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BACKGROUND: The Pregnancy Mobility Index (PMI) was developed to assess mobility in pregnant women in the Netherlands. At present, no similar questionnaire is available in Brazil. OBJECTIVE: The present study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of a Brazilian PMI. DESIGN AND SETTING: The present study was a validation study conducted at the Universidade Federal do Paraná and a public maternity ward in Curitiba, Brazil. METHODS: Text translation and cross-cultural adaptation followed international guidelines. Construct validity, internal consistency, and inter- and intra-rater reliability tests included 97 women. The Pelvic Girdle Questionnaire, Multidimensional Pain Evaluation Scale, Schober's test, and lumbar spine range of motion assessment were administered on the first day. Intra-rater reliability (n = 19) was measured after 15 days. Exploratory factor analysis was performed, and the correlation matrix was analyzed using Pearson's coefficient. RESULTS: Pregnant women (88%) understood the cultural adaptation process. The internal consistency was high (Cronbach's alpha > 0.90), construct validity was moderate, with significant correlation between lumbar spine range of motion (r = 0.283-0.369) and Schober's test (r = -0.314), and high correlation between the Multidimensional Pain Evaluation Scale (r = -0.650 and -0.499) and Pelvic Girdle Questionnaire (r = -0.737). Intra- and inter-rater reliabilities were excellent (intraclass correlation coefficient = 0.932 and 0.990, respectively). CONCLUSION: The Brazilian version of the PMI was successfully translated with excellent reliability and moderate-to-high construct validity. It is an important tool for assessing mobility in pregnant women. CLINICAL TRIAL: RBR-789tps (Validation study), https://ensaiosclinicos.gov.br/rg/RBR-789tps.

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ABSTRACT BACKGROUND: The Pregnancy Mobility Index (PMI) was developed to assess mobility in pregnant women in the Netherlands. At present, no similar questionnaire is available in Brazil. OBJECTIVE: The present study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of a Brazilian PMI. DESIGN AND SETTING: The present study was a validation study conducted at the Universidade Federal do Paraná and a public maternity ward in Curitiba, Brazil. METHODS: Text translation and cross-cultural adaptation followed international guidelines. Construct validity, internal consistency, and inter- and intra-rater reliability tests included 97 women. The Pelvic Girdle Questionnaire, Multidimensional Pain Evaluation Scale, Schober's test, and lumbar spine range of motion assessment were administered on the first day. Intra-rater reliability (n = 19) was measured after 15 days. Exploratory factor analysis was performed, and the correlation matrix was analyzed using Pearson's coefficient. RESULTS: Pregnant women (88%) understood the cultural adaptation process. The internal consistency was high (Cronbach's alpha > 0.90), construct validity was moderate, with significant correlation between lumbar spine range of motion (r = 0.283-0.369) and Schober's test (r = -0.314), and high correlation between the Multidimensional Pain Evaluation Scale (r = -0.650 and -0.499) and Pelvic Girdle Questionnaire (r = -0.737). Intra- and inter-rater reliabilities were excellent (intraclass correlation coefficient = 0.932 and 0.990, respectively). CONCLUSION: The Brazilian version of the PMI was successfully translated with excellent reliability and moderate-to-high construct validity. It is an important tool for assessing mobility in pregnant women. CLINICAL TRIAL: RBR-789tps (Validation study), https://ensaiosclinicos.gov.br/rg/RBR-789tps.

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OBJECTIVE: The aims of this study were to perform a cross-cultural adaptation of the Vulvovaginal Symptoms Questionnaire (VSQ) into Brazilian Portuguese (VSQ-Br) and evaluate its measurement properties (structural validity, construct validity, internal consistency, and reliability). METHODS: Cross-cultural adaptation was conducted through the translation, synthesis, and back-translation of the VSQ-Br. Subsequently, 314 women completed the Pelvic Floor Impact Questionnaire, Pelvic Floor Disorders Inventory, Medical Outcomes Study 36-Item Short-Form Health Survey, and VSQ-Br. Seven to 10 days later, participants completed the VSQ-Br for the second time. Data were submitted for confirmatory factor analysis. Cronbach α was used to verify internal consistency, and construct validity was assessed using Pearson correlation coefficient ( r ). Reliability was calculated using the intraclass correlation coefficient. RESULTS: Confirmatory factor analysis showed that the questions were grouped into four domains (symptoms, emotions, life impact, and sexual impact). The model showed good fit (>0.95). The Cronbach α in this study was 0.85, reflecting adequate internal consistency. Adequate reliability was confirmed, with an intraclass correlation coefficient total score of 0.80. The VSQ-Br had a weak correlation with the pelvic domain of the Pelvic Floor Disorders Inventory, the pelvic organ prolapse domain of the Pelvic Floor Impact Questionnaire, and pain, vitality, and the social aspect domains of the Medical Outcomes Study 36-Item Short-Form Health Survey. CONCLUSIONS: The VSQ-Br was validated and had acceptable measurement properties for assessing vulvovaginal symptoms in Brazilian women.

