clinical placements are a mandatory requirement within most accredited health programs. During the COVID-19 pandemic, many health settings that had traditionally provided placements cancelled their offerings. Telehealth services however, increased and emerged as an alternative placement setting. Aim: To compare the learning experiences for allied health students provided by telehealth and face-to-face accredited health placements. Methods: Health students, from a university clinic between March to December 2020, delivering both face-to-face and telehealth consultations, were invited to complete a telephone survey with 3 demographic questions; and 10-items comparing their telehealth and face-to-face learning experiences. Pearson's chi-squared/Fisher's exact test was used to examine the association between each item and consultation setting. Qualitative survey data was thematically analysed using a descriptive approach. Results: 49 students from 2 universities and 5 disciplines completed the survey. Students rated their face-to-face experiences significantly higher than their telehealth experiences across all items (all p-values <0.01). Across 9 items students reported positive learning experiences in both settings. Students had greater opportunities to work in a multidisciplinary team in a face-to-face setting. Four themes were generated: (1) placements can vary in quality regardless of setting; (2) telehealth can provide valuable learning experiences and support competency development; (3) enablers for telehealth placements and (4) barriers for telehealth placements. Conclusion: While telehealth can support student learning and competency development, in this study students preferred face-to-face experiences. To optimise telehealth placements consideration needs to be given to barriers and enablers such as technological issues and university curricula preparation.

Opportunities and Capabilities to Perform Pelvic Floor Muscle Training Are Critical for Participation: A Systematic Review and Qualitative Meta-Synthesis.

OBJECTIVE: Pelvic floor muscle training (PFMT) is considered a behavioral task that requires the interaction of physical, social, and cognitive processes. Enablers and barriers to participation in PFMT have been explored primarily in women. This review aimed to identify the barriers and enablers that influence participation in PFMT in all adult populations. METHODS: A systematic review and meta-synthesis of qualitative literature was conducted. The inclusion criteria comprised qualitative studies with populations of people aged 18 years and older who have been recommended for PFMT. Line-by-line coding and an inductive thematic analysis identified themes that were applied to the Theoretical Domains Framework and Capabilities, Opportunities, and Motivation Behavioral Model to determine behavioral influences on PFMT. RESULTS: Twenty full-text articles met inclusion criteria. PFMT was mostly influenced by individual opportunities impacted by social determinants and competing demands. Capability of carrying out PFMT was impacted by knowledge, understanding, and appropriate skill acquisition linked to self-efficacy. CONCLUSION: Increasing opportunities and capabilities for engagement in PFMT are the most important factors in optimizing positive behavior changes. Ways to address these factors include clear patient communication to boost confidence in skill acquisition and using technology to encourage autonomy and improve convenience. Future research should address the impact of health professionals' beliefs about patient participation, assess the role of social values and gender roles, and explore the timing of the implementation of behavioral change strategies to improve PFMT. IMPACT: This is believed to be the first systematic review and qualitative meta-synthesis to consider the enablers and barriers to participation in PFMT for all adult populations, purposes, and symptom complexes. Patient opportunities and capabilities are the greatest influencers on participation and self-efficacy. Individualized treatment approaches that acknowledge and address social influencers and competing demands will optimize self-efficacy and participation. LAY SUMMARY: If you have pelvic floor muscle dysfunction, your opportunities and capabilities are the greatest influencers on participation and self-efficacy in PFMT. Your physical therapist can design individualized treatment approaches that acknowledge and address social influencers and competing demands to help you optimize participation.

The Effects of Multimodal Prehabilitation Interventions in Men Affected by Prostate Cancer on Physical, Clinical and Patient Reported Outcome Measures: A Systematic Review.

OBJECTIVES: To synthesize existing evidence on the effects of multimodal prehabilitation interventions in men affected by prostate cancer on physical, clinical, and patient-reported outcome measures. DATA SOURCES: A systematic review was conducted according to the PRISMA 2020 Statement Guidelines. Electronic databases (ie, Medline, Embase, CINAHL and Cochrane CENTRAL, and clinicaltrials.gov) were searched using key search terms. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. The findings were integrated in a narrative synthesis. CONCLUSION: Of the 5863 publications screened, 118 articles were assessed in full text and 17 studies met the prescreening eligibility criteria. There were a range of study designs that included randomized controlled clinical trials (n = 11), quasi experimental (n = 4), cohort (n = 1), and case series (n = 1), covering a total of 1739 participants. The prehabilitation interventions included physical activity, peer support, pelvic floor muscle training, diet, nurse-led prehabilitation, psychological, and prehabilitation administration of phosphodiesterase-5 inhibitors. IMPLICATIONS FOR NURSING PRACTICE: Significant heterogeneity existed in the prehabilitation intervention programs for men affected by prostate cancer in terms of the composition, duration, method of administration, and the outcomes measured to quantify their impact. This systematic review has identified that multimodal prehabilitation interventions are an emerging area for practice and research among men affected by prostate cancer. Importantly, there has been a lack of focus on the inclusion of partners as critical companions during this distressing phase of the cancer care continuum. For the moment, all members of the multidisciplinary team caring for people affected by prostate cancer are encouraged to use the findings in this review to inform holistic models of care.

