Abstract ID: 28938
TITLE: Perinatal Incontinence Assessment Tools: A Psychometric Evaluation and Review
AUTHORS/AFFILIATION: Emily Gard, SPT, Alyssa Lyman, SPT, Hina Garg, PT, MS, PhD, Rocky Mountain University of Health Professions, Provo, Utah, UNITED STATES.
Purpose/Hypothesis: Approximately 40% of women report incontinence during pregnancy and postpartum. Because of the lack of an established measurement standard, this review aimed to investigate the psychometric properties of various symptom and quality-of-life (QOL) measures of incontinence during the perinatal period, specifically during pregnancy and 1 year postpartum. Number of Subjects: Not applicable. Materials and Methods: A systematic review was carried out to identify pertinent symptom and QOL tools to assess incontinence during the perinatal period, defined as pregnancy and up to 1 year postpartum. Articles in English that included the psychometric evaluation of such tools were selected. The EBSCO, MEDLINE, EMBASE, PubMed, CINAHL, Cochrane, Journal of Women's Health, Ovid, and PsycINFO databases were searched from the year 2000 to 2020, and each included study was evaluated by a quality assessment checklist. Results: A total of 2621 articles examining 60 different symptom or QOL-related incontinence assessment tools were identified; however, only 5 of those tools met the inclusion criteria. The impact of incontinence on QOL was measured in 3 tools, and the symptoms of incontinence, such as urgency, frequency, severity, or amount of leakage during activities of daily living, were measured in 4 tools. The Pelvic Floor Questionnaire (PFQ), Leakage Index (LI), and International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) demonstrated varying degrees of internal consistency (Cronbach α>0.60, >0.70, and mean interitem correlations >0.39, respectively). The PFQ also demonstrated moderate test-retest reliability (intraclass correlation coefficient >0.60). Construct validity of the ICIQ-UI SF was established by significant (P < .05) differences across age and obesity, whereas the PFQ demonstrated significant (P < .001) discriminant validity in perinatal women with symptoms pre- and postpartum. Convergent validity of the telephone-administered Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) was established with the written version (P > .05, correlation coefficient >0.90). Sensitivity across pregnancy and postpartum was demonstrated by the ICIQ-UI SF, while only bladder and sexual domains of PFQ were found to be sensitive. Conclusions: Based on psychometric comparisons, both the PFQ and the ICIQ-UI SF are superior measures of incontinence (symptom and QOL impact) among other tools in perinatal women. Future research on psychometric evaluation of all 5 tools in larger and comprehensive samples including nulliparous and multiparous women is warranted. Clinical Relevance: A standard measurement tool to assess symptoms and impact on QOL due to incontinence would facilitate collection of accurate and reliable data across the patient care continuum and clinical care settings in perinatal women. Findings from this review suggest that both outcome measures, PFQ and ICIQ-UI SF, can be clinically useful in assessing and demonstrating the impact of pelvic rehabilitation interventions in perinatal women.
Abstract ID: 30126
TITLE: Sleep Quality Among Women With Chronic Low Back Pain and Pelvic Floor Dysfunction: A Cross-Sectional Study
AUTHORS/AFFILIATIONS: Mohammed Alshehri, SPT, Jazan University, Jazan, Saudi Arabia; Muhammad Alrwaily, PT, MS, PhD, West Virginia University, Morgantown, West Virginia, UNITED STATES; King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia; Ghadah Algudairi, PT, MSc, Security Forces Hospital, Riyadh, Saudi Arabia; Einas Aleisa, PT, PhD, MS, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
Purpose/Hypothesis: Low back pain (LBP) is a prevalent disorder in Saudi Arabia. Many females with LBP who are referred to physical therapy clinics are also found to have pelvic floor dysfunction (PFD) that affects their quality of life. Therefore, we aimed to (1) investigate the association between sleep quality and PFD in women with LBP and (2) establish a criterion at which PFD is related to poor sleep quality. Number of Subjects: Two hundred twenty-two. Methods: In this cross-sectional study, we collected demographics and Arabic-validated questionnaires including the Pelvic Floor Distress Inventory (PFDI-20) and the Pittsburgh Sleep Quality Index (PSQI), with high scores on these questionnaires indicating worse symptoms. We included Arabic-speaking women with chronic LBP who were referred to several hospitals in Riyadh, Saudi Arabia. Two hundred twenty-two participants were involved in the study (age 46.77 ± 7.70 years; body mass index [BMI] 31.63 ± 4.69 kg/m2). Generalized linear model was used to assess the association between the PSQI (dependent variable) and the PFDI-20 after controlling for age, BMI, and menopausal and sexual status. Also, area under the curve (AUC) was used to determine the optimum cutoff score in the PFDI-20 related to PSQI score. The significance level was set at P < .05. Results: Among women with chronic LBP, there were 33.3% with postmenopausal status and 26.6% with no active sexual status. Most participants of the sample had high scores on the PSQI (72.9%) (ie, a score of >5 on the PSQI). The average score of the PFDI-20 was 128.90 ± 34.22. After controlling for covariates, there was a significant association between the PSQI and the PFDI-20 (β= .04, P < .001). In addition, sexual status was significantly associated with the PSQI and the PFDI-20 (β = −1.24, P = .03). The range of PFDI-20 score was between 75 and 258.33, and the cutoff score for the PFDI-20 that differentiated poor sleep quality (>4 on the PSQI) was 162 (sensitivity 0.96; specificity 0.81), and an AUC of 0.71. Conclusions: The data suggest a high prevalence of poor sleep quality in women with chronic LBP and PFD. The association between poor sleep quality and worse symptoms of PFD might be bidirectional in which future studies are needed to investigate the complex relationship between these factors. Clinical Relevance: Because poor sleep quality and PFD are associated in women with chronic LBP, clinicians/physical therapists may need to screen for sleep quality and PFD to investigate factors that might have negative influence on the treatment plans.
Abstract ID: 27910
TITLE: Bridging the Gap: The Lived Experience of Women With Diastasis Recti Abdominis
AUTHORS/AFFILIATIONS: Jennifer Wiley, PT, DPT, Veronica Leader, SPT, Katelyn Nesbit, SPT, Steven Shows, SPT, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia, UNITED STATES; Laura Santurri, PhD, MPH, CPH, Lisa Borrero, PhD, University of Indianapolis, Indianapolis, Indiana, UNITED STATES; Ruth Maher, PT, PhD, DPT, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia, UNITED STATES.
Purpose: Diastasis recti abdominis (DRA) leads to a myriad of limitations in the physical and emotional well-being of women. Research has primarily focused on diagnostic tools and treatment. Consequently, there is an absence of evidence regarding the lived experience of women with DRA and the lack of interventions and accurate patient education. The purpose of this study was to explore the lived experience of women with DRA. Subjects: Purposive sampling recruited female participants of any age with a self-reported or medical diagnosis of DRA. Participants (N = 13; 31.3 years ± 3.65) were 8 weeks to 3 years postpartum, and 26 (10 cesarean) reported births. Materials/Methods: Qualitative methodology with a basic interpretive approach and purposive sampling was used. Participants contributed their experience through a semistructured, in-depth interview. Recruitment occurred in a variety of settings including outpatient physical therapy practices, OB/GYN offices, online support groups for mothers/expecting mothers, and local colleges and universities. In-person or online interviews were completed following verbal consent and audio recordings were obtained. Transcribed audio recordings were used for coding and identification of overarching themes. Rigor and trustworthiness were enhanced using a variety of techniques. Results: Six predominant themes emerged including lack of education offered by clinicians, lack of patient knowledge, sources of self-education, impact of diagnosis, benefits of education, and problems with available education. Participants reported that lack of education limited their ability to self-identify associated signs and symptoms leading to negative impacts on body image, fear of future functional limitations, and an inability to seek appropriate treatment. Pursuit of alternative sources of knowledge resulted in inconsistent information leading to confusion and fear. Participants who received appropriate education reported an associated reduction in anxiety and increased drive to seek help with recovery. Participants also identified the need for education pre- and postpartum. Conclusions: The need for education was a pivotal outcome with associated anxiety and fear ablated with the acquisition of appropriate education. Participants stated that receiving such education pre- and postpartum would have a positive effect on body image and self-confidence. Further research should focus on specific components of education and ultimate outcomes. Clinical Relevance: The results highlight the need for effective targeted educational programs allowing women to make informed decisions. Allowing clinicians a look through the personal lens of affected women could provide the impetus to developing targeting education.
Abstract ID: 29499
TITLE: Patient-Provider Interactions and Influence on Health Care for Women With Chronic Pelvic Pain
AUTHOR/AFFILIATION: Pamela Kays, PT, DPT, EdD, A. T. Still University, Mesa, Arizona, UNITED STATES.
Purpose/Hypothesis: Despite 25 years of evidence emphasizing problematic health care experiences for women with chronic pelvic pain and the benefits of clinical empathy and patient-centered care, negative patient-provider interactions for women with chronic pelvic pain persist. Therefore, the purpose of the current study was to investigate the lived experiences of patient-provider interactions from the perspective of women with chronic pelvic pain. Subjects: Thirteen women aged 18 to 65 years who had chronic pelvic pain for a minimum of 6 months and who had pursued medical consultation/care were included. Criteria for data saturation were met after analysis of data from participant 11. Materials/Methods: This phenomenological qualitative study used semistructured, in-depth interviews. A topic guide was used for interview questions and consisted of 5 semistructured questions with probes, as necessary. Each participant was interviewed face-to-face and one-on-one, and interviews were audio-recorded. Qualitative data analysis software was used to manually code and analyze the data through thematic nodes using an open and inductive approach and constant comparison to facilitate interpretive phenomenological analysis. Results: Participants described negative patient-provider interactions during their health care encounters through patterns of health care provider behaviors and traits with a particular lack of empathy. Such patterns increased the emotional toll of living with chronic pelvic pain and impeded effective care. Conclusions: These findings highlight the need for improved integration of research into health care provider education to develop empathetic patient-provider interactions. Cultivating positive patient-provider interactions can advance best practices and ultimately result in the best care for women with chronic pelvic pain. Clinical Relevance: When participants experienced negative patient-provider interactions with lack of empathy from providers, their emotional burden increased and their path to health care stalled. Findings of the current study add to existing literature by indicating how improvements in patient-provider interactions, specifically cultivation of empathy, can decrease emotional toll and advance health care outcomes for women with chronic pelvic pain.
Abstract ID: 27263
TITLE: The Value of Interprofessional Collaboration for a Female Patient With Chronic Pelvic and Urinary Pain
AUTHOR/AFFILIATION: Maria Kapral, PT, DPT, The Ohio State University Wexner Medical Center, Columbus, Ohio, UNITED STATES.
Background and Purpose: Pelvic pain affects 15% of women and results in medical costs of $2.8 billion. Evidence supports physical therapy (PT) to reduce medical costs, needless testing, opioid use, and workforce impact in low back pain and chronic conditions. Interstitial cystitis (IC) presents with urinary urgency and frequency, dysuria, and painful bladder filling, but true diagnosis requires cystoscopy with hydrodistension. Without this test, pelvic floor physical therapists (PFPTs) must utilize their clinical judgment during examination and differential diagnosis. The PFPT should utilize interprofessional collaboration to ensure holistic assessment throughout a plan of care (POC). The purpose of this case study was to exhibit the value of interprofessional collaboration in the management of medical developments during a PT POC. Case Description: A 25-year-old woman was referred to a PFPT for possible IC, chronic dysuria, and dyspareunia. She related normal urinary frequencies but had pain during bladder filling, micturition, and intercourse. Her IC elimination diet restricted her quality of life, and pain limited her work and study. During her POC, she had multiple urinary infections with reduced pain while taking antibiotics, was diagnosed with narcolepsy and began treatment, had sudden onset of urinary incontinence and nocturnal enuresis, and had a greater trochanteric stress fracture, each requiring collaboration with other providers. Outcomes: Pain intensity was measured on the Numeric Pain Rating Scale (NPRS); functional limitations were assessed by the Patient Specific Functional Scale (PSFS); pelvic floor strength was assessed by the Modified Oxford Scale; and the Patellar-Pubic Percussion and Fulcrum tests were used to screen for the presence of a hip stress fracture. Pain reduced from worst 8/10 and average 6/10 for 2 to 6 hours a day to worst 1/10 during intercourse with inadequate lubrication and 0/10 during urination. The PSFS improved from an average score of 6/10 to 10/10. Pelvic floor strength improved from 1/5 with compensation to 3/5 isolated. The patient began a lactobacillus probiotic in collaboration with Urology to address the role of the urinary mictrobiome on urinary pain, rapidly reducing her pain. Narcolepsy medication was changed by physicians after discussion and resolved her onset of urinary incontinence and nocturnal enuresis. The PFPT found evidence of greater trochanteric stress fracture in the clinic and collaborated with urgent care via written methods to identify concerns and optimize diagnostic testing. Discussion: In this case, the PFPT played a major role in collaboration with other disciplines for holistic care beyond the complaints of referral. Symptom patterns and external forces were identified and managed using evidence-based practice to optimize care through these collaborations. This case study demonstrates the value of communication between referring providers and PFPTs in patient management and the opportunity for PFPTs to advocate for their patients.
Abstract ID: 28203
TITLE: Telehealth-Only Interface in the Successful Treatment of Urinary Incontinence: A Case Series
AUTHOR/AFFILIATION: Sarah Kleinstein, PT, DPT, NYU Langone Health/Rusk Rehabilitation, New York City, New York, UNITED STATES.