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INTRODUCTION AND HYPOTHESIS: Pelvic floor dysfunction may be treated and prevented during pregnancy and postpartum, as it decreases women's quality of life. The aim of the present study was to translate and validate the Brazilian Portuguese questionnaire for the assessment of pelvic floor disorders and their risk factors during pregnancy and postpartum. METHODS: This is a cross-sectional study. Two translators fluent in German translated the German version of the questionnaire into English. The back translation was performed by two other translators. The final version was tested on Brazilian pregnant/puerperal women. The participants answered the questionnaire twice, with an interval of 7-10 days between sessions. They also completed the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). To evaluate the test-retest reliability, we used the intraclass correlation coefficient (ICC), Cronbach's alpha coefficient, to test the internal consistency, and Pearson's linear correlation to assess construct validity. RESULTS: Sixty-six women were included (77% pregnant; 23% puerperal women), with a mean age of 26.5 ± 5.8 years and a body mass index of 26.4 ± 5.7 kg/cm2. There were no missing ceiling or floor effects. The construct validity presented a moderate correlation with the role physical domain of the SF-36 (r = -0.48), the ICC test-retest showed good reliability of 0.72, and the internal consistency was 0.71. CONCLUSIONS: These results provide evidence that the questionnaire for the assessment of pelvic floor disorders and their risk factors during pregnancy and postpartum is a valid and reliable instrument when utilized in Brazilian pregnant and postpartum women.

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INTRODUCTION AND HYPOTHESIS: Sympathetic and parasympathetic pathways of the autonomic nervous system (ANS) regulate the lower urinary tract. The aim of the present study was to synthesize the evidence regarding ANS regulation in women with urinary incontinence (UI) evaluated through heart rate variability (HRV). METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Five databases were researched in April 2021 (PubMed, CINHAL, Scopus, Web of Science and Cochrane Library) and included cross-sectional studies in full-length publications in the English language. Studies assessed the HRV during bladder filling (group A) and after voiding (group B). The Joanna Briggs Institute (JBI) checklist was applied for methodological quality assessment purposes. RESULTS: A total of 920 articles were identified and 5 studies were included. Most studies analyzed the HRV by linear indexes. Studies from group A (n = 2) presented fair methodological quality; one study from group B (n = 3) showed fair methodological quality (Im et al. Korean J Urol. 51:183, 2010) whereas the others presented high methodological quality. One study from group A found an increase in both modulations between women with overactive bladder (OAB) versus women with stress UI, whereas a decrease was reported between incontinent and continent women. Studies from group B showed a decreased sympathetic and parasympathetic modulation in AOB with detrusor overactivity (DO), whereas one study found an increase in both modulations in women with OAB compared with stress UI. CONCLUSION: Parasympathetic and sympathetic modulation increased during bladder filling and rest in UI with OAB associated or not with DO. Both modulations decreased during bladder filling in incontinent women and during rest in OAB.

