Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Randomization and Blinding
2.3. Follow-Up
2.4. Interventions
2.4.1. Pelvic Floor Muscle Training Group (PFMT-G)
2.4.2. Hypopressive Exercise Group (HE-G)
2.4.3. Combination Training Group (PFMT+HE-G)
2.4.4. Educational Strategy (All Groups)
2.5. Physiotherapy Assessment
2.6. Data Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | PFMT Group (n = 32) | HE Group (n = 31) | PFMT+HE Group (n = 31) | Total Sample (n = 94) |
---|---|---|---|---|
Age years, (SD) | 48 (12) | 48 (8) | 46 (8) | 47 (10) |
BMI kg/m2, (SD) | 24.39 (4.77) | 24.63 (3.72) | 26.21 (4.73) | 25.07 (4.47) |
Menopause, n (%) | 14 (44%) | 10 (32%) | 10 (32%) | 34 (36%) |
Parity, (SD) | 2 (1) | 2 (1) | 2 (1) | 2 (1) |
Smoking, n (%) | 2 (6.3%) | 8 (25.8%) | 7 (22.6%) | 17 (18.1%) |
High blood pressure, n (%) | 2 (6.3%) | 2 (6.5%) | 2 (6.5%) | 6 (6.4%) |
Depression, n (%) | 4 (12.5%) | 3 (9.7%) | 7 (22.6%) | 14 (14.9%) |
Respiratory disease, n (%) | 3 (9.4%) | 8 (25.8%) | 3 (9.7%) | 14 (14.9%) |
Constipation, n (%) | 10 (31.3%) | 14 (45.2%) | 10 (32.3%) | 34 (36.2%) |
Physical activity, n (%) | 24 (75%) | 24 (77.4%) | 21 (67.7%) | 69 (73.4%) |
Pelvic floor dysfunction | 94 (100%) | |||
UI, n (%) | 27 (84.4%) | 26 (83.9%) | 26 (83.9%) | 79 (84.0%) |
AI, n (%) | 13 (56.3%) | 17 (54.8%) | 9 (29.0%) | 44 (46.8%) |
POP, n (%) | 13 (40.6%) | 11 (35.5%) | 19 (61.3%) | 43 (45.7%) |
Previous PF surgery, n (%) | 3 (9.4%) | 4 (12.9%) | 1 (3.4%) | 8 (8.5%) |
PFDI-20 total, (DE) | 71.71 (45.22) | 70.20 (35.23) | 69.19 (51.62) | 70.38 (44.08) |
POPDI, (SD) | 18.49 (14.58) | 17.61 (14.34) | 22.45 (21.05) | 19.50 (16.87) |
CRADI, (SD) | 16.51 (18.26) | 20.47 (14.57) | 14.22 (12.07) | 17.06 (15.27) |
UDI, (SD) | 36.72 (21.93) | 32.12 (21.44) | 32.53 (25.22) | 33.82 (22.76) |
PFIQ-7 V0 total, (SD) | 45.39 (43.71) | 32.26 (31.36) | 35.48 (28.57) | 37.79 (35.34) |
POPIQ, (SD) | 11.16 (16.96) | 7.68 (12.94) | 9.37 (13.72) | 9.42 (14.58) |
CRAIQ, (SD) | 11.31 (18.09) | 4.15 (9.18) | 4.91 (8.65) | 6.84 (13.07) |
UIQ, (SD) | 22.92 (19.52) | 20.43 (19.87) | 21.20 (19.02) | 21.53 (19.29) |
LAT grade | ||||
0, n (%) | 3 (9.4%) | 1 (3.2%) | 3 (9.7%) | 7 (7.4%) |
1, n (%) | 4 (12.5%) | 2 (6.5%) | 6 (19.4%) | 12 (12.8%) |
2, n (%) | 5 (15.6%) | 2 (6.5%) | 4 (12.9%) | 11 (11.7%) |
3, n (%) | 15 (46.9%) | 15 (48.4%) | 11 (35.5%) | 41 (43.6%) |
4, n (%) | 4(12.5%) | 10 (32.3%) | 7 (22.6%) | 21 (22.3%) |
5, n (%) | 1 (3.1%) | 1 (3.2%) | 0 (0.0%) | 2 (2.1%) |
Manometry cmH2O, (SD) | 16.51 (14.19) | 22.87 (15.92) | 18.0 (13.86) | 19.11 (14.76) |
Dynamometry g, (SD) | 239.16 (216.10) | 370.20 (307.03) | 268.74 (216.63) | 293.55 (254.57) |
Basal tone g, (SD) | 206.67 (17.80) | 204.13 (13.70) | 200.47 (15.73) | 203.76 (15.84) |
Nearby muscles contraction, n (%) | 27 (84.4%) | 23 (74.2%) | 25 (77.4%) | 74 (78.7%) |
Apnea during PFM contraction, n (%) | 27 (84.4%) | 17 (54.8%) | 25 (80.6%) | 69 (73.4%) |
