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Biomedical subjects

Kari Bø

Publications and source records attributed to Kari Bø.

At least 19 recordsLinked to original sources
PubMed2006

Do pregnant women exercise their pelvic floor muscles?

The aims of the present study were to assess the number of women performing pelvic floor muscle training (PFMT) during pregnancy and to compare the background variables in those exercising and in those who did not. Four hundred and sixty-seven pregnant women (response rate 84%), mean age 31.5 years (range 20-49), answered a questionnaire on general physical activity level during pregnancy including PFMT. The questionnaire was sent out in week 32 of gestation and answered within week 36. Twenty-four percent reported problems with urinary incontinence and 9% flatus/fecal incontinence. The percentages of pregnant women performing PFMT at least once a week before pregnancy and during trimesters 1, 2, and 3 were 7, 12.9, 17.6, and 17.4%, respectively. More women with lower prepregnancy BMI and with present and past pelvic girdle pain were performing regular PFMT. No significant differences were found in any other background variables. It is concluded that relatively few women perform regular PFMT during pregnancy. In conclusion, only 17% of pregnant Norwegian women reported performing PFMT during pregnancy.

Adult↗
PubMed2006

Reliability of pelvic floor muscle strength assessment using different test positions and tools.

AIMS: The aims of this study were to determine the intra-therapist reliability for digital muscle testing and vaginal manometry on maximum voluntary contraction strength and endurance. In addition, we assessed how reliability varied with different tools and different testing positions. METHODS: Subjects included 20 female physiotherapists. The modified Oxford scale was used for the digital muscle testing, and the Peritron perineometer was used for the vaginal resting pressure and vaginal squeeze pressure assessments. Strength and endurance testing were performed. The highest of the maximum voluntary contraction scores was used in strength analysis, and a fatigue index value was calculated from the endurance repetitions. Bent-knee lying, supine, sitting, and standing positions were used. The time interval for between-session reliability was 2-6 weeks. RESULTS: Kappa values for the between-session reliability of digital muscle testing were 0.69, 0.69, 0.86, and 0.79 for the four test positions, respectively. Intra-class correlation coefficient (ICC) values for squeeze pressure readings for the four positions were 0.95, 0.91, 0.96, and 0.92 for maximum voluntary contraction, and 0.05, 0.42, 0.13, and 0.35 for endurance testing. ICC values for resting pressure were 0.74, 0.77, 0.47, and 0.29. CONCLUSIONS: Reliability of digital muscle testing was very good in sitting and good in the other three positions. vaginal resting pressure demonstrated very good reliability in all four positions for maximum voluntary contraction, but was unreliable for endurance testing. Vaginal resting pressure was not reliable in upright positions. Both measurement tools are reliable in certain positions, with manometry demonstrating higher reliability coefficients.

Adult↗
PubMed2006

Can pelvic floor muscle training prevent and treat pelvic organ prolapse?

BACKGROUND AND METHODS: Pelvic floor muscle dysfunction may cause urinary and fecal incontinence, pelvic organ prolapse (POP), pain, and sexual disturbances. The aim of the present study is to review the literature on the effectiveness of pelvic floor muscle training (PFMT) to prevent and treat POP, and the possible theories and mechanisms on how PFMT could prevent or reverse prolapse. RESULTS: No studies were found on prevention of POP. One uncontrolled study and one low-quality RCT were found in the treatment of prolapse. The results showed a positive effect of PFMT in severe, but not in mild prolapse. A review is presented of the main hypothesis of mechanisms on how PFMT may be effective. The two mechanisms are morphological changes occurring after strength training and use of a conscious contraction during increase in abdominal pressure in daily activities. CONCLUSIONS: In addition to the theory of functional anatomy and exercise science, one randomized controlled trial (RCT) is supportive for a positive effect of PFMT in the treatment of POP. There is an urgent need for more RCT with high methodological quality, use of valid and reproducible methods to assess degree of prolapse, and appropriate training protocols to evaluate the effect of PFMT in the prevention and treatment of POP.

Exercise Therapy↗
PubMed2005

Effect of test position on pelvic floor muscle assessment.