Background and Purpose: Pelvic floor muscle training (PFMT) is the recommended first-line treatment of stress urinary incontinence (UI) in women. Several studies have examined the use of biofeedback, mobile technology, and mailed and computer-based instructional material to treat UI remotely; however, none have examined the efficacy of treating UI exclusively through real-time telehealth physical therapy video visits. This case series demonstrates that PFMT can be effectively instructed, personalized, and advanced exclusively over telehealth, leading to fewer episodes of UI and improved quality of life. Case Description: This case series examines 3 patients with primary complaints of UI for greater than 6 months. All were referred for virtual evaluation between April and June 2020. Initial assessment and all subsequent treatments were provided by a physical therapist through a secure telemedicine portal, Epic, connected to a smartphone or computer. Intervention included bladder training and careful instruction on pelvic floor contraction and relaxation using imagery and movement. No additional equipment, such as biofeedback, was utilized. Progress was assessed using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) and a bladder diary. Patient 1 was a 47-year-old woman who developed urge UI and nocturia after a hip arthroscopy. The patient leaked a small amount of urine most days of the week and scored 9/21 on the ICIQ-UI SF. Patient 2 was a 41-year-old woman who developed mixed UI during pregnancy. Pregnancy/postpartum period was complicated by a pubic symphysis separation and uterine prolapse. The patient leaked a moderate amount of urine daily and scored 11/21 on the ICIQ-UI SF. Patient 3 was a 40-year-old trans female who developed mixed UI and frequency/urgency after vaginoplasty. The patient voided 15+ times daily, leaked a moderate amount of urine approximately 5 times per day, and scored 20/21 on the ICIQ-UI SF. Outcomes: All patients reported a significant decrease in episodes of UI and amount of urine leaked. Patients with frequency reported fewer voids both during the day and overnight. Patient 1 was seen for 5 sessions with a resolution of nocturia and urge UI, scoring 3/21 on the ICIQ-UI SF. Patient 2's UI resolved in 2 sessions. The remainder of treatments focused on strengthening for pubic symphysis separation and prolapse. Patient 3 was seen for 7 sessions, decreased frequency to 8 times per day, with 2 small leaks a day and improving the ICIQ-UI SF to 12/21. Discussion: While PFMT is standard practice for addressing UI, instruction often must be personalized and synchronous to meet the needs of many patients. Currently, as the Centers for Disease Control and Prevention continues to recommend limited contact, many practices are looking to expand virtual offerings. Numerous studies have shown that remote physical therapy is a successful interface in rehabilitating patients after stroke, total knee arthroplasty, and cardiac events. Telehealth is a cost-effective and viable option for patients unable to easily access clinics. While there is precedent for a hybrid model, based on this case series, PFMT for the treatment of UI can be successfully conducted exclusively over telehealth.
Abstract ID: 28709
TITLE: Potential Referral Barriers for Males With Urinary Incontinence to Pelvic Health Physiotherapists: Preliminary Study
AUTHORS/AFFILIATION: Richelle Caya, PT, DPT, Deb Davey, PT, MBA-HC, FAAOMPT, EDPP, University of Illinois at Chicago, UNITED STATES.
Purpose/Hypothesis: Male urinary incontinence (MUI) is common and negatively impacts quality of life. Pelvic health physiotherapy (PHPT) is proposed as a first-line intervention for MUI. Previous studies report that males who may benefit from PHPT do not receive this intervention. Anecdotally, it is generally agreed that most males seeking PHPT are referred by a medical provider. This preliminary study seeks to investigate potential barriers to referral for PHPT for MUI, with the hypothesis that barriers occur at the provider referral level. Subjects: Currently practicing physicians, physician assistants, and nurse practitioners in the United States. Materials and Methods: A 16-item survey was developed using language similar to previous surveys that explored referral barriers to other specialty physiotherapy settings. Participants for this preliminary survey were recruited via social media pages, publicly available e-mails on University Web sites, and word of mouth. Results: Fifty-three providers completed the survey. Not all participants responded to every question. Seventy-six percent of the respondents specialized in urology (n = 40); 14% were primary care providers (PCPs) (n = 8); and 9% were from other specialties (n = 5). Of the 34 urologists who responded to an awareness question,100% were aware of PHPT treating MUI and 82% had referred 10 times or more in the past year (n = 28). Of the PCPs, only 57% reported that they were aware of the specialty (n = 4) and 14% reported that they had referred 10 times or more in the past year (n = 1). The remaining PCPs (87%) reported that they had not referred at all in the past year (n = 6). Among multiple-choice answer responses, 43% of urologists (n = 17) indicated uncertainty in identifying appropriate patients for PHPT. Conclusions: These preliminary results identified that urologists treating MUI were aware of PHPT and regularly made referrals. Almost half of PCPs were not aware of PHPT for MUI and most did not regularly refer. Because of low respondent rates from PCPs, ongoing data collection for this survey will specifically recruit PCPs to investigate this further. Clinical Relevance: Lack of awareness of PHPT among PCPs may present as a barrier to referral to PHPT for MUI. PCPs may benefit from education and literature on PHPT so that they can appropriately refer to both urology and PT, thereby reducing delay of care for MUI. This study suggests that among urologists, awareness is not a key barrier to PHPT, but difficulty identifying appropriate patients for PHPT may influence referral patterns. This could be related to lack of communication between the medical providers and physical therapy specialist. Research is needed to further explore these potential barriers to PHPT for MUI.
Abstract ID: 28413
TITLE: Physical Therapy Students' Education, Knowledge, and Beliefs Toward Working With LGBTQ+ Patients: A Survey
AUTHORS/AFFILIATION: Kathryn Bauson, SPT, Anja Smith, SPT, Kelsey Smith, SPT, Melissa Weisbrick, SPT, Christine A. Cabelka, PT, PhD, MPT, WCS, CLT, The College of St Scholastica, Duluth, Minnesota, UNITED STATES.
Purpose/Hypothesis: Members of the LGBTQ+ community experience inconsistencies in access to health care as well as treatments provided. Surveys of nursing and medical students indicate a lack of clinical confidence, knowledge of LGBTQ+ health care terminology, and education related to the unique psychosocial aspects of this population. A physiotherapy-focused study found 4 common themes that caused members of the LGBTQ+ community to feel uncomfortable about their previous experience with physiotherapists: assumptions about sexuality and gender identity, proximity/exposure of their bodies, discrimination including reports of continued misgendering (using birth gender, rather than patient's preferred gender) or fear of discrimination, and lack of knowledge about transgender health issues such as hormone therapy and related surgical procedures. The purpose of this study was to identify the current knowledge, education, and preparedness of third-year DPT students related to treatment of the LGBTQ+ population. Number of Subjects: One hundred ninety third-year DPT students. Materials and Methods: A 24-question survey of knowledge, education, and preparedness to treat members of the LGBTQ+ population was developed using Qualtrics. Purposeful convenience sampling was used with the goal of representation from each of the 9 regions of DPT education programs in the United States. Selected DPT program directors were contacted via e-mail and asked to forward the anonymous survey link to their current third-year DPT students. Data were collected from February 2020 to April 2020. The study received institutional review board approval. Results: A total of 190 responses were collected, with 36 schools being represented. Ninety-four students (54.97%) reported knowledge of unique needs of the LGBTQ+ community before entering their DPT program. Ninety-three students (54.39%) indicated that their program integrated topics specific to care of LGBTQ+ patients within other courses, while only 8 students (4.68%) reported their program taught a stand-alone course covering these topics. Eighty-two students (47.67%) felt that their program adequately prepared them to work with the LGBTQ+ population. One hundred twenty-four students (72%) believed that health care providers need specific training on unique aspects of care for the LGBTQ+ community. One hundred sixty students (93%) felt confident in treating LGBTQ+ patients. Conclusions: The majority of DPT programs surveyed are providing some form of education regarding the LGBTQ+ community. Despite more than half of students reporting their didactic education did not adequately prepare them, more than 90% reported feeling confident in treating LGBTQ+ patients. Clinical Relevance: Cultural competence and sensitivity are important aspects of health care education. Although students report feeling confident in treating the LGBTQ+ population, they acknowledge that specific training on unique aspects of care for this population is necessary. With recent health care legislation, there is an even greater need to include education regarding underserved populations within the DPT curriculum.
Abstract ID: 27699
TITLE: Reduction of Contralateral Genu Recurvatum to Eliminate Chronic Hip Pain in a 36-Year-Old Postpartum Female Runner
AUTHORS/AFFILIATION: Caitlin Kothe, PT, DPT, MD, CSCS, Tennessee Sports Medicine Group, South College, Knoxville, Tennessee, UNITED STATES.
Background: It is well documented that femoral acetabular impingement (FAI) is a common cause of hip pain and reduced function. Much attention has been paid to the osteology contributing to this pathology, as well as the proximal hip musculature that stabilizes the joint itself. Unfortunately, muscular impairments that could affect the movement of the pelvis or femur, such as diastasis recti or quadriceps weakness, are findings that are often overlooked. With surgical intervention to the bony morphology, patients have seen measurable pain reduction, improved function, and success in return to sports. However, in a recent review, up to 18% of patients did not return to sports or were unsatisfied with their hip function following surgery. Reiman et al recently published evidence that postoperative rehabilitation after surgical intervention for FAI is lacking in both description and depth of programs. Protocols for this rehabilitation intermittently discuss weight-bearing restrictions and pelvic girdle strength and will infrequently use “normalized gait” as a criterion for stage progression. However, very little attention has been paid to the specific restoration of normal gait kinematics in this population, especially in the presence of preexisting impairments, such as are frequently seen in the postpartum female. Purpose: The purpose of this case study was to demonstrate the impact of changing gait kinematics in a patient with bilateral hip labral repair/osteochondroplasty who had failed to return to running after following a postoperative protocol and had ongoing anterior hip pain and chronic diastasis recti. Case Description: The patient was a 36-year-old woman with a prior right anterior cruciate ligament reconstruction 15 years prior. She had a long history of physical therapy (72 visits total) both pre- and postoperatively for right hip labral repair on December 12, 2018, followed by left hip labral repair on December 10, 2019. Initial evaluation at our clinic disclosed a history of 2 full-term pregnancies with immediate return to running following a 6-week rest period after birth. A focused evaluation revealed chronic diastasis recti. However, a full movement pattern evaluation showed minimal lumbopelvic instability but rather left knee hyperextension at rest and throughout gait, mild loss of right knee extension, and right greater than left anterior hip pain with walking, stair climbing, and attempts to run. Movement analysis during single-limb stance on the left demonstrated knee hyperextension to at least 10°, with excessive left femoral internal rotation and pelvic rotation to the right, creating excessive hip adduction in the flexed right hip. Correction of the left knee hyperextension eliminated pain but was difficult for the patient to maintain independently. She was fitted with a knee hyperextension blocking brace (worn during all walking and activities of daily living for 4 weeks), given gait cuing to reduce knee hyperextension, and asked to perform functional strengthening exercises to reduce femoral internal rotation and improve eccentric quadriceps strength. She also completed a personalized program for diastasis recti. Outcomes: Physical therapy was performed in 8 visits over 10 weeks. Following the interventions, the patient was weaned from the brace and subsequently was able to return to running. She also reported an improved Lower Extremity Functional Scale score (from 55/80 to 73/80) and reported occasional tightness in the right anterior hip but 0/10 pain. She reduced her diastasis recti to close above and below the umbilicus and less than 1 in at the umbilicus. Discussion: This case highlights the importance of movement analysis and gait retraining as a component of postoperative therapy for FAI. It serves to highlight the critical role knee hyperextension may play in the pathokinesiology of lower-limb injuries, the importance of effectively ruling out comorbid musculoskeletal pathologies, and the complex nature of individualized physical therapy.
Abstract ID: 27163
TITLE: Movement System Impairment-Guided Approach to Management of a Patient With Persistent Genital Arousal Disorder
AUTHOR/AFFILIATION: Michele Strauss, PT, DPT, Penn Therapy and Fitness, Woodbury Heights, New Jersey, UNITED STATES.
Background and Purpose: Persistent genital arousal disorder (PGAD) is characterized by persistent, unwanted, and distressing sensations of genital arousal in the absence of sexual desire. PGAD can be devastating for patients, as it is associated with anxiety, depression, and suicide. Existing literature regarding physical therapy management of patients with PGAD includes case reports describing manual therapy directed at pelvic floor musculature. The purpose of this case report was to describe the physical therapist management of a patient with PGAD using a movement system impairment-guided approach. Case Description: The patient was a 61-year-old woman with onset of clitoral throbbing, feeling of having to climax, dyspareunia, and urinary urge incontinence following electroconvulsive shock therapy (ECT) treatment 8 years prior to initial evaluation. She had secondary complaints of low back pain and fecal incontinence that began prior to ECT. The patient's symptoms of genital arousal were aggravated by sitting, lying down, driving, and intercourse and alleviated by standing. The patient initially rated clitoral throbbing with sitting as 9/10 on the Numeric Pain Rating Scale (NPRS). Movement system impairments were consistent with a physical therapist diagnosis of lumbar rotation with extension syndrome with movement pattern coordination deficit of the pelvic floor musculature. The patient's goals included sitting and sleeping through the night without increased feelings of genital arousal and being able to engage in intercourse without pain. Interventions included postural correction and functional training to correct observed movement faults with an emphasis on avoiding symptom-reproducing lumbar rotation and extension. Interventions also included abdominal and hip muscle strengthening as well as pelvic floor muscle coordination exercises to address difficulty with relaxing and lengthening the pelvic floor muscles. Manual therapy to address myofascial restrictions in the hip and pelvic floor muscles was performed. Patient education included pelvic floor muscle anatomy and function, healthy bladder habits, and the effect of stool consistency on fecal incontinence. Outcomes: The patient was seen for 8 sessions over 13 weeks. NPRS score decreased from 9/10 to 0/10 with sitting and 9/10 to 3/10 with intercourse. Genitourinary Pain Index score improved from 30 to 21. Pelvic Floor Distress Inventory score improved from 115 to 32. The patient was able to sit for 30 minutes and sleep through the night without increased genital arousal. Discussion: This case describes the movement system impairment-guided treatment of a patient with PGAD. The patient's symptoms of genital arousal were alleviated in response to correction of lumbar movement impairments. This symptom pattern was similar to recent descriptions of movement-related urinary urgency and low back and pelvic pain. Patients with PGAD may benefit from a movement system impairment-guided approach to physical therapy treatment in addition to previously described manual therapy interventions.
Abstract ID: 30001
TITLE: Pelvic Health Literacy in Postpartum Women: A Comparison Based on Household Income
AUTHORS/AFFILIATION: Angela Pereira, SPT, Cara Morrison, PT, DPT, Kari Bargstadt-Wilson, PT, Julie Peterson, PT, DPT, Kailey Snyder, PhD, MS, Creighton University, Omaha, Nebraska, UNITED STATES.
