2016 Combined Sections Meeting Platforms

TITLE: Building Better Bones Now! The Effects of an Osteoporosis and Bone Health Educational Program on the Knowledge, Beliefs, and Self-efficacy of High School Girls AUTHORS/INSTITUTIONS: C.H. Gill, M.F. Chenette, J.M. Lovins, L.K. Milovitch-Sera, H.M. Nguyen, Physical Therapy, University of Maryland Eastern Shore, Princess Anne, Maryland, UNITED STATES. ABSTRACT BODY: Purpose/Hypothesis: Osteoporosis (OP) is a disease of the bones that typically presents in older age. Prevention of OP should occur during adolescence before peak bone mass is reached. Education is a key aspect of prevention. The purpose of this study was to develop an educational program targeting 10th- to 11th-grade girls regarding their knowledge, beliefs, and behaviors of bone health and OP prevention. Number of Subjects: Eighteen 10th- to 11th-grade girls. Materials/Methods: The educational program, “Building Better Bones Now!” created by the investigators, was delivered in two 60-minute sessions. Subjects participated in educational presentations, interactive activities, and pre- and posttestings. Pretests consisted of the Bone and Health Osteoporosis Knowledge Questionnaire (KQ), Osteoporosis Health Belief Scale (OHBS), and Behavior Questionnaire (BQ). Tests administered immediately after the conclusion of educational sessions (posttest 1) included the KQ, OHBS, and Self-Efficacy Scale. Tests administered 4 weeks after the conclusion of the program (posttest 2) included the KQ, OHBS, and BQ. Results: A history of fracture was reported in 50% of participants' mothers, 50% of grandmothers and aunts, and 28% of the participants. Only 22% of participants had a family history of OP. Significant differences were found in KQ scores between pretest and both posttests (39.9% pre- and posttest 1 and 28.9% pre- and posttest 2). Posttest 1 and 2 OHBS scores for benefits of calcium were greater than pretest scores (P ≤ .001). Posttest 1 score for health motivation (OHBS) was greater than that for pretest (P = .03). The OSES classified subjects' self-efficacy level as moderately high. Results demonstrated that subjects gained knowledge after education sessions and interactive activities from pretest to posttest 1 and posttest 2. With regard to beliefs, subjects demonstrated (from pretest to posttest) an increase in the perceived benefits of calcium and health motivation. Conclusions: This study addressed OP education and prevention in high school–aged girls, a population in which minimal research has been reported. The results of this study showed significant increase in knowledge regarding bone health and OP following the educational program compared with pretests. However, the subjects demonstrated only a minimal change in their health beliefs regarding OP. Clinical Relevance: OP is a preventable disease if addressed early in life. Prevention begins with education of adolescents on proper diet and exercise, and how to avoid certain behaviors that may contribute to the disease process. Physical therapists (PTs) have an important role in prevention and in the promotion of health, wellness, and fitness for individuals throughout the life span. PTs can have an impact on the primary prevention of OP by promoting optimal bone health through the education of young women. In addition, it is our professional duty and social responsibility to educate patients, parents, families, and community members regarding OP and the means to achieve optimal bone health. TITLE: Quantifying the Acute Effects of TENS Use in a Patient With Dysparenuia Using Ultrasound Imaging With Shear Wave Elastography AUTHORS/INSTITUTIONS: K.E. Abraham, R.M. Maher, Physical Therapy, Shenandoah University, Winchester, Virginia, UNITED STATES. ABSTRACT BODY: Background and Purpose: Dyspareunia is defined as recurrent or persistent pain with vaginal entry or penile vaginal intercourse and is associated with pelvic floor dysfunction typically identified via digital examination and/or surface electromyography (sEMG). A new ultrasound (US) imaging mode has become available that uses remotely induced shear waves to quantify the mechanical properties of tissue according to Young's modulus. The purpose of this case study was to determine if US with shear wave elastography (SWE) could quantify associated tonal qualities and measure the effects of perineal transcutaneous electrical nerve stimulation (TENS). Case Description: A 52-year old woman presenting with dyspareunia that began following an abdominal hysterectomy was prescribed topical estrogen and referred for physical therapy. The patient presented with a noncontracting, nonrelaxing pelvic floor trigger points in the left obturator internus muscle and performed Valsalva-type maneuver when asked to contract her pelvic floor muscles (PFMs). Her treatment consisted of several sessions of sEMG biofeedback, pelvic floor manual therapy, external manual therapy, and dilator use. Failure to make progress prompted a review of the literature, which