Brandt Corlia, van Vuuren Elizabeth C Janse
Department of Physiotherapy, University of the Witwatersrand, South Africa.
Department of Economic and Business Science, University of the Free State, South Africa.
S Afr J Physiother. 2019 Feb 14;75(1):472. doi: 10.4102/sajp.v75i1.472. eCollection 2019.
There is little evidence on movement impairment of the abdominal and pelvic floor muscles (PFM) in women with pelvic organ prolapse (POP).
The aim of this study was to determine the movement impairments and interactions between the PFM and abdominal muscles in POP.
The PFM and abdominal muscles of 100 conveniently sampled South African women with POP were assessed by ultrasonography, electromyography (EMG), the PERFECT scale, Sahrmann scale and a Pressure Biofeedback Unit (PBU). A demographic questionnaire determined contextual factors (exercise and medical history) and Visual Faces Scale pain intensities. Data were analysed descriptively and with Spearman and Pearson correlation coefficients.
Participants (59 ± 9.31 years) were mostly unemployed (80%), physically inactive (85%), with comorbidities, heart or vascular disease, hypothyroidism and depression. The mean levator hiatus at rest (56.38 mm, standard deviation [SD] 9.95), thickness (5.1 mm, SD 1.41), amount of movement (4.28 mm, SD 6.84), strength (level 1.89, SD 1.13) and endurance (4.04 s, SD 3.32) of the PFM indicated dysfunction. Median values of zero were found for the Sahrmann scale (interquartile [IQ] range [0-1]) and PBU (IQ range [0-2]) and 10.95 µV for abdominal EMG (IQ range [7.9-17.8]). Pelvic floor muscle strength, endurance, movement and EMG activity correlation was fair ( > 0.4, < 0.001), as was PFM strength, endurance and abdominal muscle function ( > 0.4, < 0.05).
Movement impairment of local and global stability and mobility functions of PFM and abdominal muscles was present, as well as correlations between these functions. Addressing these impairments may affect the identified contextual factors (socio-economic, psychological and lifestyle factors) and the possible activity limitations and participation restrictions in patients with POP. Further research is needed to investigate these interactions.
The findings suggest that assessment and management of patients with POP might need to be based on a comprehensive neuro-musculoskeletal assessment and a holistic approach. Standardised protocols for patients with pelvic floor dysfunction (PFD) should therefore be used with caution. Randomised controlled trials should investigate patient-specific and holistic intervention approaches.
关于盆腔器官脱垂（POP）女性腹部和盆底肌（PFM）运动功能障碍的证据很少。
本研究旨在确定POP患者PFM与腹部肌肉之间的运动功能障碍及相互作用。
采用超声、肌电图（EMG）、PERFECT量表、Sahrmann量表和压力生物反馈仪（PBU）对100例方便抽样的南非POP女性的PFM和腹部肌肉进行评估。一份人口统计学调查问卷确定了背景因素（运动和病史）以及视觉面部疼痛强度量表。对数据进行描述性分析，并计算Spearman和Pearson相关系数。
参与者（59±9.31岁）大多失业（80%）、身体活动不足（85%），患有合并症、心脏或血管疾病、甲状腺功能减退和抑郁症。PFM静息时平均提肌裂孔（56.38mm，标准差[SD]9.95）、厚度（5.1mm，SD 1.41）、运动量（4.28mm，SD 6.84）、力量（1.89级，SD 1.13）和耐力（4.04s，SD 3.32）表明存在功能障碍。Sahrmann量表（四分位间距[IQ]范围[0 - 1]）和PBU（IQ范围[0 - 2]）的中位数为零，腹部EMG为10.95μV（IQ范围[7.9 - 17.8]）。盆底肌力量、耐力、运动和EMG活动之间的相关性中等（>0.4，<0.001），PFM力量、耐力与腹部肌肉功能之间的相关性也中等（>0.4，<0.05）。
PFM和腹部肌肉的局部和整体稳定性及运动功能存在运动功能障碍，且这些功能之间存在相关性。解决这些功能障碍可能会影响已确定的背景因素（社会经济、心理和生活方式因素）以及POP患者可能存在的活动受限和参与限制。需要进一步研究来调查这些相互作用。
研究结果表明，对POP患者的评估和管理可能需要基于全面的神经肌肉骨骼评估和整体方法。因此，应谨慎使用针对盆底功能障碍（PFD）患者的标准化方案。随机对照试验应研究针对患者个体的整体干预方法。