Purpose/Hypothesis: Pelvic floor dysfunction is a common problem among postpartum women. However, few women obtain treatment of issues such as urinary incontinence or pelvic organ prolapse. More novel education programs are needed to help women better understand how to identify issues and improve their pelvic health literacy. An educational webinar has been developed for this purpose for postpartum women. Early evidence suggests this webinar is effective at increasing knowledge. The purpose of this study was to explore the relationship between household income and changes in pelvic health literacy after viewing an educational webinar. Materials/Methods: Women who were 19 years or older and had given birth within the past year were recruited via social media. The subjects were 16 postpartum women. Women completed a demographic survey, Prolapse and Incontinence Knowledge Questionnaire (PIKQ), and a telephonic interview before and after viewing a one-time online webinar. Survey data were analyzed via an independent t tests to compare 2 household income groups, less than $100 000 (n = 8) and more than $100 000 (n = 8). Qualitative data were analyzed via immersion and crystallization, followed by a comparative analysis of the 2 income groups. Results: All women demonstrated significant improvement in PIKQ knowledge after viewing the webinar (P < .001). There were no significant differences in PIKQ scores based on income. However, 2 main thematic differences were found between income groups related to interview responses. Before viewing the webinar, those with incomes of more than $100 000 were more likely to utilize scientific language when describing pelvic health (eg, diastasis recti, incontinence, muscle instability) and provide greater specificity when discussing strengthening exercises (eg, Kegels, crunches, pelvic tilts). Those with incomes of less than $100 000 were more likely to state “I don't know” or give broad general descriptions of exercises (eg, abdominal exercises, pelvic floor exercises). Following the webinar, both groups of women had improved in their descriptions and use of scientific language and those in the lower-income group more closely matched the higher-income group. Conclusion: The qualitative findings suggest that women with higher household incomes may have a greater initial ability to articulate their knowledge of pelvic floor health before watching a one-time webinar. Importantly, their knowledge still increased after webinar viewing, indicating they still had more to learn. The differences in initial answers could be linked to resource access, background knowledge and education levels, peer groups, or physician-provided education, but more research is needed. After viewing the webinar, both groups demonstrated improved pelvic health knowledge, indicating webinars to be a useful tool when working with postpartum populations. Clinical Relevance: Online webinars appear to be an effective strategy for improving pelvic floor knowledge among postpartum women. Furthermore, household income does not appear to influence knowledge change. Therefore, online webinars may be useful supplementation to resources provided in a clinical setting. However, future research should consider the influence of additional sociodemographic variables.
Abstract ID: 27810
TITLE: Physical Therapy Interventions for a Transgender Patient With Dyssynergic Defecation: A Case Report
AUTHOR/AFFILIATION: Charena Chetchavat, PT, DPT, CLT-LANA, Agile Physical Therapy, Palo Alto, California, UNITED STATES.
Background and Purpose: Dyssynergic defecation is the paradoxical anal contraction or inadequate anal relaxation during straining or bearing down. Chronic straining, as seen with dyssynergic defecation, can lead to pelvic floor hypertonicity, increasing the risk for hemorrhoids and anal fissures. There is an increased tendency toward constipation with antidepressant use, stressful life events, and certain medications. Transgender patients are more likely to have more perceived stress, depression, anxiety, suicidality, substance abuse, and HIV exposure, thus making them more likely to experience constipation-type symptoms. The purpose of this case report was to describe a comprehensive approach for physical therapy management of dyssynergic defecation in a transgender patient to improve clinical decision-making in this patient population. Case Description: The patient was a 22-year-old, identifying as nonbinary, complaining of difficult and painful defecation, irritable bowel syndrome (IBS)-type symptoms, bleeding after anal intercourse, and bleeding from hemorrhoids beginning 6 years prior. Medical history included IBS, anal fissures, depression, anxiety, attention-deficit/hyperactive disorder, and transgender status. They managed their symptoms using fiber supplementation, stool softeners, manual evacuation, and enemas. They did not engage in regular exercise and had a poor diet. Assessment revealed dysfunctional motor control of pelvic floor and abdominal musculature, overactive and weak pelvic floor muscles, tenderness with palpation of left iliococcygeus, and performed Valsalva maneuver with activity. Plan of care consisted of 8 treatment sessions including manual therapy, neuromuscular reeducation of diaphragm, abdomen, and pelvic floor, and lifestyle recommendations to improve bowel habits. Outcomes: The patient had decreased pelvic floor muscle tone, increased pelvic floor strength from 3/5 to 4/5, and the ability to have pain-free bowel movements and anal intercourse. Discussion: Neuromuscular reeducation, combined with lifestyle recommendations, improved defecation mechanics and stool quality, resulting in decreased pain. Greatest symptom improvement was reported after addressing sources of stress and anxiety. Important factors to consider for this patient's symptoms included sleep, the role of the nervous system, and stressors that accompany transgender status. Future research should be completed regarding the psychosocial impact of transgender status on gastrointestinal function.
Abstract ID: 28443
TITLE: Manipulation Therapy for Idiopathic Genital Pain—A Clinical Case Report
AUTHORS/AFFILIATIONS: Yingzhi Li, Yunnan University of Traditional Chinese Medicine, Kunming, China; Howe Liu, PT, PhD, MPT; Charles Nichols, PT, DPT, Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, Texas, UNITED STATES; David C. Mason, DO, Department of Family Medicine and Osteopathic Manipulative Medicine, University of North Texas Health Science Center–Texas College of Osteopathic Medicine, Fort Worth, Texas, UNITED STATES.
Background: Peripheral nerves that supply innervation to the penis and scrotum include the pudendal nerve to penis, scrotum, and pelvic floor muscles: genitofemoral nerve to cremasteric muscle; and ilioinguinal nerve (IIN) innervation of penile root and anterosuperior scrotum. Genital pain treated via manipulative treatment has not been frequently reported, particularly with a male patient. Thus, this case report describes the process of diagnosis and treatment using manual therapy for idiopathic penile pain. Case Description: A 54-year-old male patient was referred for insidious pain at the root of his penis and superior left scrotum with dysuria 3 weeks prior. The patient denied radicular symptoms including tingling, numbness, or swelling in lower extremities. MRI, ultrasound, and blood/urine tests were normal. Radiographs demonstrated a scoliotic left convex lumbar segment. His medical history included occasional low back pain with spontaneous resolution. He reported being healthy with no previous surgery. The patient entered the examination room with maximal assistance to the examination table and could only lie on his right side in fetal position due to complaints of severe, burning pain (pain 9/10). Inspection of scrotum revealed no edema or herniation in inguinal canal area. Palpation revealed pain in left L4 transverse process area and left inguinal area. The patient denied paravertebral muscle pain, pubic symphysis pain, or bilateral flank/gluteal area pain. Active trunk motion aggravated his pain, and neurological testing was normal including bilateral cremasteric reflexes. Lower-limb strength testing was normal except left hip flexion pain. Outcomes: Based on patient history, laboratory results, radiological examination, and physical examination, the following could be excluded: muscle strain, urinary stone, infection, herniation, and femoral/obturator nerve impingement. Inguinal canal pain could indicate IIN pathology due to impingement, and a scoliotic left convex lumbar segment could increase tension in the neuroforaminal space. Therefore, based on symptoms of left L4 transverse process tenderness, burning pain of penile root and superior left scrotum, and tenderness of inguinal ligament canal, this was considered a nerve pathology. Initial intervention included ligamentous articular strain and high-velocity thrust techniques for symptomatic relief and segmental mobilization and strain-counter-strain with soft-tissue mobilization. The patient was reevaluated following interventions, and numeric pain rating was reported to be 3-4/10. The following day, the patient was able to walk into the treatment room independently. He reported that penile pain decreased to 4-5/10. The patient's symptoms resolved completely by day 4. He was discharged home on day 5. Six-month follow-up revealed no further symptoms. Discussion: This case illustrates how a medical history, physical examination, and a reasoned diagnostic process to evaluate anatomical structures can be used to find the cause of an unusual pathology of penile pain and illustrates an intervention strategy that can be used by manual therapy clinicians.
Abstract ID: 28794
TITLE: Lumbopelvic Considerations for a Male Athlete With Pelvic Pain: A Case Reflection
AUTHORS/AFFILIATIONS: Ebony Jackson Clark, PT, DPT, CLT, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, UNITED STATES; Diane Borello-France, PT, PhD, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, UNITED STATES.
Background and Purpose: Prostatitis affects up to 2% to 16% of men in the United States and is the third most common urologic diagnosis for men younger than 50 years. Prostatitis risk factors include age (30-50 years), bladder or urethral infection, pelvic trauma or surgery, and urinary catheter use. Chronic pelvic pain syndrome (CPPS) is the most common type of prostatitis at 90%, constitutes 8% to 14% of urology clinic visits, and half of the patients diagnosed with CPPS have pelvic floor spasm. CPPS leads to significant reduction in quality of life due to psychological distress. Symptoms of CPPS include pain (lower abdominal, pelvic, inner thighs, genital or perineal area), bladder symptoms including incomplete emptying, hesitancy, dribbling, and burning or painful urination (dysuria). In addition, men may complain of abdominal bloating, diarrhea, and sexual dysfunction. Pelvic health physical therapy (PT) is an effective treatment of pelvic pain and is recommended for both the assessment and management of pelvic pain. The purpose of this case reflection is to describe the effectiveness of a PT intervention for a male athlete with CPPS and pelvic floor pain. Case Description: The patient was a 53-year-old male ultramarathoner with the diagnosis of CPPS. He reported a 2-year history of penile, testicular, and rectal pain, burning with urination, incomplete bladder emptying, and difficult initiating his urine stream. He also reported lower abdominal pain with running. The PT examination revealed decreased pelvic load transfer, lumbopelvic motor control strategies, lumbopelvic mobility, pelvic floor muscle (PFM) strength, and PFM range of motion. PT interventions included manual therapy, neuromuscular reeducation, and functional training activities that required PFM and lumbopelvic muscle activation. Outcomes: The patient attended 9 PT treatment sessions over a 9-week episode of care. He met all PT goals including resolution of penile, testicular, and rectal pain; painful urination; sense of incomplete bladder emptying; and no longer had difficulty initiating urination. In addition, he was able to run without abdominal pain and became independent managing PFM spasms. He achieved an increase in lumbopelvic motor control, PFM range of motion, and strength. Finally, he achieved the minimum clinically important difference on the Male Genitourinary Pain Index Questionnaire score. Conclusion/Discussion: PT interventions utilizing manual therapy, neuromuscular reeducation, and functional therapeutic exercise to improve PFM and lumbopelvic muscle motor control were effective to reduce this patient's physical impairments, activity limitations, and participation restrictions. The knowledge gained from this case can be applied to improve outcomes and quality of life for future male patients with pelvic pain and supports pelvic floor PT intervention for male athletes with pelvic floor dysfunction.
Abstract ID: 28641
TITLE: Analysis of Postoperative Gait, Hip Strength, and Patient-Reported Outcomes Following Unstable Pelvic Ring Fractures
AUTHOR/AFFILIATION: Chase Dean, MD, Department of Orthopedics, University of Colorado, Aurora, Colorado, UNITED STATES; Jason Nadeau, SPT, MS, Department of Orthopedics, Denver Health Medical Center, Denver, Colorado, UNITED STATES; Physical Therapy Program, University of Colorado, Aurora, Colorado, UNITED STATES; Lori Chambers, MD, Department of Orthopedics, Denver Health Medical Center, Denver, Colorado, UNITED STATES, Kate Worster, PhD, UCHealth Foot and Ankle Center–Central Park, Denver, Colorado, UNITED STATES; David Rojas, MD, Joshua Parry, MD, MS, Department of Orthopedics, Denver Health Medical Center, Denver, Colorado, UNITED STATES; Kenneth Hunt, MD, UCHealth Foot and Ankle Center–Central Park, Denver, Colorado, UNITED STATES; Cyril Mauffrey, MD, FACS, FRCS, FAAOS, Department of Orthopedics, Denver Health Medical Center, Denver, Colorado, UNITED STATES.
Purpose/Hypothesis: The purpose of this study was to examine clinical gait parameters, hip muscle strength, pelvic functional and psychological outcomes, and history of post-acute (PAC) physical therapy (PT) following fixation of rotationally unstable (Tile B) and rotationally and vertically unstable (Tile C) pelvic ring fractures. Number of Subjects: Nine. Materials and Methods: An interim cross-sectional analysis was performed for adults who received definitive fixation of Tile B (n = 4) or Tile C (n = 5) pelvic ring fractures at a level 1 trauma center over a 3-year period. Patients with stable pelvic, lower extremity, and acetabular fractures; central or peripheral nervous injuries; prior use of an assistive device; and postoperative presentation outside of 1 to 5 years were excluded. Nine eligible patients received one lower extremity instrumented gait analysis and strength testing with digital dynamometry. Maximum, minimum, and mean values of kinetic, kinematic, and temporospatial variables were calculated for all planes at the pelvis and hip. Validated patient-reported outcomes of pelvic function (Majeed), general function (SF-36), anxiety symptoms (HAM-A), and depression symptoms were collected at the time of gait analysis. The number of days of PAC PT (inpatient rehabilitation, skilled nursing, and home health) was recorded. Group medians were compared between fracture type and amount of PAC PT (≥5 days, n = 4; <5 days, n = 5) for all continuous variables using the nonparametric Wilcoxon rank sum test. Results: Patients with Tile C fractures had a higher injury severity score (P = .037), lower left hip abduction strength (P = .037), higher left peak hip flexion moment (P = .020), higher right peak hip abduction moment (P = .037), higher right mean hip rotation angle (P = .037), higher SF-36 physical function score (P = .036), and lower HAM-A Insomnia score (P = .018), compared with patients with Tile B fractures. There were no differences in walking speed or other outcome metrics between fracture types. Patients who completed 5 or more days of PAC PT, regardless of fracture type, had higher left peak hip power (P = .037), higher left peak hip adduction moment (P = .020), and scored better on Majeed Sitting (P = .040), Majeed Standing–Gait Unaided (P = .011), and SF-36 Pain (P = .026), compared with those who did not. Completion of PAC PT did not significantly improve walking speed, hip strength, or pelvis and hip kinematics. Conclusions: Patients recovering from Tile C pelvic ring fractures may benefit from more aggressive hip abductor strengthening. PAC PT may positively impact hip kinetics and patient-reported outcomes following unstable pelvic fractures. It is unclear why patients with Tile C fractures had some improved gait parameters compared with those with Tile B fractures, which contradicts expected findings. Perhaps, a larger patient sample would clarify these results. Clinical Relevance: Patient-centered care is integral to pelvic health PT and medicine. Given the functional deficits caused by unstable pelvic ring injuries, pelvic trauma surgeons and therapists must be mindful of gait, strength, and psychological impairments and include appropriate assessments and rehabilitation strategies when treating these patients.
