Pelvic Floor Disorders
Conditions
Keywords
Hypopressive exercises, Pelvic floor muscle trianing, Ultrasound, Active pelvic floor muscle contraction
Brief summary
The purpose of this randomized controlled trial is to compare the effectiveness of different modalities of hypopressive exercise in women with pelvic floor dysfunction. The study evaluates the effects of performing the hypopressive manoeuvre with or without the specific postural programme traditionally used in hypopressive exercise and with or without the addition of voluntary pelvic floor muscle contraction. Transabdominal ultrasound biofeedback is incorporated into the groups performing the hypopressive manoeuvre without the specific postural programme.
Detailed description
This is a four-arm, parallel-group randomized controlled trial conducted in women with pelvic floor dysfunction. Participants are randomly allocated to one of four intervention groups combining different components of hypopressive exercise: the hypopressive manoeuvre performed within the specific postural programme traditionally used in hypopressive exercise, with or without voluntary pelvic floor muscle contraction; or the hypopressive manoeuvre performed without the specific postural programme, with or without voluntary pelvic floor muscle contraction. All interventions are delivered individually under physiotherapist supervision and include an educational component addressing the anatomy and physiology of the abdominopelvic cavity and pelvic floor, together with hygienic and behavioural recommendations for the prevention and management of pelvic floor dysfunction. The hypopressive manoeuvre consists of expiration followed by expiratory apnoea and active rib-cage expansion without inhalation, accompanied by inward and cranial displacement of the abdominal wall. In the groups using the specific hypopressive postural programme, the manoeuvre is incorporated into a sequence of postures performed in different body positions according to the principles of Hypopressive Abdominal Gymnastics. In the groups performing the hypopressive manoeuvre without the specific postural programme, real-time transabdominal ultrasound imaging is used as visual biofeedback to facilitate motor learning and contraction of the transversus abdominis muscle during performance of the manoeuvre. Interventions are performed twice weekly in individually supervised 45-minute sessions. Participants following the specific hypopressive postural programme receive 16 sessions over 8 weeks, whereas participants performing the hypopressive manoeuvre without the specific postural programme receive 12 sessions over 6 weeks.
Interventions
See information included in arm/group descriptions.
OTHERHypopressive maneuver
See information included in arm/group descriptions.
OTHERHypopressive exercises plus pelvic floor muscle contraction
See information included in arm/group descriptions.
OTHERHypopressive maneuver plus pelvic floor muscle contraction
See information included in arm/group descriptions.
Sponsors
University of Alcala
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Assessor-blinded randomized controlled trial
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Women diagnosed with pelvic floor dysfunction by their doctor. * With minimum strength of the pelvic floor muscles of 3 according to Modified Oxford Score
Exclusion criteria
* Women who are pregnant or women who have had a vaginal or caesarean birth in the past six months. * Women whose PFD is severe and the first indication is surgical (POP-Q grade III-IV prolapses). * Women with only urinary incontinence or fecal urgency. * Women with pain in the pelvic-perineal region of 3 cm in the visual analog scale, where a score of 0 cm means no pain, and a score of 10cm, the maximum pain that the participant can imagine. * Women who have received pelvic floor physiotherapy treatment in the last 12 months. * Women who are unable to voluntarily contract the pelvic floor muscles, quantified by the Modified Oxford Score by a score less than or equal to 2. * Women with any pathology that may affect the treatment (neurological, gynecological or urological), or with recurrent urinary infection or hematuria. * Women with cognitive limitations to understand the information, answer the questionnaires, consent and / or participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in life impact of pelvic floor dysfunction | 4 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 month and 6 months after the intervention. | It will be assessed by the PFIQ-7 Spanish version. The PFIQ-7 consists of 3 scales of 7 questions each taken from the Urinary Impact Questionnaire, the Pelvic Organ Prolapse Impact Questionnaire, and the Colorectal-Anal Impact Questionnaire. The 3 scales are scored from 0 (least impact) to 100 (greatest impact) and an overall summary score (0 to 300). |
| Change in symptoms and quality of life: PFDI-20 | 4 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 months and 6 months after the intervention. | It will be assessed by PFDI-20 that is both a symptom inventory and a measure of the degree of bother and distress caused by pelvic floor symptoms. The PFDI-20 includes 20 questions and 3 scales. Each of the 3 scales is scored from 0 (least distress) to 100 (greatest distress). The sum of the scores of these 3 scales serves as the overall summary score of the PFDI-20 and ranges from 0 - 300 and the higher the score, the worse quality of life. The 3 scales include questions taken from the following widely used outcome measures: Urinary Distress Inventory - 6 questions, Pelvic Organ Prolapse Distress Inventory - 6 questions, and Colorectal-Anal Distress Inventory - 8 questions collecting data about UI, POP and colorectal and anal symptoms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in pelvic floor muscle strength by dinamometry | 4 assessments to evaluate change from baseline after the intervention period (2 months from baseline), 3 months and 6 months after the intervention. | It will be measured by dynamometry (measured in GRAMS). |
| Change in pelvic floor muscle pasive tone | 4 assessments to evaluate change from baseline after the intervention period (2 months from baseline), 3 months and 6 months after the intervention. | It will be measured by dinamometry (measured in GRAMS) |
Countries
Spain
Contacts
PRINCIPAL_INVESTIGATORMaría Torres-Lacomba, PhD
University of Alcalá
Outcome results
None listed