TITLE: You Want Me to Ask What? Making IPV Inquiry Relevant and Practical to Physical Therapists
AUTHORS: Katrina Trent1, Kate Carlson2
INSTITUTIONS: 1. Center for Joint Replacement, Ridgeview Medical Center, Waconia, Minnesota, USA.
2. Regions Hospital, St Paul, Minnesota, USA.
ABSTRACT BODY:
Background & Purpose: Physical therapists (PTs) are one of many allied health professionals who should be routinely inquiring about intimate partner violence (IPV), recognizing health implications, providing education about unhealthy relationships, and encouraging access to resources. Research shows that a large proportion of patients seen in health care have experienced IPV and that there are long-term consequences of abuse that directly impact health. However, asking about IPV is not usually considered within the scope of practice for most PTs. In addition, many PTs are unaware of either the high prevalence rates of IPV or the relationship between abuse and common symptoms treated by PTs. Case Description: We developed and implemented practical educational methods that create both competence and comfort in discussing IPV. These methods were applied to students in a Doctor of Physical Therapy program and to clinicians in outpatient clinics and hospitals. The techniques included didactic presentation of definitions, prevalence, and health care implications. Goals of inquiry were defined to reduce concerns about scope of practice and applicability. Interviewing techniques were observed and then practiced through role-play, writing, and discussion. Students applied health behavior models to the inquiry/education process and learned how to identify and access appropriate resources in their organization and community. Outcomes: After the education session, therapists rated themselves by using the Visual Analog Scale for behaviors that they believed were demonstrated before the educational program and how they perceived performance after the intervention. Difference bar graphs show the amount of change for each question by individual and indicate improvement in response to and consideration of IPV in rehabilitation. Narrative feedback also indicated a greater understanding of the impact of stress on the healing process. The educational intervention improved compliance with routine inquiry. Clinicians exhibited a greater understanding of the impact of stress and abuse on physical therapy rehabilitation and were more comfortable asking patients about IPV. Discussion: In analyzing the results of the Visual Analog Scale survey, the greatest change occurred in the areas of comfort and confidence in working with patients who revealed histories of violence and frequency of inquiry about stress and IPV. Practicing therapists learned a number of lessons after following through with routine inquiry. They discovered that patients often talk freely about issues the therapists were once afraid to introduce and that patients appreciate and expect a more holistic approach to their health care. They learned that becoming comfortable and confident in discussing IPV is a personal journey, impacted by experiences and continuing education, as well as by the work environment. They also realized the limitations of professional practice guidelines and recognized personal agendas about wanting to "fix" patients and all of their problems.
TITLE: Does Intravaginal Neuromuscular Electrical Stimulation Elicit a Pelvic Floor Muscle Contraction? A Pilot Study Using Sonography
AUTHORS: Ruth M. Maher, Jill Crockett, Carrie Kozel, Erin Landers, Dharmisha Naik, Julie Vertucci, Melanie Wilkes
INSTITUTION: Department of Physical Therapy, North Georgia College & State University, Dahlonega, Georgia, USA.
ABSTRACT BODY:
Purpose/Hypothesis: Neuromuscular electrical stimulation (NMES) of the pelvic floor has been shown to be a valuable treatment for women with stress urinary incontinence. However, there are also numerous studies that show NMES has little effect on "cure" for those with stress urinary incontinence. The purpose of this study was to assess the effect intravaginal NMES and participant position have on pelvic floor muscles (PFM). Number of Subjects: Seven healthy nulliparous female participants aged 23 to 30 years were recruited for this study. All subjects gave informed consent and were shown how to insert the vaginal electrode appropriately. Materials/Methods: Prior to testing, each participant completed a bladder-filling protocol to allow for delineation of the bladder from the pelvic floor fascia and associated PFM. Each participant inserted a vaginal electrode with a stimulation area of 2.31 cm2. A stimulator generated a biphasic current of 50 Hz, a 0.3-ms fixed pulse width, a 5-s on-off time, and a duty cycle of 1 to 2 seconds. Participants gradually increased the intensity of NMES up to the level of tolerable discomfort (0-100 mA). A 3.5-MHz curvilinear transducer was used to assess the effect of NMES on the PFM. Results: Despite each participant reporting a sensation of PFM contraction, sonography confirmed that only 1 participant had a PFM contraction. This participant tolerated a higher intensity of NMES in all positions than the other participants (44 mA in the supine position and 39 mA in the standing position). Average current intensity was 26 mA in the supine position and 28 mA in the standing position. Conclusions: Participant sensation of a PFM contraction elicited via NMES was unreliable. Furthermore, sonography confirmed a PFM for only 1 out of 7 participants. This finding may explain why the literature is divided regarding the efficacy of NMES. The average current density used in this study was 11.26 mA/cm2 in supine and 12.12 mA/cm2 in the standing position. While previous studies have indicated that larger electrodes produce stronger motor responses than smaller electrodes, few studies, if any, report the electrode size, current density, or indeed the position of the participant during the NMES intervention. A previous pilot study by one of the authors using a novel investigational NMES device with a superficial electrode stimulation surface area of 1525 cm2 (current density 38.13 mA/cm2) showed that a PFM contraction was seen on sonography for all participants. Clinical Relevance: Intravaginal NMES is used worldwide in an effort to elicit a PFM contraction. If the purpose of NMES is to enhance the strength and ultimate function of the PFM, how can this occur if no contraction is evident? The size of the vaginal space does restrict the size and orientation of the stimulating surface area. In addition, the acute sensory excitation due to the current density can cause discomfort, which often limits the effectiveness of stimulation. We would encourage physical therapists to assess their patients during intravaginal NMES via observation with sonography or visible inspection of the perineal body in an effort to ensure that contraction is occurring.