suggested TENS and the novel use of US with SWE. The protocol consisted of conventional TENS (100 Hz, 150 microseconds), with intensity set to a maximum tolerable level. Electrodes were placed in 2 configurations (perineum/sacrum; suprapubic/sacrum). Stimulation was for 5 minutes, with a washout period of 20 minutes between protocols. US with SWE was acquired pre- and post-TENS transabdominally with a curvilinear array. Outcomes: Three regions of interest were selected within a transverse view of the PFM from right to left. The pre-TENS values from right to left were 139.1, 56.1, and 25 kPa and post-TENS values were 13.1, 20.8, and 11.9 kPa, with percent changes of 91%, 63%, and 52%, respectively. Immediately following both protocols, the patient could insert a pear-shaped Periform vaginal probe (7.5 × 3.5 cm) without pain but reported a little burning following protocol 1 but no symptoms following protocol 2. On completion of both protocols, the patient reported feeling complete relaxation in her pelvis. She no longer used Valsalva-type maneuver in an attempt to contract her pelvic floor, and a trace contraction was observable via US imaging. Discussion: US with SWE provides a means to assess various morphological characteristics including the stiffness of tissue. We were able to quantify the effect of TENS on the pelvic floor in a patient with dyspareunia. The effects were readily confirmed by the patient, and the ability to tolerate penetration via a vaginal probe was exceptionally tolerated without provocation of symptoms. More surprising was the rate at which symptoms and morphological characteristics changed following 2 bouts of 5 minutes of TENS applied to the perineum. Unfortunately, we did not assess Doppler blood flow characteristics but we postulate that the mechanism of the change was due to blood flow changes and not necessarily gating of pain. REFERENCES 1. van Lankveld JJ, Granot M, Weijmar Schultz WC, et al. Women's sexual pain disorders. J Sex Med. 2010;7(1, pt 2):615–631. 2. Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the Pelvic Floor Clinical Assessment Group of the International Continence Society. Neurourol Urodyn. 2005;24 (4):374–380. 3. Eby SF, Song P, Chen S, Chen Q, Greenleaf JF, An KN. Validation of shear wave elastography in skeletal muscle. J Biomech. 2013;46(14):2381–2387. 4. Schneider MP, Tellenbach M, Mordasini L, Thalmann GN, Kessler TM. Refractory chronic pelvic pain syndrome in men: can transcutaneous electrical nerve stimulation help? BJU Int. 2013;112(2):E159–E163. 5. Vallinga MS, Spoelstra SK, Hemel IL, van de Wiel HB, Weijmar Schultz WC. Transcutaneous electrical nerve stimulation as an additional treatment for women suffering from therapy-resistant provoked vestibulodynia: a feasibility study. J Sex Med. 2014;12(1):228–237. TITLE: The Effect of Diaphragmatic Breathing Exercise on Females With Urge Urinary Incontinence AUTHORS/INSTITUTIONS: L.M. Bordenave, T.L. Roehling, Physical Therapy Program, A.T. Still University of Health Sciences, Mesa, Arizona, UNITED STATES. ABSTRACT BODY: Purpose/Hypothesis: The purpose of this study was to determine if diaphragmatic breathing exercises improve symptoms of urogenital distress and quality of life in women older than 25 years with urge urinary incontinence (UUI). UUI is associated with involuntary detrusor (bladder) contraction accompanied by loss of urine. The detrusor is composed of smooth muscle and is autonomically innervated by sympathetic and parasympathetic nerves. An imbalance between sympathetic and parasympathetic innervation is believed to be one cause of UUI, particularly higher parasympathetic activity. Diaphragmatic breathing is used by physical therapists to inhibit parasympathetic activation and promote detrusor relaxation; therefore, diaphragmatic breathing may be an effective treatment to help decrease urge symptoms and improve quality of life. Number of Subjects: Eight. Materials/Methods: Eight participants (aged 30-74 years) with at least a 3-month history of UUI or mixed urinary incontinence participated in this 3-phase study. The first phase was a 3-week baseline period, followed by a 3-week intervention phase and then a 3-week follow-up period, identical to the baseline phase. The intervention consisted of diaphragmatic breathing performed 5 minutes in the morning, 5 minutes at night, and throughout the day when subjects experienced urges to urinate. Throughout the study, participants completed a daily bladder diary and a weekly Kings Health Questionnaire (KHQ) and Urogenital Distress Inventory (UDI). Results: A mean of the 4 baseline measures was calculated to have a single baseline measure for comparison for the KHQ and UDI. The scores reported at the end of the intervention phase were used to evaluate the outcome of the intervention. Data were analyzed in Microsoft Excel. All subjects demonstrated an improvement in both KHQ and UDI scores. Mean KHQ scores for the baseline period ranged from 312.5 to 29.17. Postintervention scores ranged