Abstract ID: 29625
TITLE: Comparison of Peripheral Muscle Stiffness in Women With and Without Chronic Pelvic Pain
AUTHORS/AFFILIATIONS: Laurel Proulx, PT, DPT, Kelli Brizzolara, PT, PhD, Texas Woman's University, Denton, Texas, UNITED STATES; Shane Koppenhaver, PT, PhD, Baylor University, Waco, Texas, UNITED STATES; Patricia Jane Rodriguez, PT, DPT, Audie L. Murphy Veterans Hospital, San Antonio, Texas, UNITED STATES.
Purpose/Hypothesis: Chronic pelvic pain (CPP) affects roughly 15% of women aged 18 to 50 years. CPP is made up of a cluster of symptoms including voiding dysfunction, low back pain, painful intercourse, and muscular dysfunction of both pelvic floor and peripheral stabilizing muscles (eg, abdominals). Taut bands, trigger points, or muscular stiffness are common targets of physical therapy intervention in women with CPP to address impairments of local muscle tenderness and pain referral to the pelvic region. However, clinical identification of stiffness is known to be subjective and unreliable. The purpose of this study was to use the MyotonPro to quantify differences in peripheral muscles stiffness between those with and without CPP. Number of Subjects: One hundred ninety-seven. Materials and Methods: One hundred forty-nine women with CPP (35.68 years ± 7.58) and 48 healthy controls (34.85 years ± 9.16) completed a single testing session. All participants answered questionnaires of health history, pain, function, and quality of life. A researcher blinded to group assignment took muscle stiffness measurements using the MyotonPro. Eleven muscles were assessed: the rectus femoris, rectus abdominis, tensor fasciae latae, gluteus medius, quadratus lumborum, iliacus, adductor longus, adductor magnus, paraspinals at the levels of L1-L2 and L4-L5, and the piriformis. Muscles were chosen on the basis of their anatomical or biomechanical link to the presentation of CPP, muscles known as facilitators of pelvic floor activation, hip rotator muscles due to the fascial relationship to the pelvic floor, and muscles that surround the tract of peripheral pelvic nerves thought to contribute to CPP. Means and standard deviations were computed for continuous data, and frequency distributions were analyzed for categorical data to describe the population. Muscle stiffness differences between groups were evaluated using an analysis of covariance, with age and body mass index as covariates. Results: Women with CPP had significantly more births (P = .004) and abdominal surgical procedures (P = .019) than women without CPP. There was a significant difference between groups in peripheral muscle stiffness as measured by the MyotonPro in 5 of the 11 muscles measured: rectus femoris (P = .001), adductor longus (P = .004), lumbar paraspinals at L1-L2 (P = .017) and L4-L5 (P = .036), and the piriformis (P = .009). Conclusions: The results showed that women with CPP demonstrated muscle stiffness that was significantly greater than those without CPP in the rectus femoris, adductor longus, lumbar paraspinals at L1-L2 and L4-L5, and piriformis. The MyotonPro was able to detect differences in peripheral muscle stiffness between women with and without CPP. Clinical Relevance: These results support the use of mechanical deformation (MyotonPro) as an outcome measure for future intervention trials aimed at the variable of muscle stiffness in CPP. Further correlation analysis of specific muscle stiffness measurements with outcomes of pain and pelvic floor function is necessary to determine whether treating “stiffness” should be a clinical priority for CPP.
Abstract ID: 28534
TITLE: The Management of the Early Postpartum Runner With SUI: A Case Study
AUTHORS/AFFILIATIONS: Lisa M. Sator, PT, DPT, Good Shepherd Penn Partners, Philadelphia, Pennsylvania, UNITED STATES; Michael Steimling PT, DPT, Department of Rehabilitation Sciences, Moravian College, Bethlehem, Pennsylvania, UNITED STATES.
Background and Purpose: Stress urinary incontinence (SUI) is a barrier for many postpartum (PP) females to return to running. The prevalence of SUI in the PP population is approximately 20%, with an increased risk of developing SUI if you are a female athlete who participates in impact activities such as running. A recent PP return-to-running guideline advocates: delaying impact activity for at least 12 weeks to allow for adequate tissue healing, reestablishing normal pelvic and lower extremity muscular capacity before returning to running, and return to exercise should be under the guidance of a pelvic health physical therapist. While these recommendations remain logical, there is limited high-quality evidence to steer the management of runners in the PP period. This case explores the implementation of a successful management strategy consisting of pelvic floor muscle (PFM) training and graded return-to-running program for a runner with SUI in the early PP period. Case Description: A 35-year-old healthy female physician, G1P1, status post vaginal delivery at 38 weeks' gestation to 8.5-pound healthy baby with second-degree perineal tear laceration. The patient's PP course was complicated by PP hemorrhage secondary to uterine atony. The patient was discharged home with her newborn once stable from complications of hemorrhage. At initial physical therapy (PT) evaluation 8 weeks PP, the patient reported moderate SUI symptoms after returning to running at 4.5 weeks PP. Her running regimen consisted of 5 miles at an 8-minute pace, 7 days a week. Examination findings were consistent with PFM underactivity, which included poor PFM endurance and increased accessory muscle use with PFM contraction. The patient's goal was to be able to run 2 miles with absent to mild SUI in 8 weeks. Management: The patient was instructed to cease running and to focus on PFM capacity. The patient was prescribed PFM endurance contractions in supine, sitting, standing, and functional positions, with feedback to reduce accessory muscle contraction and use of forced exhalation 2 times daily over 4 weeks. At 12 weeks postpartum, she was prescribed a run/walk progression that started with 10 minutes of cumulative intermittent running and progressed to 30 minutes of continuous running over 6 weeks. Outcomes: After 5 visits over 10 weeks, the patient was able to return to running 4 miles at 8-minute pace with no SUI symptoms. Her Pelvic Floor Distress Inventory score improved from 62.5 to 0. Discussion: It may be that, in this case, focused intervention to address PFM capacity deficits, followed by a graded running program, allowed this patient to return to running without SUI symptoms. The initial interventions of reducing impact activity in addition to PFM training may have provided the optimal stimulus for adequate PP recovery. Followed by a graded return-to-running program applied at the appropriate time may have provided the novel overload to the PFM to allow for improved running tolerance. The management strategy explored in this case provides an example of guidelines on informed care for female runners in the early PP period. Future efforts should focus on advocating to increase the role of physical therapy in PP recovery.
Abstract ID: 28314
TITLE: Concentric Versus Isometric Pelvic Floor Muscle Training for Fecal Incontinence
AUTHORS/AFFILIATIONS: R. A. Jalanivich, SPT, C. J. Rocha, SPT, J. G. Wagner, SPT, B. L. Ward, SPT, S. C. Zuiker, SPT, J. L. Swartz, PT, L. J. Tuttle PT, PhD, San Diego State University Doctor of Physical Therapy Program, San Diego, California, UNITED STATES.
Purpose/Hypothesis: Fecal incontinence (FI) is an underreported problem, with a prevalence between 2% and 24% and has a significant impact on quality of life. FI is associated with obstetric trauma (ie, childbirth) due to damage of the levator ani, external anal sphincter, and puborectalis muscles—voluntary contractile structures involved in sphincter control for continence. Damage to these structures may lead to muscle weakness. Resistance training is widely used to strengthen skeletal muscles of the body, and numerous rehabilitation protocols outline the safe introduction and progression of resistance training postinjury. However, there is scarce literature assessing the efficacy of such resistance training for the muscles of the pelvic floor (PF). We hypothesized that concentric training would show greater improvement than isometric training in anal squeeze pressure and reduction of FI symptoms. Subjects: Twenty-nine women with FI, aged 27 to 81 years (mean = 61 years), participated and were randomly assigned to concentric (n = 14) or isometric (n = 15) training. Materials/Methods: Participants performed biofeedback and exercise training once per week for 12 weeks with a physical therapist and performed exercises at home daily. The concentric group trained with a balloon catheter (Endoflip), while the isometric group used a fixed-size probe. Each group received the same dosage: 3 sets of 10-second repetitions in supine, sitting, and standing positions. High-resolution anal manometry was performed before and after the 12 weeks of training to measure changes in maximum anal squeeze pressure (primary outcome). Changes in FI symptoms were measured using validated questionnaires (Urogenital Distress Inventory [UDI], Fecal Incontinence Severity Index [FISI], Wexner) before and after training (secondary outcome). Interventions were aimed to specifically target strengthening constriction and closure of the sphincter to better address the physiologic function of these muscles. Mixed-methods repeated-measures analysis of variance was used to determine changes over time and between groups (P < .05). Results are means (SD). Results: There was no significant difference between groups in age, body mass index, anal resting/squeeze pressure, or any symptom measures at baseline (P ≥ .05). Both groups had a significant improvement in maximum anal squeeze pressure (concentric: 129 (52) to 144 (74) mm Hg; isometric: 107 (44) to 117 (48) mm Hg; P = .026). Significant improvements within groups for the FISI (concentric: 28 (14) to 21 (14); isometric: 25 (9) to 21 (8); P = .00), Wexner (concentric: 12 (4) to 8 (5); isometric: 11 (4) to 7 (3); P = .00), and UDI (concentric: 25 (23) to 16 (16); isometric: 30 (23) to 21 (17); P = .004). There was no difference between groups in improvements in maximum anal squeeze pressure or in symptoms (P > .05). Conclusion: Both interventions improved maximum anal squeeze pressure and FI symptoms; neither was shown to be superior. Exercise prescription can be determined on the basis of patient preference and equipment availability. Clinical Relevance: Resistance training (concentric or isometric) of the PF improved anal squeeze pressures and symptoms in women with FI. Both treatments were able to be done at home and one was not found superior to the other. Funding Source: NIH NICHD R01HD088688.
Abstract ID: 28299
TITLE: Knowledge of Pelvic Health Among Undergraduate Students
AUTHORS/AFFILIATIONS: A. Adamson, PT, DPT, J. Karges-Brown, SPT, K. Grosshuesch, SPT, T. Hovaldt, SPT, E. Thyen, SPT, A. Weier, SPT, Physical Therapy, Pacific Northwest University of Health Sciences, Yakima, Washington, UNITED STATES; and Physical Therapy, University of South Dakota, Vermillion, South Dakota, UNITED STATES.
Purpose/Hypothesis: Pelvic floor disorders are prevalent; there are a limited number of patients with these disorders who seek medical help. To continue to investigate the limitations that prevent individuals from seeking medical care, the purpose of this study was to identify the knowledge college undergraduates has about pelvic health (PH) norms and whether they could identify symptoms that would warrant medical intervention. Number of Subjects: One hundred thirty. Materials and Methods: College undergraduate students completed a nonexperimental Web-based survey. Questions gathered the following: demographics, middle/high school health education topics, identification of abnormal PH symptoms, and attitudes regarding knowing when to seek help for pelvic symptoms. They were asked whether they felt there was a need for more education prior to college on PH and if they knew physical therapy (PT) was a medical source for PH conditions. Results: Of the students (mean age = 23.6 years; 87.7% female, 12.3% male) who completed the survey, 69.2% had their secondary education in a rural community and 90.8% attended public school. The majority had health education required for middle (85.4%) and high school (63.1%). Education was never provided for most on the appropriate length of time one should go between urinating, normal toileting posture when urinating, posture/habits when having a bowel movement, pain that was normal versus abnormal related to the bowel, or abnormal signs and symptoms of the bladder/bowel following childbirth. The majority also incorrectly identified the following as normal or did not know if it was normal: to urinate every time one leaves the house, to have to urinate every time one arrives home, to always hover rather than sit on a toilet, to urinate every 1 to 2 hours during the day, to have consistent and intense low back pain during menstruation, and to have a separation of the muscles down the middle of the abdomen 6 months postpartum. More than 73.1% felt comfortable knowing when to seek help from a medical provider despite 74.6% reporting more information prior to college would be of benefit and 90.0% feeling the educational system should incorporate more PH. Furthermore, 73.8% reported they were unaware that physical therapy (PT) treated PH conditions. Conclusions: A survey of college undergraduates reveals a lack of PH knowledge. Health education was required for most before college, but few responded that topics on urinary, bowel, pelvic, and sexual symptoms were ever discussed. Most students responded they would have benefited from more information/education on PH prior to college. Many were unaware PT could provide care for abnormal urinary, bowel, pelvic, and sexual symptoms. Clinical Relevance: Young patients may not be aware of abnormal habits or risk factors for PH conditions. Physical therapists need to advocate for education for this group in and out of the medical setting and promote PT as a source of help for PH disorders. In turn, the knowledge could lead these individuals to seek help, seek help sooner, and potentially reduce the prevalence or effects of pelvic floor disorders.
Abstract ID: 27091
TITLE: Soft-Tissue Mobilization Has Long-term Benefits in Treatment of Chronic Pain and Mobility Restrictions Resulting From Cesarean Section Surgery
AUTHORS/AFFILIATIONS: J. B. Wasserman, PT, DPT, MS, PhD, Franklin Pierce University, Manchester, New Hampshire, UNITED STATES; A. Demers, Trinity Pelvic Health and Wellness, Winter Park, Florida, UNITED STATES; A. Newton, Holistic Hawaii Pelvic Health, Honolulu, Hawaii, UNITED STATES.
