Showing papers by "Kari Bø published in 2013"

Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression

Abstract: Purpose We describe exercise level in mid-pregnancy, associated sociodemographic variables, and investigate the association between exercise in mid-pregnancy and subsequent low-back pain, pelvic girdle pain and depression at 32 weeks of pregnancy. Material and methods The study included 3482 pregnant women participating in the Akershus Birth Cohort study (response rate 80.5%). Data were collected by a questionnaire in pregnancy weeks 17-21, pregnancy week 32 and electronic birth journal. The results were analysed by logistic regression and are presented as crude (cOR) and adjusted OR (aOR) with 95% CI. Results Only 14.6% of the respondents followed the current exercise prescription for exercise during pregnancy (≥3 times a week, >20 min at moderate intensity). One-third of the study sample exercised less than once a week at pregnancy weeks 17-21. Women exercising either 1-2 times or ≥3 times a week at mid-pregnancy were more often primiparous, higher-educated and had less often prepregnacy body mass index >30 kg/m2 compared with women exercising less than once a week. Women who exercised ≥3 times a week were less likely to report pelvic girdle pain (aOR: 0.76, 95% CI 0.61 to 0.96), while women exercising 1-2 times a week were less likely to report low-back pain (aOR: 0.80, 95% CI 0.66 to 0.97) and depression (aOR: 0.66, 95% CI 0.48 to 0.91). Conclusions Few Norwegian women follow current exercise prescriptions for exercise in mid-pregnancy. The results may indicate an association between exercising mid-pregnancy and lower prevalence of low-back pain, pelvic girdle pain and depression in late pregnancy.

Does it work in the long term?—A systematic review on pelvic floor muscle training for female stress urinary incontinence

Abstract: Aims There is level 1, grade A evidence that pelvic floor muscle training (PFMT) is effective in treatment of stress urinary incontinence (SUI), but long-term outcome has been questioned. The aim of this systematic review was to evaluate the long-term outcome of PFMT for female SUI. Methods Computerized search on PubMed up to year 2012 was undertaken with the search strategy: pelvic floor AND (urinary incontinence OR stress urinary incontinence) AND (training OR exercise OR physical activity) AND (follow-up OR long-term). Limitations were: humans, female, clinical trial, English, and adults. Inclusion criteria were: studies on SUI using PFMT with or without biofeedback as the intervention, follow-up period of ≥1 year. Exclusion criteria were studies using electrical stimulation alone and studies in the peripartum period. Results Nineteen studies were included (1,141 women followed between 1 and 15 years). Statistical meta-analysis was not performed due to high heterogeneity. Only two studies provided follow-up interventions. Losses to follow-up during the long-term period ranged between 0% and 39%. Long-term adherence to PFMT varied between 10% and 70%. Five studies reported that the initial success rate on SUI and MUI was maintained at long-term. Long-term success based on responders to the original trial varied between 41% and 85%. Surgery rates at long term varied between 4.9% and 58%. Conclusions Short-term outcome of PFMT can be maintained at long-term follow-up without incentives for continued training, but there is a high heterogeneity in both interventional and methodological quality in short-and long-term pelvic floor muscle training studies. Neurourol. Urodynam. 32: 215–223, 2013. © 2012 Wiley Periodicals, Inc.

Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study.

Abstract: Objectives To evaluate the learning process for acquiring three- and four-dimensional (3D/4D) transperineal ultrasound volumes of the levator hiatus (LH) dimensions at rest, during pelvic floor muscle (PFM) contraction and on Valsalva maneuver, and for analyzing the ultrasound volumes, as well as to perform an interobserver reliability study between two independent ultrasound examiners. Methods This was a prospective study including 22 women. We monitored the learning process of an inexperienced examiner (IE) performing 3D/4D transperineal ultrasonography and analyzing the volumes. The examination included acquiring volumes during three PFM contractions and three Valsalva maneuvers. LH dimensions were determined in the axial plane. The learning process was documented by estimating agreement between the IE and an experienced examiner (E) using the intraclass correlation coefficient. Agreement was calculated in blocks of 10 ultrasound examinations and analyzed volumes. After the learning process was complete the interobserver reliability for the technique was calculated between these two independent examiners. Results For offline analysis of the first 10 ultrasound volumes obtained by E, good to very good agreement between E and IE was achieved for all LH measurements except for the left and right levator–urethra gap and pubic arc. For the next 10 analyzed volumes, agreement improved for all LH measurements. Volumes that had been obtained by IE and E were then re-evaluated by IE, and good to very good agreement was found for all LH measurements indicating consistency in volume acquisition. The interobserver reliability study showed excellent ICC values (ICC, 0.81–0.97) for all LH measurements except the pubic arc (ICC = 0.67). Conclusion 3D/4D transperineal ultrasound is a reliable technique that can be learned in a short period of time. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Stages of Change Model for Participation in Physical Activity during Pregnancy