TITLE: Physical Activity and Recovery Postpartum
AUTHORS: Carol C. Figuers1, Rachel E. Beck1, Kristen L. Molzon1, Koren L. Wagner1, Jim Cavanaugh2
INSTITUTIONS: 1. Duke University, Durham, North Carolina, USA.
2. University of New England, Portland, Maine, USA.
ABSTRACT BODY:
Purpose/Hypothesis: Decreased physical activity has been reported in postpartum women but rarely directly measured. Consequently, little is known of activity changes that occur during this period. Various factors presumably play a role in activity changes that occur, including physical and emotional demands of motherhood. How factors such as headache, urinary incontinence, and low back pain might influence activity remains unclear. The purpose of this study was to describe physical activity as measured by a Step Activity Monitor (SAM) and compare activity at 4 weeks versus 6 months. In addition, the accuracy of pedometers versus SAMs was examined. Finally, barriers to exercise for postpartum women were identified. Number of Subjects: Fourteen women were recruited into the study as a sample of convenience. Materials/Methods: Subjects were assessed at 4 weeks and 6 months postpartum including self-reported symptoms, 8 days of physical activity monitoring using the SAM, and administration of a Physical Activity Recall survey. Results: There was a significant increase in step activity from 4 weeks to 6 months postpartum (P = .0205). Pedometers demonstrated 69% to 74% accuracy for measuring step counts compared with that demonstrated by SAM. Reports of headache and urinary incontinence were present at both 4 weeks and 6 months; however, low back pain was reported only at 4 weeks postpartum. Compared to pre-pregnancy, most subjects reported decreased activity levels. Time constraints and fatigue were common barriers to exercise. Conclusions: Pedometers may be more useful as a motivational tool for fitness than as an accurate tool for research. Activity in postpartum women appears to increase as time progresses from delivery. Postpartum women report reduced levels of physical activity when comparing to the pre-pregnancy stage. Clinical Relevance: At least some postpartum women would benefit from physical activity recommendations to address barriers to exercise.
TITLE: Effect of the Combination of Strain-Counterstrain, Home Dilator Therapy, and Hamstring Stretching on Sexual Function for a Patient With Dyspareunia: A Case Report
AUTHORS: Laura Fazio1, Ellen Wruble-Hakim1, Jill Arnold2, E. A. Reicherter1, Laura Scheufele3, Vincent Conroy1
INSTITUTIONS: 1. Department of Physical Therapy and Rehabilitation Science, University of Maryland at Baltimore, Baltimore, Maryland, USA.