from 194.44 to 16.67. A Wilcoxon signed rank test demonstrated significant differences (P < .005). Mean UDI scores for the baseline period ranged from 65.21 to 15.26. Postintervention UDI scores ranged from 38.85 to 5.55. A Wilcoxon signed rank test demonstrated significance (P < .005). Conclusions: A 3-week intervention of diaphragmatic breathing for women with UUI improves symptoms of distress and quality of life. Clinical Relevance: Diaphragmatic breathing is an intervention employed by physical therapists that can reduce symptoms of urinary distress and improve quality of life in women with UUI. TITLE: Activity Limitations During Pregnancy: Is There a Difference Between Pelvic Girdle Pain and Nonspecific Low Back Pain? AUTHORS/INSTITUTIONS: C.M. Chiarello, Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, UNITED STATES. ABSTRACT BODY: Purpose/Hypothesis: Back pain (BP) affects 20% to 90% of women during pregnancy. On the basis of pain location and a cluster of positive examination tests, 20% to 50% of pregnancy-related BP is classified as pelvic girdle pain (PGP). PGP is characterized by diminished load transfer due to decreased pelvic force closure. Inability of the pelvis to attenuate normal loading may result in limited participation in daily activities. The purpose of this investigation was to compare the functional activities of pregnant women with PGP to pregnant women with other types of BP. Number of Subjects: A convenience sample of 66 women between the ages of 21 and 44 years with self-reports of BP in the second and third trimesters of pregnancy participated. Materials/Methods: The outcome measure used to determine functional activities was the modified Pregnancy Mobility Index (PMI), a valid and reliable 24-item self-report questionnaire that establishes the mobility impact of BP and PGP in pregnant women. The PMI is divided into 3 subscales; daily mobility in the house, ability to perform normal household activities, and mobility outdoors. Initially, the participants completed the PMI and diagramed the location of their symptoms on a body chart. The women were then examined with the following tests: posterior pelvic pain provocation (PPPP) test, active straight leg raise (ASLR), and sacral compression. A research assistant, blind to the data collection procedures, scored the PMI and assigned the participants to either PGP or BP group post hoc. A woman was classified as having PGP if 3 of the 4 tests (pain location, ASLR, PPPP, and sacral compression) were positive. Results: Thirty-three women were found to have PGP, whereas 33 were classified as having nonspecific BP. Student t tests indicated that there was no difference between the groups for age, weeks of gestation, number of pregnancies, height, or weight. Analysis of variance revealed that the PGP group exhibited a statistically significant poorer scores than the BP group in all aspects of the PMI: mobility in the house (P < .002), household activities (P < .0001), mobility outdoors (P < .003), and total PMI (P < .0004). Conclusions: Women in their second and third trimesters with pregnancy-related PGP exhibited greater limitations in physical activities than pregnant women with nonspecific BP. These activities included basic transfers, housework, ambulation, and traveling by various modes. PGP represents a greater threat to function and social engagement than other types of BP. Clinical Relevance: It is essential that women with pregnancy-related PGP receive the appropriate interventions in a timely manner to limit and reverse deleterious effects on daily function. TITLE: Pelvic Floor Dysfunction in Mechanical Low Back Pain AUTHORS/INSTITUTIONS: S.P. Dufour, B. Vandyken, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, CANADA; C. Vandyken, Pelvic Health Solutions, Cambridge, Ontario, CANADA. ABSTRACT BODY: Purpose/Hypothesis: The prevalence and cost of lower back pain continue to rise despite the range of available therapeutic interventions, indicating a deficiency in current approaches. The purpose of this study was to assess the prevalence and type of pelvic floor dysfunctions among patients with mechanical low back pain to better understand the relevance of pelvic floor rehabilitation herein. On the basis of recent European research, we hypothesized pelvic floor dysfunction, specifically hypertonicity, to be positively correlated with mechanical low back pain. Number of Subjects: A total of 100 subjects were recruited to participate and 84 consented; of those, 55 met the inclusion criteria. Subjects were drawn from 6 different clinical sites (Ontario and Alberta, Canada). Data collection was ongoing until 100 subjects had been included. Materials/Methods: In this prospective cross-sectional study, female patients presenting with a primary complaint of mechanical lower back pain were invited to participate. Following consent, potential participants underwent a screening process to exclude participants with features of central sensitization (Pain Catastrophizing