Postural and Musculoskeletal Disorders in Women with Urinary Incontinence: A Research Report

Introduction: To investigate and compare the prevalence of some postural and musculoskeletal disorders in women with and without Urinary Incontinence (UI). Urinary Incontinence (UI) is one of the most important social and health problems in women. Limited studies have shown that UI prevalence is around 35%-55% in Iran. Nevertheless, to the best of our knowledge, there is no exact and reliable data reported in the literature on the prevalence of musculoskeletal, postural, or other related disorders in UI patients in Iran. Methods and Materials: The current study was conducted based on the data obtained from 166 incontinent and 90 continent women attending Vali-e-Asr University Hospital between 2010 and 2012. After collecting participants’ demographic information, postural status was assessed. In addition, we measured values for pelvic inclination and lumbar lordosis angles. Finally, vaginal tone and pelvic floor muscle strength and endurance were evaluated. Kolmogorov-Smirnov (K-S) goodness-of-fit, Independent t, X2, and Pearson correlation tests were used for the purposes of data analysis. Results: The prevalence of low back pain, chronic pelvic pain, and pelvic asymmetry were significantly higher in incontinent women compared with that in continent women (p<0.05). It was found that lumbar lordosis was significantly different between the two groups (P=0.021); however, no significant difference was observed regarding pelvic inclination (P=0.20). Conclusion: The present study confirms the hypothesis that incontinent women have higher prevalence of low back and pelvic pain and pelvic asymmetry. It is recommented that further epidemiologic and comprehensive etiologic investigations be conducted on these findings.Keywords: Urinary Incontinence, Posture, Musculoskeletal Disorders, Wome

The Reliability of Standing Sagittal Measurements of Spinal Curvature and Range of Motion in Older Women With and Without Hyperkyphosis Using a Skin-Surface Device.

OBJECTIVE:The purpose of this study was to investigate the intrarater reliability of a skin-surface instrument (Spinal Mouse, Idiag, Voletswil, Switzerland) in measuring standing sagittal curvature and global mobility of the spine in older women with and without hyperkyphosis. METHODS:Measurements were made in 19 women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 67 ± 5 years, and 14 women without hyperkyphosis (thoracic kyphosis angle <50°), mean age 63 ± 6 years. Sagittal thoracic and lumbar curvature and mobility of the spine were assessed with the Spinal Mouse during neutral standing, full spinal flexion, and full spinal extension. Tests were performed by the same examiner on 2 days with a 72-hour interval. The intrarater reliability of the measurements was analyzed using the intraclass correlation coefficient, standard error of measurement and minimal detectable change. RESULTS:Intraclass correlation coefficients ranged from 0.89 to 0.99 in both groups. The standard errors of measurement ranged from 1.02° to 2.06° in the hyperkyphosis group and from 1.15° to 2.22° in the normal group. The minimal detectable change ranged from 2.85° to 5.73° in the hyperkyphosis group and from 3.20° to 6.17° in the normal group. CONCLUSIONS:Our results indicated that the Spinal Mouse has excellent intrarater reliability for the measurement of sagittal thoracic and lumbar curvature and mobility of the spine in older women

The reliability and validity of a designed setup for the assessment of static back extensor force and endurance in older women with and without hyperkyphosis.

ObjectiveThe purpose of this study was to investigate the intra-rater reliability and validity of a designed load cell setup for the measurement of back extensor muscle force and endurance.ParticipantsThe study sample included 19 older women with hyperkyphosis, mean age 67.0 ± 5.0 years, and 14 older women without hyperkyphosis, mean age 63.0 ± 6.0 years.MethodsMaximum back extensor force and endurance were measured in a sitting position with a designed load cell setup. Tests were performed by the same examiner on two separate days within a 72-hour interval. The intra-rater reliability of the measurements was analyzed using intraclass correlation coefficient (ICC), standard errors of measurement (SEM), and minimal detectable change (MDC). The validity of the setup was determined using Pearson correlation analysis and independent t-test.ResultsUsing our designed load cell, the values of ICC indicated very high reliability of force measurement (hyperkyphosis group: 0.96, normal group: 0.97) and high reliability of endurance measurement (hyperkyphosis group: 0.82, normal group: 0.89). For all tests, the values of SEM and MDC were low in both groups. A significant correlation between two documented forces (load cell force and target force) and significant differences in the muscle force and endurance among the two groups were found.ConclusionThe measurements of static back muscle force and endurance are reliable and valid with our designed setup in older women with and without hyperkyphosis

Cupping: a reasonable choice for attenuating morphine withdrawal symptoms in Wistar rats

