Relationship among vaginal palpation,vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

Background:

The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function.

Objective:

To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM.

Method:

This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p<0.05).

Results:

There was a strong positive correlation between PFM function and PFM contraction pressure (0.90). In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively) and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively).

Conclusions:

This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment.     

Total glucosides of paeony for rheumatoid arthritis: A systematic review of randomized controlled trials

BackgroundTotal glucosides of paeony (TGP) is commonly used to treat rheumatoid arthritis (RA) in China. However, clinical practice hasn’t been well informed by evidence from appropriately conducted systematic reviews. This PRISMA-compliant systematic review aims at examining the effectiveness and safety of TGP for RA.MethodsRandomized controlled trials (RCTs) comparing TGP with placebo, no treatment, or disease-modifying antirheumatic drugs (DMARDs) for patients with RA were retrieved by searching seven databases. Primary outcomes included disease improvement and disease remission. Secondary outcomes included adverse effects, pain, health-related quality of life, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Data extraction and analyses were conducted according to the Cochrane standards. We assessed risk of bias for each included studies and quality of evidence on pre-specified outcomes.ResultsEight studies enrolling 1209 patients with active RA were included in this systematic review. On the basis of traditional DMARD(s), TGP might be beneficial for patients with RA in improvement of American College of Rheumatology (ACR) 20 response rate, ACR 50 response rate, ACR70 response rate, and in reduction of adverse effects, compared with no treatment. The overall methodological quality of included studies and the quality of evidence for each outcome were limited.ConclusionsCurrent trials suggested potential benefits of TGP for RA on the basis of traditional DMARD(s). Therefore, TGP may be a good choice for RA as an adjuvant therapy. However, considering the limited methodological quality and strength of evidence, high-quality RCTs are warranted to support the use of TGP for RA.     

Therapeutic ultrasound for knee osteoarthritis: A systematic review and meta-analysis with grade quality assessment

BackgroundTherapeutic ultrasound (US) is a widely used intervention in physical therapy to manage pain and to aid in the healing of soft tissue.ObjectiveThis systematic review aimed to determine the effects of therapeutic US on knee osteoarthritis (KOA) symptoms.MethodsPubMed, MEDLINE, EMBASE, Google Scholar, and the Cochrane databases were searched from inception to April 2019. Randomized controlled trials (RCTs) involving adults with symptomatic KOA that compared therapeutic US with a sham or other control were included. The methodological quality of the trials was assessed at the study level using the Cochrane Risk of Bias tool. The quality of evidence at the outcome level- and overall- was assessed using GRADE methodology. Meta-analyses were conducted using random effects models, and heterogeneity was assessed using the I² statistic.ResultsFour studies (N = 234 participants) were eligible for inclusion in our primary analyses assessing therapeutic US versus sham. The methodological quality of the included RCTs ranged from moderate to very low. Treatment with therapeutic US resulted in small, statistically significant benefits for pain (approximate 9.6% improvement on a 0–100 visual analog scale [95% confidence interval: 2, 17.4%]) and self-reported measures of function (approximate 12.8% improvement on a 0–100 visual analog scale [0.4, 25.2%]). The overall quality of the evidence was very low. No adverse events were reported in any of the included studies.ConclusionsThe use of therapeutic US may provide additional benefits to physical therapy regimens in terms of symptom relief in individuals with KOA. However, it is not possible to make any meaningful recommendations for clinical practice due to the small number of applicable RCTs and the low methodological quality of the RCTs deemed eligible for this study.     

