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Biomedical subjects

J F Wyman

Publications and source records attributed to J F Wyman.

At least 19 recordsLinked to original sources
PubMed2002

Effects of pelvic floor muscle training on strength and predictors of response in the treatment of urinary incontinence.

AIMS: The objectives of this study were (1) to determine the effect of training on pelvic floor muscle strength; (2) to determine whether changes in pelvic floor muscle strength correlate with changes in continence; and (3) to determine whether demographic characteristics, clinical incontinence severity indices, or urodynamic measures predict response to pelvic floor muscle training. METHODS: One hundred thirty-four women with urinary incontinence (95=genuine stress incontinence [GSI]; 19=detrusor instability [DI]; 20=mixed incontinence [GSI+DI]) were randomized to pelvic floor muscle training (n=67) or bladder training (n=67). Urinary diaries, urodynamic evaluation, and vaginal pressure measurements by using balloon manometry were performed at baseline and after 12 weeks of therapy. Primary outcome measures consisted of incontinent episodes per week and vaginal pressure measurements. RESULTS: Both treatment groups had a reduction in incontinent episodes (P</=0.004). Vaginal pressures increased more with pelvic floor muscle training than with bladder training (P=0.0003). Other than a weak correlation between a reduction in incontinent episodes/week and an increase in maximum sustained vaginal pressure in women with GSI (r=0.32, P=0.04), there were no significant correlations between increases in pelvic floor muscle strength and improvement in continence status. There were no significant correlations between baseline demographic characteristics, clinical incontinence severity, or urodynamic measures and increases in vaginal pressure or improvement in clinical severity after pelvic floor muscle training. CONCLUSIONS: Pelvic floor muscle training improves continence and increases vaginal pressure measurements, but the direct correlations between these alterations are weak. A woman's response to behavioral treatment does not depend on her demographic characteristics, clinical incontinence severity, urodynamic measures, or initial pelvic floor muscle strength.

Exercise Therapy↗
PubMed2001

Reliability of stationary dynamometer muscle strength testing in community-dwelling older adults.

OBJECTIVES: To determine the 1-week test-retest reliability of stationary dynamometer scores in the measurement of muscle strength in older adults and to determine the reliability of composite scores obtained by combining right and left lower limb strength scores for each muscle group. DESIGN: In separate sessions, 1 therapist performed repeated measurements of muscle force production. SETTING: Outpatient physical therapy clinic of a large teaching hospital. PARTICIPANTS: A convenience sample of 25 volunteers aged 70 to 87 years residing independently in the community and who did not have significant health problems. INTERVENTION: On 2 separate occasions, 1 week apart, bilateral isometric force measurements were obtained for the flexor and extensor muscle groups of the ankle, knee, and hip joints. MAIN OUTCOME MEASURES: For test-retest reliability of individual and composite scores, the intraclass correlation coefficients (ICCs) and 90% confidence intervals were determined. RESULTS: The mean scores for ankle dorsiflexion, knee flexion and extension, and hip flexion exhibited excellent reliability with ICCs ranging from.90 to.76 for the individual lower limb scores and.91 to.84 for the composite scores. Scores for the remaining muscle groups exhibited good reliability with ICCs ranging from.74 to.71 for the composite scores. CONCLUSION: The stationary dynamometer is a reliable tool to use in determining lower limb muscle force production in elderly adults.

