다발성 경화증이있는 여성의 골반 바닥에 대한 척추 안정화의 영향

Pelvic floor muscle exercises will be taught with an innovative approach based on the principles of finding, feeling, forcing, following and functional training of the pelvic floor muscles. Pelvic floor muscle exercises will be applied as 3 sets in the first 2 weeks, 4 sets in the 3rd and 4th weeks, 5 sets in the 5th and 6th weeks, and finally 6 sets in the 7th and 8th weeks. Individuals will continue their pelvic floor muscle exercises as a home program.

Pelvic floor muscle exercises will be taught with an innovative approach based on the principles of finding, feeling, forcing, following and functional training of the pelvic floor muscles. Pelvic floor muscle exercises will be applied as 3 sets in the first 2 weeks, 4 sets in the 3rd and 4th weeks, 5 sets in the 5th and 6th weeks, and finally 6 sets in the 7th and 8th weeks. Individuals will continue their pelvic floor muscle exercises as a home program.

Spinal stabilization exercises focusing on the pelvic floor will be administered under physiotherapist supervision three times per week for eight weeks. Each session will consist of 5 minutes of warm-up, 30 minutes of pelvic floor-focused spinal stabilization exercises, and 5 minutes of cool-down. Stabilization and posture training will be provided at the outset, including instruction on identifying the neutral position of the spine to ensure proper posture. Correct pelvic floor muscle contraction and abdominal bracing techniques will be demonstrated. The exercise program will comprise three phases: static (weeks 1-2), dynamic (weeks 3-5), and functional (weeks 6-8). Throughout all exercises, participants will maintain a neutral spine position and abdominal bracing, with contractions held for 5-10 seconds and repeated 10 times. Additionally, participants will be instructed to continue pelvic floor exercises as a home program on non-supervised days.

This program consists of 3 phases: 30 minutes of spinal stabilization exercises focusing on the pelvic floor, 5 minutes of warm-up and 5 minutes of cool-down exercises.The exercises will consist of 3 phases: static, dynamic and functional phases. Individuals will perform static phase exercises for the first 2 weeks, then dynamic phase exercises in the 3rd and 5th weeks and finally functional phase exercise in the 6th and 8th weeks. Individuals will be asked to maintain neutral spine position and abdominal bracing during pelvic floor muscle contraction during all exercises. Individuals will maintain the contraction for 5-10 seconds for 10 repetitions in each position in all phases.

Urinary symptoms will be assessed with the International Incontinence Questionnaire Short Form. The International Incontinence Questionnaire Short Form consists of a total of six questions. The total score is obtained by summing the scores of questions 3, 4 and 5. Scores that can be obtained from the scale vary between 0-21; a low score indicates that urinary incontinence affects quality of life a little, while a high score indicates that it affects it a lot.

A bladder diary will be used to assess bladder function for lower urinary tract symptoms. Patients will be asked to complete a 24-hour bladder diary on three non-consecutive days. Average day-night voiding frequency, voiding volume and number of urinary incontinence will be calculated by averaging the three daily urinary diaries.

Overactive Bladder-Version8 will be used to assess the degree of lower urinary system symptoms due to overactive bladder. The score to be obtained from the scale ranges from "0" the best to "40" the worst. If the total score on the scale is more than 8, the subjects are considered to have possible lower urinary tract symptoms.

Pelvic floor muscle function will be evaluated with the 632 Myomed biofeedback device. The pressure probe and device will be disinfected in each individual before the application and the probe will be used with a condom to ensure the hygiene of the individual. During the assessment, the pressure probe will be inserted intravaginally while the individual is supine, knees bent and slightly apart. Assessment results will be recorded in hectopascal.

Vaginal palpation method will be used to measure pelvic floor muscle strength. The assessment will be performed in supine position, with hips and knees flexed and soles of the feet in contact with the bed. After taking the necessary hygiene measures, the physiotherapist will place the index and middle finger intravaginally. The individual will then be asked to pinch the physiotherapist's fingers and pull upwards for pelvic floor muscle contraction. The outcome value will be scored with the Modified Oxford grading system.

The lateral bridge test will be used to assess the endurance of the lateral core muscles. Individuals will be asked to place their forearms and feet on the side of one side in a position to carry their body weight, then they will be asked to maintain this position by lifting their hips from the bed. The test will be terminated when the proper posture is broken or the pelvis falls on the bed, and the time from maintaining the proper position to breaking the position will be recorded in seconds. The test will be performed separately on the right and left side.

Flexor endurance test will be used to assess the endurance of the anterior core muscles. Individuals will be placed on the bed with their trunk at 60°, knees and hips at 90° flexion and supported by their feet. In this position, the time in seconds will be recorded until they lose 60° of trunk flexion.

The extensor endurance test will be used to evaluate the endurance of the posterior core muscles. Individuals will lie in a prone position with pelvis, hips and knees supported on the bed and the upper trunk will be positioned on the edge of the bed in a straight, slightly extended position. Individuals will be stabilized by their feet. The test will be terminated when the trunk falls from the horizontal position to flexion and the time in this position will be recorded in seconds.

Stabilizer Pressure Biofeedback device will be used to assess deep lumbar muscular strength. Individuals will be asked to lie in a prone position and keep their knees in a straight position, their spine straight and their head in a comfortable position. The cushion of the measuring device will be placed under their abdominal area with the air completely deflated. After the manometer needle is set to 70 mm/Hg, the individuals will be asked to contract the transversus abdominous muscles for 5 seconds as taught. The test will be performed for 10 s and 3 repetitions and the average of the results of the 3 tests will be recorded in mm/Hg.

King Health Questionnaire will be used to assess quality of life. The questionnaire consists of two parts and includes 32 items. . On the complaint severity scale, the best score is "0" and the worst score is "30". In other subsections of the King Health Questionnaire, the best score is "0" and the worst score is "100".

The Global Perceived Impact scale will be used to assess the subjective perception of improvement after the training. Participants will be asked to rate on a scale of 1 to 9 the extent to which their complaints have improved compared to before the training. The description of the scores is; '1' 'much improved', '2' 'much improved', '3' 'moderately improved', '4' 'slightly improved', '5' 'unchanged', '6' 'slightly worsened', '7' 'moderately worsened', '8' 'much worsened', '9' 'much worsened'.

The health problem perceived by individuals will be assessed with the Patient-specific complaints instrument. The numbered classification scale-11 (0-10) will be used for scoring. The individual will be asked to give a score between 0-10 for the severity of the problem caused by lower urinary tract symptoms as perceived by the individual. 0 means "no complaint at all" and 10 means "very severe complaint".

The compliance of the individuals with the training will be evaluated using a 10-centimeter visual analog scale. At the end of the study, the individuals in the control and experimental groups will be asked to evaluate the training program given to them by marking the place that best expresses themselves on a 10 cm line between 0 (I did not apply the treatment given at all) and 10 (I applied the treatment given completely). The distance between the marked point and the starting point will be recorded.