The aims of this study were to analyse the effect of different body positions on pelvic floor muscle (PFM) assessment using digital muscle testing, manometry and transabdominal ultrasound. In addition, subject acceptance of each testing position was recorded. Subjects were 20 women's health physiotherapists. The testing protocol included the best of three maximum voluntary contractions tested in each of four positions (crook lying, supine, sitting and standing). Significant differences in muscle strength and subject acceptance between positions were found with each tool, most often between lying and upright positions. Digital muscle testing and vaginal squeeze-pressure scores were highest in the lying position, and vaginal resting pressure and transabdominal ultrasound scores were highest in the standing position. Subjects preferred the lying positions for internal examinations. The clinical significance of these differences and the reasons for these variations require further investigation.

Adult↗
PubMed2005

Predictors of return to work in patients sick listed for sub-acute low back pain: a 12-month follow-up study.

OBJECTIVE: To investigate whether personal and work-related factors, physical performance and back-specific questionnaires predict return to work. A prospective study identifying prognostic factors for return to work. SUBJECTS: Ninety-three patients sick-listed for 8-12 weeks for non-specific sub-acute low back pain included in a randomized controlled trial. METHODS: Patients were examined with regard to demographic variables, a battery of back-specific questionnaires and physical tests before entering a randomized controlled trial. A stepwise backward Cox regression model was established to identify the most powerful predictors. RESULTS: During follow-up 78.5% of the patients have returned to full-time work. Fear-avoidance beliefs for work (relative risk (RR) for 1 SD change 0.49; 95% confidence interval (CI) 0.38-0.64), disability (RR 1.39, 95% CI 1.02-1.88) and cardiovascular fitness (RR 1.42, 95% CI 1.12-1.79) were identified as the best predictors for return to work. The prevalence of correct predictions was 69.3%. CONCLUSION: The predictors identified in the present study may reflect personal risk factors in a patient who gets acute low back pain. On the other hand, they may support that fear of pain and injury may be more disabling than pain itself, and that deconditioning is a result of altered behaviour reflecting attitudes towards low back pain in society, and information and advice given in primary healthcare.

Acute Disease↗
PubMed2005

Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years.

OBJECTIVE: Pelvic floor muscle training effectively treats female stress urinary incontinence. However, data on long-term efficacy and adherence are sparse. Our aims were to assess current lower urinary tract symptoms and exercise adherence 15 years after ending organized training. METHODS: Originally, 52 women with urodynamic stress urinary incontinence were randomly assigned to home or intensive exercise. After 6 months, 60% in the intensive group were almost or completely continent, compared with 17% in the home group. Fifteen years later, all original study subjects were invited to complete a postal questionnaire assessing urinary symptoms (using validated outcome tools) and current pelvic floor muscle training. RESULTS: Response rate was 90.4%. There were no differences in any urinary outcomes or satisfaction between the 2 study groups as a whole or when restricted to those without intervening stress urinary incontinence surgery. One half of both groups had stress urinary incontinence surgery during the 15-year follow-up period. Twenty-eight percent performed pelvic floor muscle training at least weekly; this rate did not differ by original group assignment or operated status. More operated women reported severe incontinence (P = .03) and leakage that interfered with daily life (P = .04) than did nonoperated women. There were no other differences between operated and nonoperated women. CONCLUSION: The marked benefit of intensive pelvic floor muscle training seen short-term was not maintained 15 years later. Long-term adherence to training is low. Urinary symptoms were equally common in both operated and nonoperated women. Further studies are needed to understand factors associated with long-term effectiveness of stress urinary incontinence treatments.

Adult↗
PubMed2005

Does the size of the vaginal probe affect measurement of pelvic floor muscle strength?

BACKGROUND: The most commonly used method to measure pelvic floor muscle (PFM) strength is vaginal squeeze pressure. There are, however, several apparatuses available for this purpose, and sizes of the probes differ significantly. The aim of the present investigation was to assess whether the size of two commonly used vaginal probes influences measurement of PFM strength. METHODS: Twenty female physical therapy students, mean age 25.1 years (range 21-38), participated in the study. All were able to contract the PFM, as assessed by means of vaginal palpation and observation of inward movement of the perineum. Two measuring devices with different lengths and diameters, the Peritron and the Camtech, were used in order to assess vaginal squeeze pressure. Each woman performed six contractions with each apparatus. RESULTS: Mean maximum squeeze pressure for the whole group with the Camtech was 19.7 cm H(2)O (95% CI: 16.5-22.9) and with the Peritron 36.5 cm H(2)O (95% CI: 31.7-41.3), P < 0.01. Nine women preferred the Camtech, four preferred the Peritron, and seven did not have any specific preferences. CONCLUSIONS: Measurements of vaginal squeeze pressure differ depending on the vaginal probe used. Results from published studies using various probes should, therefore, not be compared or combined in systematic reviews or meta-analysis.