2. Her Health Physical Therapy, Columbia, Maryland, USA.
3. Department of Physical Therapy, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
ABSTRACT BODY:
Background & Purpose:Dyspareunia is defined as persistent or recurrent pain with attempted or complete vaginal entry or penile-vaginal intercourse. Documented causes include injury during childbirth, vulvar vestibulitis, endometriosis, pelvic inflammatory disease, and interstitial cystitis. Another etiology of dyspareunia is characterized by hypertonicity of pelvic floor muscles (PFM) leading to the presence of trigger points. The hypertonic PFM are often in spasm, resulting in painful intercourse. Trigger point therapy has been well documented for treatment of pelvic floor hypertonicity; however, the effects of strain-counterstrain were not found in the literature. The purpose of this case report was to determine whether sexual function could be improved with the use of strain-counterstrain techniques, in place of traditional trigger point therapies for dyspareunia, when used in conjunction with home dilator therapy and hamstring stretching programs. Case Description: The subject was a 48-year-old woman experiencing pain during intercourse for a duration of 11/2; years. Her medical history included 3 vaginal deliveries with episiotomies, stress urinary incontinence, lumbar laminectomy, and Raynaud's disease. Physical therapy evaluation confirmed the findings of PFM hypertonia and pain, pelvic malalignments, and decreased hamstring flexibility. Interventions included strain-counterstrain to release PFM trigger points, home dilator therapy, muscle energy techniques to correct pelvic malalignments, and a home exercise program emphasizing hamstring stretching. Outcomes: Progress was assessed using the Female Sexual Function Index, Verbal Numeric Pain Scale (0-10), presence of PFM trigger points, dilator size, and Straight Leg Raise Test results. Following intervention, the subject demonstrated decreased pain during intercourse (from 5-6/10 to 2/10), decreased palpable PFM trigger points, increased size of dilator tolerated (from 7.1 cm to 11.2 cm), and insignificant change in hamstring length (left: 47[degrees]-54[degrees]; right: 63[degrees]-62[degrees]. The subject demonstrated improved sexual function on the Female Sexual Function Index (from 24.0 to 30.9), moving from dysfunctional to functional category. Discussion: This subject demonstrated significant improvements in initial symptoms. Implementation of strain-counterstrain to release PFM trigger points, along with dilator use to maintain and stretch PFM, resulted in decreased complaints of pain, improved sexual function, normalized PFM tone, and minimized discomfort with intercourse. The subject reported compliance with the home dilator program and noncompliance with hamstring stretching. Support for strain-counterstrain appears to be limited in the literature as an intervention to reduce PFM trigger points; however, the results of this case report provide some evidence of its effectiveness. Further investigation is needed to better define strain-counterstrain's efficacy with this patient population.
TITLE: The Effects of Home-Based vs Class-Based Pilates in Healthy College-Aged Females
AUTHORS: Betsy Donahoe-Fillmore, C. Jayne Brahler, Kelly Beasley, Mary I. Fisher, Holly VanCleave, Renee Bowman
INSTITUTION: University of Dayton, Dayton, Ohio, USA.
ABSTRACT BODY:
Purpose/Hypothesis: The purpose of this study was to determine the effects of Pilates practice on body composition/mass, flexibility, stress level, core strength, and balance in college-aged females and whether differences exist between subjects who participated in instructor-led Pilates and those who participated in home-based Pilates as compared with age-matched controls. Number of Subjects: A convenience sample of female college students (N = 103; 18-35 years old) was enrolled. Materials/Methods: Three groups participated in this study. Group 1 was an instructor-led class taught for 50 minutes 2 times per week. Group 2 was home-based and watched a 20-minute DVD 3 times per week for the first 3 weeks and a 50-minute DVD 2 times per week for 7 weeks. Group 3 was an age- and gender-matched control group. Pre- and postmeasurements of body composition, flexibility, stress level, core strength, and balance were collected. Means and standard deviations were computed for all variables. Independent t tests were utilized to determine whether the groups were different at baseline and for all measured variables. Paired samples t tests were run to determine whether there was a statistically significant change in any of the measured variables from pre- to posttest. Results: There were no differences between groups at baseline except in trunk extension (P = .033). Postintervention, there was a significant increase in bilateral leg flexibility for the Pilates home-based group (3.26", P = .030; 3.35", P = .039, respectively), a significant difference for core flexion endurance (35.6 seconds, P = .015; 28.9 seconds, P = .009, respectively) for both class-based Pilates and control groups, and a significant difference in balance for the Pilates home-based group (P = .001). BMI and body fat percentage had a significant effect on core endurance, extension (P = .002), and flexion (P = .000). Conclusions: Pilates practice was found to have a positive effect on core endurance, flexibility, and balance. No significant effect on stress levels was found. Clinical Relevance: Pilates may be a useful adjunct to therapy to improve core strength, flexibility, and balance.
TITLE: Normative Values of Arm Circumference in Women Over Age 18
AUTHORS: Beth Marcoux, Wendy L. Baker, Morgan Fielder, Kara Nordstrom, Alexis Silvestri
INSTITUTION: Physical Therapy Department, University of Rhode Island, Kingston, Rhode Island, USA.