Variable | To | PFMT Group | HE Group | PFMT+HE Group | |||
---|---|---|---|---|---|---|---|
Mean | 95%CI | Mean | 95%CI | Mean | 95%CI | ||
PFDI-20 | A1 | −30.55 | (−40.70 to −20.39) | −32.17 | (−42.48 to −21.86) | −24.41 | (−34.72 to −14.09) |
PFDI-20 | A2 | −35.07 | (−46.63 to −23.52) | −34.30 | (−46.03 to −22.57) | −25.24 | (−36.98 to −13.50) |
PFDI-20 | A3 | −39.49 | (-49.86 to −29.11) | −40.80 | (−51.34 to −30.27) | −24.71 | (−35.25 to −14.17) |
PFDI-20 | A4 | −41.70 | (−51.61 to −31.78) | −41.69 | (−51.76 to −31.62) | −25.77 | (−35.85 to −15.69) |
POPDI | A1 | −7.95 | (−11.83 to −4.07) | −9.07 | (−13.04 to −5.10) | −5.82 | (−9.79 to −1.84) |
POPDI | A2 | −8.24 | (−12.84 to −3.63) | −8.49 | (−13.20 to −3.78) | −4.75 | (−9.46 to −0.03) |
POPDI | A3 | −9.44 | (−13.22 to −5.66) | −10.84 | (−14.71 to −6.98) | −6.77 | (−10.64 to −2.90) |
POPDI | A4 | −13.11 | (−16.94 to −9.29) | −10.58 | (−14.49 to −6.67) | −6.10 | (−10.02 to −2.18) |
CRADI | A1 | −5.91 | (−9.42 to −2.40) | −7.28 | (−10.95 to −3.62) | −3.21 | (−6.87 to 0.46) |
CRADI | A2 | −7.54 | (−11.58 to −3.49) | −6.53 | (−10.75 to −2.30) | −5.50 | (−9.73 to −1.28) |
CRADI | A3 | −9.44 | (−12.74 to −6.15) | −8.72 | (−12.16 to −5.28) | −5.76 | (−9.21 to −2.32) |
CRADI | A4 | −8.17 | (−11.66 to −4.67) | −9.57 | (−13.22 to −5.92) | −4.21 | (−7.86 to −0.56) |
UDI | A1 | −15.83 | (−21.45 to −10.22) | −15.74 | (−21.41 to −10.06) | −15.11 | (−20.77 to −9.44) |
UDI | A2 | −21.06 | (−26.44 to −15.69) | −17.03 | (−22.46 to −11.60) | −14.62 | (−20.04 to −9.20) |
UDI | A3 | −20.30 | (−25.82 to −14.77) | −21.21 | (−26.80 to −15.63) | −12.99 | (−18.56 to −7.42) |
UDI | A4 | −20.57 | (−25.29 to −15.84) | −21.44 | (−26.21 to −16.67) | −15.77 | (−20.54 to −11.01) |
PFIQ-7 | A1 | −21.49 | (−30.60 to −12.38) | −18.73 | (−28.00 to −9.47) | −14.78 | (−23.93 to −5.64) |
PFIQ-7 | A2 | −26.14 | (−34.83 to −17.45) | −25.01 | (−33.84 to −16.18) | −12.21 | (−20.93 to −3.48) |
PFIQ-7 | A3 | −26.6 | (−33.46 to −19.74) | −26.17 | (−33.14 to −19.19) | −18.50 | (−25.39 to −11.62) |
PFIQ-7 | A4 | −26.69 | (−33.79 to −19.58) | −23.22 | (−30.44 to −16.00) | −14.41 | (−21.55 to −7.28) |
POPIQ | A1 | −5.57 | (−9.86 to −1.27) | −5.01 | (−9.39 to −0.63) | −2.96 | (−7.30 to 1.38) |
POPIQ | A2 | −7.92 | (−11.94 to −3.90) | −6.29 | (−10.39 to −2.19) | −2.03 | (−6.09 to 2.04) |
POPIQ | A3 | −7.30 | (−10.15 to −4.45) | −6.16 | (−9.07 to −3.26) | −4.03 | (−6.91 to −1.15) |
POPIQ | A4 | −6.88 | (−9.68 to −4.09) | −6.02 | (−8.87 to −3.17) | −2.02 | (−4.84 to 0.81) |
CRAIQ | A1 | −5.17 | (−8.49 to −1.86) | −3.98 | (−7.39 to −0.57) | −3.05 | (−6.39 to 0.30) |
CRAIQ | A2 | −5.36 | (−9.11 to −1.61) | −4.49 | (−8.34 to −0.63) | −0.14 | (−3.93 to 3.65) |
CRAIQ | A3 | −5.65 | (−7.78 to −3.53) | −4.81 | (−7.00 to −2.62) | −2.53 | (−4.68 to −0.38) |
CRAIQ | A4 | −6.01 | (−8.05 to −3.97) | −2.35 | (−4.45 to −0.26) | −1.04 | (−3.10 to 1.02) |