Adult↗
PubMed2005

Evaluation of female pelvic-floor muscle function and strength.

Evaluation of pelvic-floor muscle (PFM) function and strength is necessary (1) to be able to teach and give feedback regarding a woman's ability to contract the PFM and (2) to document changes in PFM function and strength throughout intervention. The aims of this article are to give an overview of methods to assess PFM function and strength and to discuss the responsiveness, reliability, and validity of data obtained with the methods available for clinical practice and research today. Palpation, visual observation, electromyography, ultrasound, and magnetic resonance imaging (MRI) measure different aspects of PFM function. Vaginal palpation is standard when assessing the ability to contract the PFM. However, ultrasound and MRI seem to be more objective measurements of the lifting aspect of the PFM. Dynamometers can measure force directly and may yield more valid measurements of PFM strength than pressure transducers. Further research is needed to establish reliability and validity scores for imaging techniques. Imaging techniques may become important clinical tools in future physical therapist practice and research to measure both pathophysiology and impairment of PFM dysfunction.

Electromyography↗
PubMed2004

Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women.

The aim of the study was to measure pelvic floor muscle function in continent and incontinent nulliparous pregnant women. The study group consisted of 103 nulliparous pregnant women at 20 weeks of pregnancy. Women reporting urinary incontinence once per week or more during the previous month were classified as incontinent. Function was measured by vaginal squeeze pressure (muscle strength) and increment in thickness of the superficial pelvic floor muscles (urogenital diaphragm) assessed by perineal ultrasound. Seventy-one women were classified as continent and 32 women as incontinent. Continent women had statistically significantly higher maximal vaginal squeeze pressure and increment in muscle thickness when compared with incontinent women. There was a strong correlation between measurements of vaginal squeeze pressure and perineal ultrasound measurements of increment in muscle thickness. This study demonstrates statistically significant differences in pelvic floor muscle function measured by strength and thickness in continent compared with incontinent nulliparous pregnant women.

Adult↗
PubMed2004

Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work?

To date several randomized controlled trials (RCT) have shown that pelvic floor muscle (PFM) training is effective in the treatment of female stress (SUI) and mixed urinary incontinence and, therefore, it is recommended as a first-line therapy. While the effectiveness of treatment is established, there are different theoretical rationales for why PFM training is effective. The aims of this article are to discuss the theories behind why PFM training is effective in treating SUI and to discuss each theory in the framework of new knowledge of functional anatomy and examples of results from RCTs. There are three proposed theories to explain the effectiveness of PFM training for SUI: 1) women learn to consciously pre-contract the PFMs before and during increases in abdominal pressure (such as coughing, physical activity) to prevent leakage; 2) strength training builds up long-lasting muscle volume and thus provides structural support; and 3) abdominal muscle training indirectly strengthens the PFM. The first can be placed in a behavioral construct, while the two latter both have the aim of changing neuromuscular function and morphology, thus making the PFM contraction automatic. To date there are RCTs and basic anatomy studies to support the first two concepts only.

Female↗
PubMed2004

Urinary incontinence, pelvic floor dysfunction, exercise and sport.

Urinary incontinence is defined as "the complaint of any involuntary leakage of urine" and is a common problem in the female population with prevalence rates varying between 10% and 55% in 15- to 64-year-old women. The most frequent form of urinary incontinence in women is stress urinary incontinence, defined as "involuntary leakage on effort or exertion, or on sneezing or coughing". The aim of this article is to systematically review the literature on urinary incontinence and participation in sport and fitness activities with a special emphasis on prevalence and treatment in female elite athletes. Stress urinary incontinence is a barrier to women's participation in sport and fitness activities and, therefore, it may be a threat to women's health, self-esteem and well-being. The prevalence during sports among young, nulliparous elite athletes varies between 0% (golf) and 80% (trampolinists). The highest prevalence is found in sports involving high impact activities such as gymnastics, track and field, and some ball games. A 'stiff' and strong pelvic floor positioned at an optimal level inside the pelvis may be a crucial factor in counteracting the increases in abdominal pressure occurring during high-impact activities. There are no randomised controlled trials or reports on the effect of any treatment for stress urinary incontinence in female elite athletes. However, strength training of the pelvic floor muscles has been shown to be effective in treating stress urinary incontinence in parous females in the general population. In randomised controlled trials, reported cure rates, defined as <2g of leakage on pad tests, varied between 44% and 69%. Pelvic floor muscle training has no serious adverse effects and has been recommended as first-line treatment in the general population. Use of preventive devices such as vaginal tampons or pessaries can prevent leakage during high impact physical activity. The pelvic floor muscles need to be much stronger in elite athletes than in other women. There is a need for more basic research on pelvic floor muscle function during physical activity and the effect of pelvic floor muscle training in female elite athletes.

