Research Report Abstracts - Gesundheit

eS484
Research Report Poster Display
Number: RR-PO-312-9-Wed Wednesday 22 June 13:00
RAI: Exhibit Halls 2&3
KNOWLEDGE ABOUT AND FUNCTION OF THE
PELVIC FLOOR MUSCLE IN NULLIPAROUS
PREGNANT WOMEN
Hilde G. 1,2 , Stær-Jensen J. 2 , Ellström Engh M. 2,3 , Brækken
I.H. 2 ,BoK. 1,2
Norwegian School of Sport Sciences, Department of Sports
Medicine, Oslo, Norway, 2Akershus University Hospital,
Department of Obstetrics and Gynaecology, Lørenskog,
Norway, 3University of Oslo, Faculty Division Akershus University,
Oslo, Norway
Purpose: A Cochrane review recommends antenatal pelvic
floor muscle training (PFMT) in prevention of urinary incontinence
(UI). However to date there is scant knowledge about
to which degree nulliparous pregnant women do practice
PFMT, their ability to perform a correct contraction, and
their actual pelvic floor muscle function. The aim of the
present study was to investigate knowledge about PFMT, ability
to contract, and muscle function in pregnant nulliparous
women.
Relevance: Awareness of nulliparous pregnant women’s
knowledge of PFMT, their ability to contract, and pelvic floor
muscle (PFM) function is important to guide clinical practice
in antenatal health care.
Participants: 130 consecutive healthy nulliparous pregnant
women attending routine ultrasound assessment in gestation
week 18–22 were included.
Methods: This was a cross sectional study including clinical
assessment of ability to contract using observation and
vaginal palpation. Maximum voluntary contraction (MVC),
endurance, and resting pressure of the PFM were measured
by a squeeze pressure transducer (Camtech AS, Norway). UI
was assessed by International consultation on incontinence
questionnaire short form (ICIQ-UI SF).
Analysis: Results are presented as means with SD or
95% confidence intervals (CI) or frequencies (%). Differences
in groups (SUI versus no SUI) were analyzed using
independent-samples t-test. Significance level was set to 0.05.
Results: Mean age of the study group was 29 years
(SD 4.3). The prevalence of UI was 43.1%. Of these
82% reported stress urinary incontinence (SUI). Of the
included women 89% had heard of PFMT. Sources of
information were brochure/magazines/newspaper: 41.5%,
midwife/nurses: 26.9%, friends: 25.4%, physical therapists:
14.6%, physicians: 12.3%, fitness instructors: 10.8%, DVDs:
5.4%, antenatal classes: 0.8%, other sources: 17.7%. Forty
eight percent did not perform PFMT. Seventeen percent
reported to exercise when needed, 18.5% exercised 1–2 times
per week, 10.0% at least 3 times per week, and 6.9% every
day. Pre-contraction of the pelvic floor on cough and sneeze
was reported by 35%, 21% reported that they did not precontract,
whereas 44% did not know. 92.3% reported to be
able to stop the urine stream during voiding. Clinical examination
by observation and palpation showed that, 13.8%
did not contract correctly, of which two were straining.
Mean MVC was 32.9 cm H2O (SD 16.1, range 0–88), mean
endurance was 203.7 cm H2O (SD 103.7), and mean resting
pressure was 40.5 cm H2O (SD 9.3). Women without SUI
had statistically significant stronger PFM when compared to
women with SUI. Mean difference in MVC was 6.9 cm H2O
(CI: 1.1–12.6, p = 0.019), and 50.6 cm H2O (CI: 13.9–87.4,
p = 0.007) in endurance. No difference was found in resting
pressure.
Conclusions: Brochure/magazines/newspaper represented
the biggest source of PFMT information. Few women performed
exercises three times or more weekly. The majority of
pregnant women were able to stop the urine stream, but more
than 13% did not contract correctly. More than 40% had UI
during pregnancy. Women having SUI had significantly less
PFM strength and endurance compared to women without
SUI.
Implications: A prerequisite for effective antenatal PFMT is
ability to perform correct contractions. This implies the need
for education and proper clinical examination.
Keywords: Antenatal pelvic floor muscle training; Ability to
contract; Pelvic floor muscle function
Funding acknowledgements: We gratefully acknowledge
financial support through The Research Council of Norway.
Ethics approval: The study was approved by the Norwegian
Regional South Medical Ethics Committee (2009/289a).
Research Report Platform Presentation
Number: RR-PL-1490 Thursday 23 June 14:00
RAI: Elicium 2
A RANDOMISED TRIAL OF TARGETED
TREATMENT FOR LOW BACK PAIN COMPARED
WITH CURRENT BEST PRACTICE: THE START
BACK TRIAL [ISRCTN37113406]
Hill J., Dunn K.M., Lewis M., Mason E., Vohora K., Main
C., Konstantinou K., Sowden G., Somerville S., Whitehurst
D., Hay E.
Arthritis Research UK Primary Care Centre, Keele University,
Keele, United Kingdom
Purpose: This randomised controlled trial compared the
effectiveness of a low back pain (LBP) subgroup and targeted
treatment approach (targeted group) against current best practice
(control) in primary care. Our pre-specified subgroup
analysis tested whether: (i) low risk patients had non-inferior
outcomes, and (ii) medium and high risk patients had superior
outcomes with targeted treatment.
Relevance: A potential method to increase treatment effectiveness
and reduce treatment variability is to account for LBP
heterogeneity by tailoring treatments to different subgroups.
One untested approach is to target treatment according to risk