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INTRODUCTION AND HYPOTHESIS: The differential diagnosis of urinary symptoms may allow health professionals to establish a therapeutic objective and to choose the appropriate treatment for the patient's complaint. The aim of this study was to cross-culturally adapt the Three Incontinence Questionnaire (3IQ) into Brazilian Portuguese (3IQ-Br) and to analyze test-retest reliability, construct, and criterion validity in women. METHODS: The cross-cultural adaptation of the 3IQ-Br included forward-translation, back-translation, and consensus among an expert committee. Participants with and without urinary incontinence (UI) completed the 3IQ-Br, King's Health Questionnaire (KHQ), and Questionnaire for Female Urinary Incontinence Diagnosis (QUID-Br). Only women with UI answered 3IQ-Br after 7-10 days. Test-retest reliability and construct validity were analyzed using the Cohen linear kappa (k). The 3IQ-Br accuracy was analyzed using the area under the curve (AUC) of the receiver-operating characteristic (ROC) curve, considering the sensitivity and specificity to correctly classify women with and without UI. RESULTS: The reliability of each question from the 3IQ-Br was considered substantial in the test-retest. The agreement among 3IQ-Br, QUID-Br, and KHQ was almost perfect for UI diagnosis (k > 0.8). The 3IQ-Br was considered to have good accuracy in distinguishing women with UI considering the KHQ (AUC 0.83, 95% confidence interval [CI] 0.78 to 0.87, p < 0.001), and fair to the QUID-Br (AUC 0.73, 95% CI 0.68 to 0.78; p < 0.001). CONCLUSIONS: The results of this study showed that this version of the 3IQ-Br has acceptable measurement properties for identifying and differentiating UI symptoms in Brazilian women.

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Abstract Introduction: Pelvic floor muscle training (PFMT) and neuromuscular electrical stimulation (NMES) are physiotherapeutic conservative treatments to prevent and to treat pelvic floor dysfunctions. Objective: To investigate the immediate effect of one session of PFMT versus NMES associated to pelvic floor muscle (PFM) contraction on the PFM function in nulliparous women. Methods: This is a cross-sectional experimental study. Twenty women were randomized into the "PFMT Group" and "NMES Group". PFM function evaluation was performed by vaginal palpation and manometry before and after a single session. PFMT was composed by one series of eight sustained contractions of 6 seconds and one series of four fast contractions, in four different positions. NMES parameters were: biphasic pulsed current; frequency: 50 Hz; pulse duration: 0.7 ms; cycle on:off 4:8s; rise/decay: 2/2s, time: 20 minutes; and intensity: participant' sensibility. Data was analyzed by the ANOVA two-way for repeated measures to verify the difference between groups, within group and the interactions for PFM function. A 5% probability was considered in all tests. Results: There were no significant differences between groups. At intra-group analysis, there was a significant decrease in the maximal voluntary contraction (p = 0.01), by manometry, between pre- and post-session for both groups. Conclusion: The immediate effects of a single session of PFMT and NMES associated with voluntary PFM contraction are similar on PFM function, that is, no difference was found between groups.

Resumo Introdução: O treinamento dos músculos do assoalho pélvico (TMAP) e estimulação elétrica neuromuscular (EENM) são recursos fisioterapêuticos utilizados para prevenir e reabilitar de forma conservadora as disfunções do assoalho pélvico. Objetivo: Investigar o efeito imediato de uma sessão de TMAP versus EENM associada à contração dos músculos do assoalho pélvico (MAP) sobre a função dos MAP em mulheres nulíparas. Métodos: Estudo experimental transversal. Vinte mulheres foram randomizadas em "Grupo TMAP" e "Grupo EENM". A avaliação da função dos MAP foi realizada por palpação vaginal e manometria, antes e após uma única sessão. O TMAP foi composto por uma série de oito contrações sustentadas de 6 segundos e uma série de quatro contrações rápidas, em quatro posições diferentes. Os parâmetros de EENM foram: corrente bifásica pulsada; frequência: 50 Hz; duração do pulso: 0,7 ms; ciclo on:off 4:8s; subida/descida: 2/2s; tempo: 20 minutos; e intensidade: sensibilidade da participante. O teste de ANOVA two-way para medidas repetidas foi aplicado para verificar a diferença intra e entre grupos e as interações para as variáveis da função dos MAP. Considerou-se nível de significância de 5% em todos os testes. Resultados: Não houve diferenças significativas na comparação entre grupos. Na análise intragrupo houve diminuição significativa da variável contração voluntária máxima (p = 0,01), por manometria, entre pré e pós-sessão para ambos os grupos. Conclusão: Os efeitos imediatos de uma única sessão de TMAP e EENM associados à contração voluntária dos MAP são semelhantes na função dos MAP, ou seja, nenhuma diferença foi observada entre os grupos.

