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The Effectiveness of Pelvic Floor Muscle

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UNIVERSITAT DE LLEIDA “The effectiveness of Pelvic Floor Muscle Training through Immersive Virtual Reality for the treatment of Stress Urinary Incontinence based on the impact on the quality of life in adult women elite athletes” - A randomized controlled trial - Done by: Clàudia Arumí Trujillo FACULTAT D’INFERMERIA I FISIOTERÀPIA Grau en Fisioteràpia Tutor: Francesc Valenzuela Pascual Final degree assignment 2017/18 25th May 2018 INDEX TABLE INDEX ....................................................................................................................... 4 FIGURE INDEX ..................................................................................................................... 5 ACRONYM INDEX ................................................................................................................ 6 RESUMEN ............................................................................................................................ 7 ABSTRACT ........................................................................................................................... 8 INTRODUCTION ................................................................................................................... 9 1 THEORICAL FRAMEWORK .........................................................................................10 1.1 ANATOMY AND PHISIOLOGY ..............................................................................10 1.1.1 URINARY WOMEN SYSTEM .........................................................................10 1.1.2 REPRODUCTIVE SYSTEM ............................................................................11 1.1.3 INNERVATION CONTROL OF THE URINATION ...........................................11 1.1.4 URINATE PHISIOLOGY .................................................................................11 1.1.5 FEMALE PELVIC FLOOR ANATOMY ............................................................14 1.2 URINARY INCONTINENCE ...................................................................................17 1.2.1 RISK FACTORS ..............................................................................................18 1.3 TYPES OF URINARY INCONTINENCE .................................................................18 1.3.1 STRESS URINARY INCONTINENCE (SUI) ....................................................18 1.3.2 URGENCY URINARY INCONTINCE (UII) ......................................................19 1.3.3 MIXED URINARY INCONTINENCE (MUI) ......................................................19 1.4 STRESS URINARY INCONTINENCE PHISIOPATOLGY. ABDOMINO-PELVIC- DIAPHRAGM SYSTEM. ...................................................................................................19 1.4.1 FUNCTIONAL RELATION BETWEEN SYSTEMS: TRANSVERSALITY AND VERTICALITY ...............................................................................................................20 1.5 POPULATION ........................................................................................................21 1.6 DESCRIPTION OF THE INTERVENTION .............................................................22 1.6.1 PELVIC FLOOR MUSCLE TRAINING (PFMT)................................................22 1.6.2 BIOFEEDBACK ...............................................................................................24 1.6.3 IMMERSIVE VIRTUAL REALITY ....................................................................25 2 JUSTIFICATION............................................................................................................27 3 HYPOTHESIS ...............................................................................................................28 4 OBJECTIVES ................................................................................................................28 4.1 PRIMARY OBJECTIVE ..........................................................................................28 4.2 SECONDARY OBJECTIVES .................................................................................28 5 METHODOLOGY ..........................................................................................................29 5.1 DESIGN .................................................................................................................29 5.2 STUDY SUBJECTS ...............................................................................................30 2 5.2.1 INCLUSION CRITERIA ...................................................................................31 5.2.2 EXCLUSION CRITERIA ..................................................................................31 5.3 STUDY VARIABLES ..............................................................................................33 5.3.1 TYPES OF OUTCOME MEASURES ..............................................................33 5.4 DATA COLLECTION AND ANALYSIS ...................................................................37 5.5 GENERALIZATION AND APPLICABILITY .............................................................37 5.6 STATISTICAL ANALYSIS ......................................................................................38 5.7 INTERVENTION PLAN ..........................................................................................40 5.7.1 SYSTEM CHARACTERISTICS ..........................................................................40 5.7.2 SYSTEM ARCHITECTURE ................................................................................41 5.7.3 FIRST ASSESSMENT ........................................................................................42 6 CALENDAR ...................................................................................................................47 7 LIMITATIONS AND BIAS ..............................................................................................48 7.1 FUTURE INVESTIGATIONS ..................................................................................49 8 ETHICAL ASPECTCS AND DIFFUSION ......................................................................49 8.1 ADVERSE EFFECTS .............................................................................................50 9 STUDY ORGANIZATION ..............................................................................................51 9.1 RECORD OF DATA AND PRESERVATION OF DOCUMENTS.............................52 9.2 PUBLICATION CONDITIONS ................................................................................52 10 BUDGET....................................................................................................................52 11 BIBLIOGRAPHY ........................................................................................................54 12 ANNEX ......................................................................................................................59 12.1 OPEN CLINICA ......................................................................................................59 12.2 BASELINE SOCIODEMOGRAPHIC TABLE ..........................................................60 12.3 UROGYNEACOLOGICAL ANAMNESIS ................................................................61 12.4 SUMMARY RECOMMENDATIONS .......................................................................63 12.5 FACT SHEET FOR PATIENTS ..............................................................................64 12.6 INFORMED CONSENT FOR PATIENTS ...............................................................68 12.7 ICIQ – SF ...............................................................................................................69 12.8 PAD TEST 1H ........................................................................................................70 12.9 INCONTINENCE SEVERITY INDEX ......................................................................71 12.10 EAU RECOMMENDATIONS ..............................................................................72 3 TABLE INDEX Table 1. Innervation control of the urination ..........................................................................11 Table 2: Modified Oxford rating scale for the pelvic floor musculature ..................................36 Table 3. Approximate equivalences between the scale of Laycock assessment and the pressure measured by the perineometer in mm Hg ..............................................................36 Table 4. Schedule of enrolment, interventions, and assessments SPIRIT. ..........................47 Table 5. Facilities and rrhh budget .......................................................................................53 Table 6. Physiotherapist’s material budget ...........................................................................53 Table 7. Office material budget .............................................................................................53 Table 8. Baseline sociodemographic characteristics ...........................................................60 Table 9. Summary of Recommendations in UI assessment ..................................................63 Table 10. Pad test 1 hour standardization ............................................................................70 4 FIGURE INDEX Figure 1. The pelvis and perineum contain and support terminal parts of the gastrointestinal, urinary, and reproductive systems. .......................................................................................11 Figure 2. Urethral pressure and Vesical pressure during the filling urination phase ..............12
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