Abstract: Background. The transtheoretical model (TTM) has been successful in promoting health behavioral change in the general population. However, there is a scant knowledge about physical activity in relation to the TTM during pregnancy. Hence, the aims of the present study were (1) to assess readiness to become or stay physically active according to the TTM and (2) to compare background and health variables across the TTM. Methods. Healthy pregnant women () were allocated to the study from Oslo University Hospital, Norway. The participants filled in a validated self-administered questionnaire, physical activity pregnancy questionnaire (PAPQ) in gestation, weeks 32–36. The questionnaire contained 53 questions with one particular question addressing the TTM and the five stages: (1) precontemplation stage, (2) contemplation stage, (3) preparation stage, (4) action stage, and (5) maintenance stage. Results. More than half of the participants (53%) were involved in regular exercise (stages 4-5); however, only six specified that they had recently started an exercise program (stage 4). About 33% reported engaging in some physical activity, but not regularly (stage 3). The results showed that receiving advice from health professionals to exercise during pregnancy increased the likeliness of being in stages 4-5, while higher age, multiparity, pregravid overweight, unhealthy eating habits, pelvic girdle pain, and urinary incontinence were more prevalent with low readiness to change exercise habits (stages 1–3). Conclusion. According to the TTM, more than half of the participants reported to be physically active. Moreover, most of the participants classified as inactive showed a high motivational readiness or intention to increase their physical activity level. Hence, pregnancy may be a window of opportunity for the establishment of long-term physical activity habits.

Impact of Childbirth and Mode of Delivery on Vaginal Resting Pressure and on Pelvic Floor Muscle Strength and Endurance

Abstract: Objective We sought to study impact of delivery mode on vaginal resting pressure (VRP) and on pelvic floor muscle (PFM) strength and endurance, and whether these measurements differed in women with and without urinary incontinence. Study Design We conducted a cohort study following 277 nulliparous women from midpregnancy to 6 weeks postpartum. Manometer was used for PFM measurements; differences were analyzed by t test (within groups) and analysis of variance (between groups). Results Only VRP changed significantly (10% reduction, P = .001) after emergency cesarean section. After normal and instrumental vaginal delivery, VRP was reduced by 29% and 30%; PFM strength by 54% and 66%; and endurance by 53% and 65%, respectively. Significant differences for all PFM measures ( P P Conclusion Pronounced reductions in VRP and in PFM strength and endurance were found after vaginal delivery. Continent women were stronger than incontinent counterparts.

Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women.

Abstract: Introduction and hypothesis Theoretically, tight or strong pelvic floor muscles may impair the progress of labor and lead to instrumental deliveries. We aimed to investigate whether vaginal resting pressure, pelvic floor muscle strength, or endurance at midpregnancy affect delivery outcome.

Pelvic floor muscle injuries 6 weeks post partum-an intra- and inter-rater study.

Abstract: Aim To evaluate intra- and inter-rater reliability when diagnosing major defects, and inter-rater reliability of diagnosing minor defects and muscle thickness of the pubovisceral muscle in primiparous women 6 weeks after vaginal delivery, using 3D/4D transperineal ultrasound. Methods Forty primiparous women were assessed using 3D/4D transperineal ultrasound. Volumes were acquired at maximal pelvic floor muscle (PFM) contraction, and diagnosis of muscle defects were done using tomographic ultrasound imaging (TUI) of the axial plane. Thickness was measured in three central levels of TUI. The stored volumes were analyzed offline by two investigators blinded to each others' results and the women's clinical data. Cohen's kappa (κ) and percentual agreement were calculated for defects, intraclass correlations coefficient (ICC) with 95% confidence intervals were calculated for thickness. Results Excellent intra-rater values were found for all major defects. Inter-rater values for bilateral and right-sided defects were excellent, and good for left-sided. Agreement for minor defects was poor. Measuring thickness ICC of 0.72 was found for the left side and 0.48 for the right side, although up to half of the cases had to be excluded owing to poor demarcation of the muscle. Conclusion Tomographic ultrasound imaging of the axial plane using three central slices seems to be a reliable tool for detecting major pubovisceral muscle defects shortly after childbirth. Minor defects showed low reliability. Muscle thickness measurements showed moderate reliability, but too many cases had to be excluded for this to be a useful method for determining muscle thinning 6 weeks after delivery.

Pelvic floor muscle strength and urinary incontinence in hyperandrogenic women with polycystic ovary syndrome.

Abstract: Introduction and hypothesis Hyperandrogenism in women with polycystic ovary syndrome (PCOS) could increase muscle mass and thereby pelvic floor muscle (PFM) strength, reducing the risk of urinary incontinence (UI). The aim of the present study was to assess PFM strength and UI among hyperandrogenic women with PCOS and a control group for comparison.

