O papel da palpação vaginal na aprendizagem motora dos músculos do assoalho pélvico em mulheres com incontinência urinária de esforço: ensaio clínico randomizado controlado

• Ano de defesa: 2021
• Autor(a) principal: Ferreira, Leticia De Azevedo [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Physical Therapy Modalities; Pelvic Floor Muscles; Knowledge; Urinary Incontinence; Modalidades De Fisioterapia; Músculos Do Assoalho Pélvico; Conhecimento; Incontinência Urinária
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=11261030; https://repositorio.unifesp.br/handle/11600/68154

Objective: To evaluate the effects of a program with verbal instructions, body awareness techniques and vaginal palpation of pelvic floor muscle (PFM) on motor control of women with stress urinary incontinence (SUI). In addition, to evaluate PFM strength and endurance, the use of accessory muscles during PFM contraction, and the self-efficacy and expectations of patients with the results of the PFM awareness program. Methods: This is a randomized, controlled, single-center clinical trial with two intervention groups. Patients with predominant SUI symptoms (n=73) were recruited. The Experimental Group received vaginal palpation (manual techniques) for body and perineal awareness; and the Control Group received verbal instructions of PFM anatomy and function. The primary outcome included evaluation of the number of fast contractions (Fast) measured by vaginal palpation (bidigital touch). Secondary outcomes involved evaluating PFM using visual and vaginal palpation (bidigital touch) of muscle performance (Oxford scale) and muscle endurance; the use of muscles (abdominal, gluteal, hip adductor) considered accessory during voluntary contraction of PFM; and the self- efficacy and expectations of patients with the results of the Pelvic Floor Exercises Self- efficacy Scale. To analyse the differences between groups, the likelihood ratio test, Mann- Whitney test, and Fisher's Exact Test were used. And to analyse the primary, secondary and their differences between the moments before and after the intervention we used the ANOVA with 5% cut for significance. Results: No significant differences were identified between the groups in relation to the primary outcome: 7.4 (±2.3) in the Experimental Group, and 7.0 (±2.2) in the Control Group (p=0.556). A significant increase in the number of fast contractions in both groups after 1 month of intervention (p<0.000) was observed. No statistical difference was detected in muscle performance (Oxford scale) and PFM endurance (Experimental Group 3.5 (±0.8) and 3.4 (±1.1) Control Group, p=0.748). Regarding the use of gluteal, abdominal and adductor muscles associated to PFM contraction, it was observed a decrease in the use in both groups, with significant results for the adductor in the Experimental Group from 37% initial to 16% after 1 month; and in the Control Group from 81% initial to 44% after 1 month (p=0.010). In the Pelvic Floor Exercises Self-efficacy Scale, self-perception of results demonstrated motivation and confidence regarding the benefits of PFM exercises; and in relation to performance expectations that were evaluated only after 1 month of intervention, both groups demonstrated felt able to perform PFM contraction (71.2 (±18.2) in the Experimental Group versus 78.5 (±10.7) in the Control Group) (p=0,196). Conclusions: Vaginal palpation did not significantly increase the number of rapid contractions of PFM when compared to verbal instructions; both groups, Experimental and Control, showed improvement in motor control of PFM.