Assessing muscle function of the male pelvic floor using real time ultrasound.

AIMS: Following surgical removal of the prostate, there may be compromise to the function of the pelvic floor muscles causing continence problems. Assessing the pelvic floor muscles of male patients can be an invasive process that causes discomfort, making it worthwhile to evaluate alternatives to the conventional method of Digital Rectal Examination (DRE). Real time ultrasound (RTUS) has been used with female patients as an alternative to internal assessments. This paper examines the reliability and validity of assessing the male pelvic floor using abdominal RTUS. METHODS: Twenty-eight men (mean age 66.2) with a history of treatment for prostate cancer were recruited to the study. They were assessed via DRE and RTUS. Findings from the procedures were correlated for evaluation of validity, and the RTUS readings were repeated by different therapists to assess reliability. RESULTS: Measurements on screen correlated moderately with DRE findings (r = 0.57, P = 0.002), and RTUS was found to have good reliability (Intra-class Correlation Coefficient = 0.90). Continent men had more movement of the bladder wall on RTUS than those who were incontinent (P = 0.043). Scar tissue and an inability to maintain a moderately full bladder were found to cause the most difficulty in getting a complete picture of pelvic floor movement. CONCLUSIONS: RTUS can be used clinically to examine male pelvic floor function, and its use would be enhanced once it has been established by DRE that a true pelvic floor contraction is occurring. RTUS can give an indication of pelvic floor function as an alternative measurement method when DRE is contraindicated.

The history of urologic surgery: from reeds to robotics.

Bladder function has interested man since prehistoric times. Evidence of health and well being was often measured from observation of urine. When urologic function was impaired, the extent of the ensuing pain often called for dramatic measures to obtain relief. The practice of urology has advanced substantially since the days when reeds were used to alleviate obstruction of the bladder. This article presents a brief historical overview of urology and the strides made in prostate surgery with modern technology.

Pelvic Floor Muscle Training in Radical Prostatectomy and Recent Understanding of the Male Continence Mechanism: A Review.

OBJECTIVE: Pelvic floor muscle training (PFMT) is recommended as part of supportive care for patients with prostate cancer. It can assist in reducing treatment-related symptoms such as urinary incontinence. This literature review aims to discuss recent innovative findings on the pathophysiology of the male continence mechanism and implications for PFMT in radical prostatectomy. DATA SOURCES: CINAHL, Embase, Web of Science, Emcare and PsycINFO were searched until January 2020. CONCLUSION: Nurses providing supportive care for patients undergoing radical prostatectomy can engage in-clinic in the instruction and recommendation of pre- and postoperative PFMT and delivering guidance on home-based programs to promote motor learning. IMPLICATIONS FOR NURSING PRACTICE: Optimal postoperative urinary incontinence outcomes are suggested to be promoted by preoperative PFMT. Training focused on the urethral and anterior pelvic floor muscle complex has been shown to facilitate mid urethral occlusion required for continence. Prescription of PFMT should be individualised, focusing on skill acquisition and motor learning, which is in line with recent knowledge developments in male pelvic floor anatomy.

The Impact of Exercise and Nutrition as Part of a Person-Centered Approach to Prehabilitation in Patients with Bladder Cancer.

BACKGROUND: Muscle invasive bladder cancer (MIBC) is commonly treated with radical cystectomy. Patients who require radical cystectomy are often frail, unwell, have multiple comorbidities, and can experience unmet supportive care needs. Due to these complexities, patients requiring radical cystectomy are often considered high risk for anesthetics, and therefore improving their physical and psychological well-being is crucial prior to radical surgery. Prehabilitation is the practice of enhancing a patient's functional and psychological capacity before surgery, with the aim of improving postoperative outcomes. This narrative review aims to identify and evaluate the role of physical exercise, nutritional intervention, and person-centered holistic approaches to prehabilitation in people affected by MIBC treated by radical cystectomy. DATA SOURCES: Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and grey literature were searched using Google scholar until June 2020. CONCLUSION: Evidence to support specific prehabilitation clinical recommendations in people affected by MIBC is emerging. Prehabilitation including exercise prescription, nutritional intervention, and person-centered holistic support is an important part of the clinical pathway for people affected by MIBC. Individualized prehabilitation programs across the multidisciplinary team should be considered to provide specific individual recommendations to avoid "one size fits all". Given the limited research in this clinical area, future high-quality multi-center prospective trials are urgently needed. IMPLICATIONS FOR NURSING PRACTICE: People affected by MIBC can experience a range of unmet supportive care needs in routine clinical care delivery at the time of diagnosis and into survivorship. Evidence is emerging around the role of multidisciplinary interventions in the form of exercise, nutritional input, and holistic supportive care to improve physical and psychological well-being prior to major surgery. Specialist nurses are ideally placed to ensure that individual holistic care needs are addressed, and appropriate care and support is provided. Nurses can trigger timely referrals to members of the multidisciplinary team to coordinate an integrated person-centered approach to prehabilitation service provision to address the unmet needs of people undergoing treatment for MIBC.

