Lumbopelvic Motor Control Impairment, Perineal Sensory Dysfunction, Postpartum Functional Recovery, Postpartum Pelvic Floor Dysfunction, Postpartum Urinary Incontinence
Conditions
Keywords
Postpartum Exercise, Sensorimotor Physiotherapy, Pelvic Floor Rehabilitation, Lumbopelvic Motor Control, Perineal Sensory Function, Biofeedback, Functional Recovery, Postpartum Urinary Incontinence
Brief summary
This study evaluated whether a 12-week exercise-based sensorimotor physiotherapy program could improve pelvic health and functional recovery in postpartum women. Participants were women aged 18-40 years who were between 6 weeks and 6 months after a singleton delivery. They were randomly assigned to either a sensorimotor physiotherapy group or a control group. The physiotherapy group received supervised exercises targeting pelvic floor activation, lumbopelvic motor control, sensory re-education, proprioceptive training, functional stabilization, and biofeedback-assisted training. The control group received standard postpartum education and home advice. The main outcomes were pelvic motor control and perineal sensory function. Other outcomes included pelvic floor muscle strength, urinary symptoms, pelvic distress, core endurance, postural stability, pain intensity, and health-related quality of life. Outcomes were assessed at baseline, week 6, week 12, and week 24. The study aimed to determine whether structured sensorimotor physiotherapy provides greater benefits than standard postpartum advice and whether recovery patterns differ according to vaginal or cesarean delivery.
Detailed description
This was a prospective, single-center, assessor-blinded, stratified, parallel-group randomized controlled trial conducted in postpartum women. The study was designed to evaluate the effects of a structured 12-week exercise-based sensorimotor physiotherapy program on postpartum pelvic health, lumbopelvic motor control, sensory function, and functional recovery. Eligible postpartum women were stratified according to delivery mode, vaginal delivery or cesarean delivery, and then randomly allocated to either the Sensorimotor Physiotherapy Group or the Control Group. The intervention group received supervised individual physiotherapy sessions twice weekly for 12 weeks, together with a structured home exercise program. The intervention included pelvic floor activation, lumbopelvic motor control training, proprioceptive exercises, sensory re-education, functional stabilization, and surface electromyography-assisted biofeedback. The control group received standard postpartum education and general home advice. Outcome assessments were performed at baseline, week 6, week 12, and week 24 by blinded assessors. The primary focus was to determine whether the sensorimotor physiotherapy program improved pelvic motor control and perineal sensory function compared with standard postpartum advice. Secondary outcomes were used to evaluate broader functional and patient-reported recovery, including pelvic floor strength, urinary symptoms, pelvic distress, core endurance, postural stability, pain intensity, and health-related quality of life. Delivery mode was examined as an exploratory factor that could influence recovery patterns.
Interventions
BEHAVIORALExercise-Based Sensorimotor Physiotherapy Program
A 12-week physiotherapist-led exercise-based sensorimotor physiotherapy program delivered individually twice weekly for approximately 45 minutes per session. The program included pelvic floor activation, diaphragmatic breathing, lumbopelvic motor control training, abdominal-pelvic floor synergy exercises, proprioceptive training, tactile discrimination tasks, sensory re-education, functional stabilization, task-specific training, and surface electromyography-assisted biofeedback. Participants also completed a structured home exercise program for 15-20 minutes per day, five days per week.
OTHERStandard Postpartum Education and Home Advice
A standard postpartum education and home advice program including information on postpartum anatomy, posture correction, bladder care, and general pelvic floor exercises. Participants received a printed home exercise leaflet and two telephone contacts at weeks 4 and 8 to encourage continuation of general advice. No supervised physiotherapy, individualized exercise progression, biofeedback, or structured sensorimotor training was provided.
Sponsors
Özge BAYKAN ÇOPUROĞLU
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcome assessors were blinded to group allocation. Participants were instructed not to disclose their assigned group during follow-up assessments. Blinding of participants and the treating physiotherapist was not feasible because of the supervised exercise-based nature of the intervention.
