QUESTION: How much does adding supervised group and independent individual exercise including pelvic floor muscle training (PFMT) to multidisciplinary pain management affect pelvic and genital pain in women with endometr...QUESTION: How much does adding supervised group and independent individual exercise including pelvic floor muscle training (PFMT) to multidisciplinary pain management affect pelvic and genital pain in women with endometriosis? How much does it affect dyspareunia, dysuria, quality of life (with emphasis on psychological distress, including symptoms of depression and anxiety), symptoms of chronic constipation and pelvic floor muscle (PFM) function? DESIGN: A two-armed, parallel-group, randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes. PARTICIPANTS: Women aged 18 to 45 years with laparoscopically confirmed endometriosis experiencing pelvic/genital pain. INTERVENTION: All participants attended a pain management course. The exercise group (n = 41) then performed weekly supervised general exercise training including PFMT for 4 months, and home training two to three times/week. The control group (n = 40) received no further intervention. OUTCOME MEASURES: Primary outcomes were the change in worst pelvic/genital pain over 1 month and current pelvic/genital pain measured on a numerical rating scale at 4 and 12 months. Secondary outcomes measured at the same time points were: location and concerns related to dyspareunia; presence of dysuria; symptoms of chronic constipation assessed with the Knowles-Eccersley-Scott-Symptom scale; and quality of life with emphasis on psychological distress, including symptoms of depression and anxiety assessed with Hopkins Symptom Checklist-5. PFM function was measured with surface electromyography and manometry at baseline and 4 months. RESULTS: The intervention did not improve worst pelvic/genital pain but it did have a clear benefit on current pelvic/genital pain at the end of the intervention (MD 1.1, 95% CI 0.2 to 2.1). This benefit was still present at the 12-month follow-up (MD 1.5, 95% CI 0.2 to 2.7). The effects on other outcome measures were unclear. CONCLUSION: Adding supervised group and independent individual exercise including PFMT to pain management did not improve worst pelvic/genital pain but improved current pelvic/genital pain. Effects on other outcomes warrant further investigation. REGISTRATION: NCT05091268.
QUESTIONS: What are the effects of transversus abdominis (TrA) or rectus abdominis (RA) activation exercises, compared with general exercise without specific abdominal activation, on the inter-recti distance (IRD) in pre...QUESTIONS: What are the effects of transversus abdominis (TrA) or rectus abdominis (RA) activation exercises, compared with general exercise without specific abdominal activation, on the inter-recti distance (IRD) in pregnant women? How do TrA and RA activation exercises compare with general exercise for their effects on pelvic floor dysfunction? DESIGN: Three-arm randomised controlled trial with assessor blinding, concealed allocation and intention-to-treat analysis. PARTICIPANTS: Sixty-three primigravida pregnant women at 18 to 21 gestational weeks. INTERVENTION: The control group performed general exercises without abdominal focus. In addition to the control group intervention, the drawing-in group added TrA activation exercises, and the abdominal crunch group added RA-targeted exercises. All groups completed 24 sessions over 12 weeks. OUTCOME MEASURES: The primary outcome was change in IRD (mm), measured 2 cm above and below the umbilicus, at rest and during active trunk flexion. The secondary outcome was the Pelvic Floor Bother Questionnaire, which scores the severity of symptoms of pelvic floor dysfunction. RESULTS: All groups showed a similar increase in IRD after intervention. No substantial differences were observed between either targeted exercise group and the control group. At 2 cm above the umbilicus, general exercises had a similar effect to the in-drawing TrA exercises (between-group difference 6 mm, 95% CI -3 to 15) or the RA exercises (4 mm, 95% CI -5 to 12) at rest. Similar or smaller between-group differences occurred below the umbilicus and during trunk flexion. Similar or smaller between-group differences occurred between the drawing-in and abdominal crunch groups. No substantial between-group differences were found in pelvic floor dysfunction symptoms. CONCLUSION: A 12-week abdominal exercise program focusing on TrA or RA activation did not substantially change IRD or pelvic floor dysfunction symptoms compared with general exercise; this suggests that pregnant women do not need to avoid targeted TrA or RA exercises. REGISTRATION: RBR-4v2r4bg.
