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Vol. 22. Num. 5.01 September 2018
Pages 345-434
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Vol. 22. Num. 5.01 September 2018
Pages 345-434
Original Research
DOI: 10.1016/j.bjpt.2017.12.006
Effects of three interventions in facilitating voluntary pelvic floor muscle contraction in women: a randomized controlled trial
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Elaine Cristine L. Mateus-Vasconcelosa, Luiz Gustavo O. Britob, Patricia Driussoc, Thaís D. Silvaa, Flávia I. Antônioa, Cristine H.J. Ferreiraa,
Corresponding author
cristine@fmrp.usp.br

Corresponding author at: Department of Health Sciences, Physiotherapy Course, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 – Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
a University of São Paulo (USP), Ribeirão Preto Medical School, Physical Therapy Course, Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto, SP, Brazil
b State University of Campinas (UNICAMP), Department of Gynecology and Obstetrics, Campinas, Brazil
c Federal University of Sao Carlos, Department of Physical Therapy, São Carlos, SP, Brazil
Highlights

  • Training of the pelvic floor muscles (PFM) is essential in the treatment of pelvic floor dysfunctions.

  • Only women who are able to contract the PFM are eligible for PFM training.

  • There is no consensus as to the best method to facilitate PFM contraction.

  • Vaginal palpation with posterior pelvic tilt and vaginal palpation showed the larger effect to facilitate a PFM contraction.

  • There was significant improvement among all of the groups in UI and the largest changes were respectively noted in the PG, PTG, ESG and CG.

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Tables (5)
Table 1. Characteristics of the study participants.
Table 2. Assessment of pelvic floor muscles function by digital palpation, according to the Modified Oxford Scale for pelvic floor muscles, after intervention, considering change as FPFA grade ≥2 in the study to determine the effects of 3 interventions in facilitating voluntary pelvic floor muscle contractions in women.
Table 3. Assessment of pelvic floor muscles function by digital palpation, according to the Modified Oxford Scale for pelvic floor muscles, after intervention, considering change as FPFA grade ≥3 in the study to determine the effects of 3 interventions in facilitating voluntary pelvic floor muscle contractions in women.
Table 4. Effects of the intervention in reports of urinary incontinence regarding frequency, severity, and impact on quality of life, assessed using the ICIQ-IU-SF in the study to determine the effects of 3 interventions in facilitating voluntary pelvic floor muscle contractions in women.
Table 5. Between-groups differences after interventions in relation to total ICIQ-SF score in the study to determine the effects of 3 interventions in facilitating voluntary pelvic floor muscle contractions in women.
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Abstract
Objective

To evaluate the effect of vaginal palpation, vaginal palpation associated with posterior pelvic tilt, and intravaginal electrical stimulation in facilitating voluntary contraction of the pelvic floor muscles in women.

Methods

A randomized controlled trial in which 132 women with pelvic floor muscles function graded at 0 or 1 using the Modified Oxford Scale were randomized into four groups: vaginal palpation (n=33); vaginal palpation with posterior pelvic tilt (n=33); intravaginal electrical stimulation (n=33) and a control group (n=33) that only received verbal instructions. The primary outcome was evaluated by the Modified Oxford Scale and the secondary using the ICIQ-UI-SF. The assessment was performed at baseline with follow-up assessment after eight weeks.

Results

A total of 69.7% of the women from posterior pelvic tilt; 63.6% from vaginal palpation; 33.3% from intravaginal electrical stimulation; and 18.2% from control group (p<0.001) were able to attain Modified Oxford Scale greater than or equal to 2 after eight weeks. In comparison with control group, the posterior pelvic tilt (OR=10.35; 95% CI=3.26–32.84) and vaginal palpation (OR=7.87; 95% CI=2.53–24.47) had the most significant improvement as opposed to intravaginal electrical stimulation (OR=2.25; 95% CI=0.72–7.06). There was significant improvement among all of the groups in UI. The largest changes respectively were noted in the vaginal palpation, posterior pelvic tilt, intravaginal electrical stimulation and control group. There were no reports of adverse effects.

Conclusion

Vaginal palpation with posterior pelvic tilt and vaginal palpation were more effective interventions to facilitate pelvic floor muscles contraction when compared with intravaginal electrical stimulation and controls. Vaginal palpation was the most effective in improving urinary incontinence.

Clinical Trials Identifier: ClinicalTrial.gov: NCT02062242.

Keywords:
Pelvic floor
Physical therapy
Facilitation
Muscle contraction
Electrical stimulation
Vaginal palpation

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