Verbal and Visual Feedback Immediately Affect the Electromyographic Activity of Female Pelvic Floor Muscles

ObjectiveThe purpose of this study was to assess the immediate effect of verbal and visual feedback on pelvic floor muscles (PFM) in nulliparous women without pelvic floor dysfunction.MethodsIn this observational, single-assessor, cross-sectional study, 45 female university students were evaluated using bidigital vaginal palpation and vaginal surface electromyography (EMG). EMG assessments were performed at 2 time points (T1 and T2). According to the protocol, participants performed 5 maximal voluntary contractions (MVC) with 10-second intervals, 5 sustained voluntary contractions (SVC) for 10 seconds, and a 60-second voluntary contraction until fatigue (CUF) before (T1) and after (T2) receiving verbal instructions and visual feedback on PFM contractions. At T2, women received visual feedback on their PFM contraction. Root mean square (RMS) for each repetition (MVC and VCF) was recorded, and mean value was calculated. Compensatory mechanisms during contraction were recorded visually. The difference in mean RMS (mV) for MVC, SVC, and CUF; curve integral for MVC, SVC, and CUF; median frequency (Hz) for CUF between T1 and T2 were analyzed with repeated measures multivariate analysis of variance.ResultsBefore the instructions, most participants (95.6%) performed PFM MVC using at least 1 compensatory mechanism. PFM EMG outcomes changed at T2: RMS and curve integral were reduced in T2 (P < .05) for MVC, SVC, and CUF. The median frequency increased from T1 to T2 in the CUF group (P = .01).ConclusionVerbal and visual feedback had an immediate impact on the EMG activity of PFM in nulliparous continent women.     

Manual therapy and exercise for impingementrelated shoulder pain

Abstract

Background: Shoulder complaints are among the commonest causes of musculoskeletal pain. They are potentially disabling and frequently cause absenteeism from work and claims for sickness benefits. One of the most prevalent subtypes of shoulder pain is impingement. This is often managed physiotherapeutically, with 'hands-on' manual therapy and exercises being mainstays.

Objectives: To assess the effectiveness of manual therapy and exercises to improve pain, disability and function in people with shoulder impingement.

Methods: A systematic review was conducted including systematic reviews, quasi-randomized trials and randomized controlled trials published up to October 2008. Searches included the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Medline, Embase, Cinahl and PEDro. Methodological quality and risk of bias were assessed with appropriate instruments. All findings were critically analysed and discussed, and summary conclusions formulated.

Results: Eight systematic reviews and six randomized controlled trials were included. Methodological quality and risk of bias as well as population and treatment parameters varied. Clinical heterogeneity prevented meta-analysis, thus all findings were synthesized narratively. The included research provides limited evidence to support the use of manual therapy and exercise interventions for shoulder impingement. This primarily relates to subacute and chronic conditions and short to medium-term effectiveness.

Conclusions: Manual therapy and exercise seem effective for shoulder impingement, but varying methodological quality and risk of bias in reviews and trials warrant caution in the interpretation of the results. There is a need for further good-quality primary research.     

Clinical effects of date palm (Phoenix dactylifera L.): A systematic review on clinical trials

PurposeThe aim of present study was to review and categorize the clinical trials investigating the clinical effects of different botanical parts of dates compared with any controls.MethodsAll clinical trials (randomized, pilot, quasi-experimental, cross-over. and non-randomized clinical trials) evaluating the clinical effects of date palm from 2000 until August 2019 in English and Persian languages were included in this systematic review. The methodological quality of the included studies was evaluated according to the risk of bias assessment of Cochrane handbook of systematic reviews, and then reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.ResultsTwenty-six studies met the inclusion criteria. Studies were performed in 8 categories based on different botanical parts of date palm. These categories were obstetrics, gynecology, oncology, dermatology, hematology, gastroenterology, endocrinology, metabolism, and infertility. A total of 38 % of included studies were randomized controlled trials. Further, 80 % of the included studies had performance and detection bias. Finally, about 50 % of them had selection bias and about 20 % had attrition and reporting bias.ConclusionThe widespread consumption of date palm as medicinal and botanical plant suggests the importance of this plant in human healthcare. The clinical trials conducted so far have explained a number of clinical effects of date palm. However, there is not enough clinical evidence to support the clinical effects in other review articles and traditional medical systems, and further randomized controlled trials with robust designs and methods are required.     