Introduction/Background: The long-term effects of a soft-tissue mobilization intervention to treat chronic cesarean section (C-section) scar pain were investigated. Material and Methods: A previous randomized clinical trial of 28 women demonstrated the effectiveness of four 30-minute sessions of soft-tissue mobilizations in alleviating pain of greater than 6 months' duration. These women were followed up 12 to 14 months after the final treatment with the same primary outcomes measures: pressure pain threshold (PPT) measured via a pressure algometer, scar mobility (SM) measured via a modified adheremeter, Numeric Pain Rating Scale over 30 days (NPRS30), Numeric Pain Rating Scale over 2 days (NPRS2), Oswestry Disability Index (ODI), and the Global Rating of Change (GROC) scale. The scores were compared with those at baseline and at 2-month follow-up. Results: Of the 28 women, 13 (46.4%) participated in the follow-up. Baseline data did not differ between participants and nonparticipants in the follow-up. From baseline to 1-year follow-up: PPT mean increase of 6.05 N (P < .000) exceeding the SEM of 1.65 N, SM mean increase of 847 mm2 (P = .005) exceeding the SEM of 314 mm2, NPRS30 mean reduction of 3.2 (P = .002), NPRS2 mean reduction of 3.3 (P = .001); both of these exceeded the Minimally Clinically Important Differences (MCID) for the NPRS2. For the ODI, there was a mean reduction of 10.08 (P < .000), exceeding the MCID of 9.5, and for the GROC, there was a mean improvement of 6.09 (P < .000), exceeding the MCID of 5. From the end of the first study (2 months postcessation of treatment) to the 1-year follow-up, there was no significant change in measured outcomes for PPT, NPRS2, NPRS30, ODI, or GROC, indicating that all improvements gained from the treatments were maintained. For SM, there was a further improvement of 515 mm2 (P = .003), indicating continued gains in mobility over the year following treatment. Conclusions: A brief intervention of soft-tissue mobilization has long-term benefits in reducing chronic pain and immobility resulting from C-section surgery. CLINICAL TRIALS registration number: 160448-02. This study was funded by a grant from the APTA Section on Women's Health.
Abstract ID: 27337
TITLE: Is the Pelvic Floor Really Doing What We Think It Is Doing: A Pilot Study
AUTHOR: Brent D. Anderson, PT, PhD, OCS, PMA-CPT, Polestar Physical Therapy, Siler City, North Carolina, UNITED STATES.
Background and Purpose: Over the past 30 years, the pelvic floor has been shown to be an active player in its synergistic activity maintaining intra-abdominal pressure (IAP) appropriate for the anticipated load. As a result, physical therapists, Pilates teachers, and other restorative movement practitioners have incorporated active pelvic floor lifting as a standard cue to improve core control. The purpose of this pilot study was to examine whether the cues used by experienced movement teachers truly facilitate an elevation of the pelvic floor. Study Description: Seventy-nine experienced Pilates teachers were examined using standard protocol of pelvic floor activity with a curvilinear head RTUS imaging device. Subjects were asked to create the same image that they would use to teach their students to lift the pelvic floor. Measurements were taken and recorded. Outcomes: The 79 female subjects measured were divided into 3 categories: (a) pelvic floor successfully lifted (True), (b) pelvic floor descended when subject thought they were lifting pelvic floor (False), or (c) inactive with self-cueing (inactive). Results showed groups with the following: (a) 35, (b) 36, and (c) 4 subjects. Childbearing, weight, age, and years teaching did not seem to have a statistical relevance to the 3 groups. A 50% failure to lift the pelvic floor accurately with self-cueing indicates that there is a significant misperception pertaining to pelvic floor proprioception during an attempt to contract and lift the pelvic floor. Discussion: This pilot study clearly demonstrates a significant misperception on the part of the subjects but does not answer the question as to how the pelvic floor should participate in the effort to increase IAP. Further studies will need to be conducted to evaluate how the pelvic floor truly participates in the synergistic activity associated with maintaining IAP. In the meantime, this pilot study would indicate that active cueing of the pelvic floor does not seem to be accurate even in expert movers/teachers.
Abstract ID: 27902
TITLE: Fragile X Primary Ovarian Insufficiency (FXPOI): a Case for Proactive Physical Therapy Intervention
AUTHORS/AFFILIATION: Cornelia Lieb-Lundell, PT, DPT, MA, PCS, emeritus, Anna M. Edwards, PT, DPT, MA, MBA, University of St Augustine, San Marcos, California, UNITED STATES.
Purpose: This abstract summarizes relevant information regarding Fragile X associated Primary Ovarian Insufficiency (FXPOI), which is one of 3 conditions related to FMR1 gene dysfunction. An abnormal X-linked FMR1 gene is the basis of a variety of associated disorders that can affect more than one family member and may appear in more than one generation. For affected families, specifically the woman carrying the gene, this collection of health conditions will impact her, various family members, their care provider community, and the physical therapist who may be involved in several stages of care. Description: Fragile X, a disorder of the FMR1 gene, is more frequently associated with the pediatric population, is usually more severe in males, and is the most common genetic cause of intellectual disability. However, there are 2 additional disorders caused by the same gene that are less known. One is Fragile X associated tremor and ataxia syndrome (FXTAS), a neurodegenerative disorder seen more often in older men. The other is Fragile X associated primary ovarian insufficiency (FXPOI), a chronic disorder characterized by oligomenorrhea and/or premature menopause occurring in women before 40 years of age. It is estimated to be the cause in approximately 20% of cases of infertility in females who carry the FMR1 gene. Furthermore, a small percentage of women with FXPOI will go on to develop FXTAS at an advanced age. This poster reviews the pathophysiology and physical therapy management of issues related to FXPOI and demonstrates the relevance of planning and implementing a proactive intervention plan. Unique features of this health condition that the physical therapist would address are presented. Summary of Use: This project presents an educational tool to increase an understanding of this underreported health condition. It is estimated that one in 200 females carry the altered gene and within that group 25% will go onto develop FXPOI. The clinical picture can include an increased risk for osteoporosis, a range of musculoskeletal issues, a decrease in balance, complications related to hypermobility, an increased risk for cardiac complications, and a long list of additional medical issues. Furthermore, management may be complicated by the presence of anxiety and mild learning ability variances. Importance to Members: Informal interviews with persons who carry this genetic variation revealed that patients have a difficult time finding a physical therapist who is knowledgeable about this health condition. In addition, they find that the therapist is not communicating at a level that supports the productive implementation of a recommended program. The therapist's issue often is limited access to accurate diagnostic information, resulting in a mismatch in implementing a relevant program.
Abstract ID: 29205
TITLE: Nonimmediate Effects of Abdominal Mass Increase to Postural Control: A Parallel Study to Pregnancy-Related Falls
AUTHORS/AFFILIATIONS: Adriana M. Degani, PT, PhD, Department of Physical Therapy, Western Michigan University, Kalamazoo, Michigan, UNITED STATES; Vinicius Cardoso, PT, PhD, Alessandra Magalhães, PT, PhD, BioSignal Laboratory, School of Physical Therapy, Federal University of Piauí, Parnaíba, PI, Brazil; Alessander Danna-dos-Santos, PT, PhD, Department of Physical Therapy, Western Michigan University, Kalamazoo, Michigan, UNITED STATES.
Purpose/Hypothesis: Morphological and physiological changes emerge in subsequent phases of pregnancy. However, their cumulative effect has impaired our ability to determine their individual roles to the development of a higher risk for falls in this population. Studying these factors separately will assist further improvement of current guidelines of prenatal care by allowing better management of fall risk during pregnancy. This study investigated the potential effects of an added abdominal mass to the postural behavior of nonpregnant women in reproductive age. Our main hypothesis was centered on the prediction that an additional abdominal mass would immediately induce postural instability as indicated by increases in amplitude, velocity, and regularity of the body sway displacement in time, especially in the anterior-posterior direction. Materials/Methods: The study included 10 healthy women who were evaluated for analyses of their postural behavior. Instrumented posturography was used to quantify multiple dynamic indices extracted from the body's center-of-pressure migration during 120 seconds of quiet bipedal stance on a force platform under 4 conditions: before wearing a pregnancy vest (Baseline), immediately after wearing a pregnancy vest with 7% of the body weight (VestOn), 24 hours after continuous use of the vest (Vest24h), and immediately after its removal (VestOff). Nonparametric statistics investigated the effects of this additional mechanical load to several indices of body sway. Friedman's statistical tests, followed by Wilcoxon procedures, were used to investigate the effects of the pregnancy vest (Baseline, VestOn, Vest24h, and VestOff) to all variables of interest. The level of significance was kept at 5%. Results: Results revealed changes in postural behavior as an effect of the additional abdominal weight. Interestingly, these changes did not happen immediately right after its application but along the following 24 hours. In addition, a directional selective effect was observed. Only indices of body sway in the medial-lateral direction were significantly affected. Conclusions: Our findings suggest that the occurrence of postural adjustments elicited by the load application was developed between VestOn and Vest24h. Such adjustments are commonly described in the literature as a way to optimize postural function in circumstances of sudden changes in the environmental conditions and suboptimal function of sensory or motor apparatuses. Readjusting of the sensory contributions to balance control has been shown to occur along the extended period of times (eg, years) when impairments are slowly introduced by the aging or disease processes as well as in very short time lapses when environmental conditions change abruptly. To occur, these adjustments may include functional modifications on neural networks including spinal, subcortical, and cortical substrates. Our results support this rationale. Clinical Relevance: Directional selective effects of additional abdominal load found here are nontrivial and may be related to increased risks of falling in daily situations involving pivoting movements. This hypothesis should be further explored to improve balance control and decrease fall risk during pregnancy.
Abstract ID: 27995
TITLE: Barriers to Exercise in Postpartum Women: A Mixed-Methods Systematic Review
AUTHORS/AFFILIATION: R. Edie, SPT, A. Lacewell, SPT, C. Streisel, SPT, L. Wheeler, SPT, E. George, SPT, J. Wrigley, MA, MSLS, L. Pietrosimone, PT, DPT, PhD, C. Figuers, PT, EdD, Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, UNITED STATES.
Purpose: Exercise is a safe and beneficial way of improving physical and psychological well-being in postpartum people; however, postpartum people are less likely to meet the recommended guidelines for physical activity. Identifying the barriers to exercise in the postpartum period may assist health care professionals to better understand how to counsel postpartum women on strategies for exercise. Methods: A systematic literature search was conducted in MEDLINE/PubMed, EMBASE, Scopus, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases of both qualitative and quantitative studies that examined the barriers to exercise among postpartum people. The articles were selected on the basis of predetermined inclusion and exclusion criteria. The Downs and Black Checklist of Methodological Quality was used to assess study quality. Results: Of the final studies, 10 studies met the inclusion criteria (7 qualitative and 3 quantitative). Barriers were categorized into the following categories: intrapersonal, interpersonal, sociocultural/demographic, physical environment, and health care environment. The most reported barriers in each category were lack of support from family, friends, and other mothers (9/10 mentioned), time and/or unpredictable routines/schedule and busy with domestic chores/care/responsibilities (both 8/10 mentioned), tiredness and/or lack of sleep (7/10 mentioned), weather (7/10 mentioned), and breastfeeding (3/10 mentioned), respectively. Conclusion: Physical therapists and other health care professionals should be aware of the major reported barriers to exercise among postpartum people, as this will help guide them in providing meaningful education and counseling strategies to increase exercise and well-being in this unique, important population. Further research is needed to capture a more diverse group of postpartum people, as well as considering how policy may affect exercise postpartum. Clinical Relevance: Identifying top reported barriers to exercise in postpartum women helps physical therapists better counsel women on specific ways to increase their physical activity. Physical therapists are trained to provide skillful exercise recommendations and should query postpartum patients on barriers to exercise as part of routine patient care encounters.
Abstract ID: 27099
TITLE: Prevalence of Coccygodynia in Women Undergoing Pelvic Floor Physical Therapy for Pelvic Pain Syndromes
AUTHORS/AFFILIATIONS: Cynthia E. Neville, PT, DPT, WCS, Division of Physical Medicine and Rehabilitation, Mayo Clinic Alix School of Medicine and Science, Mayo Clinic, Jacksonville, Florida, UNITED STATES; Aakriti R. Carrubba, MD, Anita H. Chen, MD, Department of Gynecologic Surgery, Mayo Clinic, Jacksonville, Florida, UNITED STATES.
Objective: To determine the prevalence of coccygodynia in women undergoing pelvic floor physical therapy for pain syndromes. Study Design and Outcomes: Retrospective analysis of medical records. Background and Aims: Coccygodynia is a painful condition of the tailbone that affects females 5 times more than males. Pelvic floor examination is routinely performed in women with pelvic pain to determine pelvic floor muscle function and dysfunction. Muscles of the pelvic floor attach directly to the coccyx. Dynamic MRI studies show that with performance of correct pelvic floor muscle contraction (shortening), the coccyx should move cranially, and with adequate pelvic floor muscle relaxation (lengthening), the coccyx should move caudally. Coccyx pain may lead to impaired contraction and relaxation of the pelvic floor muscles and contribute to pelvic floor muscle dysfunction, myalgia, and pain. The prevalence of coccygodynia in the general population is unknown. Prior studies have reviewed risk factors for coccygodynia (including age, history of trauma, and body mass index [BMI]), clinical characteristics, diagnostic criteria, and treatment options. The incidence of coccygodynia in patients presenting with low back pain ranges from 1% to 2.7%. The prevalence of coccygodynia in women with pelvic floor disorders has not been reported. The aim of this study was to identify the prevalence of coccygodynia in a representative cohort of women undergoing physical therapy for pelvic floor pain syndromes. Hypothesis: There is a high prevalence of coccygodynia among female patients with pelvic pain. Methods: The medical records of women undergoing physical therapy treatment of pelvic pain syndromes between November 1, 2019, and August 10, 2020, were reviewed retrospectively. All subjects diagnosed with pelvic pain syndromes seeking care at a tertiary academic medical system in an outpatient physical therapy clinic were included in the study. Results: A total of 171 patients met inclusion criteria, with a median age of 49 (range, 16-85) years. There were 63 (36.8%) patients with physical examination findings showing coccygodynia and 108 (63.2%) patients without. When comparing these 2 groups, there were no differences in age, BMI, marital status, race, ethnicity, insurance payer, menopause status, parity, or medical comorbidities. There were no significant differences in any specific comorbidities between patients with and without coccygodynia; however, patients with coccygodynia had more combined “other” comorbidities (79% vs 60%, P = .01). Patients with coccygodynia had significantly higher Visual Analog Scale pain scores (P = .004), Pelvic Floor Distress Inventory score (P = .010), and higher rates of muscle spasm (P = .003), fibromyalgia (P = .025), and opioid usage (P = .026). On pelvic examination, patients with coccygodynia were significantly more likely to have sacrococcygeal joint hypermobility (17.5% vs 6.5%, P = .024), sacrococcygeal joint hypomobility (65.1% vs 9%, P < .001), coccygeus muscle spasm (77.8% vs 10.2%, P < .001), anococcygeal ligament pain (63.5% vs 5.6%, P < .001), external anal sphincter pain (33.3% vs 1.9%, P < .001), impaired pelvic floor muscle endurance (57.1% vs 40.7%, P = .038), and impaired pelvic floor muscle coordination (92.3% vs 53.5%, P = .01). Conclusions: In our study, up to 36.8% of patients seeking pelvic floor physical therapy for pelvic pain diagnoses were found to have coexisting coccygodynia. These patients had higher pain scores, more symptoms of pelvic floor dysfunction, and higher rates of muscle spasm, fibromyalgia, and opioid usage. Women with coccygodynia had findings of coccyx examination, suggesting that impairments related to the coccyx may need to be addressed in treatment considerations. This study highlights the importance of screening for and identifying coccyx pain when evaluating women with pelvic pain diagnoses.