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Objetivo: Avaliar a relação entre diástase músculo reto abdominal (DMRA) supra- e infraumbilical com a contração da musculatura do assoalho pélvico (MAP) de mulheres no pós-parto imediato, internadas em uma maternidade pública. Metodologia: Estudo transversal aprovado pelo Comitê de Ética em Seres Humanos (nº 1.674.698; CAA 6163616.8.0000.0096). Participaram 60 puérperas de baixo risco, assistidas nas enfermarias de uma maternidade. A DMRA foi avaliada pela palpação abdominal e graduada conforme a quantidade de polpas digitais. A contração da MAP foi avaliada por meio da inspeção visual. A correlação das variáveis foi realizada pelo teste de Spearman, com nível de significância em p<0,05. Resultados: 40 puérperas (66,7%) apresentaram DMRA supraumbilical e 23 participantes (38,4%) mantinham DMRA infraumbilical maior do que 2 polpas digitais. Cerca de 71,4% das puérperas contraíram MAP isoladamente e 12,7% contraíram MAP utilizando mecanismos compensatórios; 14,3% das puérperas não conseguiram realizar a contração. A DMRA supraumbilical está correlacionada com a contração da MAP com músculos acessórios de primíparas (p=0,03; r=-0,46); a sustentação da contração da MAP em multíparas (p=0,03; r=-0,43); e a ausência da contração da MAP (=0,03; r=0,35) e ao tempo de sustentação da contração (p=0,02; r=-0,40) em puérperas que realizaram parto vaginal. Conclusão: A presença da DMRA supraumbilical apresenta correlação com a função da MAP de puérperas de acordo com a paridade e a via de parto do último parto. (AU)

Aim: to analyze the relationship between supra- and infraumbilical diastasis recti abdominis (DRA) and pelvic floor musculature (PFM) contraction of women at immediate postpartum, admitted in a public maternity hospital. Methodology: Cross-sectional study approved by the Human Ethics Committee (nº 1.674.698; CAA 56163616.8.0000.0096). Sixty low-risk puerperal women attended at the maternity participated were included. DRA was assessed by abdominal palpation and graded according to number of digital pulps. PFM contraction was assessed by visual inspection. The correlation of variables was performed using the Spearman test, with a significance level of p <0.05. Results: 40 participants (66.7%) had supraumbilical DRA and 23 participants (38.4%) had infraumbilical DRA greater than 2 digital pulps. About 71.4% of women contract only PFM and 12.7% contract PFM using compensatory mechanisms; 14.3% of puerperal women were unable to perform a contraction. Supraumbilical DRA is correlated with PFM contraction and accessory muscles (p = 0.03; r = -0.46); to time of sustained PFM contraction in multiparous women (p = 0.03; r = -0.43); and absence of PFM contraction (= 0.03; r = 0.35) and the time of sustained PFM contraction (p = 0.02; r = -0.40) in puerperal women who underwent vaginal delivery. Conclusion: The presence of supraumbilical DRA correlates with PFM function according to the parity and the type of delivery. (AU)

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INTRODUCTION: Pelvic floor muscle training (PFMT) exercises and neuromuscular electrical stimulation (NMES) are described as conservative interventions to prevent or treat female stress urinary incontinence (SUI). However, it has not been described yet the effect of PFMT associated to intravaginal NMES which evaluated the cost-effectiveness and cost-utility of treating. AIMS: To evaluate the effects of intravaginal NMES associated with the PFMT protocol on urinary loss and quality of life in women with SUI and to evaluate the cost-effectiveness and cost-utility and pelvic floor muscle in women with SUI. METHODS: Randomized controlled trial study with economic evaluation. Inclusion criteria are woman (biological), aged ≥ 18 years old and with a report of SUI ≥ once/week. Exclusion criteria are presence of vaginal or urinary infection, virginity, being in the gestational or puerperium period, or neurological disease. Participants will undergo physical therapy assessment and intervention: anamnesis, pelvic floor muscle assessment by vaginal palpation and manometry (PeritronTM), questionnaires (Short-Form 6 Dimensions-Brazil (SF-6D), King's Health Questionnaire (KHQ) and King´s Health Questionnaire for Scoring Algorithm), health costs, and voiding diary. Participants will be randomly allocated into 3 groups: CG (control group), IG 1 (intervention group 1, PFMT), and IG2 (intervention group 2, PFMT + NMES). The statistical analysis will be performed by intention to treat, and multivariate analysis of mixed effects will be used to compare outcomes. Effect size measurements will be calculated and will be provided by Cohen's d test. A significance level of 5% will be adopted. Additionally, the incremental cost-effectiveness and incremental cost-utility ratios will be used. DISCUSSION: This protocol can corroborate with the literature in order to identify the effect of techniques, based on the possibility of confirming the hypothesis that the NMES associated with PFMT performed concurrently will be the best treatment option; considering the effectiveness, cost-effectiveness, and cost-utility analysis, it will be used as an option for optimization of the treatment of SUI. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-6gtzg4 . Registered on September 3, 2019.