Scale score >30) or radiculopathy. Subjects who met the screening criteria were included in the study and went on to participate in an internal pelvic examination (digital palpation) to determine the status of the pelvic floor. In addition, subjects completed the Oswestry Low Back Disability Scale and were asked if they were experiencing any self-reported symptoms of pelvic floor dysfunction including urinary and fecal incontinence, chronic constipation, and pelvic pain (including dyspareunia). Results: To date, this sample (N = 55) has a mean age of 41.9 years (SD = 13.4). Of these, 98% (54/55) were determined to have some form of pelvic floor dysfunction. Specifically, 82% (44/54) of the participants had a component of hypertonicitiy. Furthermore, the digital examination of the pelvic floor was highly congruent with the self-reported indications of pelvic floor dysfunction. Importantly, 21% (18/84) of potential subjects were excluded from the study during the screening phase because of their score on the Pain Catastrophizing Scale. This finding is beyond the scope of the present study but has important implications related to the importance of screening patients and using a biopsychosocial approach. Conclusions: Our findings corroborate and extend the findings of recent research supporting the hypothesis that pelvic floor dysfunction is highly correlated with mechanical lower back pain. Clinical Relevance: Movement toward comprehensive approaches that better address the various features that influence mechanical lower back pain has potential to more optimally address this pervasive issue. Standard practice to address presumed pelvic floor dysfunction includes Kegel exercises, which are contraindicated when hypertonicity is present. Our findings suggest that current practice patterns related to mechanical lower back pain warrant further attention. TITLE: Physical Symptoms Associated With Postpartum Depression: A Review of the Literature AUTHORS/INSTITUTIONS: A. Simonds, S. University, New UNITED STATES. ABSTRACT BODY: Purpose/Hypothesis: The purpose of this review was to the physical symptoms associated with is a experienced by to 20% of women after The physical of in the population has been but the physical of is not symptoms physical from and make it more for and patients to at the physical symptoms of may and improve to women with Physical therapists with women during pregnancy and may have an important role in the screening and potential of the physical symptoms of Number of Subjects: Materials/Methods: A was and from to included and criteria were or symptoms. The were by and using the for of Results: were selected for review on inclusion criteria and scored as level or level of and tests to the among physical symptoms and of A positive between physical symptoms and was Physical symptoms associated with values included pain back pelvic girdle perineal of pain after incontinence, constipation, decreased and decreased sexual Women with 5 or more physical symptoms were more at for at 3 = and 6 to = Physical symptoms were present to The between physical symptoms and was significant at and Conclusions: and bladder and sexual dysfunction were associated with the first Health should women for physical symptoms immediately after through the Clinical Relevance: Pain was the associated with Postpartum physical symptoms were throughout the first indicating a for physical health beyond the and an to pain after TITLE: During in Females AUTHORS/INSTITUTIONS: S. Rehabilitation Sciences, University of UNITED STATES. ABSTRACT BODY: Purpose/Hypothesis: Ultrasound for the have been for comparison with percent change from with a using an active leg to reported the internal muscle the change of change than for the muscle of and the external muscle with and of change with a contraction of the muscles not within the data During the leg test, the is an which that the active of muscle may or may not changes as the straight leg is that the abdominal muscles may not readily back to their after an activity. The of muscle to be to help determine if the muscle is in a to Number of Subjects: and with a mean age of 25 All were of abdominal in had no more than 2 or no Materials/Methods: Ultrasound of abdominal muscles was performed at in the with the curvilinear and to on the and during of the leg test the back for was using the program at during on at the and at end when back at of and was at Results: abdominal were with the no significant difference in at between pre- and During the leg at the change demonstrated by was was showed a decrease of by changes for was for in the group and for the and in had a positive change and in the The muscle demonstrated a further change from to end of the test when the were at (P = .005). Conclusions: was within reported the test created a greater in and with a change in for the may a different set of The decrease in at the end of the test may or at the Clinical Relevance: with to and

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