UIQ | A1 | −11.05 | (−15.13 to −6.97) | −10.9 | (−15.04 to −6.75) | −10.13 | (−14.27 to −6.00) |
UIQ | A2 | −13.45 | (−17.19 to −9.70) | −14.31 | (−18.11 to −10.51) | −11.18 | (−14.97 to −7.39) |
UIQ | A3 | −13.70 | (−17.30 to −10.10) | −15.00 | (−18.65 to −11.35) | −12.48 | (−16.13 to −8.83) |
UIQ | A4 | −13.40 | (−17.61 to −9.19) | −14.75 | (−19.02 to −10.48) | −10.55 | (−14.81 to −6.28) |
Manometry | A1 | 9.32 | (6.03 to 12.61) | 8.70 | (5.37 to 12.03) | 8.61 | (5.41 to 11.80) |
Manometry | A2 | 9.36 | (5.97 to 12.75) | 7.10 | (3.67 to 10.53) | 10.12 | (6.83 to 13.41) |
Manometry | A3 | 9.30 | (5.88 to 12.71) | 7.25 | (3.80 to 10.70) | 8.50 | (5.19 to 11.82) |
Manometry | A4 | 9.31 | (5.44 to 13.18) | 8.46 | (4.55 to 12.37) | 9.88 | (6.12 to 13.63) |
Dynamometry | A1 | 247.68 | (175.12 to 320.23) | 106.18 | (35.12 to 177.23) | 153.84 | (85.02 to 222.65) |
Dynamometry | A2 | 225.28 | (154.72 to 295.84) | 121.12 | (51.74 to 190.49) | 132.80 | (63.98 to 201.62) |
Dynamometry | A3 | 225.80 | (141.85 to 309.76) | 152.09 | (68.36 to 235.83) | 149.98 | (68.10 to 231.87) |
Dynamometry | A4 | 216.68 | (132.01 to 301.34) | 181.80 | (98.56 to 265.05) | 174.22 | (91.65 to 256.80) |
Basal tone | A1 | −0.2 | (−3.74 to 3.34) | 3.31 | (−0.09 to 6.71) | 1.83 | (−1.64 to 5.31) |
Basal tone | A2 | 4.09 | (0.27 to 7.91) | 7.6 | (3.90 to 11.30) | 2.12 | (−1.72 to 5.97) |
Basal tone | A3 | 8.61 | (−7.32 to 24.54) | 6.73 | (−8.97 to 22.43) | 22.87 | (6.82 to 38.91) |
Basal tone | A4 | 9.08 | (5.58 to 12.59) | 8.47 | (5.07 to 11.86) | 6.53 | (3.00 to 10.06) |
Variable | (HE-G)–(PFMT-G) | (PFMT+HE-G)–(PFMT-G) | ||
---|---|---|---|---|
Mean Diff. | p-Value | Mean Diff. | p-Value | |
PFDI-20 | −0.54 | 0.9326 | 11.67 | 0.0703 |
POPDI | −0.06 | 0.9785 | 3.83 | 0.0935 |
CRADI | −0.26 | 0.9040 | 3.09 | 0.1535 |
UDI | 0.59 | 0.8503 | 4.82 | 0.1233 |
PFIQ-7 | 1.95 | 0.6675 | 10.25 | 0.0248 |
POPIQ | 1.05 | 0.6175 | 4.16 | 0.0485 |
CRAIQ | 1.64 | 0.2768 | 3.86 | 0.0110 |
UIQ | −0.84 | 0.7119 | 1.81 | 0.4260 |
Manometry | −1.44 | 0.5280 | −0.04 | 0.9844 |
Dynamometry | −86.07 | 0.0887 | −72.63 | 0.1481 |
Basal tone | 1.04 | 0.7721 | 2.87 | 0.4333 |
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Navarro-Brazález, B.; Prieto-Gómez, V.; Prieto-Merino, D.; Sánchez-Sánchez, B.; McLean, L.; Torres-Lacomba, M. Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial. J. Clin. Med. 2020, 9, 1149. https://doi.org/10.3390/jcm9041149
Navarro-Brazález B, Prieto-Gómez V, Prieto-Merino D, Sánchez-Sánchez B, McLean L, Torres-Lacomba M. Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial. Journal of Clinical Medicine. 2020; 9(4):1149. https://doi.org/10.3390/jcm9041149
Chicago/Turabian StyleNavarro-Brazález, Beatriz, Virginia Prieto-Gómez, David Prieto-Merino, Beatriz Sánchez-Sánchez, Linda McLean, and María Torres-Lacomba. 2020. "Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial" Journal of Clinical Medicine 9, no. 4: 1149. https://doi.org/10.3390/jcm9041149