Background: Nowadays, the sedative drugs are the main treatments to attenuate the opioid withdrawal symptoms. However, physical therapies are found a safe alternative treatment without any serious adverse effects. This study aimed to evaluate the effects of cupping treatment on the morphine withdrawal symptoms in rats.Methods: Eighty rats were divided into two main groups; treated with morphine or saline, and each group was also divided to cupping and sham cupping subgroups (with single or daily treatment). Injection of morphine and saline were done in the morphine and saline groups twice a day for nine days. On the ninth day, the naloxone was administered and the withdrawal symptoms including jumping, rearing, body grooming, abdominal writing, and wet-dog shaking were recorded for 60 minutes. Cupping or sham cupping was applied on the GV14 once before or daily after withdrawal induction in each group.Results: The results revealed that a single cupping before the withdrawal induction significantly attenuated the withdrawal symptoms in the morphine group (p<0.01).But, the daily cupping failed to decrease the withdrawal symptoms in this group. The results also indicated that the daily cupping in the saline group increased the naloxone-induced withdrawal symptoms significantly (p<0.01).Conclusions: Single session cupping before the withdrawal induction could decreased the withdrawal symptoms. This finding might be related to the modulation of GABAergic system

Reliability of Rehabilitative Ultrasound Imaging In Measuring Thickness of Levator Scapula Muscle in Asymptomatic Women

Introduction: Levator Scapula Muscle (LSM) is one of the stabilizers of the scapulae. Shortening of this muscle disrupts shoulder biomechanics and results in shoulder pain. Rehabilitative Ultrasound imaging (RUSI) has been introduced as a non-invasive method to measure muscle thickness. The present study aimed to determine the intra-rater reliability of RUSI to measure thickness of LSM in a group of asymptomatic women. Materials and method: Images of LSM were taken using RUSI at the level of the forth cervical vertebra in sitting position in 20 asymptomatic women aged 20-36 years. Images were obtained by one examiner on two separate days and muscle thickness was measured using RUSI. Intraclass Correlation Coefficients (ICC), Standard Error of Measurement (SEM), Smallest Detectable Difference (SDD), and Bland-Altman plot were used for the assessment of reliability. Results: The results of ICC (0.9), SEM (0.26 mm), and SDD (0.72 mm) values revealed an excellent intra-rater reliability and accuracy of RUSI to measure LSM thickness in asymptomatic women. Conclusion: The method of RUSI used in the current study is recommended to measure LSM thickness. It can be used to measure thickness of LSM in patients with shoulder pain where the thickness of the muscle varies according to the level of pain and spasm.Keywords: Levator Scapula; Ultrasonography; Muscle; Reliability; Shoulde

Electrical Stimulation for Lower Urinary Tract Dysfunction in People with Multiple Sclerosis: A Systematic Review

Introduction: Lower urinary tract dysfunction (LUTD) is highly prevalent in patients with multiple sclerosis (MS) who suffer from some degrees of voiding dysfunction and/or urinary incontinence (UI), six to eight years after the initial diagnosis of MS. Electrostimulation is an established therapeutic option for neurogenic LUTD. This study aimed to investigate the efficacy of various types of electrical stimulation (ES) used for LUTD in MS patients. Materials and Methods: A systematic review of English-language articles was carried out in PEDro, PubMed, Science Direct, and Google Scholar databases between 1980 and 2017 using the following keywords: multiple sclerosis, electrical stimulation, LUTD, and neurogenic bladder. All the titles and abstracts were checked. Thereafter, full-text copies were obtained in cases where the studies had possible relevance. We carried out a background search by examining reference lists of all obtained articles. Ten treatment studies were identified in the search process. Results: Out of 10 articles, four were about the effects of percutaneous tibial nerve stimulation (PTNS) on LUTD. In three studies, neuromuscular ES, and in one study, interferential current was used. One study surveyed the effect of ES on the dorsal penile or clitoral nerve, and another studied the effect of ES on sacral dermatomes with regard to urinary symptoms. Also, three studies surveyed the effect of ES and its combination with pelvic floor muscle (PFM) training. Conclusion: This review showed that various types of non-invasive ES used for neurogenic LUTD in patients with MS for suppressing detrusor overactivity have also improved bladder compliance. Patients with MS require daily home stimulation treatments. Also, a combination of ES with PFM training is effective in reducing the symptoms of LUTD in MS patients.Keywords: Electrical Neuromodulation, Lower Urinary Tract Dysfunction, Multiple Sclerosis, Neurogenic Bladde

Intra-rater reliability of sonographic measurement of the supraspinatus muscle thickness in Empty can, Full can and Hug up tests