QUESTION: What do people with chronic knee pain value in physiotherapy consultations and how much are they willing to pay for a telerehabilitation consultation as opposed to an in-person consultation? DESIGN: Discrete ch...QUESTION: What do people with chronic knee pain value in physiotherapy consultations and how much are they willing to pay for a telerehabilitation consultation as opposed to an in-person consultation? DESIGN: Discrete choice experiment and contingent valuation. PARTICIPANTS: A total of 844 Australian adults with a clinical diagnosis of knee osteoarthritis were recruited in April 2021. DATA COLLECTION: Participants were presented with a series of hypothetical scenarios and asked to choose between telerehabilitation (videoconferencing) or in-person physiotherapy consultations. Seven attributes (listening and discussion time; choice of physiotherapist; consultation security/privacy; travel time; pain improvement; waiting time; and consultation cost) with varying levels presented in each scenario. DATA ANALYSIS: A generalised mixed multinomial logit model was used to estimate the strength of preferences across attributes, the implied monetary willingness to pay for telerehabilitation consultations, and the likely uptake of telerehabilitation in the population. RESULTS: Participants were willing to pay AU$38.68 less for a telerehabilitation consultation compared with an in-person consultation. For a plausible set of base case attribute values, 40% of participants chose telerehabilitation. However, preferences for telerehabilitation consults increased when there was less waiting and travel time, more communication time, and when offered at a lower fee. Younger adults, females, those not working, those more confident using videoconferencing technology and those with less knee pain were more likely to prefer telerehabilitation. CONCLUSION: People with chronic knee pain prefer in-person consultations but there is a demand for telerehabilitation physiotherapy consultations, particularly if offered at a lower fee, if there is a substantial amount of travel and waiting time for an in-person consultation, or if telerehabilitation offers more communication time with the physiotherapist.
QUESTION: How much do interventions other than prescribed pharmacology or exercise training change dyspnoea and health-related quality of life in adults with stable chronic lung disease? DESIGN: Systematic review with me...QUESTION: How much do interventions other than prescribed pharmacology or exercise training change dyspnoea and health-related quality of life in adults with stable chronic lung disease? DESIGN: Systematic review with meta-analysis. PARTICIPANTS: Adults with a chronic lung disease. INTERVENTION AND FOLLOW-UP: Any non-pharmacological intervention, other than exercise training, applied to reduce dyspnoea or improve health-related quality of life. OUTCOME MEASURES: Dyspnoea, measured at rest, on exertion or during daily activities, and health-related quality of life measured using a validated questionnaire. DATA SOURCES: CINAHL, PEDro, PubMed and EMBASE were searched. Studies were included if they had at least one group that was prescribed a non-pharmacological intervention other than exercise training, and at least one group that received usual care. RESULTS: Thirteen randomised controlled trials and two randomised cross-over trials met the study criteria. For adults with obstructive lung diseases, low quality evidence suggests that pursed lip breathing may result in a moderate reduction in dyspnoea when measured within 3 months of treatment initiation (SMD -0.45), although the effect may be substantially larger or smaller (95% CI -0.87 to -0.04). Similarly, breathing re-training may result in small to moderate improvements in health-related quality of life when measured ≥ 3 months following treatment initiation (SMD -0.31, 95% CI -0.48 to -0.14). CONCLUSION: In adults with chronic lung diseases, there is low quality evidence that breathing techniques may reduce dyspnoea and improve health-related quality of life. REGISTRATION: CRD42024491524.
QUESTION: How much do pain self-efficacy, kinesiophobia, stress and health-related quality of life mediate reductions in pain intensity and disability in people with chronic low back pain receiving a patient-led goal set...QUESTION: How much do pain self-efficacy, kinesiophobia, stress and health-related quality of life mediate reductions in pain intensity and disability in people with chronic low back pain receiving a patient-led goal setting and pain science education intervention compared with general exercise advice? DESIGN: Secondary causal mediation analysis of a two-arm randomised controlled trial. PARTICIPANTS: Seventy-five people with chronic low back pain. DATA ANALYSIS: Analyses were conducted in R software following a prospectively registered analysis plan. Four potential mediators were investigated independently using causal mediation analysis for pain intensity and disability. Mediator-outcome confounders were identified and controlled for, with sensitivity analyses used to assess robustness to confounding assumptions. RESULTS: All hypothesised mechanisms mediated the intervention effect on pain intensity (-1.8 points on a 0 to 10 scale): kinesiophobia (-1.0 indirect effect (IE), 95% CI -1.9 to -0.4, proportion mediated (PM), 58%), health-related quality of life (-0.7 IE, 95% CI -1.2 to -0.2, PM 36%), pain self-efficacy (-0.6 IE, 95% CI -1.2 to -0.2, PM 32%) and stress (-0.4 IE, 95% CI -0.9 to -0.0, PM 20%). Three hypothesised mechanisms mediated the intervention effect on disability (-10.6 points on a 0 to 100 scale): pain self-efficacy (-7.5 IE, 95% CI -13.0 to -3.1, PM 71%), health-related quality of life (-6.4 IE, 95% CI -11.3 to -2.3, PM 60%) and stress (-4.1 IE, 95% CI -8.6 to -0.9, PM 38%). CONCLUSION: Targeting pain self-efficacy, kinesiophobia and health-related quality of life may drive important reductions in pain intensity and disability following a goal setting and educational intervention for people with chronic low back pain. These mechanisms can be addressed through strategies that actively build confidence, reframe threat and support re-engagement in valued activities. Targeting self-efficacy can include grading individual goals and enabling individuals to experience improvements that build confidence. Kinesiophobia can be targeted by refining education to address unhelpful beliefs about activity and harm. Health-related quality of life can be targeted through focusing on meaningful, values-based goals that foster intrinsic motivation and help individuals reconnect with important roles and activities. REGISTRATION: OSF osf.io/w6kdr.