Exercise and pelvic girdle pain during pregnancy. Are there any associations

Abstract: Background: To date, there is scant knowledge and inconsistent results about physical activity, exercise and job strain in relation to pelvic girdle pain (PGP). Hence, the aims of the present study were: 1) determine prevalence of PGP and severe PGP during pregnancy and 2) compare background and lifestyle factors in addition to total physical activity level (at work, commuting, housework and recreational exercise) in those who experienced PGP and those who did not in pregnancy. Methods: Healthy pregnant women (n = 467) were allocated to the study from Oslo University Hospital, Norway. The participants filled in a validated self-administered questionnaire, Physical-Activity-Pregnancy-Questionnaire (PAPQ) in gestation-week 32 - 36. The questionnaire contained 53 questions with nine specific questions addressing PGP. The key question on PGP was asked cross-sectionally and also posed retrospectively for pre-pregnancy, 1st and 2nd trimester (During this pregnancy, did you experience any PGP?) (“Yes versus No”). Results: More than half of the women (57.5%) reported to suffer from PGP, with 18.4% reporting severe PGP. Compared the no-PGP group, women with PGP were significantly more likely to be sick-listed, multiparous, they perceived their job to be physically demanding, as well as had physically demanding household chores, including childcare. In addition, they were more prone to have experienced PGP in previous pregnancies and suffered from urinary incontinence (UI) in the current pregnancy. Most women with severe PGP reported to be sedentary in the 3rd trimester; however they performed more strengthening exercises at home than the women without PGP. Severe PGP also showed an association with standing/walking ≥50% at work. Conclusion: Women who exercised regularly in the 3rd trimester were less likely to report PGP, while job strain was associated with higher prevalence of PGP. There is a need for a prospective study with larger sample size to further evaluate if exercise has any causal association with PGP.

Do major defects of the levator ani muscle heal within the first 6 months postpartum

Abstract: Hypothesis / aims of study The levator ani muscle (LAM) is an important part of the pelvic floor support. During vaginal delivery the LAM, especially the most medial part, is stretched, which may result in muscle tearing. Studies examining women many years after delivery have found that women with POP have a higher prevalence of LAM defects than women without POP. LAM defects were diagnosed in 13-39.5% (1) of women after vaginal delivery. The highest prevalence was found in women as early as 48-72 hours postpartum (1). This might suggest rehabilitation potential for the LAM in line with other injured striated muscles in the body. MRI studies indicate that such LAM defects can recover, although the greatest potential for recovery is when there is no major pelvic floor muscle damage (2). The large variation in reported prevalence of LAM defects may be explained by lack of consistency in the definition and classification of LAM defects (3). We used three central slices of tomographic ultrasound imaging (TUI) recorded using 3D/4D transperineal ultrasound, which is one of the best validated methods for diagnosing LAM defects. Our intention was to study whether LAM defects diagnosed early after delivery persisted at 6 months postpartum. The aim of the present study was to use transperineal 3D/4D ultrasound to compare the status of LAM defects at 6 weeks and 6 months postpartum in women delivering their first child.

Randomized controlled trial of pelvic floor muscle training to prevent and treat pelvic organ prolapse in postpartum primiparous women

Abstract: Hypothesis / aims of study It has been estimated that about 50% of all parous women have lost some of the supportive mechanism of the pelvic floor (1). Several randomized controlled trials have shown that pelvic floor muscle training (PFMT) is effective in treating pelvic organ prolapse (POP) in middle aged women (2), and that PFMT reduces the levator hiatus area, lifts the bladder neck and rectal ampulla, increases pelvic floor muscle strength and thickness and reduces muscle length (3). However, search on PubMed did not reveal any studies on the effect of PFMT in prevention and treatment of POP in the postpartum period. The aim of the present study was to assess the effect of a four month postpartum PFMT program on symptoms of POP and POP-Q stage in primiparous women.

Can a pelvic floor muscle contraction reduce vaginal resting pressure and resting emg activity

Abstract: Hypothesis / aims of study Overactive pelvic floor muscles (PFM) has been defined as “a situation in which the pelvic floor muscles do not relax, or may even contract when relaxation is functionally needed for example during micturition or defecation (1). Overactivity of the PFM is difficult to assess and quantify, and there is no consensus of a specific cut off point for the condition. Vaginal resting pressure and resting surface EMG (sEMG) have been suggested as methods to assess PFM overactivity. A commonly used intervention in physiotherapy to reduce muscle activity is the “contract –relax” method. The method is based on the theory that the muscle can reduce its resting activity after contraction. The purpose of the present study was to assess if there are differences in vaginal resting pressure and sEMG activity before and after PFM contraction, and to compare a possible difference in women with provoked Vestibulodynia (PVD) and asymptomatic controls.

Pelvic organ support assessed during pregnancy and post partum; a cohort study following 229 nulliparous pregnant women from mid-pregnancy until one year post partum using pop-q

Abstract: Hypothesis / aims of study The association between vaginal childbirth and development of pelvic organ prolapse (POP) later in life has been known for a long time. Since caesarean section is not fully protective against developing symptoms later, an effect of the pregnancy itself on pelvic organ support has been suspected. Studies of short term effects of pregnancy and delivery on pelvic organ support are few and results are conflicting (1, 2). The aim of the present study was to evaluate changes in pelvic organ support from midpregnancy until one year post partum among nulliparous pregnant women using the pelvic organ prolapse quantification system (POP-Q).