Abstract ID: 27454
TITLE: Does Physical Therapy Prevent the Development of Pelvic Floor Dysfunction During the Fourth Trimester?
AUTHORS/AFFILIATION: Connie Matheny, PT, PhD, Marsha Trantham, PT, MSPT, PhD, Benjamin Bahr, SPT, Amber Feng, SPT, Maci Talley, SPT, Division of Physical Therapy, Southwest Baptist University, Bolivar, Missouri, UNITED STATES.
Purpose/Hypothesis: The first 12 weeks after delivery, known as the fourth trimester, are an essential time for a new mother and her infant. During that time, many new mothers experience various physical, emotional, and biological changes from pregnancy and birth. Unfortunately, many of these challenges are considered typical by postnatal women. In addition, postpartum women are typically only seen by a physician for a brief visit 6 weeks after giving birth. As neuromusculoskeletal experts, physical therapists are of great value in treating the various dysfunctions that may occur in postpartum women. This review seeks to determine whether fourth-trimester physical therapy decreases the chance of developing pelvic floor dysfunction in postnatal women. Number of Subjects: Seven hundred forty-three. Materials and Methods: The researchers utilized Ebscohost and Google Scholar for research supporting the systematic review hypothesis. Search terms included pelvic floor AND physical therapy AND postnatal. Studies selected were peer-reviewed articles published in English between the years 2015 and 2020. After removing duplicates, 734 studies were evaluated and narrowed to 35 studies for eligibility consideration. The studies reviewed focused on interventions with postnatal women in the fourth trimester. An article analysis was performed by 2 researchers individually to confirm the eligibility and quality of the studies using the Downs and Black Checklist. A third neutral researcher resolved any discrepancies in scores. Results: The original search yielded 1290 records. Ultimately, 6 studies were included in the review and 2 of the articles chosen were good quality, with an average score of 20, while 4 studies were fair quality, with an average score of 16.25. Early, fourth-trimester pelvic floor rehabilitation to decrease pelvic floor dysfunction was supported in 5 of the 6 studies reviewed. Conclusions: Literature supports physical therapists as musculoskeletal experts equipped to treat and care for the pelvic floor. Early pelvic floor rehabilitation during the fourth trimester provides immediate and lasting improvements of the pelvic floor and decreases the chances of dysfunction. According to the majority of the literature, implementing physical therapy early in the fourth trimester showed improvements in pain, muscle function, and quality of life. Clinical Relevance: The current standard of care for pelvic floor physical therapy starts late in or after the fourth trimester, around the sixth to eighth weeks. Research has shown that starting pelvic floor rehabilitation earlier can decrease pelvic floor dysfunction and is not hazardous to postpartum mothers. Research on long-term effects of pelvic floor training in postnatal women is limited, and more research is needed to examine the impact of long-term pelvic floor care aimed at reducing pelvic floor dysfunction. In addition, research is needed to determine the optimal dosing and timing of pelvic floor physical therapy.
Abstract ID: 29983
TITLE: Physical Therapy Interventions to Treat Pelvic Pain in Adolescent Females: A Scoping Review
AUTHORS/AFFILIATIONS: Kristen Cook, SPT, The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, UNITED STATES; Christine Masnfield, PT, DPT, Nationwide Children's Hospital, Columbus, Ohio, UNITED STATES; Anna Biszaha, MLIS, The Ohio State University Health Sciences Library, Columbus, Ohio, UNITED STATES; Catherine Quatman-Yates, PT, DPT, PhD, The Ohio State University, School of Health and Rehabilitation Sciences and Sports Medicine Research Institute, Columbus, Ohio, UNITED STATES.
Purpose/Hypothesis: Pelvic pain and dysmenorrhea are common complaints among adolescent females and can negatively affect their quality of life. Physical symptoms and psychosocial stressors secondary to pelvic pain can lead to an increased absence from school and decreased participation in daily and recreational activities. The purpose of this study was to systematically scope the literature to identify, provide an overview, and synthesize interventions that can be used by physical therapists to manage pelvic pain in adolescent females. Materials/Methods: PubMed, EMBASE, Web of Science, CINAHL, SPORTDiscus, Cochrane, Scopus, and PEDro research databases were systematically searched up to February 19, 2020, to identify articles related to the scoping review's purpose. Key search concepts included ((“pelvic pain” or “pelvic floor dysfunction”) and (“physical therapist” or “physical therapy” or “physiotherapy”) and (“adolescent” or “teenager” or “young adult”). Inclusion criteria entailed the following: (1) written in English, (2) published within the past 20 years, (3) peer-reviewed journal articles, (5) investigated a physical therapeutic intervention, and (6) the mean age of study participants ranged between 13 and 24 years. Each study was independently evaluated by 2 reviewers for risk of bias. Results: The initial search yielded 8448 articles and 37 articles were ultimately included. Physical therapy interventions studied in the identified articles included manual therapy (n = 2), yoga (n = 8), massage (n = 2), aerobic exercise (n = 8), dry needling (n = 1), stretching (n = 13), kinesiology tape (n = 2), isometric exercises (n = 3), transcutaneous electrical nerve stimulation (n = 2), thermotherapy (n = 3), relaxation exercises (n = 7), and various other strengthening exercises and physical activity (n = 9). Outcomes varied between articles, but the most common outcomes included pain intensity (n = 34), dysmenorrhea severity relating to physical and psychological symptoms (n = 19), and pain duration (n = 12). The articles included were randomized controlled trials (n = 33), cohort studies (n = 3), and quasi-experimental study (n = 1). All reviewed articles except for one found that the specific therapeutic interventions and physical activity produced statistically significant results. The findings suggest that physical therapy management is beneficial for adolescent females with pelvic pain. There were limited direct comparisons between intervention options and limited evidence to directly support interventions to address pelvic pain in this population, however. Conclusion: A review of the current literature indicates that various physical therapy interventions may be effective in decreasing pelvic pain and improving the quality of life of adolescent females with pelvic pain. Additional research on interventions for pelvic pain, specifically in the adolescent population, is warranted to provide evidence-based physical therapy treatment. Further evidence is needed to determine which therapeutic interventions provide positive improvements in pain and function in those with pelvic pain. Clinical Relevance: Physical therapy interventions may be beneficial in treating pelvic pain in the adolescent population. However, clinicians should be mindful that the breadth, depth, and quality of studies are less prevalent for the adolescent population.
Abstract ID: 28914
TITLE: Physical Activity Relationship to Pelvic Floor Dysfunction, Pain, Sleep Quality, Health-Related Quality of Life, and Stress for Arab Women: A Predictive Correlation Study
AUTHORS/AFFILIATIONS: Lori M. Walton, PhD, DPT, MScPT, MPH(s), University of Scranton, Scranton, Pennsylvania, UNITED STATES; Veena Raigangar, MScPT, MEd, Noora Kalsoom Naqashband, PT, DPT, Asma Abulleil, BScPT, Saba Alothman, BScPT, Ayaa Yahia, BScPT, Nabil Saad, BScPT, Wasama Azam, BScPT, University of Sharjah, University City, Sharjah, United Arab Emirates.
Purpose/Hypothesis: Our study aimed to examine whether physical activity (PA) levels could predict the outcomes of stress, health-related quality of life (HRQOL), pain perception, pelvic floor dysfunction, and sleep quality. Number of Subjects: Our study recruited 214 Arab women, 30 to 50 years of age, living in the United Arab Emirates (UAE), who volunteered to participate in the research. Materials and Methods: Research Ethics Committee (REC) approval and voluntary consent were obtained before beginning the study. Participants were recruited from social media throughout the UAE. Each participant completed a Perceived Stress Scale (PSS), World Health Organization Quality of Life: Brief Version (WHOQOL-BREF), McGill Pain Questionnaire (MGPQ), Pittsburgh Sleep Quality Index (PSQI), Pelvic Floor Dysfunction Index-20 (PFDI-20), and International Physical Activity Questionnaire-Short Form (IPAQ-SF) in Arabic or English Language version. Data were compiled and analyzed on SPSS 25.0, using a multiple linear regression equation and descriptive statistical analysis. Results: A significant predictive correlation between PA levels reported on the IPAQ-SF and pelvic function, HRQOL, and sleep quality scores (P < .001), and a significant inverse predictive correlation was found between PA and pain and stress (P < .01). Conclusions: Higher PA was directly related to better pelvic floor function scores (PFDI-20), sleep quality, HRQOL, and decreased pain and stress levels for Arab women between the ages of 30 and 50 years. Clinical Relevance: Clinical prescription of PA for patients with pelvic floor dysfunction, high levels of stress, or pain may be additionally helpful in treatment of pelvic floor issues. Specific PA prescription should be studied in future research related to the pelvic floor.
Abstract ID: 30330
TITLE: From the Core to the Floor—Pelvic Health Literacy in Postpartum Women
AUTHORS/AFFILIATIONS: Cara Morrison, PT, DPT, Spooner Physical Therapy, Phoenix, Arizona, UNITED STATES; Kailey Snyder, PhD, MS, Kari Bargstadt-Wilson, PT, Creighton University Omaha, Nebraska, UNITED STATES; Julie A. Peterson, PT, DPT, Creighton Therapy and Wellness, Omaha, Nebraska, UNITED STATES.
Purpose/Hypothesis: The purpose of this study was to (1) explore changes in the perception of postpartum women's understanding of the core/pelvic floor and their role in urinary incontinence (UI) and pelvic organ prolapse (POP) and (2) determine whether there is a significant difference in pelvic floor and UI/POP knowledge and understanding pre- and post-webinar. Number of Subjects: Sixteen. Materials and Methods: Participants were recruited through maternal-child organizations' social media pages as well as snowball sampling. Inclusion criteria included giving birth within the past 12 months and being 19 years or older. Women were initially provided a demographics survey and the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). In addition, they participated in a semistructured telephone interview to assess their baseline understanding of UI, POP, and function of the pelvic floor muscle group. They were then provided a link to a 30-minute prerecorded webinar regarding UI, POP, and the pelvic floor in addition to potential medical and physical therapy interventions. Post-viewing, they were provided the PIKQ and participated in a follow-up semistructured interview. The pre- and post-PIKQ surveys were analyzed utilizing a paired-samples t test to assess changes in scores regarding the UI questions, POP questions, and total PIKQ score. Qualitative crystallization/immersion was utilized to assess overarching themes among interview questions pre- and post-webinar. Results: The majority of women were Caucasian (81.25%), had at least a bachelor's degree (81.25%), and were 32.75 ± 3.44 years old. Specific to the PIKQ, significant score improvements between pre- and post-webinar were seen; UI items: t15 =−2.35, P < .033; POP items: t15 =−4.283, P < .001; and Total PIKQ: t15 =−3.927, P < .001. Interview findings revealed a better understanding of the different types of UI and POP, how to incorporate the entire core muscle groups in functional activities, and specific cues on how to best isolate the pelvic floor during a contraction. Conclusions: Following a short educational webinar, participants demonstrated significant improvements in the understanding of POP and UI as well as treatment options, including how to more efficiently utilize the pelvic floor muscles. Limitations included a small, predominantly Caucasian sample size, which prevented us from generalizing results to a larger population. Considerations for future research would include a larger sample size as well as incorporating additional education regarding diastasis recti abdominis. Clinical Relevance: A 30-minute webinar appears to be an effective strategy for increasing pelvic health knowledge in postpartum women. Clinical settings should consider the addition of webinars for postpartum patient education. This could allow women to be better able to identify when further treatment should be obtained and ultimately reduce the severity of pelvic health distress among postpartum women.
Abstract ID: 28603
TITLE: Running Behavior and Urinary Incontinence in Female Runners
AUTHORS/AFFILIATION: Heather M. Hamilton, DPT, Mira Mariano, PT, PhD, Old Dominion University, Norfolk, Virginia, UNITED STATES.
Background and Purpose: Compared with sedentary women, female athletes have a 177% higher risk of experiencing urinary incontinence (UI). Although pregnancy and delivery have been associated with an increased risk of UI, young nulliparous athletes have also reported the presence of UI. It is therefore important to understand sports-specific demands on the pelvic floor. Running is a popular, accessible form of physical activity with many health benefits. However, running places a high demand on the pelvic floor muscles due to increased ground reaction forces that can transfer to the continence mechanism. The purpose of this study was to understand the prevalence of UI and related running behavior specifically in female runners. Methods: This cross-sectional study involved an online, anonymous survey that was developed using Qualtrics software and included questions related to current running behavior, running history during and after pregnancy, and UI and its effect on running behavior. The survey was e-mailed and posted on social media by local running groups and running stores. Inclusion criteria were female runners at least 20 years old and running at least once per week. Proportions and descriptive statistics were used to assess the data. Results: A total of 803 participants completed the online survey. Fifty-four percent of the participants reported at least one delivery. At least 40% of the parous runners reported urine leakage after their first delivery, and the majority of these women reported that the urine leakage lasted greater than 1 year after delivery. Of all the runners, 55% reported that they “never” leak urine, 31% reported they leak “once per week or less often,” and 14% reported leaking at least 2 to 3 times per week. Twenty-three percent of participants reported leaking urine during physical activity or exercise, and 16% reported urine leakage during running. The most common strategy to manage UI was to urinate more frequently (35%). Of the participants who were currently experiencing UI during running, 72% reported that they have not notified their health care provider, and the most common reason for not seeking treatment was that their symptoms were not bothersome enough. Discussion: Nearly a quarter of the participants reported leaking urine during physical activity, and the majority of participants reporting UI had not notified their health care provider. The prevalence of UI in postpartum runners in the current sample is similar to that reported in the literature. The total prevalence of UI in female runners in this study was slightly lower than that in other studies of female athletes, which may be due to the high proportion of nulliparous runners (46%) in the current sample. UI can lead to decreased participation in physical activity and affect psychological well-being. Despite the benefit of pelvic floor physical therapy for treating UI, very few runners experiencing UI have notified their health care provider. Increasing awareness of UI treatment options may improve access to care and allow women to successfully continue running throughout their lifetime.