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Urinary incontinence (UI) is directly correlated with the risk of death and negatively affects the quality of life of women. During the COVID-19 pandemic, women had to adapt their lifestyles to get accustomed to the restrictive measures. The present study aimed to investigate the association between lifestyle habits, anxiety, and depression symptoms during the COVID-19 pandemic between incontinent and continent women. Seventy-seven Brazilian participants aged >18 years were assessed through semi-structured telephonic interviews from July to August 2020. The interview included a questionnaire to investigate lifestyle habit changes and two questions from the King's Health Questionnaire (KHQ) to identify the presence of UI and the Hospital Anxiety and Depression Scale (HADS). Women were allocated into two groups according to their answers to the KHQ: incontinent and continent. The chi-square test was applied, the significance level was set at 5%. Significant differences were found between groups regarding the habit to study and the time spent talking to relatives/friends (p < .05). Neither anxiety nor depression symptoms showed a significant association between the groups. It seems that women with UI changed specific lifestyle habits during the COVID-19 pandemic compared to continent women, while anxiety and depression symptoms did not differ between the groups.

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INTRODUCTION AND HYPOTHESIS: The International Continence Society recommends vaginal palpation as a method for assessing pelvic floor muscle (PFM) function. Our aim was to analyze the agreement between preferences of examiner and participants according to unidigital and bidigital vaginal palpation during PFM assessment. The second aim was to investigate qualitatively women's perception of vaginal palpation. METHODS: Maximal voluntary contractions (MVCs) were requested during both types of vaginal palpation and were classified by the Modified Oxford Scale (MOS). Examiner and participants answered if they had preferences regarding vaginal palpation. Women answered qualitatively what they felt during the assessment. Cohen's linear kappa (κ) evaluated the agreement after allocation of the women with a weaker and stronger MVC and qualitative analysis was performed by transcription considering age range (18-35; 36-59; ≥60 years). RESULTS: Agreement was almost zero for women with weaker and stronger MVC at unidigital (κ = 0.06 and κ = -0.12) and bidigital vaginal palpation (κ = 0.008 and κ = 0.005). Participants associated bidigital palpation with more perception and an easier way of contracting the PFMs. Women between 36 and 59 years associated unidigital palpation with a harder but comfortable way of contracting the PFMs. Subjects aged ≥60 years associated bidigital palpation with an uncomfortable, harder way of contracting PFM, with less space into the vagina. CONCLUSIONS: Agreement between preferences was almost zero neither between women with a weaker and stronger PFM contraction, nor between the types of vaginal palpation. Bidigital palpation increased women's perception, made the contraction easier, and was associated with less space in the vaginal canal and less comfort.