Exercise↗
PubMed2003

Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction.

AIMS: The purpose of the present study was to compare the effectiveness of instruction to contract the pelvic floor muscles (PFM), the transversus abdominis (TrA), and the TrA + PFM visualized as displacement of the pelvic floor by ultrasound. MATERIALS AND METHODS: Twenty female physical therapists, mean age 41.1 years (range 26-56) participated in the study. A 3.5 MHz 35 mm curved linear array ultrasound transducer (Dornier Medtech) was placed in the mid-sagittal plane immediately suprapubically, angled at 15-30 degrees from the vertical depending on subcutaneous fat and anatomical variations, to image the pelvic floor. Six trials of three maneuvers in random order were performed: contraction of PFM, TrA, and TrA + PFM. RESULTS: In spite of correct contractions assessed by palpation and clinical observation, one subject demonstrated a downward movement of the pelvic floor during PFM contraction on ultrasound. Six subjects (30%) showed a downward movement during a TrA- contraction, and two during the combined TrA + PFM contraction. Instruction to contract PFM produced significantly greater mean displacement: 11.2 mm (95% CI 7.2-15.3) than TrA 4.3 mm (95% CI -0.2-8.8), P < 0.01, and combination: 8.5 mm (95% CI 5.2-12), P = 0.04. Hence, instruction of PFM contraction produced a 61.6% greater displacement of the pelvic floor in the correct direction than a TrA contraction. CONCLUSIONS: It is concluded that ultrasound is a more valid method than palpation and clinical observation to assess PFM function, and that instruction to contract the PFM produces a significantly more effective pelvic floor muscle contraction than instruction to perform a TrA contraction.

Abdomen↗
PubMed2003

Pelvic floor muscle strength and response to pelvic floor muscle training for stress urinary incontinence.

AIMS: Several randomized controlled trials have demonstrated that pelvic floor muscle training is effective to treat stress urinary incontinence. The aim of the present study was to compare muscle strength increase and maximal strength in responders and non-responders to pelvic floor muscle training. MATERIALS AND METHODS: Fifty-two women with urodynamically proven stress incontinence who had participated in a six months randomized controlled trial on pelvic floor muscle training, mean age 45.4 years (range 24-64), participated in the study. The women were classified as responders and non-responders based on a combination of five effect variables covering urodynamic measurement, pad test with standardized bladder volume, and self-reports. Pelvic floor muscle strength was measured with a vaginal balloon connected to a fiber optic micro tip transducer (Camtech AS, Sandvika, Norway). RESULTS: There was a positive correlation between improvement in PFM maximal strength and improvement measured by leakage index (r = 0.34, P < 0.01), and reduction in urinary leakage measured by the pad test (r = 0.23, P = 0.05). The total sample of 52 women comprised 21 responders, 18 unclassifiable, and 13 non-responders. There was a statistically significant difference in maximal strength after the training period between responders and non-responders; 24.0 cm H2O (95% CI:18.1-29.9) versus 12.7 cm H2O (95% CI: 6.8-18.6) P < 0.001), and strength increase; 14.8 cm H2O (95% CI: 8.9-20.7) versus 5.0 cm H2O (95% CI: 2.6-12.6), respectively (P = 0.03). CONCLUSIONS: There was a positive relation between both pelvic floor muscle strength increase and maximal strength, and improvement of stress urinary incontinence.

Adult↗
PubMed2003

Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial.

