Melanie R Meister1, Siobhan Sutcliffe2, Chiara Ghetti3, Christine M Chu4, Theresa M Spitznagle5, Jerry L Lowder3. 1. Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, University of Kansas School of Medicine, 2000 Cambridge, Kansas City, MO, 66160, USA. mmeister@kumc.edu. 2. Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, USA. 3. Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA. 4. Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, University of North Carolina, Chapel Hill, NC, USA. 5. Department of Physical Therapy, Washington University in St. Louis, St. Louis, MO, USA.
Abstract
INTRODUCTION AND HYPOTHESIS: Pelvic floor myofascial pain (PFMP) is associated with lower urinary tract symptoms (LUTS). The objective of this study was to test movement-based pelvic floor physical therapy (PT) for patients with PFMP and LUTS. We hypothesized that movement-based PT designed to target PFMP would result in significant improvement in both PFMP and concomitant LUTS. METHODS: This pilot trial enrolled patients with moderate-to-severe PFMP on palpation who were referred to movement-based PT to diagnose and treat pelvic floor dysfunction in the context of body alignment and movement patterns. The primary outcome was change in Urogenital Distress Inventory (UDI) scores after PT. Factors associated with PT attendance were also measured. We aimed to enroll 55 participants to achieve 80% power to detect a difference in 11 points on the UDI scores with an alpha-level of 0.05, accounting for a 10% loss to follow-up. The sample size was increased to 65 owing to a higher-than-expected loss-to-follow-up rate. RESULTS: Sixty-five patients were enrolled and 62 analyzed. Thirty-eight (61.3%) attended PT, and 30 (48.4%) completed a follow-up PT Attendance (PTA) survey. Overall, UDI score and irritative, obstructive, and stress subscales (p<0.0001) improved in participants who attended PT as well as mean myofascial examination scores at each site. CONCLUSIONS: Participants who attended movement-based PT demonstrated an improvement in LUTS. Future studies should extend our findings by: first, confirming whether the myofascial pain-directed elements of PT improved LUTS; second, investigating whether movement-based PT improves prolapse symptoms; and third, including a non-PT control arm to rule out the possible influence of a placebo effect and behavioral modifications on LUTS and PFMP.
INTRODUCTION AND HYPOTHESIS: Pelvic floor myofascial pain (PFMP) is associated with lower urinary tract symptoms (LUTS). The objective of this study was to test movement-based pelvic floor physical therapy (PT) for patients with PFMP and LUTS. We hypothesized that movement-based PT designed to target PFMP would result in significant improvement in both PFMP and concomitant LUTS. METHODS: This pilot trial enrolled patients with moderate-to-severe PFMP on palpation who were referred to movement-based PT to diagnose and treat pelvic floor dysfunction in the context of body alignment and movement patterns. The primary outcome was change in Urogenital Distress Inventory (UDI) scores after PT. Factors associated with PT attendance were also measured. We aimed to enroll 55 participants to achieve 80% power to detect a difference in 11 points on the UDI scores with an alpha-level of 0.05, accounting for a 10% loss to follow-up. The sample size was increased to 65 owing to a higher-than-expected loss-to-follow-up rate. RESULTS: Sixty-five patients were enrolled and 62 analyzed. Thirty-eight (61.3%) attended PT, and 30 (48.4%) completed a follow-up PT Attendance (PTA) survey. Overall, UDI score and irritative, obstructive, and stress subscales (p<0.0001) improved in participants who attended PT as well as mean myofascial examination scores at each site. CONCLUSIONS: Participants who attended movement-based PT demonstrated an improvement in LUTS. Future studies should extend our findings by: first, confirming whether the myofascial pain-directed elements of PT improved LUTS; second, investigating whether movement-based PT improves prolapse symptoms; and third, including a non-PT control arm to rule out the possible influence of a placebo effect and behavioral modifications on LUTS and PFMP.
Authors: Melanie R Meister; Siobhan Sutcliffe; Chiara Ghetti; Christine M Chu; Theresa Spitznagle; David K Warren; Jerry L Lowder Journal: Am J Obstet Gynecol Date: 2018-12-07 Impact factor: 8.661
Authors: Rob Riemsma; Suzanne Hagen; Ruth Kirschner-Hermanns; Christine Norton; Helle Wijk; Karl-Erik Andersson; Christopher Chapple; Julian Spinks; Adrian Wagg; Edward Hutt; Kate Misso; Sohan Deshpande; Jos Kleijnen; Ian Milsom Journal: BMC Med Date: 2017-03-24 Impact factor: 8.775