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INTRODUCTION AND HYPOTHESIS: The aim of the present study was to evaluate the inter- and intra-rater reliability of the PERFECT scheme assessed by uni- and bidigital vaginal palpation in young nulligravid women. METHODS: Forty healthy women [median age 22 (19-34) years] were evaluated by unidigital vaginal palpation by both Examiners A and C, while the other 40 participants [median age 23.5 (19-35) years] were assessed by Examiners B and C by bidigital vaginal palpation. Inter- and intra-rater reliability of all items of the PERFECT scheme were evaluated: P = power (Modified Oxford Scale); E = endurance; R = repetitions; F = fast contractions. Cohen's linear weighted kappa (κw) was used to assess the reliability of the power, while the intraclass correlation coefficient (ICC) was applied for the other items. A priori sample size calculation found that 40 participants would be adequate. RESULTS: Inter-rater reliability of unidigital palpation was considered fair for power (κw = 0.34) and poor for other items (ICC < 0.50); bidigital inter-rater reliability was considered moderate (power: κw = 0.57; endurance: ICC = 0.53; fast contractions: ICC = 0.65, respectively) and low (repetitions: ICC = 0.27). Intra-rater reliability was substantial for power (κw = 0.73 and 0.62), moderate for fast contractions (ICC = 0.63 and 0.51) and poor for repetitions (ICC < 0.50), respectively, for uni- and bidigital palpation. Endurance showed poor (ICC < 0.50) and moderate (ICC = 0.61) reliability for uni- and bidigital palpation. CONCLUSIONS: The PERFECT scheme carried out by bidigital vaginal palpation presents higher reliability when two examiners carry out the physical examination. When one examiner is responsible for PFM assessment, both types of palpation are recommended for evaluation of power and fast contraction; endurance should be evaluated using bidigital palpation. Examiners should be careful during the assessment of repetition of sustained contractions because inter- and intra-reliabilities for both types of palpation were classified as poor.

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OBJECTIVE: The purpose of this study was to assess the immediate effect of verbal and visual feedback on pelvic floor muscles (PFM) in nulliparous women without pelvic floor dysfunction. METHODS: In this observational, single-assessor, cross-sectional study, 45 female university students were evaluated using bidigital vaginal palpation and vaginal surface electromyography (EMG). EMG assessments were performed at 2 time points (T1 and T2). According to the protocol, participants performed 5 maximal voluntary contractions (MVC) with 10-second intervals, 5 sustained voluntary contractions (SVC) for 10 seconds, and a 60-second voluntary contraction until fatigue (CUF) before (T1) and after (T2) receiving verbal instructions and visual feedback on PFM contractions. At T2, women received visual feedback on their PFM contraction. Root mean square (RMS) for each repetition (MVC and VCF) was recorded, and mean value was calculated. Compensatory mechanisms during contraction were recorded visually. The difference in mean RMS (mV) for MVC, SVC, and CUF; curve integral for MVC, SVC, and CUF; median frequency (Hz) for CUF between T1 and T2 were analyzed with repeated measures multivariate analysis of variance. RESULTS: Before the instructions, most participants (95.6%) performed PFM MVC using at least 1 compensatory mechanism. PFM EMG outcomes changed at T2: RMS and curve integral were reduced in T2 (P < .05) for MVC, SVC, and CUF. The median frequency increased from T1 to T2 in the CUF group (P = .01). CONCLUSION: Verbal and visual feedback had an immediate impact on the EMG activity of PFM in nulliparous continent women.

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INTRODUCTION AND HYPOTHESIS: To verify the intra- and inter-rater reliability of urethral mobility measurement evaluated by ultrasound (US). METHODS: This is a reliability study realized according to Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. Twenty-one nulliparous women (25.5 ± 3.3 SD years) were volunteers. Two examiners (E1 and E2) performed the measurement of urethral mobility at rest and Valsalva on the same day. Three measurements were recorded for each moment and the mean of them were used for analysis. To perform the analysis, bladder mobility was calculated using the following equation: [Formula: see text], where "x" is the vertical distance, "y" is the horizontal distance from the dorsocaudal margin of the pubic symphysis, "V" is the Valsalva maneuver, and "R" means rest. The intraclass correlation coefficient (ICC) was calculated considering: ICC ≥ 0.75, excellent; 0.40 ≤ ICC <0.75, satisfactory; ICC < 0.40, poor, with a significance level of 5% and 95% confidence interval. RESULTS: The intra-rater reliabilities of E1 and E2 were considered excellent between the two evaluations, with ICC 0.98 (p < 0.0001) for the E1 and 0.84 (p < 0.0001) for E2. The inter-rater reliability was considered excellent (ICC = 0.83). CONCLUSIONS: Both intra- and inter-rater reliabilities of urethral mobility measurement were considered to have excellent agreement.

