Effectiveness of Different Hypopressive Exercises in Pelvic Floor Dysfunction

Study Overview
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Brief Summary
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The purpose of the study is to compare the efficacy of different modalities of hypopressive exercises and biofeedback with ultrasound in women with pelvic floor dysfunctions, considering the efficacy of the treatment as improving the specific quality of life related to pelvic floor dysfunctions and improvement of the muscular properties of the pelvic floor muscles.

Official Title
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Effectiveness of Different Hypopressive Exercises for Treating Pelvic Floor Dysfunction in Women: Randomized Controlled Trial

Conditions
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Pelvic Floor Disorders

Intervention / Treatment
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* Other: Hypopressive exercises
* Other: Hypopressive maneuver
* Other: Hypopressive exercises plus pelvic floor muscle contraction
* Other: Hypopressive maneuver plus pelvic floor muscle contraction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women diagnosed with pelvic floor dysfunction by their doctor. With minimum strength of the pelvic floor muscles of 3 according to Modified Oxford Score Exclusion Criteria: Women who are pregnant or women who have had a vaginal or caesarean birth in the past six months. Women whose PFD is severe and the first indication is surgical (POP-Q grade III-IV prolapses). Women with only urinary incontinence or fecal urgency. Women with pain in the pelvic-perineal region of 3 cm in the visual analog scale, where a score of 0 cm means no pain, and a score of 10cm, the maximum pain that the participant can imagine. Women who have received pelvic floor physiotherapy treatment in the last 12 months. Women who are unable to voluntarily contract the pelvic floor muscles, quantified by the Modified Oxford Score by a score less than or equal to 2. Women with any pathology that may affect the treatment (neurological, gynecological or urological), or with recurrent urinary infection or hematuria. Women with cognitive limitations to understand the information, answer the questionnaires, consent and / or participate in the study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hypopressive exercisesE<br>Hypopressive exercises described according to Dr. Caufriez Anatomical and physiological explanation of the abdomen-pelvic cavity (perineal organs, bone, ligament and muscle structures of the entire abdomen-pelvic cavity). Hypopressive exercises according to the original method described by Dr. Caufriez, which is based on performing the hypopressive maneuver in 33 postures that he described (1,2). | Other: Hypopressive exercises<br>* See information included in arm/group descriptions.<br>|
| Experimental: Hypopressive exercises&PFM contraction<br>Hypopressive exercises + active pelvic floor muscle contraction: Anatomical and physiological explanation of the abdomen-pelvic cavity (perineal organs, bone, ligament and muscle structures of the entire abdomen-pelvic cavity). Hypopressive exercises according to the original method described by Dr.Caufriez, which is based on performing the hypopressive maneuver in 33 postures he described, plus the active contraction of the pelvic floor muscles (PFM) during the hypopressive maneuver. | Other: Hypopressive exercises plus pelvic floor muscle contraction<br>* See information included in arm/group descriptions.<br>|
| Experimental: Hypopressive maneuver<br>Hypopressive maneuver: Anatomical and physiological explanation of the abdomen-pelvic cavity (perineal organs, bone, ligament and muscle structures of the entire abdomen-pelvic cavity). Hypopressive maneuver with transabdominal ultrasound biofeedback. | Other: Hypopressive maneuver<br>* See information included in arm/group descriptions.<br>|
| Experimental: Hypopressive maneuver&PFM contraction<br>Hypopressive maneuver + pelvic floor muscles contraction: Anatomical and physiological explanation of the abdomen-pelvic cavity (perineal organs, bone, ligament and muscle structures of the entire abdomen-pelvic cavity). Hypopressive maneuver plus active contraction of the pelvic floor muscles with transabdominal ultrasound biofeedback. | Other: Hypopressive maneuver plus pelvic floor muscle contraction<br>* See information included in arm/group descriptions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in life impact of pelvic floor dysfunction | It will be assessed by the PFIQ-7 Spanish version. The PFIQ-7 consists of 3 scales of 7 questions each taken from the Urinary Impact Questionnaire, the Pelvic Organ Prolapse Impact Questionnaire, and the Colorectal-Anal Impact Questionnaire. The 3 scales are scored from 0 (least impact) to 100 (greatest impact) and an overall summary score (0 to 300). | 5 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 months, 6 months and 12 months after the intervention. | 
| Change in symptoms and quality of life: PFDI-20 | It will be assessed by PFDI-20 that is both a symptom inventory and a measure of the degree of bother and distress caused by pelvic floor symptoms. The PFDI-20 includes 20 questions and 3 scales. Each of the 3 scales is scored from 0 (least distress) to 100 (greatest distress). The sum of the scores of these 3 scales serves as the overall summary score of the PFDI-20 and ranges from 0 - 300 and the higher the score, the worse quality of life. The 3 scales include questions taken from the following widely used outcome measures: Urinary Distress Inventory - 6 questions, Pelvic Organ Prolapse Distress Inventory - 6 questions, and Colorectal-Anal Distress Inventory - 8 questions collecting data about UI, POP and colorectal and anal symptoms. | 5 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 months, 6 months and 12 months after the intervention. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in pelvic floor muscle strength | It will be measured by Modified Oxford Scale to rate pelvic floor muscle contraction on a scale of 0-5: 0 = no contraction; 1 = minor muscle; 'flicker'; 2 = weak muscle; contraction; 3 = moderate muscle contraction; 4 = good muscle contraction and 5 = strong muscle contraction. T) | 5 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 months, 6 months and 12 months after the intervention. | 
| Change in pelvic floor muscle strength | It will be measured by dynamometry (measured in GRAMS). | 5 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 months, 6 months and 12 months after the intervention. | 
| Change in pelvic floor muscle pasive tone | It will be measured by dinamometry (measured in GRAMS) | 5 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 months, 6 months and 12 months after the intervention. | 
| Cahnge in the displacement of the base of the bladder during voluntary contraction of the pelvic floor | It will be measured by Ultrasound | 5 assessments to evaluate change from baseline: at baseline, after the intervention period (2 months from baseline), 3 months, 6 months and 12 months after the intervention. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hypopressive exercises, Pelvic floor muscle trianing, Ultrasound