Intervention model description
Participants were stratified by delivery mode, vaginal delivery or cesarean delivery, and then randomly allocated in a 1:1 ratio to either the Sensorimotor Physiotherapy Group or the Control Group. The Sensorimotor Physiotherapy Group received a 12-week supervised exercise-based sensorimotor physiotherapy program, while the Control Group received standard postpartum education and home advice.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Women aged 18-40 years. * Postpartum women between 6 weeks and 6 months after delivery. * Singleton delivery. * Vaginal delivery or cesarean delivery. * Ability to understand and perform the required assessment procedures. * Ability to participate in the exercise-based intervention procedures. * Provision of written informed consent before enrollment.
Exclusion criteria
* Third- or fourth-degree perineal tears. * Pelvic organ prolapse stage II or higher according to the POP-Q classification. * Active urinary tract infection or genital infection. * Previous pelvic or abdominal surgery unrelated to cesarean delivery. * Neurological conditions affecting lumbopelvic motor control. * Musculoskeletal conditions affecting lumbopelvic motor control. * Chronic pelvic pain syndromes. * Psychiatric disorders limiting participation. * Participation in structured physiotherapy or pelvic rehabilitation within the preceding 6 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pelvic Motor Control Composite Score | Baseline, week 6, week 12, and week 24 | Pelvic motor control was assessed using the Pelvic Motor Control Composite Score, an experimental composite index derived from surface electromyography-based parameters including normalized root mean square amplitude, onset latency, relaxation time, and contraction intermittency. Higher scores indicate better lumbopelvic motor control. |
| Change in Perineal Sensory Function | Baseline, week 6, week 12, and week 24 | Perineal sensory function was assessed using pressure detection threshold measured with a calibrated handheld algometer and two-point discrimination measured with a precision caliper. Lower values indicate better sensory responsiveness and tactile discrimination. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pelvic Floor Muscle Strength | Baseline, week 6, week 12, and week 24 | Pelvic floor muscle strength was assessed using the Modified Oxford Scale and the PERFECT scheme. Higher scores indicate greater pelvic floor muscle strength and function. |
| Change in Urinary Incontinence Severity | Baseline, week 6, week 12, and week 24 | Urinary incontinence severity was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Higher scores indicate greater urinary incontinence severity. |
| Change in Pelvic Floor Distress | Baseline, week 6, week 12, and week 24 | Pelvic floor-related distress was assessed using the Pelvic Floor Distress Inventory-20. Higher scores indicate greater pelvic floor symptom-related distress. |
| Change in Pelvic Floor Impact on Daily Function | Baseline, week 6, week 12, and week 24 | The functional impact of pelvic floor symptoms was assessed using the Pelvic Floor Impact Questionnaire-7. Higher scores indicate greater negative impact of pelvic floor symptoms on daily activities and quality of life. |
| Change in Core Endurance | Baseline, week 6, week 12, and week 24 | Core endurance was assessed using prone plank and side plank duration. Longer duration indicates better core endurance. |
| Change in Postural Stability | Baseline, week 6, week 12, and week 24 | Postural stability was assessed using center-of-pressure displacement during stabilometry. Lower center-of-pressure displacement or sway area indicates better postural stability. |
| Change in Pain Intensity | Baseline, week 6, week 12, and week 24 | Pain intensity was assessed using a 0-10 visual analogue scale. Higher scores indicate greater pain intensity. |
| Change in Health-Related Quality of Life | Baseline, week 6, week 12, and week 24 | Health-related quality of life was assessed using the 12-item Short Form Health Survey version 2. Higher scores indicate better perceived health-related quality of life. |
Countries
Turkey (Türkiye)
Contacts
STUDY_CHAIRÖzge Çopuroğlu
Kayseri University
Outcome results
None listed