Changes in pelvic floor morphometry and muscle function after multimodal physiotherapy for gynaecological cancer survivors suffering from dyspareunia: a prospective interventional study
| Autor: | Marie-Pierre Cyr, W.H. Gotlieb, Paul Bessette, Marie-Hélène Mayrand, Korine Lapointe-Milot, Chantale Dumoulin, Mélanie Morin, Annick Pina |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Population Physical Therapy Sports Therapy and Rehabilitation Gynaecological cancer Biofeedback Pelvic Floor Muscle Muscle tone Cancer Survivors Neoplasms medicine Humans Prospective Studies education Physical Therapy Modalities Ultrasonography education.field_of_study Pelvic floor business.industry Pelvic Floor Clinical trial Dyspareunia medicine.anatomical_structure Physical therapy Female Manual therapy business Muscle Contraction |
| Zdroj: | Physiotherapy. 114:54-62 |
| ISSN: | 0031-9406 0393-5698 |
| Popis: | Objective To investigate the changes in pelvic floor morphometry and muscle function after multimodal pelvic floor physiotherapy treatment in gynaecological cancer survivors suffering from painful intercourse (dyspareunia). Design Prospective interventional study. Setting Three university hospitals. Participants Thirty-one gynaecological cancer survivors with dyspareunia. Intervention The treatment consisted of 12 weekly sessions of physiotherapy combining education, pelvic floor muscle exercises with biofeedback, manual therapy and home exercises. Main outcome measures Women were assessed at baseline and post-treatment. Pelvic floor morphometry was evaluated at rest and on maximal contraction by measuring bladder neck position, anorectal and levator plate angles as well as levator hiatal dimensions with three-dimensional/four-dimensional transperineal ultrasound imaging. Pelvic floor muscle function was evaluated by measuring passive forces (muscle tone measure), flexibility, stiffness, strength, coordination and endurance with an intra-vaginal dynamometric speculum. Results Significant changes in pelvic floor morphometry and muscle function were found post-treatment. The parameters assessing the changes from rest to maximal contraction significantly improved (e.g., mean change of levator hiatal area narrowing 14 %, 95% CI 11 to 18, Cohen’s d effect size 1.48)), supporting the hypothesis of decreased muscle tone and improved muscle contractility following treatment. Women also presented with a significant decrease in tone (mean change -0.4 N, 95% CI -0.7 to -0.1, Cohen’s d effect size 0.57) and stiffness (mean change -0.1 N/mm, 95% CI -0.2 to -0.1, Cohen’s d effect size 0.59), as well as significant improvements in flexibility (mean change 9.0 mm, 95% CI 5.8 to 12.2, Cohen’s d effect size 1.08), coordination (mean change 3 rapid contractions, 95% CI 2 to 4, Cohen’s d effect size 0.85) and endurance (mean change 683 %*s, 95% CI 388 to 978, Cohen’s d effect size 0.90). Conclusion Our findings suggest significant improvements in pelvic floor morphometry and muscle function after a multimodal physiotherapy treatment in gynaecological cancer survivors with dyspareunia. These effects may represent key treatment mechanisms to reduce dyspareunia, supporting the rationale for multimodal physiotherapy in this population. Clinical trial registration number (ClinicalTrials.gov) NCT03935698 |
| Databáze: | OpenAIRE |
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