ABSTRACT BODY:
Purpose/Hypothesis: Lymphedema is a serious condition that can develop following breast cancer surgery. It is the abnormal collection of interstitial fluid in and around the axillary space and results in pain, discomfort, and decreased function in the involved upper extremity (UE). Sixty-eight percent of women will develop this condition following treatment of breast cancer. A clinical diagnosis of lymphedema is reached when there is a 2-cm circumferential increase in the affected arm when compared to the unaffected arm. This clinical definition raises the question of the impact of hand dominance and participation in athletic activities on arm circumference. The purpose of this project was to determine whether UE circumference differences exist in healthy subjects. Number of Subjects: Three hundred ten women (mean age = 32.47 +/- 15.16 years) consented to have girth measurements taken at 5 standardized points along both UEs. Subjects were recruited through workout facilities, sporting events for women, a flower show, and 2 universities in Rhode Island. Materials/Methods: Subjects also completed consent forms and a short questionnaire. Various aspects of the subjects, including hand dominance, activity level, and age, were analyzed. Results: Two-way ANOVA tests comparing women younger than 24 years with those older than 25 years found a statistically significant difference in arm circumference at the forearm (F = 16.412, df = 308, P < .01). There were also significant differences (F = 8.54, df = 308, P < .01) for those who exercised 3 times per week. Conclusions: This study suggests a need to further clarify the clinical definition of lymphedema in women younger than 25 years, as circumferential differences at the midpoint of the forearm may exist because of exercise habits. Clinical Relevance: The age of the patient may impact the determination of lymphedema and the need for treatment. Arm circumference in younger women who are active sports participants may vary because of activities alone.
TITLE: Selected Electromyographic Activity in Women During Pushups on 3 Surfaces
AUTHORS: Christina Bair1, Brandi Buckley1, Rayanne Pralle1, Melanie Schroeter1, Barb Smith1, Michael Jorgensen2
INSTITUTIONS: 1. Department of Physical Therapy, Wichita State University, Wichita, Kansas, USA.
2. College of Engineering, Wichita State University, Wichita, Kansas, USA.
ABSTRACT BODY:
Purpose/Hypothesis: This study's purpose was to determine whether performing a pushup on a BOSU ball and on an exercise bench influenced electromyographic, or EMG, activity when compared with the activity of a pushup on a stable surface in females. The hypothesis was that there is no significant difference in EMG activity in selected muscles during a pushup with hands on a BOSU ball and a pushup with feet on exercise bench as compared with a pushup on a stable surface. Number of Subjects: Eighteen healthy women recruited from a convenience sample of college students aged between 18 and 28 years participated. Materials/Methods: This study examined EMG activity from biceps, triceps, rectus abdominus, external obliques, pectoralis major, latissimus dorsi, and posterior deltoids while subjects performed a pushup with hands on a BOSU(R) ball, a pushup with feet on an exercise bench, and a pushup with hands and feet on the floor. The participant began the pushup in the top 1 position, which occurs while the participant has the elbows extended. After this, the participant lowered into a bottom position with elbows bent. Then the participant returned to the top 2 position, which is the return to the elbows extended position. An electrogoniometer was placed on the participant's left elbow to record relative elbow position during the pushups. A repeated-measures analysis of variance was performed to detect significant differences in each muscle's EMG activation between each pushup type. Results: A significant increase in EMG activity occurred during the bench pushup compared with the BOSU(R) ball pushup, contradicting previous findings. Pectoralis major, rectus abdominus, and the external oblique muscles showed the greatest EMG activity in specific positions during the 3 types of pushups. Most muscles showed greater EMG activity in the top 2 position than in the top 1 position. Researchers observed trembling of both arms of some subjects while holding the top 2 position. This might be due to muscle fatigue or residual muscle activation. Conclusions: This study showed a significant increase in EMG activity during the bench pushup compared with the BOSU(R) ball pushup. Combining unstable surfaces with resistance exercises, such as a pushup, may provide a greater challenge than performing a standard pushup. Female anatomy and physiology (including varying muscle bulk and strength), the use of a BOSU(R) ball instead of a Swiss ball, varying hand placement for each participant, and not incorporating manual resistance for the maximum voluntary contractions may have resulted in differences seen in this study as compared with other studies. Clinical Relevance: In a physical therapy clinic, the current study's findings support using a bench pushup to elicit greater EMG muscle activity as part of a strength training program for female patients.
