Obstetric Perineal Trauma and Physiotherapy

Study Overview
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Brief Summary
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The main objective is to investigate effects of perineal trauma at birth on women´s health and whether early physiotherapy improves pelvic floor strength. This will be achieved by an acknowledged/validated questionnaire sent electronically 6 weeks after first delivery. Women with symptomes of urinary incontinence according to the questionnaire will be offered participation in a single-blinded randomized intervention study to compare outcome after targeted physiotherapy with conventional advice and support. Intervention encompasses weekly pelvic floor training for 12 weeks. Pelvic strength will be measured and symptom information collected before and after intervention and 12 months postpartum in both groups. Pelvic floor problems after delivery are common and often persistent, including urinary/fecal incontinence, pelvic organ prolapse and sexual problems. Such symptoms reduce QoL and handicap women in multiple ways, physically, psychologically and socially. More knowledge of whether interventions and guidelines in this field can improve health and QoL is required.

Detailed Description
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Single-blind randomized controlled trial (RCT) to assess and compare the effects of early pelvic floor muscle training and present standard care/advice on pelvic floor muscle (PFM) strength, symptoms from the pelvic floor and bothersome symptoms (QoL) after obstetric perineal repair. Procedure/Study design: Single-blind randomized controlled trial. Details of test administration and data collection methods: PFM strength will be measured with Myomed 932® (Enraf-Nonius, Delft, Netherlands) for squeeze pressure, vaginally and rectally. Pelvic floor symptoms, (bladder/bowel function, prolapse symptoms, sexual function) and bothersomeness will be measured with the validated Icelandic version of the Australian Female Pelvic Floor Questionnaire. Assessment and treatment will begin from 6th week postpartum. After initial assessment, instruction on pelvic floor function the pelvic floor questionnaire administration, participants will be randomized to intervention and control groups by a person not involved in measurements or treatment. The intervention group will receive individual treatment by a physiotherapist not involved in the initial assesment. This will be in the form of intensive PFMT with vaginal/rectal pressure feedback once a week for 12 weeks and be encouraged to do daily exercises. Repeated assessment of pelvic floor function and questionnaire administration will be after 12 weeks for both groups and repeated 12 months after birth. Assessment of pelvic floor function includes rectal/vaginal resting pressure, PFM strength (maximal voluntary contraction, strongest of three measured as a vaginal and anal squeeze pressure), and endurance for 10 sec (area under the curve both rectal and vaginal). Preliminary assumption of power (beta) of 80% and a level of significance (alfa) of 5% and estimating 1 against 3 women with symptoms of urinary incontinence in treatment vs. control groups, respectively after intervention, ca. 40 women will be needed per group.

Official Title
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Obstetric Perineal Trauma, Pelvic Floor Symptoms and Early Physiotherapy Intervention

Conditions
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Pregnancy Complications

Intervention / Treatment
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* Other: Physiotherapy intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Healthy primiparas after delivery at LSH ≥18 years Diagnosed with urinary incontinence according to the self administered Australian Pelvic floor Questionnaire (Icelandic version) 6 weeks post partum. Able to attend intervention in the capital area Answer the Australian Pelvic Floor Questionnaire Exclusion Criteria: Diseases or conditions that can interfere with pelvic floor function (other than childbirth), such as prior pelvic floor surgery or ability to benefit from the intervention Women unable to understand Icelandic Woman with cognitive disabilities.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Physiotherapy intervention<br>Intensive pelvic floor muscle training (PFMT) given by a physiotherapist with vaginal/rectal pressure feedback once a week for 12 weeks. | Other: Physiotherapy intervention<br>* Compare the effect of early physiotherapy intervention (pelvic floor muscle training, PFMT) with standard care on pelvic floor dysfunction symptoms, quality of life (QoL) and (pelvic floor muscle (PFM) strength, for women who answered the questionnaire positively for 1) urinary incontinence, 2) other dysfunction of the pelvic floor.<br>|
| No Intervention: No intervention<br>Standard care | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Urinary incontinence rates measured by scores on the Australian Female PelvicFloor questionnaire | Urinary incontinence rates measured by scores on the Australian Female PelvicFloor questionnaire | 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fecal/flatal incontinence measured by scores on the Australian Female PelvicFloor questionnaire | Fecal/flatal incontinence measured by scores on the Australian Female PelvicFloor questionnaire | 16 weeks | 
| Sexual dysfunction measured by scores on the Australian Female PelvicFloor questionnaire | Sexual dysfunction measured by scores on the Australian Female PelvicFloor questionnaire | 16 weeks | 
| Quality of life measured by scores on the Australian Female PelvicFloor questionnaire | Quality of life measured by scores on the Australian Female PelvicFloor questionnaire | 16 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pelvic floor, obstetrics, perineal tear, physiotherapy