PERFECT SCHEME FOR PELVIC FLOOR FUNCTION EVALUATION AND QUALITY OF LIFE IN POST MENOPAUSE WOMEN
FROTA 1, A. B. ROCHA 2, J. M. HADDAD 3, T. F. MAGALHAES 4, S. A. KARBAGE 5, K. L. AUGUSTO 6, A. P. BILHAR 7, S. L. DO NASCIMENTO 8, L. S. BEZERRA9;
1Hosp. geral de fortaleza, Fortaleza, 2Univ.e de São Paulo, Fortaleza, Brazil, 3Univ.e de Sao Paulo, Sao Paulo, Brazil, 4Univ.e Federal do Ceara, Fortaleza, Brazil, 5Univ.e Federal do Cearÿ, Fortaleza - Ceara, Brazil, 6Laparoscopy and Minimally invasive surgery, Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil, 7UNIFESP, Fortaleza, Brazil, 8Univ.e Federal do CearŸ, Fortaleza, Brazil, 9Saúde Materno Infantil, Federal Univ. of Ceara, Fortaleza, Brazil.
Introduction: Pelvic floor dysfunctions (PFD) are common gynecologic disorders that affect roughly one third of adult women. Urinary incontinence (UI), pelvic organ prolapse (POP) are included and associated Quality of life (QoL) measurements have been increasingly valued. Are there differences in pelvic floor muscle function (PFM) between women with and without PFD? What is the impact of PFM function, in the general and disease-specific QoL of such patients?
Objective: We aimed to assess PFM strength, by the Oxford scale, in postmenopausal women with and without PFD, relating these results to the QoL.
Methods: Case-control, descriptive study followed the guidelines of the STROBE Statement in Urogynecology outpatient services of two tertiary hospitals, from October 2012 to October 2013. 216 Postmenopausal women without uninhibited detrusor contractions on urodynamic testing and who had not undergone hormone replacement therapy were divided into two groups: Group 1 (Control group=90) with women without PFD, and Group 2=126, with women with PFD. Women were tested for homogeneity regarding age, BMI, number of pregnancies, parity, number of cesarean sections, number of vaginal deliveries and socioeconomic status. The Medical Outcomes Study 36-item short-form (SF-36) questionnaire was used for general health-related quality of life assessment, Brazilian version of the King's Health Questionnaire (KHQ) and Prolapse Quality of Life Questionnaire (P-QoL). The researcher evaluated PFM through vaginal palpation according to the PERFECT scheme which examines power (P), endurance (E), number of timed repetitions (R), and number of timed, fast contractions (F). We analyzed date using Student's t test, Mann Whitney U test for variables not normally distributed. Multiple logistic regression analyses were used to indicate the association between dependent and independent variables. Statistical significance was considered when p<0.05. Ethics Committee of both hospitals involved approved this research, and all participants signed a consent form. Clinical Trials: NCT01891162.
Results: Age range was 58.0 ± 9.0 years, Women with PFD were older, had more deliveries and fewer years of study. In either group, the majority of women showed insufficient PFM strength during the evaluation. When divided according to degree of strength on bidigital palpation by PERFECT scheme: < 2 and > 3, the majority of women had insufficient PFM strength. All presented with decreased muscle strength (E and R), showing difficulties in maintaining contraction. Women were also divided according to presence (power >1) or absence (Power zero) of contractions displayed and there were also no significant differences between groups. There were statistically significant differences in all of the domains that comprise the SF-36. Women with PFD presented with worse QoL. Women with UI, PFM function and QoL by the KHQ demonstrated a significant difference only in the General Health Perception domain; those with more effective contractions had more favorable QoL scores. No association was demonstrated between PFM function and QoL measured by the P-QoL in women with POP
Conclusions: There were no differences in pelvic floor muscle strength between groups. Regarding PFM function and QoL, as measured by the KHQ difference was only found in the General Health Perception domain. When we assessed by the P-QoL, statistically significant differences were not found in any domain.
References: DEVREESE A. Clinical evaluation of pelvic floor muscle function in continent and incontinent women. Neurourol and Urodynam.2004; 23:190-197.