TITLE: Thoracic Kyphosis, Pulmonary Function, and Endurance in a Woman With Osteoporosis: A Clinical Case Report
AUTHORS: Jenna Sawdon-Bea1, Susan Smith2
INSTITUTIONS: 1. Department of Physical Therapy, California State University, Fresno, Fresno, California, USA.
2. Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.
ABSTRACT BODY:
Background & Purpose: One-quarter of all women older than 60 years develop vertebral deformities as a consequence of spinal osteoporosis. Severe kyphosis has been reported to be associated with reduced fitness/endurance, pulmonary function, muscle strength, and ultimately reduced survival. The purpose of this case report was to describe an individualized 5-month stretching and resistive exercise program targeted at reducing kyphosis and improving pulmonary function and endurance for a woman with osteoporosis. Case Description: A 78-year-old woman with osteoporosis and a severe thoracic kyphosis, with resultant decreases in pulmonary function and endurance. The subject performed a daily stretching and triweekly resistive exercise program over a 5-month period. Assessments of thoracic kyphosis, pulmonary function, 6-minute walk test distance, and lower extremity strength were performed at baseline, 6, 12, 16, and 20 weeks. Outcomes: The subject's index of kyphosis decreased from 15.0 to 12.7. Pulmonary function (forced vital capacity and peak expiratory flow) improved from a baseline assessment of 87% of percent predicted to 100% at 5 months and from 67% of percent predicted to 76%, respectively. 6-Minute walk distance improved from 106 to 137 m. Measures of hip flexion and hip extension (Nm) improved across both lower extremities, whereas hip abduction did not improve. Discussion: This case report illustrates how the use of stretches and exercises can decrease one's kyphosis, thereby improving pulmonary function and endurance. And although it is not clear why the subject's pulmonary function and 6-minute walk distance improved, a possible explanation is the reduction in thoracic kyphosis. Future research should address how much thoracic kyphosis must be present before impacting pulmonary function in individuals with osteoporosis.
TITLE: The Role of the Physical Therapist in the Improvement of Quality of Life and Sexual Function for Women With Urinary Incontinence
AUTHORS: Stephanie J. McAllister, Sarah H. Oleksak, Joseph Beatus
INSTITUTION: Department of Physical Therapy, University of Maryland Eastern Shore, Princess Anne, Maryland, USA.
ABSTRACT BODY:
Purpose/Hypothesis:Urinary incontinence (UI) is the complaint of involuntary leakage of urine. It represents a multidimensional phenomenon with wide-reaching pathoanatomical, psychosocial, and financial impacts. The purpose of the study was to evaluate the effects of a conservative physical therapy treatment program on pelvic floor muscle contractility, quality of life (QOL), and sexual function in women with UI. Number of Subjects: Seventeen female subjects (aged 39-82 years) with UI participated in the study. Materials/Methods: Subjects were evaluated, treated, and discharged by 2 physical therapists specializing in women's health. Recorded data included sphincter control, endurance, and ability to perform rapid repetitive contractions of the pelvic floor muscles. Subjects completed preintervention and postintervention questionnaires on QOL and sexual function. Following initial examination, subjects participated in physical therapy interventions consisting of pelvic floor muscle exercises, biofeedback-assisted pelvic floor muscle exercise, and patient education. Subjects served as their own control. Data were analyzed using SPSS, version 15.0. Results: Subjects improved in sphincter control by one manual muscle test grade (P < .001). Endurance and rapid contractions increased by 3.26 seconds and about 3 repetitions, respectively (P < .001). Paired-match t tests of QOL and sexual function demonstrated significant pre- and posttreatment improvement (P < .05). No significant relationship was found between postintervention sphincter control and reported QOL and sexual function. Conclusions: Physical therapy should be considered a first-line treatment option for women with UI. While physical therapy interventions can improve pelvic floor muscle contractility, QOL, and sexual function, it is important to note that perceived improvement is held to a higher standard than change in objective measures. Clinical Relevance: The effective management of UI in women.
TITLE: Which Exercise Is More Effective for Knee Muscle Isokinetic Strength in Obese Women? Callisthenic or Pilates
AUTHORS: Gul Baltaci, Irem Duzgun, Selma Karacan, Volga Tunay, Nevin Ergun
INSTITUTION: Department of Physiotherapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey.