Effect of Motor Control Training on Trunk Muscle Morphometry,Pain, and Disability in People With Chronic Low Back Pain: A Systematic Review and Meta-Analysis

ObjectiveThe aim of this systematic review and meta-analysis was to study the effects of motor control training (MCT) on trunk muscle morphometry measured by ultrasound imaging and pain and disability in individuals with chronic low back pain.MethodsPubMed, Web of Science, Scopus, and Cochrane Library databases were searched from study inception until January 2021. Randomized control trials evaluating both muscle morphometry and pain or disability in individuals with chronic low back pain were included. Study selection, data extraction, and quality assessment were performed by 2 reviewers independently. Modified Downs and Black tool and the Grading of Recommendations Assessment, Development and Evaluation approach were used to assess the risk of bias and quality of evidence, respectively. A meta-analysis was performed using a random effects model with mean difference or standardized mean difference (SMD).ResultsOf 3459 studies initially identified, 15 studies were included, and 13 studies were selected for meta-analysis. The results revealed no differences in the resting thickness of the transversus abdominis, internal and external oblique, and lumbar multifidus muscles in studies that compared MCT with other interventions. The transversus abdominis muscles contraction ratio was greater (SMD = 0.93; 95% confidence interval [CI], –0.0 to 1.85) and lower pain (weighted mean difference: –1.07 cm; 95% CI, –1.91 to –0.22 cm; P = .01) and disability (SMD = –0.86; 95% CI, –1.42 to –0. 29; P < .01) scores were found in the groups who underwent MCT compared with other interventions.ConclusionThis systematic review and meta-analysis found that motor control exercise training increased the transverse abdominis contraction ratio (muscle activation) and improved the level of pain and disability compared to other interventions in people with chronic low back pain. However, motor control exercise training was not superior to other interventions in increasing the resting thickness of deep abdominal and lumbar multifidus muscles in intervention times less than 12 weeks.     

Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials

ObjectiveThis systematic review of randomized controlled trials aimed to examine the effectiveness of dry needling in the treatment of myofascial trigger points and to explore the impact of specific aspects of the technique on its effectiveness.MethodsRelevant studies published between 2000 and 2015 were identified by searching PubMed, Scopus, The Cochrane Library and Physiotherapy Evidence Database. Studies identified by electronic searches were screened against a set of pre-defined inclusion criteria.ResultsFifteen studies were included in this systematic review. The main outcomes that were measured were pain, range of motion, disability, depression and quality of life. The results suggest that dry needling is effective in the short term for pain relief, increase range of motion and improve quality of life when compared to no intervention/sham/placebo. There is insufficient evidence on its effect on disability, analgesic medication intake and sleep quality.ConclusionsDespite some evidence for a positive effect in the short term, further randomized clinical trials of high methodological quality, using standardized procedures for the application of dry needling are needed.     

Effect of dexmedetomidine on hemodynamics in patients undergoing hysterectomy: a meta-analysis and systematic review

ObjectiveWe conducted a meta-analysis and systematic review to evaluate the effects of dexmedetomidine on the hemodynamics of patients undergoing hysterectomy.MethodsWe searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases for clinical randomized controlled trials (RCTs) that allowed direct or indirect comparisons of hemodynamic indicators. We also searched nine English-language databases up to April 2021 to identify relevant research. The Cochrane risk-of-bias tool for RCTs was applied to assess the methodological quality of the eligible studies. The meta-analysis was conducted using RevMan 5.4 software.ResultsNine trials were included in this systematic review. The effect of dexmedetomidine on heart rate during surgery was significantly smaller than that of other sedatives. Intraoperative systolic and diastolic blood pressure and mean arterial pressure were more stable in the dexmedetomidine group compared with the control group. The postoperative modified Observer’s Assessment of Alertness Score was also better in the dexmedetomidine compared with the control group.ConclusionsDexmedetomidine increases hemodynamic stability in patients undergoing hysterectomy, reduces the cardiovascular stress response during surgery, and effectively prevents postoperative adverse reactions, with good safety.     

A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa

Abstract

Purpose: The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa. Method: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale. Results: Eight randomised controlled trials involving 213 patients (age range: 16–36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score≥3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported. Conclusions: The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research.