Aged↗
PubMed2000

Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To determine if urge urinary incontinence is associated with risk of falls and non-spine fractures in older women. METHODS: Type and frequency of incontinent episodes were assessed by 6,049 community-dwelling women using a self-completed questionnaire. Postcards were subsequently mailed every 4 months to inquire about falls and fractures. Incident fractures were confirmed by radiographic report. Logistic and proportional hazard models were used to assess the independent association of urge urinary incontinence and risk of falling or fracture. RESULTS: The mean age of the women was 78.5 (+/- 4.6) years. During an average follow-up of 3 years, 55% of women reported falling, and 8.5% reported fractures. One-quarter of the women (1,493) reported weekly or more frequent urge incontinence, 19% (1,137) reported weekly or more frequent stress incontinence, and 708 (12%) reported both types of incontinence. In multivariate models, weekly or more frequent urge incontinence was associated independently with risk of falling (odds ratio = 1.26; 95% confidence interval (CI), 1.14-1.40) and with non-spine nontraumatic fracture (relative hazard 1.34; 95% CI, 1.06-1.69; P = .02). Stress incontinence was not associated independently with falls or fracture. CONCLUSIONS: Weekly or more frequent urge incontinence was associated independently with an increased risk of falls and non-spine, nontraumatic fractures in older women. Urinary frequency, nocturia, and rushing to the bathroom to avoid urge incontinent episodes most likely increase the risk of falling, which then results in fractures. Early diagnosis and appropriate treatment of urge incontinence may decrease the risk of fracture.

Accidental Falls↗
PubMed2000

Management of urinary incontinence in adult ambulatory care populations.

During the past decade, research on urinary incontinence and its management has grown significantly. Behavioral therapy is now viewed as an important first line of treatment for stress, urge, and mixed urinary incontinence. This chapter provides a critical review of the intervention studies on lifestyle modifications, bladder training, and pelvic floor muscle training conducted in adult ambulatory care populations that were published in 1988 through 1999. Recommendations for future research are provided.

Adult↗
PubMed1999

The effect of bladder training, pelvic floor muscle training, or combination training on urodynamic parameters in women with urinary incontinence. Continence Program for Women Research Group.

The purpose of this study was to compare the effect of three conservative interventions: pelvic floor muscle training, bladder training, or both, on urodynamic parameters in women with urinary incontinence. Two hundred four women with genuine stress incontinence (GSI) or detrusor instability with or without GSI (DI +/- GSI) participated in a two-site trial comparing pelvic floor muscle training, bladder training, or both. Patients were stratified based on severity of urinary incontinence, urodynamic diagnosis, and treatment site, then randomized to a treatment group. All women underwent a comprehensive standardized evaluation including multi-channel urodynamics at the initial assessment and at the end of 12 weeks of therapy. Analysis of covariance was used to detect differences among treatment groups on urodynamic parameters. Post-treatment evaluations were available for 181 women. No differences were found among treatments on the following measurements: maximum urethral closure pressure, mean urethral closure pressure, maximum Kegel urethral closure pressure, mean Kegel urethral closure pressure, functional urethral length, pressure transmission ratios, straining urethral axis, first sensation to void, maximum cystometric capacity, and the MCC minus FSV. The effect of treatment did not differ by urodynamic diagnosis. Behavioral therapy had no effect on commonly measured urodynamic parameters. The mechanism by which clinical improvement occurs remains unknown. Neurourol. Urodynam. 18:427-436, 1999.

Exercise Therapy↗
PubMed1999

Use and costs of incontinence pads in female study volunteers. Continence Program for Women Research Group.

OBJECTIVES: We examined the use and cost of incontinence pads and the relationship to factors such as age, duration of incontinence, diurnal frequency, incontinence severity indices, urodynamic diagnosis, and quality of life. SUBJECTS AND SETTING: Three hundred fifteen women with urinary incontinence who volunteered to participate in 1 of 3 incontinence studies (behavioral intervention, estrogen supplementation, or surgery) were analyzed. Subjects were community-dwelling women aged 45 years and older living in 3 cities in the southeastern United States. METHODS: Pad use was recorded on a daily diary. The type of pads used was reported on the history. Average price of pad types was assessed at local stores and reported in 1995 dollars. Statistical comparisons used nonparametric methods. MAIN OUTCOME MEASURES: The number of pads used per week and annual cost of pads in 1995 dollars. RESULTS: Seventy-seven percent of subjects used pads at baseline. Median cost per year for the entire cohort was $46 (interquartile range $3-$138). For pad users, median annual cost was $76 (interquartile range $36-$177), with costs being greater for women with detrusor instability than those with pure genuine stress incontinence (median $135-$138 versus $63). This increased cost was likely associated with the greater use of special incontinence products among women with detrusor instability. For the entire cohort, cost and usage did not differ by urodynamic diagnosis. Cost and pad usage were significantly associated with number of incontinent episodes and quality of life, but not with age, pad weight, or duration of incontinence. CONCLUSIONS: The majority of incontinent women who sought treatment used absorbent pads at least once per week, with menstrual pads being the most common type of pad. The annual cost of pad usage was not as high as in previous estimates.

