Effectiveness of Hypopressive Exercises Versus Pelvic-perineal Physiotherapy (HEPFD)

University of Alcala

Status: Completed

Conditions: Pelvic Floor Disorders; Pelvic Pain; Fecal Incontinence; Urinary Incontinence

Treatments: Behavioral: Therapeutic education.; Other: Hypopressive exercises; Other: Physical Therapy assessment; Other: Pelvic-perineal physiotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT02259712

OE 20/2013 (Other Identifier)

Details and patient eligibility

About

Introduction: Hypopressive Exercises are included within a method of physiotherapy which was created with the purpose of strengthening the deep muscles of the abdomen without damaging ligamentous and muscular structures of the perineum, also strengthening the muscles of pelvic floor reflexively. Although this technique has been included as treatment and a prevention method of pelvic floor dysfunction, there are few studies supporting its benefits. The investigators hypothesis is that the combination of both physiotherapy treatments will provided the best results for women who suffer pelvic floor dysfunctions.

Objective: To determine whether Hypopressive Exercises are an option to include in the physiotherapy treatment of women suffer at least one pelvic floor dysfunction and whether the results reported are comparable to those provided by pelvic-perineal physiotherapy.

Subjects and methods: A randomized clinical trial, the examiner being blinded unaware of the intervention group to which subjects were assigned. Participants will be randomly assigned to three groups:

1. An experimental group, where the participants will be treated by Hypopressive exercises and hygienic and behavioral measures;
2. Another experimental group where pelvic-perineal physiotherapy will join with Hypopressive exercises and hygienic and behavioral advises;
3. And a third group where will be done pelvic-perineal physiotherapy and hygienic and behavioral measures.

Pre- intervention, immediate post-intervention, 3, 6 and 12 months assessments will be made. The selection criteria will be: adult women who present signs and symptoms that indicate a pelvic floor dysfunction or have a medical diagnosis to confirm it. All participants must understand and sign freely Informed Consent.

Sample size: Accepting an alpha risk of 0.05 and a beta risk of 0.2 in a bilateral contrast, 26 subjects were required in each group to detect a difference equal to or greater than 3 microvolts (Total of 78 subjects). It assumes a standard deviation of 4.8 microvolts and the rate of loss to follow up esteem 20% (Magalhães-Resende et al. 2012).

Data Analysis: A descriptive analysis of all variables was performed. It establish for all cases a confidence level of 95% (p <0.05). The effectiveness was assessed by comparing the experienced change of the three goups in outcome variables between physicaltherapy examinations.

Enrollment: 78 patients

Sex: Female

Ages: 18 to 85 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Women who experience signs and symptoms evidencing pelvic floor dysfunction.
• Women with a medical diagnosis of pelvic floor dysfunction.
• Women with signs and or symptoms of urinary incontinence, anal incontinence, overactive bladder syndrome and prolapse in grade I-II.
• All participants must understand and sign freely Informed Consent.

Exclusion criteria

• Women minors.
• Pregnant women.
• Women who have had a vaginal delivery or cesarean in the past six months.
• Women with pelvic floor dysfunction which is serious and the first indication is surgical (prolapses grades III-IV).
• Women who have been treated for perineal physiotherapy in the past 12 months.
• Participants submit any pathology that may affect treatment (neurological, gynecological or urological), or recurrent urinary tract infection or hematuria.
• Women with cognitive limitations in understanding the information, respond to questionnaires, consent and / or participate in the study.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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78 participants in 3 patient groups

Pelvic-perineal physiotherapy

Active Comparator group

Description:

The treatment duration is 2 days per week during 8 weks (two months). The aproximate duration of the season is 45 minutes. The protocol consists in: 1. Anatomical and physiological explanation of the pelvic girdle (perineal organs bony, ligaments and muscular structures of the entire abdominal and pelvic cavity). 2. Hygienic and behavioral advises preventing pelvic floor dysfunctions. 3. Awareness of the pelvic floor muscles. 4. Strengthening the pelvic floor muscles and the entire abdominal pelvic cavity. Use of electrostimulation and biofeedback in different positions if deemed necessary. 5. Treatment the abdominal-pelvic cavity pain if it requires.

Treatment:

Other: Pelvic-perineal physiotherapy

Behavioral: Therapeutic education.

Other: Physical Therapy assessment

Hyporessive and Pelvic-perineal PT

Experimental group

Description:

The treatment duration is 2 days per week, 8 weeks (two months). The session is about 45 minutes. All women are instructed on hygienic and behavioral advises preventing pelvic floor dysfunctions. They are teach basic anatomy and physiology to understand the importance of these advises and anatomical and physiological explanation of the pelvic girdle. The participants are also treated by doing Hypopressive exercises and by specific physiotherapy for the strengthening the pelvic floor muscles.

Treatment:

Other: Pelvic-perineal physiotherapy

Behavioral: Therapeutic education.

Other: Hypopressive exercises

Other: Physical Therapy assessment

Hypopressive exercises

Experimental group

Description:

The treatment is done 2 times per week for 8 weeks (2 months). The session duration is about 45 minutes. All participants are instructed on hygienic and behavioral advises preventing pelvic floor dysfunctions. They are teach basic anatomy and physiology to understand the importance of these advises and anatomical and physiological explanation of the pelvic girdle (perineal organs bony, ligaments and muscular structures of the entire abdominal and pelvic cavity). The participants are also treated by doing Hypopressive exercises in standing, sitting, and supine fours.

Treatment:

Behavioral: Therapeutic education.

Other: Hypopressive exercises

Other: Physical Therapy assessment