• Implications for Rehabilitation

• Supervised physical therapy might increase weight in anorexia nervosa patients.

• Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa.

• Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating disorder.

     

Pulsed electromagnetic energy in management of chronic wounds: a systematic review

Abstract

Objectives: To assess the evidence regarding effectiveness of pulsed electromagnetic energy (PEME) on the healing of chronic wounds; to explore whether there is an optimum treatment regime with regards to total current, pulse amplitude, pulse duration, and duration and frequency of treatments.

Methods: A computerised literature search of the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and PubMed was performed. Only randomised clinical trials (RCT), controlled trials, and clinical trials that studied a population aged 18 years of age or more and investigated the effects of a type of PEME in the management of a chronic wound were included. The methodological quality of the included trials was assessed qualitatively using a set of formal criteria as recommended by van Tulder et al.

Results: Eleven studies (n=360) out of 40 were included of which six were of high methodological quality. Methodological scores ranged from one to nine (maximum 11) with a mean score of 5·5 (SD=1·73). For venous ulcers, there is strong evidence that PEME is more effective than sham PEME. For pressure and plantar ulcers, there is moderate evidence that PEME, in combination with conventional wound care is better than conventional wound care alone. The heterogeneity in duration, frequency, voltage and magnetic field made it difficult to make detailed comparisons or specific recommendations regarding its application.

Discussion: Further research should focus on controlling baseline recruitment parameters within an RCT, studying vital outcomes, and exploring combinations of parameters regarding optimum usage of PEME.     

The effectiveness of Sufi music for mental health outcomes. A systematic review and meta-analysis of 21 randomised trials

BackgroundThere is some evidence that Sufi music therapy might improve physical and mental well-being; however, no systematic review or meta-analysis has pooled and critiqued the evidence. The aim of this systematic review was to evaluate the effects of Sufi music therapy on mental health outcomes.MethodsWe searched Medline, PsycINFO, the Web of Science, Science Direct, PsycARTICLES, Cochrane Library, SCOPUS, CINAHL Plus, AMED, and ULAKBIM databases, and the reference lists of the studies found. Papers published in academic peer-reviewed journals were included, as well as from other sources such as chapters in edited books, the grey literature, or conference presentations. Articles published up to March 2020 in Turkish and English were included. Our primary outcome of interest was anxiety and secondary outcomes of interest were other mental health outcomes such as depression. To assess the methodological quality of the articles, the Cochrane Risk of Bias Tool was used. The quality of evidence was assessed using the GRADEpro GDT system.ResultsThis search yielded 21 clinical trials that were eligible for inclusion. A meta-analysis, using a random effects model, of 18 randomised controlled trials involving 1454 participants showed that Sufi music therapy with makams, compared with treatment as usual (TAU) or a no-music control group, reduced symptoms of anxiety in the short term in patients undergoing an operation or treatments such as chemotherapy or haemodialysis (standardised mean difference SMD= −1.15, 95 % CI, −1.64 to −0.65; very low-quality evidence). The evidence of Sufi music with makam's effect on anxiety is rated as very low. Qualitative synthesis of secondary outcomes revealed significant effects for depression, positive symptoms in schizophrenia, stress, which however were based on fewer studies. Trials were of moderate methodological quality, and there was significant heterogeneity across the studies.ConclusionSufi music may reduce anxiety of patients undergoing medical procedures like haemodialysis, coronary artery surgery, angiography, colonoscopy, bone marrow aspiration and biopsy procedures. Evidence from single studies suggests effects on depression and stress as well. However, due to methodological limitations of the studies, further, higher quality studies are required in other cultures.     