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PubMed1999

Continence for women: evidence-based practice.

Approximately 20% of women ages 25-64 years experience urinary incontinence. The symptoms increase during perimenopause, when 31% of women report that they experience incontinent episodes at least once per month. Bladder training and pelvic muscle exercise are the recommended initial treatment and can be taught effectively in the ambulatory care setting. Bladder training enables women to accommodate greater volumes of urine and extend between-voiding intervals. Pelvic muscle exercise increases muscle strength and reduces unwanted urine leakage. Accumulated research results provide evidence-based guidelines for nursing practice. The Association of Women's Health, Obstetric and Neonatal Nurses has identified continence for women as the focus of its third research utilization project. This article presents the rationale, evidence base, and educational strategies compiled by the Research Utilization 3 Nurse Scientist Team. Nurses can enable women to incorporate these noninvasive techniques into self-care.

Adult↗
PubMed1998

Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group.

OBJECTIVE: We compared the efficacy of bladder training, pelvic muscle exercise with biofeedback-assisted instruction, and combination therapy, on urinary incontinence in women. The primary hypothesis was that combination therapy would be the most effective in reducing incontinent episodes. STUDY DESIGN: A randomized clinical trial with three treatment groups was conducted in gynecologic practices at two university medical centers. Two hundred and four women diagnosed with genuine stress incontinence (n = 145) and/or detrusor instability (n = 59) received a 12-week intervention program (6 weekly office visits and 6 weeks of mail/telephone contact) with immediate and 3-month follow-up. Outcome variables included number of incontinent episodes, quality of life, perceived improvement, and satisfaction. Data analyses consisted of analysis of covariance using baseline values as covariates and chi2 tests. RESULTS: The combination therapy group had significantly fewer incontinent episodes, better quality of life, and greater treatment satisfaction immediately after treatment. No differences among groups were observed 3 months later. Women with genuine stress incontinence had greater improvement in life impact, and those with detrusor instability had less symptom distress at the immediate follow-up; otherwise, no differences were noted by diagnosis, incontinence severity, or treatment site. CONCLUSIONS: Combination therapy had the greatest immediate efficacy in the management of female urinary incontinence regardless of urodynamic diagnosis. However, each of the 3 interventions had similar effects 3 months after treatment. Results suggest that the specific treatment may not be as important as having a structured intervention program with education, counseling, and frequent patient contact.

Aged↗
PubMed1998

Addressing urinary incontinence with educational continence-care competencies.

This article is a report of a task force formed from a discussion group hosted by the American Nurses Association on the AHCPR Guidelines on Urinary Incontinence. The need to standardize content related to bladder incontinence to be used in curriculums was identified as an initial step in implementing the guidelines. A task force was formed to develop educational competencies to be used by schools in identifying content that should be addressed at various levels of preparation. Although special training is needed when continence care is a significant part of a nurse's practice, it is expected that by using the educational competencies, schools will produce graduates at the basic level able to provide beginning continence care and graduate nurses able to address advanced incontinence problems.

American Nurses' Association↗
PubMed1998

Continence nurses: a survey of who they are and what they do.

This survey is the first report on the characteristics, functions, and barriers to practice reported by continence care nurses in the United States. The data obtained provide valuable information regarding a new subspecialization in nursing.

Adolescent↗
PubMed1997

Relationship between urethral and vaginal pressures during pelvic muscle contraction. The Continence Program for Women Research Group.