ABSTRACT BODY:
Purpose/Hypothesis: There is a need to find ways to increase the physical activity levels and improve the muscle strength for preventing knee problems of obese women. The aim of this study was to investigate which exercise would be more effective, either callisthenic or Pilates, in improving knee muscle strength in obese women. Number of Subjects: This randomized controlled trial tested 103 female participants with obesity. Materials/Methods: Thirty-four participants (mean age +/- SD: 40 +/- 8 years, BMI: 31.04 +/- 4.83 kg/m2) did callisthenic exercises 3 days per week for 6 months, 31 participants (mean age +/- SD: 37 +/- 8 years, BMI: 31.04 +/- 4.83 kg/m2) did Pilates exercise 3 days per week for 6 months, and 38 participants (mean age +/- SD: 41 +/- 7 years, BMI: 27.09 +/- 4.77 kg/m2) did not exercise as control group. All subjects were evaluated pre-training, 3 months, and posttraining. All isokinetic tests were performed by using an Isomed 2000 Isokinetic Dynamometer at 1800 per second during knee flexion and extension. Peak torque and total work were recorded on the dominant side. Repeated measures were used for statistical analyses within groups, and Bonferroni method was used for post hoc analyses for the comparison of the 3 groups. Results: Peak torques of knee flexion and extension were not significantly different at pre- and posttraining on 3rd and 6th month in all groups (P > .05). Peak torques of knee flexion were significantly different between pre- and post-training in both callisthenic and Pilates groups (P < .05). The most increase in the peak torque of knee flexion was found in the callisthenic group (22%). Peak torques of knee extension were significantly different between pre- and posttraining on 3rd month in the callisthenic group and between pre- and posttraining on 3rd and 6th months in the Pilates group (P < .05). There was no statistically significant difference in total work of knee flexion in pre- and posttraining on 3rd and 6th month in all groups (P > .05). Total work of knee flexion was significantly different between pre- and posttraining in both callisthenic and Pilates groups and pre- and posttraining on 3rd month in the control group (P < .05). Significant difference was found in the total work of knee extension between pre- and posttraining in both callisthenic and Pilates groups (P < .05). The most improvement in total work of knee flexion (47%) and extension (31%) was found in the callisthenic group, respectively. Conclusions: Besides Pilates exercises, callisthenic exercises can be recommended for strengthening in obese women. Women enjoyed Pilates and callisthenic exercises, and participation for 24 weeks increased knee strength. Clinical Relevance: Both Pilates exercises and callisthenic exercises were found to be effective in increasing the isokinetic strength of knee muscles.
TITLE: The Incidence of Urinary Incontinence and Low Back Pain in Female Collegiate Athletes
AUTHORS: Elizabeth R. Ikeda, Sally A. Carey, Meghen L. Flaig, Amanda L. Grove, Alice L. Loraine
INSTITUTION: School of Physical Therapy, The University of Montana, Missoula, Montana, USA.
ABSTRACT BODY:
Purpose/Hypothesis: The purposes of this study were to (1) describe the prevalence of urinary incontinence (UI) and low back pain (LBP) in female collegiate athletes and (2) investigate the relationship between UI and LBP in this population. Number of Subjects: Female athletes from 3 campuses of The University of Montana (UM), aged 18 to 25 years, participated in the survey. E-mails were sent to 218 athletes, and 80 responded to the survey; 5 did not meet criteria. Materials/Methods: An anonymous self-report Web-based questionnaire was developed using itoselect software housed at UM. An e-mail request to participate was sent with a link to the survey. The survey contained questions regarding demographics, physical characteristics, general health, and sports participation. Questions about UI and LBP included provoking situations, duration, frequency, intensity, effect on sport participation, treatment, and education. Results: Descriptive statistics were calculated for all data. The chi-square statistic was used to assess the relationship between UI and LBP frequency. Athletes who responded participated in basketball, cheerleading, cross country, golf, rodeo, soccer, tennis, track and field, and volleyball. UI was reported in 19% of athletes (14/75). The incidence was highest in basketball and volleyball athletes (25%), followed by soccer (20%) athletes. UI occurred most often with coughing/ sneezing and running/jumping. The majority had UI for more than 1 year (67%); 21% reported daily or weekly problems; and 80% reported "a few drops" versus large volume. No athletes reported missing practice or competition because of UI, and only 1 had sought treatment. LBP was present in 40% of athletes (30/75). The incidence was highest in soccer and volleyball athletes (50%), followed by basketball (40%) and track and field (38%) athletes. The LBP duration was more than 1 year in 67% and frequency was more than monthly in 93%. A traumatic injury was reported in 60% of athletes with LBP. Pain intensity was moderate (4) or worse in 64%. Of athletes with LBP, 44% had sought medical attention and 25% had missed practice or competition because of back pain. LBP was more frequent in athletes with UI (50%) than in athletes without UI (38%), [chi]2 = 8.53 (P = .003). UI was more frequent in athletes with LBP (23%) than in athletes without LBP (16%), [chi]2 = 3.27 (P = .07). Conclusions: Subjects in this study had a lower incidence of UI than that reported in other published studies. UI neither was severe nor affected participation in sports. As in previous studies, greater incidence was seen in high impact sports. The incidence and severity of LBP were relatively high and affected sport participation. Athletes with LBP were more likely to seek treatment than those with UI. There was a relationship between LBP and UI, though underlying mechanisms are not known. Clinical Relevance: The incidence of UI and LBP is substantial in female collegiate athletes. Clinicians should screen for UI in athletes who seek treatment of LBP and screen for LBP in athletes treated for UI.