Dry needling for the management of spasticity,pain, and range of movement in adults after stroke: A systematic review

ObjectiveTo summarise the available evidence about the effectiveness of deep dry needling (DN) on spasticity, pain-related outcomes, and range-of-movement (ROM) in adults after stroke.DesignA computer search of Web of Science, Scopus, Medline, Cochrane Library, Cinahl, and Physiotherapy Evidence Database (PEDro) was conducted. A hand search of the reference lists of the selected studies and other relevant publications was also undertaken. Studies were assessed by two independent reviewers and included if they complied with the following criteria: (1) participants were adults after a stroke, (2) use of DN alone or within a multimodal approach, compared to no intervention or other treatments; (3) assessment of spasticity, pain, or joint ROM as a primary or secondary outcome. We included randomised controlled trials (RCTs), case series, and case reports. Data were extracted using a standardised protocol. The methodological quality of the studies was assessed with the Checklist for Measuring quality.ResultsA total of sixteen studies, 7 of which were RCTs, were selected. All studies generally reported an improvement of spasticity level, pain intensity, and ROM after the use of DN, alone or combined with other interventions, in stroke survivors.ConclusionThe management of adults after stroke with DN may impact positively on spasticity, pain, and ROM. However, there was significant heterogeneity across trials in terms of sample size, control groups, treated muscles, and outcome measures, and a meta-analysis was not feasible. Further research should include proper blinding, sham placebo DN as control intervention, and investigate long-term effects.     

The Effectiveness of Physiotherapeutic Interventions in the Management of Delayed Onset Muscle Soreness: a Systematic Review

Abstract

Delayed-onset muscle soreness (DOMS) is a commonly occurring myogenic condition, which develops following strenuous eccentric exercise, but the effectiveness of physiotherapy treatment has not been systematically assessed. This systematic review aimed to determine the effectiveness and quality of the evidence for management of DOMS. Relevant databases (Cochrane, 1993-2003; Medline, 1966-2003, Embase, 1966-2003; Cinahl, 1982-2003; and PEDro, 1952-2003) were searched. The methodological quality of randomised controlled trials was systematically assessed using the PEDro scale. Thirty trials (electrophysical interventions, n = 11; conventional agents, n = 19) were included. There was limited evidence (of high methodological quality) that athletic massage and light concentric exercise are more effective than no treatment, while the evidence for compression therapy, and whirlpool therapy was minimal. The evidence did not support the use of static stretching, cryotherapy, acupuncture, pulsed ultrasound, transcutaneous electrical nerve stimulation (TENS), interferential therapy, and microcurrent electrical stimulation. physiotherapeutic interventions in the     

Pelvic floor muscle training and postural balance in elderly women: An exploratory single arm trial

IntroductionTo investigate the influence of a training of mobility, gait speed and postural balance of pelvic floor muscles (PFM).MethodsA single-arm clinical trial study was approved and registered at the Brazilian Clinical Trials Registry (RBR-4rxhd4). Eighteen women over the age of 60 with pelvic floor dysfunction complaints were subjected to 10 sessions of functional electrical stimulation and digital palpation of PFM. Mobility and gait speed were evaluated by the Timed up and Go and the 10-m walk tests respectively. Standing balance was evaluated using a force plate.ResultsNo significant differences were found in mobility, gait speed, and standing balance. PFM contraction worsened mobility, gait speed, and standing balance performance.ConclusionsThe training protocol enhanced PFM strength and endurance, but the improved ability to recruit PFM did not positively affect balance, mobility, and gait speed.     

The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing

[Purpose] This study was conducted to investigate the effect of the correlation between the pelvic floor muscles (PFM) and diaphragmatic motion during breathing. [Subjects] The subjects of this study were 20 healthy female students who listened to an explanation of the study methods, purpose and agreed to participate in the experiment. [Methods] Radiograph equipment was used to examine diaphragmatic motion with contraction of the PFM during breathing, and a spirometer was used to examine lung vital capacity. [Results] The results revealed a significant change in the diaphragmatic motion and pulmonary function (FEV₁, MVV). FEV₁ and MVV showed significant differences when the PFM was contracted. Diaphragmatic motion showed a significant difference when the PFM was contracted. [Conclusion] Diaphragmatic motion and contraction of the PFM correlate with breathing. In addition, breathing is much more effective during contraction of the PFM. Therefore, PFM strengthening exercises should be included in respiratory rehabilitation programs.Key words: Abdominal muscles, Diaphragm, Pelvic floor muscle