Condensation is the performance of an effective pelvic muscle contraction increases urethral and vaginal pressures and is independent of demographic, clinical, and urodynamic factors. Our objective was to examine the relationship between urethral closure pressure and vaginal pressure during a pelvic muscle contraction in minimally trained women. Our secondary aim was to determine whether demographic, clinical, or urodynamic factors predict pelvic muscle contraction performance. Two hundred two women with urinary incontinence underwent multichannel urodynamic evaluation, including urethral profilometry and measurement of vaginal pressure during pelvic muscle contraction. One hundred forty-four women were diagnosed with genuine stress incontinence, 28 with detrusor instability, and 30 with mixed incontinence. Urethral and vaginal pressures correlated significantly during pelvic muscle contraction (P < or = 0.006). The ability to perform an adequate pelvic muscle contraction was independent of subject age, parity, hormonal or hysterectomy status, clinical severity, urethral support, and urethral profilometry measures (P > or = 0.42).

Aged↗
PubMed1997

Quality of life following bladder training in older women with urinary incontinence.

This study investigated the changes in quality of life following a randomized controlled 6-week trial of bladder training in 123 older women with urinary incontinence. Both clinical (diary, pad test) and quality of life measures (Incontinence Impact Questionnaire (IIQ), Center for Epidemiological Studies-Depression Scale (CES-D)) and visual analog scales on symptom burden were obtained at baseline, 6 weeks and 6 months following treatment. All subscales and the composite scale of the IIQ and the visual analog scales were significantly improved following bladder training, with effects maintained 6 months later. No changes were observed in CES-D scores. Women with genuine stress incontinence and those with detrusor instability with or without concomitant stress incontinence had similar improvements. We conclude that bladder training is effective in improving the quality of life of incontinent women regardless of urodynamic diagnosis.

Aged↗
PubMed1997

Quality of life in geriatric patients with lower urinary tract dysfunction.

Lower urinary tract dysfunctions, such as urinary incontinence, detrusor instability, and benign prostatic hyperplasia, are prevalent in older adults. These conditions, which can occur alone or in combination, result in irritative or obstructive symptoms that can interfere with everyday functioning, leading to negative consequences on health-related quality of life. The nature and severity of these symptoms and the perception of their impact on daily activities can be quite variable. Until recently, relatively little was known about the effect of lower urinary tract dysfunctions on general health status and quality of life. An increasing research base is now available that shows the impact of different urologic dysfunctions in clinical and general populations. This article will provide a brief background on the definition and measurement of health-related quality of life and will summarize the literature about the quality of life of community-dwelling elderly patients with urinary incontinence or prostate conditions. Implications to guide clinical practice and future research will be derived.

Aged↗
PubMed1997

The 'costs' of urinary incontinence.

Urinary incontinence is a prevalent and costly health condition. This paper discusses the 'costs' of untreated urinary incontinence. Costs are broadly conceptualised within a framework which includes physical, psychosocial, and economical components. Limited data is available documenting the different costs of incontinence. Further research is needed to better quantify these costs to aid clinicians, payers, and public policy-makers in decision-making related to incontinence management.

Cost of Illness↗
PubMed1996

Comparison between urinary diaries completed with and without intensive patient instructions.

The evaluation of the incontinent patient relies on accurate assessment of urinary symptoms. Although the 7 day urinary diary is a reproducible method of data collection, the optimal means of implementing this diary is unknown. The urinary diary is usually employed after the initial clinical pathophysiologic evaluation has been performed and the patient has received intensive instructions on the correct method of diary completion. This study aims to determine if a urinary diary provided to the patient prior to the initial clinical evaluation along with minimal instructions will provide symptom data comparable with that obtained by conventional methods. Two hundred seventy-eight women were recruited to participate in one of three clinical trials for urinary incontinence treatment. All subjects completed a diary prior to the initial clinical evaluation, the Minimal Instruction Diary, and a second diary after clinical evaluation, the Intensive Instruction Diary. The Minimal and the Intensive Instruction Diaries were compared for number of episodes of diurnal and nocturnal voluntary micturition and incontinence. Pearsons' correlation coefficients ranged from 0.67 to 0.78 for each of the urinary symptoms. Intra-subject comparison indicated a decline in reports of nocturnal voluntary micturitions from the Minimal to the Intensive Instruction Diary. No demographic or urodynamic parameters could account for the difference. The 7 day urinary diary is a reliable tool to asses urinary symptoms, which can be utilized prior to the initial clinical evaluation. Its case of use and practicality make this diary promising for use in a wider patient population.