Abstract ID: 30169
TITLE: Effectiveness of Negative Pressure Wound Therapy After Cesarean Delivery in Obese Women: A Review
AUTHORS/AFFILIATION: Adrienne H. Simonds, PT, PhD, Lauren Coleman, SPT, Rebecca Peck, SPT, Courtney Scharinger, SPT, Kristin Stetzel, SPT, Doctor of Physical Therapy Blackwood–South Program, Rutgers, The State University of New Jersey, New Jersey, UNITED STATES.
Background: Negative pressure wound therapy (NPWT) is used to accelerate wound healing by creating a closed system at the incision through application of a pump and vacuum-sealed dressing. NPWT has been shown to be effective in reducing surgical site infection (SSI) in obese women with a body mass index (BMI) of 30 kg/m2 or more. The effectiveness in women with BMI of 35 kg/m2 or more is unclear. Obesity in childbirth affects more than 40% of women. Obese women have a 2 times greater chance of cesarean section (CS) than normal weight women and are twice as likely to develop SSI after CS. Long-term outcomes after CS, such as chronic pain and postpartum depression, are correlated with intensity of acute postoperative pain after CS. Mobility limitations, combined with an increased risk of wound complications in obese women, necessitate the exploration of postoperative interventions, such as NPWT, combined with physical therapy to reduce acute complications and improve long-term outcomes after CS. Purpose: To compare the effectiveness of NPWT with usual care for the reduction of SSI in women post-CS with a BMI of 35 kg/m2 or more. Methods: An electronic search was conducted using PubMed and CINAHL. MESH terms included “obese,” “cesarean”, “wound complications,” “negative pressure therapy,” and “infection.” Articles not in English, those published prior to 2009, and those reporting results on women with BMI of less than 35 kg/m2 were excluded. Included articles compared NPWT with usual care in women post-CS and reported outcomes related to SSI. Articles were appraised with the Newcastle-Ottawa Scale for nonrandomized designs or the Cochrane Risk of Bias Tool for randomized designs. Articles were critically appraised by 2 reviewers. A third reviewer was used to resolve discrepancies. Results: Seven studies were appraised with a total of 1481 participants. Five studies found that NPWT reduced the incidence of SSI better than usual care, but only one was statistically significant (adjusted odds ratio = 0.45; 95% CI, 0.22-0.95; P = .04). Two studies found no differences in SSI incidence between the NPWT and usual care groups. NPWT devices used included Prevena, PICO Single-Use NPWT System, and KCI V.A.C. System. Suction pressure varied, with most studies using a continuous setting of 125 mm Hg. Duration of usage ranged from 3 to 7 days post-CS. Few adverse effects such as blistering at application site were reported. Sources of bias in studies on women with BMI of 35 kg/m2 or more primarily involved moderate sample sizes and heterogeneity in cohorts, such as emergency or elective CS, age, parity, and comorbidities including cardiovascular disorders and diabetes. Discussion/Conclusion: NPWT has previously been shown to be effective in reducing SSI risk in women with a BMI of 30 kg/m2 or more after CS and in subgroups of postoperative patients at risk for wound complications. NPWT was found to reduce SSI risk in women with BMI of 35 kg/m2 or more better than usual care, but results are statistically weak. In class II and III obese women, it may be necessary to explore alternative NPWT settings to ensure therapeutically effective suction intensity and/or consistent adherence of wound dressings to the CS incision. Heterogeneity in cohorts, combined with moderate sample sizes, increases the likelihood of type II error.
Abstract ID: 29968
TITLE: Factors Affecting Quality of Life Among Women With Chronic Low Back Pain: A Cross-Sectional Study
AUTHORS/AFFILIATIONS: Ghadah Algudairi, PT, MSc, Security Forces Hospital, Riyadh, Saudi Arabia; Mohammed Alshehri, SPT, Jazan University, Jazan, Saudi Arabia; Einas Aleisa, PT, PhD, MS, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; Muhammad Alrwaily, PT, PhD, MS, West Virginia University, Morgantown, West Virginia, UNITED STATES; King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.
Purpose/Hypothesis: Low back pain (LBP) is a prevalent disorder among women. Poor quality of life (QOL) is commonly reported in females with chronic LBP who are referred to physical therapy clinics. However, common factors associated with poor QOL have not been studied thoroughly in this population. Therefore, we aimed to investigate the association between QOL and demographics and clinical variables in women with chronic LBP. Number of Subjects: One hundred sixty-one. Methods: In this cross-sectional study, we included Arabic-speaking women with chronic LBP who were referred to several hospitals in Riyadh, Saudi Arabia. We collected demographics (age, marital status, and occupation) and clinical variables (body mass index [BMI], menopausal status, hormonal therapy, neuropathic pain, Visual Analog Scale [VAS] for pain, Pelvic Floor Distress Inventory [PFDI-20], and Pittsburgh Sleep Quality Index [PSQI]). In addition, Arabic-validated questionnaires for QOL including the Incontinence Impact Questionnaire (IIQ), Colorectal-Anal Impact Questionnaire (CAIQ), and Pelvic Organ Prolapse Impact Questionnaire (POPIQ) were obtained. Generalized linear models were used to assess the association between IIQ, CAIQ, and POPIQ (dependent variables) and between demographics and clinical variables. Results: One hundred sixty-one participants were involved in the study (age = 47.42 ± 7.30 years; BMI = 31.55 ± 4.68 kg/m2; VAS score = 7.35 ± 2.05; PSQI score = 8.81 ± 4.05; and PFDI-20 score = 130.60 ± 33.04). There were 29.8% of participants with higher education, 85.1% were married, 70.2% were housewife, 37.3% with menopausal status, 3.7% with hormonal therapy, and 50.9% with neuropathic pain. After controlling for demographics and clinical variables, there were significant associations between PFDI-20 and IIQ (β= .20, P < .001), CAIQ (β= .15, P < .001), and POPIQ (β= .21, P < .001). In addition, age and PSQI were significantly associated with CAIQ (β = −.44, P = .01; β= .74, P = .006, respectively). Conclusions: The data suggest that worse symptoms of pelvic floor dysfunction were associated with poor QOL in women with chronic LBP. This association might be bidirectional in which future studies are needed to investigate the complex relationship between these factors. Poor colorectal-anal–related QOL was associated with older adults and poor sleep quality. Clinical Relevance: Unique finding in this study was the relationship of age and poor sleep quality with colorectal-anal–related QOL. This may be an indication as a negative factor of poor QOL in women with chronic LBP, in whom clinicians/physical therapists might need to screen for sleep quality for better treatment plans.
Abstract ID: 28607
TITLE: Nerve Versus Muscle: A Physical Therapist's Evaluation and Management Approach to Pudendal Neuralgia
AUTHORS/AFFILIATIONS: Jessica Magee, PT, DPT, ATC, Brooks Rehabilitation, Jacksonville, Florida, UNITED STATES; Stephanie Bush, PT, DPT, Med Brooks Rehabilitation, Jacksonville, Florida, UNITED STATES.
Background and Purpose: Pudendal neuralgias are caused by compression, irritation, or traction of the pudendal nerve that can result in unilateral or bilateral pain in the female vulva, vagina, and clitoris or the male scrotum, testes, and penis, as well as urinary urgency, frequency, dysuria, obstructed defecation, and sexual dysfunction. Pudendal neuralgia is a difficult diagnostic and therapeutic complaint, often misdiagnosed by many practitioners. The literature identifies physical therapy as one of the frontline, conservative approaches for the treatment of pudendal neuralgia. Therefore, the purpose of this case report was to describe the evaluative process in differentiation between a mechanical versus neuropathic pain generator in a patient with a medical diagnosis of pudendal neuralgia. Case Description: The patient was a 46-year-old woman presenting to outpatient physical therapy with a diagnosis of pelvic pain. She reported left-sided lower abdominal, vaginal and rectal pain that was exacerbated by sitting. She also reported bladder, bowel, and sexual function changes that coincided with the onset of her chief complaint. Positive examination findings included hypertonicity and tenderness of the pelvic floor musculature, supporting the primary physical therapy diagnosis of overactive pelvic floor musculature as the source of pain. Tinel's testing along the pudendal nerve pathway was negative for reproduction of concordant symptoms at all points. Treatment consisted of manual therapy and therapeutic exercise to promote down-training and relaxation of the pelvic floor musculature. Outcomes: The patient was seen for a total of 12 visits. Outcome measures included the 3 Incontinence Questions, International Consultation on Incontinence Questionnaire-Urinary Incontinence, Incontinence Impact Questionnaire, and Functional Pelvic Pain Scale. At discharge, the patient reported 0/10 pain on the Numeric Pain Rating Scale and a reduction by 4 points to 2/32 on the Functional Pelvic Pain Scale, indicating that there was “some pain with function” with the activities of walking and running. Pelvic floor muscle function improved over the plan of care, and at the time of discharge, the patient reported a resolution of symptoms pertaining to bladder, bowel, and sexual function. Discussion: This case report describes the evaluative process in differentiation between a mechanical versus neuropathic pain generator in a patient with a medical diagnosis of pudendal neuralgia. This case demonstrates that care guided by a physical therapist specializing in pelvic floor dysfunction can make positive changes in “symptoms” of pudendal neuralgia, with the primary cause being musculoskeletal in nature.
Abstract ID: 29915
TITLE: Cognitive Components of Behavioral Therapy for Overactive Bladder: A Systematic Review
AUTHORS/AFFILIATIONS: Becca Reisch, PT, DPT, PhD, Pacific University School of Physical Therapy and Athletic Training, Hillsboro, Oregon, UNITED STATES; Brynne Gardner, PT, DPT, Results Physiotherapy, Dallas, Texas, UNITED STATES.
Purpose/Hypothesis: The purposes of this systematic review were to describe the cognitive components of behavioral therapy (BT) for overactive bladder (OAB), to evaluate the effectiveness of BT that includes a cognitive component on OAB symptoms, and to determine whether the specific impact of the cognitive component of programs could be evaluated. Number of Subjects: Four studies were included in the review. Materials and Methods: An electronic search was conducted on PubMed, CINAHL, Web of Science, Cochrane database, and PEDro databases. Inclusion criteria were trials on therapy for OAB in which at least one group received some form of BT as part of their treatment, published in English, that included neurologically intact nonpregnant participants 18 years or older. Articles could be single-arm trials or randomized controlled trials. Outcomes of interest were symptoms of OAB (urgency, frequency, nocturia, urge urinary incontinence), quality of life (QOL), and treatment satisfaction. Titles and abstracts were scanned to identify studies that included some type of BT for OAB symptoms. Those articles were then read in more depth to ascertain whether any description of a cognitive component of the BT was included. Results: The initial search yielded 519 articles. Thirty articles met the criteria of including BT in the intervention for OAB and were then evaluated further to ascertain whether the BT provided included a description of a cognitive component. Of those, 4 articles were deemed appropriate for final analysis. Methodological quality was poor for 2 studies and fair for 2. Across the studies, the cognitive components of the BT interventions were given little attention by the authors. The amount of detail provided varied widely among the 4 studies, from detailed instructions on techniques to very brief information. A total of 1099 participants were included, the majority of whom were women (91.5%), with mean ages from 49 to 60 years. Study heterogeneity precluded data pooling, but all 4 studies showed statistically significant improvements in OAB symptoms based on the results of the validated outcomes tools and/or a high percentage of participants expressing satisfaction with treatment. The specific impact of the cognitive component of BT could not be assessed, as this variable was not manipulated. Results indicate that BT with a cognitive component may be helpful in alleviating symptoms of OAB, but this aspect of BT may be underemphasized in current studies, given the known connection between OAB and anxiety and other mental health conditions. Conclusions: BT that includes a cognitive component shows promise for treatment of OAB. The relative impact of this part of BT cannot be ascertained. Future studies should thoroughly describe the cognitive components of BT and should include manipulation of this variable so that its specific impact can be ascertained. Clinical Relevance: BT with a cognitive component is helpful for reducing symptoms of OAB, but there is a need for clearer descriptions and investigations of this aspect of therapy.
Abstract ID: 28552
TITLE: Reporting Lumbopelvic Pain During Pregnancy
AUTHORS/AFFILIATIONS: Ariana Cesare, SPT, Nura Mariscal, SPT, Columbia University Program in Physical Therapy, New York City, New York, UNITED STATES; Travis Barton, Travis, MS, Sentient Energy, Inc, Santa Clara, California, UNITED STATES; Farah Hameed, MD, Department of Rehabilitation Medicine at Columbia University Irving Medical Center, New York City, New York, UNITED STATES; Cynthia Chiarello, PT, PhD, MS, Columbia University Program in Physical Therapy, New York City, New York, UNITED STATES.