TITLE: Differences in Muscle Strength Between Caucasian and African-American Women of Different Age Groups: The WIN Study
AUTHORS: Elaine Trudelle-Jackson1, Emerenciana Ferro1, James R. Morrow2, Georita Frierson3
INSTITUTIONS: 1. School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA.
2. Cooper Institute, Dallas, Texas, USA.
3. Department of Psychology, Southern Methodist University, Dallas, Texas, USA.
ABSTRACT BODY:
Purpose/Hypothesis: Age-related declines in muscle strength are associated with functional limitations such as reductions in gait speed and balance, difficulty in stair climbing, and reduction in ability to perform activities of daily living. Although strength is known to decline with age, little is known about whether muscle strength declines consistently across muscle groups and whether age-related declines are consistent between racial groups. The purposes of this study were to determine muscle strength values among apparently healthy women to determine whether muscle strength decline is consistent across muscle groups and in women of different age and racial groups. Number of Subjects: A cohort of 848 women (685 Caucasian [CA] and 163 African American [AA]) aged 20-83 years. Materials/Methods: Participants in the Women's Injury study at the Cooper Institute in Dallas, Texas, underwent an orthopedic examination that included handgrip strength and lower extremity muscle strength (hip abductors and external rotators, knee flexors and extensors) assessment. Maximal isometric strength for handgrip was assessed using a Jamar dynamometer and lower extremity strength was assessed using a handheld dynamometer. Strength data were grouped into young (20-39 years, n = 138), middle (40-59 years, n = 447), and older (60+ years, n = 263) age groups for CA (n = 685) and AA (n = 163) women. Means and standard deviations for unadjusted muscle strength and muscle strength adjusted for body mass were calculated for the 2 racial groups and for each of the age groups. Comparisons of adjusted strength values between age and racial groups were made using a 2-way MANOVA (age group / race) followed with appropriate post hoc tests. Results: No significant age / race interaction (P = .214) was found, but there were significant main effects for age and race (P < .001). Muscle strength decreased significantly with increasing age. Between the youngest and oldest age groups, percentage decrease for the 5 muscle groups ranged from 22.1% (grip strength) to 28% (hip abductors). Significant differences in strength were found between AA and CA women in all muscle groups (P < .05) except hip external rotators. Conclusions: Although AA women appeared to be stronger based on observed unadjusted strength values, statistical analysis of muscle strength adjusted for body mass revealed that CA women were stronger in all muscle groups except hip external rotators. Clinical Relevance: AA women may appear to be stronger based on unadjusted strength assessment values, but these results should be examined after adjusting for body mass before judging whether a strengthening intervention is warranted. Age-based normative values should be adjusted for body mass to determine an individual's potential for functional decline.
TITLE: Preliminary Validation of a Patient Satisfaction Instrument for Individuals Receiving Outpatient Physical Therapy Care in a Women's Health Clinic
AUTHORS: Paul F. Beattie1, Roger Nelson2, Deborah Schrodi3
INSTITUTIONS: 1. Program in Physical Therapy, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA.
