Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain.
Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain.
Int J Environ Res Public Health. 2022 Jul 29;19(15):9308. doi: 10.3390/ijerph19159308.
Seventy percent of women with pelvic floor dysfunctions (PFDs) are estimated to present deficient consciousness of their pelvic floor muscles (PFMs) and poor ability to contract them. Improving the proprioception of PFMs, defined as the capacity to know the status and position of each body part, and adequately contracting them could be a protective factor to prevent the appearance of PFDs in the general female population. This study aimed to identify the effectiveness of educational interventions and verbal instructions on how to contract and exercise the PFMs to improve the proprioception of the PFMs in women. A systematic search of studies published in the last 20 years until March 2022 was conducted in the PubMed, Cochrane Library, Web of Science, Scopus, PEDro, Lilacs, and Dialnet databases. A meta-analysis could not be performed due to the heterogeneity in the types of studies and included populations. This review followed the PRISMA guidelines for the design, search, and reporting of studies. The methodological quality was analysed via the PEDro and the Newcastle-Ottawa scales in the case of randomised clinical trials and non-randomised studies, respectively, while the quality of evidence was determined using the SIGN grading system for evidence-based guidelines. Descriptive and experimental studies published in English, Spanish, or Portuguese that evaluated the contractile capability of the PFMs in healthy women or women without a previous diagnosis of PFD were included. Seven articles that included a total of 2507 women were found, three of which were clinical trials with PEDro scores between 5 and 9 points out of 10 and four of which were non-randomised studies with NOS scores between 6 and 8 points out of 10. The outcomes were measured through vaginal palpation, visual observation, questionnaires for PFD symptoms, and self-perception reports. This review discriminated between two types of intervention, educational programmes and verbal instructions, and evaluated the changes observed in PFM strength and knowledgeability and the symptoms of PFDs. The findings showed that educational interventions and verbal instructions improve the proprioception of PFMs in women of all ages that are healthy or without a previous diagnosis of PFDs as well as their knowledge about the pelvic floor, healthy lifestyle habits, and symptoms that are potentially indicative of PFDs. Further high-quality randomised clinical trials are warranted to draw definitive conclusions about the effectiveness of educational interventions to improve the proprioception of the PFMs in women considered healthy or with mild symptoms that may be indicative of PFDs.
据估计，70%的盆底功能障碍（PFD）女性对盆底肌（PFMs）的意识不足，收缩能力较差。改善 PFMs 的本体感觉，即了解每个身体部位的状态和位置并适当收缩的能力，可能是预防普通女性人群出现 PFD 的保护因素。本研究旨在确定教育干预措施和关于如何收缩和锻炼 PFMs 的口头指导对改善女性 PFMs 本体感觉的有效性。对过去 20 年中发表的研究进行了系统检索，检索范围截至 2022 年 3 月，检索数据库包括 PubMed、Cochrane 图书馆、Web of Science、Scopus、PEDro、Lilacs 和 Dialnet。由于研究类型和纳入人群的异质性，无法进行荟萃分析。本综述遵循 PRISMA 指南进行研究的设计、检索和报告。使用 PEDro 和 Newcastle-Ottawa 量表分别对随机临床试验和非随机研究进行方法学质量分析，使用 SIGN 分级系统对基于证据的指南进行证据质量评估。纳入了以英语、西班牙语或葡萄牙语发表的评估健康女性或无先前 PFD 诊断女性 PFMs 收缩能力的描述性和实验性研究。共发现 7 篇文章，共纳入 2507 名女性，其中 3 篇为 PEDro 评分为 5-9 分的临床试验，4 篇为 NOS 评分为 6-8 分的非随机研究。结果通过阴道触诊、视觉观察、PFD 症状问卷和自我感知报告进行测量。本综述区分了两种干预类型，教育计划和口头指导，并评估了观察到的 PFMs 力量和知识变化以及 PFD 症状。研究结果表明，教育干预和口头指导可改善所有年龄段健康或无先前 PFD 诊断女性的 PFMs 本体感觉以及她们对盆底、健康生活习惯和可能提示 PFD 的症状的知识。需要进一步进行高质量的随机临床试验，以得出关于教育干预措施改善被认为健康或有轻度可能提示 PFD 症状的女性 PFMs 本体感觉的有效性的明确结论。