OBJECTIVE: Urinary incontinence is a chronic health complaint that severely reduces quality of life. Pregnancy and vaginal delivery are main risk factors in the development of urinary incontinence. The aim of this study was to assess whether intensive pelvic floor muscle training during pregnancy could prevent urinary incontinence. METHODS: We conducted a single-blind randomized controlled trial at Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting. Three hundred one healthy nulliparous women were randomly allocated to a training (n = 148) or a control group (n = 153). The training group attended a 12-week intensive pelvic floor muscle training program during pregnancy, supervised by physiotherapists. The control group received the customary information. The primary outcome measure was self-reported symptoms of urinary incontinence. The secondary outcome measure was pelvic floor muscle strength. RESULTS: At follow-up, significantly fewer women in the training group reported urinary incontinence: 48 of 148 (32%) versus 74 of 153 (48%) at 36 weeks' pregnancy (P =.007) and 29 of 148 (20%) versus 49 of 153 (32%) 3 months after delivery (P =.018). According to numbers needed to treat, intensive pelvic floor muscle training during pregnancy prevented urinary incontinence in about one in six women during pregnancy and one in eight women after delivery. Pelvic floor muscle strength was significantly higher in the training group at 36 weeks' pregnancy (P =.008) and 3 months after delivery (P =.048). CONCLUSION: Intensive pelvic floor muscle training during pregnancy prevents urinary incontinence during pregnancy and after delivery. Pelvic floor muscle strength improved significantly after intensive pelvic floor muscle training.

Adult↗
PubMed2003

Is there any difference in measurement of pelvic floor muscle strength in supine and standing position?

BACKGROUND: Traditionally, pelvic floor muscle function and strength have been measured in a supine position. However, stress urinary incontinence most often occurs in an upright position, and an important clinical question is whether measurement of pelvic floor muscle strength in the supine position reflects strength in standing. The purpose of the present study was to investigate whether there is a significant and clinical difference in pelvic floor muscle strength measurement in supine and standing position. METHODS: Eighteen women, mean age 43.4 years (range 31-64 years), with symptoms of stress and mixed incontinence attending a pelvic floor muscle-training program participated in the study. Measurement of pelvic floor muscle strength was conducted with a fiberoptic microtip transducer connected to a balloon catheter inserted into the vagina (Camtech AS, Sandvika, Norway). Measurement of resting pressure, maximum squeeze pressure, and holding period in seconds, were assessed in random order in supine and standing position. RESULTS: The mean difference between supine and standing resting pressure was 8.6 cmH2O (95% CI 4.9-12.3), p < 0.001, between supine and standing maximum strength 0.3 cmH2O (95% CI - 4.0 to 3.4), p = 0.884, and between supine and standing holding period 0.9 s (95% CI - 3.3 to 1.4), p = 0.409. CONCLUSION: Vaginal resting pressure was significantly higher in the standing compared to the supine position. Neither maximal strength nor holding time was different when comparing the two positions. Measurement of vaginal squeeze pressure is easier to perform and standardize in the supine compared to the standing position, and seems to reflect pelvic floor muscle strength in the standing position.

Adult↗
PubMed2003

Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomized controlled trial.

OBJECTIVE: To evaluate the short-term effect of physical exercise and a cognitive intervention in low back pain. DESIGN: Randomized controlled trial. SUBJECTS: Ninety-three patients sick-listed for 8-12 weeks for sub-acute low back pain were randomized to an exercise regime (n = 30), a cognitive intervention (n = 34) or a control group (n = 29). METHODS: Primary outcome measures were pain, disability, sick-listing and satisfaction with care. Secondary outcome measures were self-efficacy for pain and for function, fear-avoidance beliefs, emotional distress, generic health status and life satisfaction. RESULTS: Eighteen percent of subjects dropped out. Drop-out was most frequent in the exercise group. At 18 weeks after inclusion fear-avoidance beliefs were reduced in both intervention groups. The cognitive group demonstrated significant improvement in disability, self-efficacy for pain, emotional distress, general health and life satisfaction. Patients in the exercise group were significantly more satisfied with the treatment, and patients following the exercise protocol reduced pain significantly. No effect on sick-listing was seen. CONCLUSION: Cognitive intervention improved disability and may be feasible for most patients sick-listed in the sub-acute phase. Physical exercise reduced patients' symptoms, but requires high motivation by patients. Despite positive effects in intervention groups on variables considered as negative prognostic factors for long-term disability and sickness absence, interventions had no effect on sick-listing.

Adult↗