2. Expert Clinical Benchmarks, MedRisk, Inc, King of Prussia, Pennsylvania, USA.
3. Lancaster General Women and Babies Hospital, Lancaster, Pennsylvania, USA.
ABSTRACT BODY:
Purpose/Hypothesis: This investigation provides preliminary information regarding the factor structure, reliability, and criterion-referenced validity of measures obtained from the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care on a sample of patients in a women's health care environment. Number of Subjects: Three hundred thirty-four subjects participated in this study. Materials/Methods: Upon completion of a course of physical therapy care in a hospital-based outpatient therapy department focusing on women's health, patients were asked to complete a questionnaire assessing their satisfaction with care. Subjects rated their degree of satisfaction from 1 (very unsatisfied) to 5 (very satisfied) for each of 18 items that addressed specific issues relating to satisfaction with care and for 2 items that provided a global rating of satisfaction. Factor structure was assessed using item correlation and exploratory factor analysis. Group-level reliability for single-test administration and internal consistency of factors was assessed by calculating the Cronbach alpha. Criterion-referenced validity was investigated by correlating the item scores and mean scores of individual factors to the global measures of satisfaction. Results: The mean score for overall satisfaction with care was 4.80. Exploratory factor analysis supported a 2-factor solution: a 7-item "internal" factor ([alpha] = .88) and a 3-item "external" factor ([alpha] = .86). Factor loadings ranged from .48 to .86. Both the internal and external factors were significantly correlated with overall satisfaction (r = 0.80 and 0.63, respectively). The individual items that were most highly correlated with overall patient satisfaction were "My physical therapist answered all my questions" (r = 0.79) and "My physical therapist treated me with respect" (r = 0.71). Conclusions: The 12-item version of the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care has evidence of reliability and criterion-referenced validity when used in a women's health care environment. Similar to previous studies, overall satisfaction with physical therapy care was high. Clinical Relevance: The use of psychometrically sound measures to assess patient satisfaction with care is an important component of patient management. To our knowledge there are no reports of patient satisfaction measures that have been validated specifically for the population of people seeking physical therapy care in women's health specialty clinics. Because patients within this population may have unique characteristics that limit generalization of measures obtained from other populations, it is important to assess population-specific reliability and validity. The current investigation provides preliminary evidence supporting the MedRisk-12 instrument for use in a women's health specialty clinic. Additional, confirmatory factor analysis should, however, be performed on independent samples.
TITLE: Use of Behavioral Modification, Pelvic Floor Exercise, and EMG Biofeedback for a Patient With Spinal Cord Injury-Induced Urinary Incontinence: A Case Report
AUTHORS: Christina Godfrey, E. A. Reicherter
INSTITUTION: Department of Physical Therapy & Rehabilitation Sciences, School of Medicine, University of Maryland, Baltimore, Maryland, USA.
ABSTRACT BODY:
Background & Purpose: Although there is literature to assist physical therapists in managing patients with a diagnosis of urinary incontinence (UI), there is little to assist physical therapists in managing patients with incontinence due to spinal cord injury (SCI). This case report, based on the use of available evidence, provides a suggested protocol that may be studied with a larger patient population. The purpose of this case report was to utilize an evidence-based treatment plan of behavioral modification and pelvic floor exercise (PFE) with EMG biofeedback (EMGBF) to manage a patient with UI and pelvic floor dysfunction secondary to SCI. Case Description: The patient was a 67-year-old woman with pelvic floor weakness and UI due to T12 spinal cord abscess resection 2 years ago. The patient had bilateral lower extremity (LE) weakness (MMT = fair to fair +), v strength and control of pelvic floor musculature, y urinary frequency, and episodes of urge and stress incontinence. Because of these symptoms, the patient had interrupted sleep, fatigue, and fear of social interaction. Interventions included PFE with the use of EMGBF, LE and core musculature training, behavioral modification including education on bladder irritants, timed voiding, and control of urge. Outcome measures included (1) LE strength and range of motion, (2) bladder diary to assess voiding frequency, urge, leakage, and fluid intake, (3) EMGBF output to assess control and strength of pelvic floor musculature, and (4) Urogenital Distress Inventory and Incontinence Severity Index (Sansoni et al, 2006). Outcomes: After 11 visits over a 6-week time period, the patient experienced v voiding occurrences and episodes of stress leakage, as evidenced by reports of "slightly" or "not at all" on the Urogenital Distress Inventory and bladder diary. In addition, the patient's severity category v from 8 to 6 on the Incontinence Severity Index. She displayed moderately improved pelvic floor muscle recruitment and strength, demonstrating improved ability to initiate and sustain contractions with EMGBF. The patient had an increased improvement in LE strength by one muscle grade and was able to more safely and independently complete functional mobility tasks. Unfortunately, because of hospitalization, the patient was discharged from therapy before treatment completion. Discussion: Despite the patient's early cessation of physical therapy, the combination of PFE with EMGBF and behavioral modification resulted in improved functional and subjective outcomes. Further research is necessary to determine whether this particular combination of interventions is efficacious long-term for a patient with pelvic floor dysfunction secondary to SCI.