Improving Physical and Mental Health in Patients with Prostate Cancer Undergoing Androgen Deprivation Therapy: Strategies to Promote and Improve Physical Activity Quality and Quantity.

OBJECTIVE: Prostate cancer continues to be one of the highest-incident cancers among men. Reducing serum testosterone with androgen deprivation therapy (ADT) is a common effective treatment. While well-demonstrated for cancer suppression, there are numerous adverse effects caused by ADT that can contribute to short- and long-term prognosis. Increased levels of physical activity (PA) during treatment may reduce these side effects. However, uptake of PA is low. The purpose of this review is to identify and evaluate the current literature on strategies to promote and increase the levels of PA in patients with prostate cancer undergoing ADT. DATA SOURCES: Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and grey literature were searched using Google Scholar up until April 2020. CONCLUSION: At present the most appropriate modes and dosages of PA for specific ADT toxicities is not known. It is established that some PA in the form of exercise, whether aerobic or resistance, is better than being sedentary for improvements in physical health, but beyond this prescription specifics have not been established. Further research is required to understand the impact of PA on the mental and physical health of men with prostate cancer undergoing ADT. IMPLICATIONS FOR NURSING PRACTICE: Being physically active and avoiding sedentary behaviour is important for men with prostate cancer undergoing ADT, especially the implementation of strength training. PA in the form of exercise can assist in reducing the adverse physical side effects in the short- and long-term, with limited understanding of the effects on mental health. PA improves mental health outcomes across populations, which may also translate to men with prostate cancer, although further research is required. An important strategy to improve PA within the prostate cancer population is to provide an early referral to an exercise professional, such as an accredited exercise physiologist/clinical exercise physiologist or physical therapist/physiotherapist, and is supported by research as best practice for people affected by cancer undergoing active treatment.

The Role of Telehealth During the COVID-19 Pandemic Across the Interdisciplinary Cancer Team: Implications for Practice.

OBJECTIVE: This literature review aims to explore the role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer care team. DATA SOURCES: Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and gray literature were searched using Google Scholar up until September 2020. CONCLUSION: Although the safe and effective delivery of cancer care via telehealth requires education and training for health care professionals and patients, telehealth has provided a timely solution to the barriers caused by the COVID-19 pandemic on the delivery of interdisciplinary cancer services. Globally, evidence has shown that telehealth in cancer care can leverage an innovative response during the COVID-19 pandemic but may provide a long-lasting solution to enable patients to be treated appropriately in their home environment. Telehealth reduces the travel burden on patients for consultation, affords a timely solution to discuss distressing side effects, initiate interventions, and enable possible treatment additions and/or changes. IMPLICATIONS FOR NURSING PRACTICE: Global public health disasters pose significant and unique challenges to the provision of necessary services for people affected by cancer. Oncology nurses can provide a central contribution in the delivery of telehealth through transformational leadership across all domains and settings in cancer care. Oncology nurses provide the "hub of cancer care" safely embedded in the interdisciplinary team. Telehealth provides a solution to the current global health crisis but could also benefit the future provision of services and broad reach clinical trials.

Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy.

Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training provides a plausible solution. Although early trials provided promising results, systematic reviews have questioned the efficacy of this intervention. A major consideration is that most clinical trials in men have applied principles developed for pelvic floor muscle training for stress urinary incontinence in women, despite differences in anatomy between sexes and differences in the mechanisms for continence/incontinence. Literature regarding continence control in men has been conflicting and often based on erroneous anatomy. New understanding of continence mechanisms in men, including the complex contribution of multiple layers of striated pelvic floor muscles, and detailed consideration of the impact of radical prostatectomy on continence anatomy and physiology, have provided foundations for a new approach to pelvic floor muscle training to prevent and treat incontinence after prostatectomy. An approach to training can be designed to target the pathophysiology of incontinence. This approach relies on principles of motor learning and exercise physiology, in a manner that is tailored to the individual patient. The aims of this review are to consider new understanding of continence control in men, the mechanisms for incontinence after radical prostatectomy, and to review the characteristics of a pelvic floor muscle training program designed to specifically target recovery of continence after prostatectomy.

Perceptions of embarrassment for men with and without urinary incontinence.

There is little information available about the impact incontinence has on men. Using photographs, men were asked to rate the perceived embarrassment of the wearer. Embarrassment ratings rose with the size of the visible wet area, but were lower from those who had experienced the problem themselves. Knowing how to deal with the feelings of embarrassment seems to be critical when dealing with incontinent males.

Systematic review of the treatment of post-prostatectomy incontinence.

A systematic review was conducted to critically analyze the literature on pelvic floor muscle training, biofeedback, electrical stimulation, and behavioral therapy for managing post-prostatectomy incontinence. Currently, there is a need for further study to better identify the specific components that determine the efficacy of conservative measures in the treatment of male incontinence post surgery.