Background: Sonography is used for measuring the muscle morphology including length, depth, cross-sectional area, bulk and pennation angle. The supraspinatus is the most common affected muscle among the rotator cuff muscles. There is no study about the reliability of sonographic measurement of supraspinatus thickness in the positions of empty can (EC), full can (FC) and hug up (HU) tests. The present study aims to investigate the intra-rater reliability of the measurement of sonographic thickness of supraspinatus muscle in the rest and positions of the EC, FC and HU tests. Methods: The present study was a descriptive-analytic study which was carried out in a cross-sectional method on ten healthy women aged: 22.10&plusmn;2.76 years without any tendon pathology. The study was carried out during four weeks (January to March in 2017). The supraspinatus thickness was scanned during rest and contracted states. The positions of measuring ultrasonic thickness of supraspinatus were as follow: position of EC test: the arm in 90-degree elevation in the scaption plane with the thumb-down, position of FC test: the arm in 90-degree elevation in the scaption plane with the thumb-up, position of HU test: the palm of hand was placed on the opposite shoulder with the elbow flexed using a 0.5-kg weight cuff. Intra-rater reliability of ultrasonic muscle thickness measurements were examined in one day. Results: All intra-rater reliability values were equal or more than 0.90: the value was 0.90 (95%CI: 0.65-0.97) in the rest position, while for the measurement of ultrasonic thickness of the supraspinatus was 0.96 (95%CI: 0.87-0.99) in the position of EC test, 0.97 (95%CI: 0.90-0.99) and 0.96 (95%CI: 0.86-0.99) in the positions of FC and HU tests, respectively. Conclusion: Measurement of ultrasonic thickness of supraspinatus muscle is a reliable method in the rest and positions of EC, FC and HU tests. This method can be used to compare the muscle thickness changes in the positions of the above tests. &nbsp

Extracorporeal shock wave therapy for the reduction of post stroke spasticity: review article and meta-analysis

Background: Spasticity is a clinical deficit of upper motor neurons lesions that presented immediately or at delayed times after lesions and occurs in about 38% of stroke patients. Extracorporeal shock wave therapy (ESWT) has been recently reported as a safe and effective method for reducing spasticity in stroke patients. In the present study, we sought to investigate the impact of the ESWT on post stroke spasticity using a meta-analysis method. Methods: All primary reports of spasticity indexed in PubMed, MEDLINE, Science Direct, Scopus and search engine of Google Scholar from January 2000 to December 2016 were searched. The following terms were used as keywords: Spasticity, muscle hypertonicity, ESWT, stroke and hemiplegia. Any report was included if it met the following criteria: involving clinical trials, full-version availability, and being written in english. Two reviewers selected articles independently and reviewed the studies considering quality and eligibility, and then they extracted general information on objectives, design, participants, and outcomes. The methodologic quality of each study was assessed using the Pedro Scale. In the statistical analyses, we considered two outcomes; Modified Ashworth scale (MAS) grade and passive rang of movement (PROM). The meta-analysis was done using random effect model in Stata, version 11 (Stata Corp., TX, USA). Results: Eleven studies within a total of 261 patients were included in this review. In seven studies the shock waves were applied to the upper limb muscles, and in four other studies, the effects of ESWT on the spasticity of the lower limb muscles were assessed. Immediately after applying the ESW, MAS grade was significantly decreased in comparison to the baseline values. (Standardized mean difference [SMD], -1.62; 95% confidence interval [CI], -2.2 to -1.04). The PROM was significantly increased immediately after ESWT in comparison to the baseline values (SMD, 3.23; CI 95%, 1.35 to 5.12). Conclusion: The results of this study showed that ESWT can immediately improve the spasticity and increased PROM, but it seems that the mechanism of action of shock waves on spasticity is still unclear. Further clinical trial studies with higher methodological quality should be recommended

Mothers\' Lived Experiences of Losing a Child to Cancer: A Phenomenological Study

Objective: The death of a child is undoubtedly the most arduous encounter for a mother in her lifetime, and it elicits numerous psychological detriments. Specifically, the death of a child resulting from cancer carries its own set of challenges. Analyzing the lived experience of these mothers can serve as a means to identify and comprehend their grief, thus becoming the foundation for efficacious interventions. Consequently, the objective of the present investigation was to scrutinize the lived experiences of grieving mothers whose children had succumbed to cancer. Methods: The current research was conducted utilizing a qualitative and phenomenological approach. The sampling technique employed was purposive, encompassing a maximum variation sampling. The study included a total of 13 bereaved mothers residing in Yazd city, who had lost their children to cancer. The methodology employed for data collection involved semi-structured interviews. Results: Subsequent to conducting the interviews and documenting them, each recorded session was transcribed and examined utilizing Colaizzi's method. This process yielded six primary themes and twenty-four secondary themes through the analysis of the data. The primary themes comprised emotional experience, physical experience, cognitive experience, challenging experience, the meaning of life, and avoidance. Conclusions: These findings demonstrate the nature of the grief experienced by mothers, and these themes have the potential to facilitate effective interventions aimed at mitigating the symptoms of grief