The role of vaginal palpation in motor learning of the pelvic floor muscles for women with stress urinary incontinence: study protocol for a randomized controlled trial

Letícia de Azevedo Ferreira, Fátima Faní Fitz, Márcia Maria Gimenez, Mayanni Magda Pereira Matias, Maria Augusta Tezelli Bortolini, Rodrigo Aquino Castro, Letícia de Azevedo Ferreira, Fátima Faní Fitz, Márcia Maria Gimenez, Mayanni Magda Pereira Matias, Maria Augusta Tezelli Bortolini, Rodrigo Aquino Castro

Abstract

Background: Approximately 30 to 50% of women are unable to correctly perform pelvic floor muscle (PFM) contractions. For women to benefit from a pelvic floor muscle training (PFMT) programme for stress urinary incontinence (SUI), the awareness phase of PFMT cannot be omitted. The purpose of this study is to evaluate whether vaginal palpation together with verbal instructions about PFMs and body awareness techniques helps women with SUI learn how to correctly contract the PFMs and improve their functions.

Methods: This single-centre, double-blind randomized controlled trial with two intervention groups was designed following the standard protocol items for randomized interventional trials (SPIRIT). The results will be reported in a manner consistent with the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Patients with SUI (n = 172) will be recruited. The experimental group will receive verbal instructions about PFM function and body awareness techniques together with vaginal palpation; the control group will receive similar protocol without vaginal palpation. The primary outcome includes the number of fast-twitch muscle fibres assessed by vaginal palpation and visual observation. Secondary outcomes include power and muscular endurance that will be assessed by visual observation and vaginal palpation (Oxford scale), the use of accessory muscles during the voluntary contraction of PFMs, and the self-efficacy and the expectations for the results using the self-efficacy scale of pelvic floor exercises.

Discussion: This study will determine whether vaginal palpation can help women with SUI to correctly perform PFM contractions and improve their functions.

Trial registration: ClinicalTrials.gov NCT03325543 . Registered on 30 November 2017. Study protocol version 1; 30 November 2020. Prospectively registered.

Keywords: Knowledge; Pelvic floor; Physical therapy modalities; Randomized controlled trial; Urinary incontinence.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26. doi: 10.1007/s00192-009-0976-9.
    1. Hay-Smith J, Bø K, Berghmans B, Hendriks E, de Bie R, van Waalwijk van Doorn ES. Pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2015. 10.1002/14651858.CD001407.pub1.
    1. Bø K, Hagen RH, Kvarstein B, Jørgensen J, Larsen S. Pelvic floor muscle exercise for the treatment of female urinary stress incontinence: III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn. 1990;9:489–502. doi: 10.1002/nau.1930090505.
    1. Castro RA, Arruda RM, Zanetti MRD, Santos PD, Sartori MGF, Girão MJBC. Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics. 2008;64:465–472. doi: 10.1590/S1807-59322008000400009.
    1. Zanetti MRD, Castro RA, Rotta AL, Santos PD, Sartori M, Girão MJBC. Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. Sao Paulo Med J. 2007;25(5):265–269. doi: 10.1590/S1516-31802007000500003.
    1. O’Neill AT, Hockey J, O’Brien P, Williams A, Morris TP, Khan T, et al. Knowledge of pelvic floor problems: a study of third trimester, primiparous women. Int Urogynecol J. 2017;28:125–129. doi: 10.1007/s00192-016-3087-4.
    1. Bø K, Mørkved S. Pelvic floor and exercise science. In: Bø K, Bary B, Siv M, Marijke VK, editors. Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice. 2. Toronto: Elsevier; 2015. pp. 111–115.
    1. Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstret Gynecol. 1991;165(2):322–329. doi: 10.1016/0002-9378(91)90085-6.
    1. Slieker-ten Hove M, Pool-Goudzwaard A, Eijkemans M, Steegers-Theunissen R, Burger C, Vierhout M. Pelvic floor muscle function in a general population of women with and without pelvic organ prolapse. Int Urogynecol J. 2010;21(3):311–319. doi: 10.1007/s00192-009-1037-0.
    1. Chiarapa TR, Cacho DP, Alves AFD. Tratamento fisioterápico. In: Chiarapa TR, Cacho DP, editors. Incontinência Urinária Feminina: assistência fisioterapêutica e multidisciplinar. São Paulo: Livraria Médica Paulista; 2007. pp. 133–146.
    1. Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87(12):631–642. doi: 10.1016/S0031-9406(05)61108-X.
    1. Sacomori C, Cardoso FL, Porto IP, Negri NB. The development and psychometric evaluation of a self-efficacy scale for practicing pelvic floor exercises. Br J Phys Ther. 2013;17(4):336–342. doi: 10.1590/S1413-35552013005000104.
    1. Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Rev Panam Salud Publica. 2015;38(6):506–514.
    1. Ghoniem G, Stanford E, Kenton K, Achtari C, Goldberg R, Mascarenhas T, et al. Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J. 2008;19:5–33. doi: 10.1007/s00192-007-0495-5.
    1. Winstein CJ. Knowledge of results and motor learning: implications for physical therapy. Phys Ther. 1991;71(2):140–149. doi: 10.1093/ptj/71.2.140.
    1. Mateus-Vasconcelos ECL, Ribeiro AM, Antônio FI, Brito LGO, Ferreira CHJ. Physiotherapy methods to facilitate pelvic floor muscle contraction: a systematic review. Physiother Theory Pract. 2018;34(6):420–432. doi: 10.1080/09593985.2017.1419520.
    1. Henderson WJ, Wang S, Egger JM, Masters M, Nygaard I. Can woman correctly contract their pelvic floor muscles without formal instruction? Female Pelvic Med Reconstr Surg. 2013;19(1):8–12. doi: 10.1097/SPV.0b013e31827ab9d0.

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