Aged↗
PubMed1996

Efficacy of estrogen supplementation in the treatment of urinary incontinence. The Continence Program for Women Research Group.

OBJECTIVE: To assess the efficacy of cyclic postmenopausal hormone replacement in treating urinary incontinence in hypoestrogenic women. METHODS: Eighty-three hypoestrogenic women complaining of urinary incontinence were included. All patients were community-dwelling, age 45 years or older, with involuntary loss of urine occurring at least once a week and urodynamic evidence of genuine stress incontinence and/or detrusor instability. Evaluation consisted of a comprehensive clinical and urodynamic research protocol. The hypoestrogenic entry criterion was a plasma estradiol level of 30 pg/mL or less. Parabasal cells on vaginal smears were also monitored. The primary outcome was the number of incontinent episodes per week, as documented on a standardized urinary diary. Secondary outcomes were the quantity of fluid loss, voluntary diurnal and nocturnal micturition frequency, generic and condition-specific health-related quality of life measurements, and patient satisfaction. A randomized, placebo-controlled, double-blind design was used. Subjects in the treatment group were given conjugated equine estrogens (0.625 mg) and medroxyprogesterone (10 mg) cyclically for 3 months. Controls received placebo tablets. RESULTS: (All results are presented as mean +/- standard deviation.) Subjects were 67 +/- 9 years old. The menopause duration was 18 +/- 11 years. The duration of incontinence was 9 +/- 9 years. Estradiol level at baseline was 9 +/- 9 pg/mL, and the parabasal cell count was 42 +/- 44%. The number of incontinent episodes at baseline was 13 +/- 10 for the treatment group and 16 +/- 4 for controls. No significant changes occurred in the number of incontinent episodes after treatment: 10 +/- 10 for the treatment group, and 13 +/- 14 for the controls (P = .7). Also, fluid loss was not changed: 176 +/- 106 g for the treatment group and 64 +/- 88 g for the control group at baseline, and 101 +/- 150 and 51 +/- 69 g after treatment, respectively (P = .7). There were no significant differences for either diurnal or nocturnal voluntary micturition, quality of life measures, or patient's perception of improvement. CONCLUSION: Three-month cyclic hormone replacement therapy did not affect either clinical or quality of life variables of incontinent, hypoestrogenic women. Long-term effects are unlikely to be substantially different. The use of estrogen supplementation as preventive or adjuvant therapy was not evaluated in this study.

Aged↗
PubMed1996

Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse. The Continence Program for Women Research Group.

OBJECTIVE: Severe prolapse may mask potential genuine stress urinary incontinence in women. Some have suggested that a suspending urethropexy be performed in women who have potential genuine stress incontinence demonstrated by barrier reduction of the prolapse preoperatively. Our aim was to compare outcomes after prolapse surgery that included a formal bladder neck suspension with those operations that did not. STUDY DESIGN: This prospective randomized clinical trial assigned 32 women with bladder neck hypermobility and stage III or IV pelvic organ prolapse to receive either a needle colposuspension or bladder neck endopelvic fascia plication as part of the vaginal reconstructive surgery. Twenty-nine subjects underwent detailed clinical, anatomic, urodynamic, and quality-of-life evaluations before and 6 weeks and 6 months after surgery; 23 completed urinary diary and quality-of-life evaluations after a mean of 2.9 years. RESULTS: Needle colposuspension increased short-term complications without providing additional protection from de novo stress incontinence. Barrier testing before surgery predicted urethral sphincteric resistance after surgery; however, such testing neither predicted a patient's function after surgery nor indicated the need for a suspending urethropexy. The combination of a needle colposuspension with a sacrospinous ligament suspension predisposed to the early development of support defects of the upper anterior vaginal segment and to failure of bladder neck support. CONCLUSIONS: Preoperative barrier testing in women with severe prolapse is not useful in identifying individuals who require a suspending urethropexy. Needle colposuspension increases short-term complications, lacks durability, and may predispose to early and severe recurrent anterior prolapse when performed with a sacrospinous ligament vault suspension.

Aged↗