Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis

There is an ongoing discussion regarding abdominal muscle (AbM) and pelvic floor muscle (PFM) synergism. Therefore, this study aimed to investigate the cocontraction between AbMs and PFMs in women with or without pelvic floor dysfunction (PFD). The following databases were searched up to December 21, 2018: MEDLINE, EMBASE, LILACS, PEDro and CENTRAL. We included any study that assessed the cocontraction between PFMs and AbMs in women with and without PFD. Two reviewers independently screened eligible articles and extracted data. The outcomes were extracted and analyzed as continuous variables with random effect models. Twenty studies were included. A meta-analysis did not show differences in women with and without PFD. However, a sensitivity analysis suggested cocontraction of the transversus abdominis (TrA) during PFM contraction in healthy women (standardized mean difference (SMD) 1.02 [95% confidence interval (CI) 1.90 to 0.14], P=0.02; I2 = not applicable; very low quality of evidence). Women with PFD during contraction of PFMs showed cocontraction of the obliquus internus (OI) (SMD 1.10 [95% CI 0.27 to 1.94], P=0.01; I2 = not applicable; very low quality of evidence), and obliquus externus (OE) (SMD 2.08 [95% CI 1.10 to 3.06], Po0.0001; I 2 = not applicable; very low quality of evidence). Increased cocontraction of the TrA may be associated with maximal contraction of PFMs in women without PFD. On the other hand, there is likely an increased cocontraction with the OI and OE in women with PFD

Análise morfológica do músculo reto abdominal de ratas prenhas diabéticas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Pelvic floor muscle training for women with lumbopelvic pain: a systematic review and meta-analysis

Background and Objective: It has been suggested that pelvic floor dysfunction may contribute to the development of lumbopelvic pain as a result of changes in trunk muscle control. However, there is limited evidence that pelvic floor muscle training (PFMT) can improve clinical outcomes in women with lumbopelvic pain. Databases and Data Treatment: Six databases were searched for randomized controlled trials (RCTs) comparing the effectiveness of PFMT to other conservative interventions (usual physiotherapy care or minimal intervention), no treatment or placebo interventions on pain and disability in women with lumbopelvic pain. Results: We included eight RCTs totalling 469 participants. PFMT was more effective than minimal intervention for lumbopelvic pain [mean difference (MD) 15.9/100 (95% confidential interval (CI), 8.2 to 23.6; p\ua0=\ua00.00; I\ua0=\ua03.92%)] and disability [standardized mean difference (SMD) 0.5 (95% CI 0.1–0.9; p\ua0=\ua00.00; I\ua0=\ua00%)] during pregnancy. PFMT was more effective than usual physiotherapy care for pain (MD 11.7/100 [95% CI 7.5–15.9; p\ua0=\ua00.00; I\ua0=\ua094.14%]) and disability (SMD 0.3 (95% CI 0.0–0.6; p\ua0=\ua00.01; I\ua0=\ua082.54%]) in non-pregnant women. Effect sizes were in general of arguable clinical relevance. Conclusions: Overall, the certainty of the evidence was very low to low. There is no conclusive evidence that the addition of PFMT to usual physiotherapy care or minimal intervention is superior to minimal intervention and usual care alone given the small number of studies and high levels of heterogeneity of included studies. Further well-designed trials are needed to establish the effectiveness of PFMT for lumbopelvic pain in women

Is there an association between diabetes and neck and back pain? A systematic review with meta-analyses.

Background and objectiveApproximately half of the population will experience either low back pain or neck pain, at some point in their lives. Previous studies suggest that people with diabetes are more likely to present with chronic somatic pain, including shoulder, knee and spinal pain. This study aimed to systematically review and appraise the literature to explore the magnitude as well as the nature of the association between diabetes and back, neck, or spinal (back and neck) pain.Databases and data treatmentA systematic search was performed using the Medline, CINAHL, EMBASE, and Web of Science electronic databases. Studies which assessed the association between diabetes and back or neck pain outcomes, in participants older than 18 years of age were included. Two independent reviewers extracted data on the incidence of pain and reported associations.ResultsEight studies were included in the meta-analyses. Meta-analyses showed that people with diabetes are more likely to report low back pain [5 studies; n: 131,431; odds ratio (OR): 1.35; 95% Confidence Interval (CI): 1.20 to 1.52; pConclusionsDiabetes is associated with low back and neck individually, and spinal pain. The longitudinal analysis showed no association between the conditions. Our results suggest that diabetes co-exists with back pain; however, a direct causal link between diabetes and back pain was not established.Systematic review registrationPROSPERO registration CRD42016050738

Pregnancy-specific urinary incontinence in women with gestational hyperglycaemia worsens the occurrence and severity of urinary incontinence and quality of life over the first year post partum

Objective: To determine the occurrence and severity of pregnancy-specific urinary incontinence (PSUI) in women with gestational hyperglycaemia, and its impact on quality of life (QoL) over the first year post partum. Study design: Three hundred and eighty-eight pregnant women with PSUI were distributed into two groups (normoglycaemic and hyperglycaemic) and analysed at five timepoints during pregnancy and the first year post partum. Gestational hyperglycaemia was defined according to the criteria of the American Diabetes Association and the glucose profile test. Relationships with outcome were analysed using Chi-squared test for categorical variables and Student's t-test for quantitative variables. Results: The overall prevalence rate of PSUI was 54.1 %, with prevalence rates of 43.3 % and 56.7 % in normoglycaemic and hyperglycaemic Brazilian pregnant women, respectively. Women with gestational hyperglycaemia had a higher amount of urine loss (p < 0.0027), frequency of UI (p < 0.0014), impact of UI on QoL (p < 0.0001), severity of UI (p = 0.0003) and total scores on the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-SF) and Incontinence Severity Index (ISI) (