Following on from Elise De’s ICS 2020 highlights, Chantale Dumoulin, Physiotherapist Representative of the Scientific Committee, has picked out which talks and presentations caught her attention.
The International Continence Society 2020 Meeting had an excellent physiotherapy program again this year. Topics were more diverse than ever. Here is a small sample of my favourite content.
Workshop 19: ICS core curriculum: The Institute of Physiotherapy in conjunction with the ICS Physiotherapy Committee presented New frontiers in conservative management for pelvic floor dysfunction. In this must-see workshop, a panel of four international experts (Cristine Carboni, Heather Lynn Moky, Melanie Morin and Serge Marchand) discussed new challenges in pelvic floor physiotherapy. More specifically, they presented the role of physiotherapists in the treatment of new clienteles, such as females with genital mutilation or patients with gender-affirming surgery. Laser therapy – a new and emerging intervention for vestibulodynia – was also presented, in addition to innovative educational approaches to improve pain management. All in all, this was a valuable workshop to inform physiotherapists of new populations and interventions, and keep up to date with best practices.
SOA7: 19th Physiotherapy Forum
As always, the Physiotherapy Forum included inspiring lectures from clinicians, and emerging and established researchers. A variety of topics were discussed from the measurement of male pelvic floor muscle (PFM) function in clinical and research settings to treatment strategies for incontinence in athletic women, and neurogenic bowel and bladder management. I recommend watching the physiotherapy forum with colleagues as it will foster interesting discussions around new and upcoming research and clinical topics on pelvic floor rehabilitation.
Abstract 25: Ignacio A. et al. Intravaginal electrical stimulation as an intervention in women who are unable to perform a voluntary pelvic floor muscle contraction: an assessor blinded randomized controlled trial. This assessor-blinded RCT aimed to evaluate the efficacy of intravaginal electrical stimulation (iES) to provide a voluntary PFM contraction in women unable to contract their PFMs. The authors found that the use of intravaginal electrical stimulation, together with attempts to perform simultaneous voluntary PFM contractions with stimulation (20min/week x 8 weeks) can facilitate the ability to voluntarily contract PFMs. Of note, this non-intensive protocol was not effective to reduce the severity of urinary incontinence (UI) after treatment. Therefore iES + PFM contraction could be used to teach women, who are unable to contract their PFMs, to voluntarily contract their PFMs before engaging in a training program. This is an interesting addition to the literature as this subpopulation (women who are unable to perform a PFM contraction) has not been specifically studied.
Abstract 465: L. Cacciari, Best in Category - Conservative Management: Morphometrical and functional changes following pelvic floor physiotherapy for urinary incontinence in older women.
In the secondary analysis of a non-inferiority RCT, Cacciari aimed to assess the PFM morphometrical and functional effects of individual versus group-based physiotherapy with respect to the reduction in UI episodes one year post-randomization in 362 older women with UI. The results showed that older women with UI benefit significantly and equally from either individual or group-based PFM physiotherapy. Participants in both intervention arms demonstrated important post-treatment gains on PFM morphometry while coughing, and PFM function during rapid, maximal and sustained contractions while coughing. More importantly, these gains were maintained in the long term (one year). These findings are important as they suggest a better control of PFMs in older women with UI following physiotherapy, thereby supporting the effect of PFM training at any age.
Abstract 524: Abuani S. Best in Category – Rehabilitation: Assessing Pelvic Floor Muscle Tone Using Digital Palpation in Women with Provoked Vestibulodynia: Association and Comparison with Dynamometry and Ultrasound Imaging
This cross-sectional study involving 208 nulliparous women with provoked vestibulodynia aimed to assess the validity of digital palpation in assessing PFM tone using the Reissing Scale by: 1) examining the association of palpation scores with dynamometry and 3D/4D transperineal ultrasound; and 2) evaluating whether the palpation grade scale can be discriminated against dynamometry and ultrasound imaging. PFM tone assessed with digital palpation was weakly or fairly associated with dynamometry and ultrasound imaging. Abuani’s results showed that the physiotherapist has a limited ability to discriminate between palpation scores against dynamometry and ultrasound measures. Although palpation is easy, inexpensive and widely used, it is subject to overlap in adjacent or closely related scores. The author concludes by stating that clinicians/researchers should be aware of these limitations when assessing PFM tone.