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OBJECTIVE: To evaluate the responsiveness of Brazilian-Portuguese version of Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) after pelvic floor muscle training (PFMT) in women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). STUDY DESIGN: This is an observational study with 72 women (51.8 ± 11.9SD years) with SUI (n = 33) and MUI (n = 39). Participants answered PFDI-20 and PFIQ-7 before and after PFMT, which consisted of a 12 weeks protocol supervised by a physiotherapist once a week with 30 min of a duration. Wilcoxon test, effect size (ES) and standardized response mean (SRM) were performed on baseline and after three months. RESULTS: We found a significant reduction in PFDI-20 and PFIQ-7 after PFMT (p < 0.001), except for Pelvic Organ Prolapses Distress Inventory (POPDI-16), Colorectal-Anal Impact Questionnaire (CRAIQ-7) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7). The responsiveness of both questionnaires was considered moderate for PFDI-20 (ES = 0.49; SEM = 0.61; p < 0.0001) and PFIQ-7 (ES = 0.51; SEM = 0.52; p < 0.0001). CONCLUSIONS: PFDI-20 and PFIQ-7 Brazilian Portuguese version presented moderate responsiveness in women with SUI and MUI who performed a PFMT.

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ABSTRACT BACKGROUND AND OBJECTIVES: The immediate puerperium extends until the 10th day after delivery, and this period is characterized by the return of the woman's body to the pre-pregnancy state. The aims of the study were to identify pain intensity and the major discomforts reported by women in the immediate puerperium period and to analyze the difference in puerperal discomfort according to parity and type of delivery. METHODS: The participants included 107 women attended in a public maternity ward. Pain and discomfort were assessed using the semi-structured physical therapy assessment form and pain intensity was measured using the visual analog scale (VAS). Mann-Whitney and Kruskal-Wallis tests were applied to identify differences in discomfort according to the type of parity and delivery. RESULTS: Colic pain related to breastfeeding with 4.81±2.52 intensity was reported by 55.14% of mothers in the puerperium, perineal pain with 4,06±2,09 intensity by 30.84%, low back pain with 4.38±2.09 intensity by 28.97%, breast pain with 4.76±2.63 intensity by 23.36% and cesarean related pain with 5.21±2.01 intensity was reported by 17.75% of mothers. No significant differences in pain intensity were found according to parity. However, significant differences were found for perineal pain intensity and cesarean section. CONCLUSION: Pain intensity evaluated by the visual analog scale was classified as moderate or light.

RESUMO JUSTIFICATIVA E OBJETIVOS: O puerpério imediato estende-se até o 10º dia após o parto, e este período é caracterizado pelo retorno do corpo da mulher ao estado pré-gravídico. Os objetivos deste estudo foram identificar a intensidade da dor e principais desconfortos relatados pelas mulheres no puerpério imediato e analisar a diferença dos desconfortos puerperais de acordo com a paridade e tipo de parto. MÉTODOS: Participaram deste estudo 107 puérperas assistidas em uma maternidade pública. A dor e os desconfortos foram avaliados por meio da ficha de avaliação fisioterapêutica semiestruturada, e a intensidade da dor foi mensurada com a escala analógica visual. Os testes de Mann-Whitney e Kruskal-Wallis foram aplicados para identificar diferenças no desconforto a partir do tipo de parto e paridade. RESULTADOS: Dor em cólica relacionada à amamentação de intensidade 4,81±2,52 foi referida por 55,14% das puérperas, dor perineal de intensidade 4,06±2,09 foi referida por 30,84%, lombalgia de intensidade 4,38±2,09 foi referida por 28,97%, dor nas mamas de intensidade 4,76±2,63 foi referida por 23,36% e dor relacionada a cesariana de intensidade 5,21±2,01 por 17,75%. Não foram encontradas diferenças significativas na intensidade da dor de acordo com a paridade. No entanto, foram encontradas diferenças significativas para intensidade da dor perineal e incisão da cesariana. CONCLUSÃO: A intensidade da dor avaliada pela escala analógica visual foi classificada como moderada ou leve.