Purpose/Hypothesis: Lumbopelvic pain (LPP) is a common problem during pregnancy, with its prevalence reported up to 90%. Both pregnancy-related physical changes and psychosocial variables, including pain beliefs, have an effect on LPP. American women have the highest prevalence of LPP but are least likely to report it. Increased LPP during pregnancy is associated with diminished postpartum recovery and, if untreated, may persist for months to years after delivery. The purpose of this study was to determine physical and psychosocial factors that contributed to reporting LPP during pregnancy to a health care provider (HCP). Subjects: English- or Spanish-speaking pregnant women older than 18 years seeking care at the obstetrical offices and clinics of a large urban medical center between July 17, 2018, and March 10, 2020. Materials/Methods: Women voluntarily completed a questionnaire that included demographics, race, financials, activities, pain beliefs and behavior, the Pregnancy Mobility Index (PMI), the Questionnaire for Urinary Incontinence Diagnosis (QUID), and the Pelvic Girdle Questionnaire (PGQ). Data were manually transferred to the Research Electronic Data Capture database for secure storage. To examine which factors contribute to a woman informing her HCP she has LPP, a full logistic regression model was constructed with all variables (PGQ, PMI, QUID, week of gestation, age, height, body mass index, ethnicity/race, pain level, pain concern, pain beliefs, and financial stability). A stepwise selection using the Bayesian Information Criterion removed insignificant variables for the most parsimonious model to obtain odds ratio (OR) with 95% confidence intervals (CIs) for the significant factors. Results: Of the 1019 questionnaires received, 851 answered to having LPP or not. Of those women, 538 (63.2%) indicated they had LPP during their current pregnancy and 313 (36.8%) did not. Of those with LPP, 233 (43.3%) reported pain to their HCP, 280 (52.0%) did not, and 25 (4.6%) did not respond. A higher pain level (OR = 1.72; 95% CI, 1.07-1.29) and week of gestation (OR = 1.07; 95% CI, 1.04-1.09) were associated with reporting LPP during pregnancy to an HCP. Conclusions: Of women surveyed, 63% had LPP, and of those women, less than half reported pain to their HCP. Week of gestation and pain level are the most predictive variables for pain reporting. Assuming a consistent pain level, the probability that a pregnant woman will report LPP to her HCP increases between 4% and 9% for every week the pregnancy progresses. Assuming equal weeks of gestation and an increase of 1 point on a 0- to 10-point pain scale, a woman is 7% to 29% more likely to tell her HCP she has LPP. Clinical Relevance: Based on the predictability of these variables in pain reporting as pregnancy progresses, we recommend HCPs screen for and inquire about LPP via the pain scale throughout pregnancy. If patients have LPP during pregnancy, we recommend a referral to physical therapy, since physical therapists are the most likely providers to treat LPP.
Abstract ID: 28254
TITLE: A Physical Therapist's Evaluation and Management of Bladder Pain Syndrome in a 32-Year-Old Man
AUTHORS/AFFILIATIONS: Jessica Magee, PT, DPT, ATC, Brooks Rehabilitation, Jacksonville, Florida, UNITED STATES; Stephanie Bush, PT, DPT, Med Brooks Rehabilitation, Jacksonville, Florida, UNITED STATES.
Background and Purpose: Bladder pain syndrome is characterized by the presence of chronic pelvic pain, pressure, or discomfort perceived to be related to the bladder, accompanied by at least one other urinary symptom such as urgency or frequency. Little is known about the prevalence of bladder pain syndromes in society. However, women are more widely affected than men. A recent Cochrane review identified pelvic floor physical therapy as a first-line intervention for treatment of bladder pain syndromes. There is a lack of literature related to the physical therapy diagnosis and management of male bladder pain syndromes. Therefore, the purpose of this case study was to describe the evaluation and physical therapy management of a 32-year-old man with bladder pain syndrome. Case Description: The patient was a 32-year-old man presenting to outpatient physical therapy with a diagnosis of overactive bladder. The patient reported experiencing symptoms for 8 years, with onset around the same time he sustained a right hip injury while running, and symptoms had worsened over the last 3 years. Prior to physical therapy, the patient had tested negative for the presence of a urinary tract infection and prostatitis. Chief complaints included increased daytime urgency and frequency, nocturia, and intermittent suprapubic pain, as well as difficulty maintaining an erection. Positive examination findings included impaired voluntary and involuntary pelvic floor muscle relaxation, external anal sphincter and puborectalis hypertonicity, and muscle guarding and tenderness at his right hip, leading to a clinical impression of overactive pelvic floor musculature, likely as a result of his hip injury. Plan of care would include manual therapy to address turgor of the hip and pelvic floor muscles, therapeutic exercise with a focus on tissue revascularization and relaxation, and patient education on strategies for management of frequency, urgency, and nocturia. Outcomes: The patient was seen for a total of 8 visits over a period of 9 weeks. Subjective improvements include decreased urinary frequency to 6 to 8 daytime voids and 0 to 1 nighttime voids and positive changes in the patient's self-perceived level of dysfunction and impact on quality of life, as evidenced by an improvement of 16 points on the National Institutes of Health–Chronic Prostatitis Symptom Index and a 9-point improvement on the Pelvic Pain and Urgency/Frequency Patient Symptom Scale. Discussion: This case report describes the evaluation and management of a male patient with bladder pain syndrome. It demonstrates how treatment by a physical therapist can make positive changes in symptoms of urinary urgency, frequency, nocturia, and suprapubic pain and improve quality of life. Most importantly, this case shows the importance of assessment and identification of impairments located outside of the pelvic floor as a contributor to pelvic floor dysfunction.
Abstract ID: 26994
TITLE: Orthopedics Meets Pelvic Floor: Piriformis Syndrome Versus Pelvic Floor Dysfunction
AUTHOR/AFFILIATION: Alexandria Burch, PT, DPT, Cleveland Clinic Akron General Health and Wellness Center, Bath, Akron, Ohio, UNITED STATES.
Background and Purpose: Pelvic floor dysfunction has been shown to have a large negative impact on quality of life but takes an average of 7 years for accurate diagnosis in men. Pelvic floor dysfunction is also a very broad term, with subcategories including impairments such as incontinence, constipation, and pain. The purpose of this case was to highlight the potential overlap in symptoms between piriformis syndrome and pelvic floor dysfunction, aid orthopedic clinicians in determining how to screen for pelvic floor dysfunction and when to refer out, and serve as a reminder of the importance of screening for nonmusculoskeletal contributions to pain. Case Description: The patient was a 40-year-old man who presented to pelvic floor physical therapy after completing orthopedic physical therapy for piriformis syndrome without relief. The patient's primary complaints were pelvic and groin pain with sitting, pain with bowel movements, pain that worsened when pushing down on the gas pedal while driving, and a history of right leg going numb with prolonged sitting. The patient described pain as “sitting on a hacky sack.” His main goal was to be able to work and drive without pain. The patient presented with pelvic floor muscle restrictions and lumbar spine contribution to pain discovered via repeated movement testing. The case was complicated by the patient being admitted to the hospital with cellulitis and abscess of the scrotum. The patient was seen in pelvic floor physical therapy 1 time per week for 8 weeks. Interventions for pelvic floor contribution to pain included diaphragmatic breathing, stretching, and manual therapy to the pelvic floor muscles. Interventions for the lumbar contributions to pain included repeated movements and core stability exercises. Postural exercises were performed to benefit both pelvic floor and lumbar contributions to pain. Outcomes: Outcome measures utilized including the Numeric Rating Scale (NRS) for pain and the National Institutes of Health (NIH)–Chronic Prostatitis Symptom Index score. Nonstandardized outcomes included patient sitting tolerance. The patient's NRS pain rating decreased from an average of 4/10 at evaluation to a maximum of 1/10 at discharge, with most of the time being pain-free. Sitting tolerance improved from approximately 10 minutes at evaluation to more than 2 hours at discharge. NIH–Chronic Prostatitis Symptom Index score was not able to be reassessed because of technological issues at time of discharge. Discussion: The patient's pain was reduced and quality of life improved with a comprehensive therapy approach to pelvic floor dysfunction. This study supports the importance of appropriate screening for pelvic floor dysfunction in patients presenting with hip or groin pain/pain with sitting and screening for nonmusculoskeletal contributions to pain.
Abstract ID: 28189
TITLE: Jumping Jacks in Women With and Without Stress Urinary Incontinence During 2 Bladder Conditions
AUTHORS/AFFILIATIONS: Erin H. Hartigan, PT, DPT, PhD, J. Adrienne McAuley, PT, DPT, Michael Lawrence, MS, University of New England, Portland, Maine, UNITED STATES; Cara L. Lewis, PT, PhD, Boston University, Boston, Massachusetts, UNITED STATES.
Disclosure: This work was supported in full by a research grant from the American Physical Therapy Association's Section on Women's Health. Purpose/Hypothesis: Women with self-reported stress urinary incontinence (SUI) (ie, leak urine when coughing, sneezing, and/or exercising) present with hip weakness and walk differently compared with women without SUI. Episodes of SUI are common during jumping tasks. The purpose was to compare hip angles and vertical excursion of center of mass (COM) during jumping jacks between women with and without SUI during 2 conditions. Materials and Methods: Women with (n = 19) and without (n = 22) SUI (age: 33.9 and 25.0 years; body mass index: 22.4 and 22.4 kg/m2, respectively) completed jumping jacks for 60 seconds in 2 conditions: no desire to void (control) and after consuming 16 ounces of water (full bladder). No cues were given for speed or technique of jumping jacks. Women reported if they had an episode of SUI (ie, leak) during testing. A motion capture system (Qualisys) captured hip angles and COM location. Hip angles (sagittal, frontal, transverse planes) at the maximum foot separation position and vertical excursion of COM and were identified using Visual3D (C-Motion). Mixed-model analyses of variance were used to compare between groups (SUI-no leak, SUI-leak, without SUI), conditions (control, full-bladder), and limbs (dominant [D], nondominant [ND]). Statistical significance was set at P < .05 (SPSS, IBM). Results: Nine women with SUI reported an episode of SUI (ie, SUI-leak) while jumping during the control condition; 7 of these 9 women also leaked during the full-bladder condition. Women without SUI were significantly younger than either SUI group (P < .001; without SUI: 25.0 years; SUI-leak: 35.1 years; and SUI-no leak: 32.8 years). Hip abduction was 1.1° less (P = .007; control: 15.2°; full: 14.1°), and vertical excursion of COM was 0.1 m less (P = .006; control: 0.187 m; full: 0.177 m) in the full-bladder condition. Hip flexion was significantly greater in the ND limb (P = .034; ND: 22.1°; D: 20.6°). No other significant interactions or main effects were found. Although not statistically significant, women in the SUI-leak group used less hip flexion than the other 2 groups (P = .184; 5°< SUI-no leak and 7°< without SUI). Conclusions: Women, regardless of SUI status, decreased hip abduction angles and minimized their COM displacement when performing jumping jacks in the full-bladder condition compared with the control condition. The greater hip flexion in the ND limb persisted across groups and conditions, thus was unlikely related to SUI status or the full bladder. Clinical Relevance: Women's lesser hip abduction angles during the full-bladder condition parallels clinicians' observations that patients may engage the adductor muscles to assist attempts at pelvic floor muscle recruitment. Although not statistically different, the lesser hip flexion in the SUI-leak group exceeded the minimally clinical important difference (ie, 3°). Perhaps, greater hip flexion is an effective strategy to prevent SUI during jumping jacks. Further investigation of this hypothesis is needed.
Abstract ID: 29255
TITLE: Significant Predictors of Self-reported Stress Urinary Incontinence in Women
AUTHORS/AFFILIATIONS: Erin H. Hartigan, PT, DPT, PhD, J. Adrienne McAuley, PT, DPT, Michael Lawrence, MS, University of New England, Portland, Maine, UNITED STATES; Cara L. Lewis, PT, PhD, Boston University, Boston, Massachusetts, UNITED STATES.
Disclosure: This work was supported by a research grant from the American Physical Therapy Association's Section on Women's Health and a University of New England's Office of Sponsored Programs mini-grant award. Purpose/Hypothesis: Stress urinary incontinence (SUI) is common in women and may be influenced by age, parity, activity level, body mass index (BMI), pelvic floor muscle (PFM), and hip function. Our purpose was to explore the potential predictors of SUI in women. Materials and Methods: Adult women with SUI (n = 40) and without SUI (n = 43) (mean age: 25.0 and 25.3 years; BMI: 22.8 and 22.3 kg/m2, respectively) with regular menses and without conditions that would influence performance on variables of interest (VOI) were enrolled. Group (SUI, without SUI) was identified using the International Consultation on Incontinence Questionnaire–Short Form scores. We collected demographic data (ie, age, parity, vaginal births, history of low back pain, BMI, activity level) as well as data on PFM performance using the PERFECT scheme (ie, power, endurance, repetitions, fast contractions, elevation/vertical displacement, co-contraction with transversus abdominis), and spontaneous contraction with cough, tenderness to palpation, tone, and ability to relax and to bear down; activity level per the Rapid Assessment of Physical Activity questionnaire; hip passive range-of-motion (PROM) angles (internal [IR] and external [ER] rotation in prone and seated, and Ober test); and strength testing (IR and ER in prone and seated and abduction in side-lying) via maximum voluntary isometric contractions (Biodex) and manual muscle testing (MMT). The order of testing leg (dominant [D] and nondominant [ND]) was randomized. Binary logistical regression models were used to identify predictors of SUI with VOI entered in groups of 5 or fewer with significance set at P < .05 (SPSS, IBM). Results: Of the demographic VOI, only age added significantly to the prediction (P = .001; odds ratio = 1.3; R2 = 0.463; overall percentage correct: 75.9). Of the clinical VOI, ND-Ober test, ND-IR prone MMT, D-ER prone MMT, D-PFM tenderness, and vertical displacement each added to the model (P ≤ .021; R2 = 0.658; overall percentage correct: 82.9), with vertical displacement having the highest odds ratio (14.0). Conclusions: Women who were older, with greater tender points, less flexible per Ober test, weaker MMT in prone (ND-IR and D-ER), and unable to create PFM vertical displacement were more likely to report SUI. Women who were unable to create vertical displacement with PFM contraction were 14 times more likely to report SUI; the next highest odds ratio identified those with PFM tenderness being 3 times more likely to report SUI. Clinical Relevance: Given the predictors of self-reported SUI, physical therapists (PTs) should emphasize the quality of PFM contraction with attention to the vertical displacement. Randomized clinical trials are needed to test the efficacy of treating SUI by improving modifiable clinical variables (ie, decreasing tenderness, increasing hip rotator strength in prone, and improving Ober test scores). If vertical displacement assessed using ultrasound imaging has the same odds ratio as intravaginal findings, then this measure would inform a wider group of PTs without expertise in internal PFM examination.