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INTRODUCTION AND HYPOTHESIS: The purpose of the present study was to test the intra- and inter-rater reliability of the measurement of post-void residual bladder volume using ultrasound. METHODS: Two evaluators performed three measurements of the height, width, and length of the empty bladder using ultrasound. The voiding residual volume was calculated using the equation: volume = length × width × height × 0.52. Intraclass correlations (ICC) were calculated considering: ICC ≥ 0.75 excellent, 0.40 ≤ ICC < 0.75 satisfactory, and ICC <0.40 poor, with a significance level of 5% and analysis of confidence intervals (95% CI). RESULTS: Twenty women participated, with an average age of 27.95 ± 3.15 years. The inter-rater ICCs for height, width, and length were 0.96 (CI 0.89-0.98), 0.88 (CI 0.71-0.95), and 0.84 (CI0.60-0.94) respectively. For the intra-rater ICCs, the values were 0.97 (CI 0.95-0.99), 0.98 (CI 0.96-0.99), and 0.97 (CI 0.94-0.99) for evaluator 1 and 0.99 (CI 0.97-0.99), 0.97 (CI 0.94-0.99), and 0.95 (CI 0.90-0.98) for evaluator 2, for height, width, and length, respectively. The residual inter-test volume was 0.96 (CI 0.90-0.99) and the intra-test volume was 0.99 (CI 0.97-0.99). All analyses presented p < 0.0001. CONCLUSIONS: The intra- and inter-rater reliability for both the post-void residual volume and measurement of the bladder dimensions showed excellent agreement.

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OBJECTIVES: The aim of this study was to analyze the effects of virtual dance exercise on skeletal muscle architecture and function in community-dwelling older women. METHODS: Forty-two moderately active older women participated in this study and chose to join either the control group (CG; n=20; 70.3 ± 5.6 years) or exercise group (EG; n=22; 69.3 ± 3.7 years). Participants in the CG maintained their lifestyle and those in the EG performed group dance exercise using Dance Central game for Xbox 360® and Kinect for 40 min, 3 times/week, for 12 weeks. The primary outcomes were: ankle plantar flexion and dorsiflexion peak torque (PT), medial gastrocnemius muscle thickness (MT), fascicle length (FL), and pennation angle (PA). The secondary outcomes were: lower limbs range of motion (ROM), calf circumference (CC), 6 m customary gait speed, and handgrip strength. Data were analyzed using an ANOVA mixed model test (p<0.05). RESULTS: EG participants improved plantar flexion PT at 60°/s (16.3%; p<0.01), MT (8.7%; p<0.01) and ankle dorsiflexion ROM (5.1%; p=0.04) when compared to baseline, and exhibited enhanced CC values compared to CG (1.7%; p=0.03). CONCLUSIONS: Virtual dance exercise can be recommended to increase muscle mass. Moreover, ankle plantar flexion strength and dorsiflexion ROM gains may contribute to improve functionality and fall avoidance in moderately active older women.

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O objetivo deste estudo foi avaliar a satisfação de puérperas após intervenção fisioterapêutica em educação em saúde. Estudo transversal e observacional que contou com a participação de 63 puérperas internadas em alojamento conjunto de uma maternidade. Foram realizadas atividades de educação em saúde abordando modificações e adaptações do puerpério, utilizando materiais de apoio de baixo custo, linguagem simples e exercícios preventivos. As mulheres também receberam uma cartilha educativa elaborada pelos pesquisadores. Posteriormente, foi realizada a avaliação da satisfação da puérpera em relação ao atendimento fisioterapêutico. A maioria das puérperas apresentou-se muito satisfeitas (55,5%) e satisfeitas (44,4%) com o atendimento. O esclarecimento de dúvidas foi melhor que esperado (39,6%) e como esperado (47,6%). A maioria das participantes sanou dúvidas (93,6%), afirmou que participaria novamente da atividade e recomendaria a assistência para outras mulheres (93,6%). Estratégias fisioterapêuticas de educação em saúde são satisfatórias para mulheres do puerpério imediato.

The satisfaction of puerperal females after physiotherapy intervention in health education is evaluated. Current transversal and observational study involved 63 puerperal females hospitalized in the maternity ward. Health education activities were undertaken dealing with puerperal modifications and adaptations, employing low cost material, simple diction and preventive exercises. They also received an educational handout prepared by the researchers. Puerperal satisfaction was then evaluated with regard to physiotherapy care. Most puerperal females were very satisfied (55.5%) and satisfied (44.4%) with the care. Quitting doubts was more than expected (39.6%) and as expected (47.6%). Most participants said they did not have any more doubts (93.6%) and would participate in the activity once more and would recommend it to other women (93.6%). Physiotherapy strategies in health education are satisfactory for immediate puerperal females.

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