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European Spine Journal : Official... Mar 2020To analyze pelvic compensation during walking in patients with severe sagittal plane deformity by using motion analysis.
PURPOSE
To analyze pelvic compensation during walking in patients with severe sagittal plane deformity by using motion analysis.
METHODS
A total of 44 patients with sagittal plane deformity who were scheduled to undergo surgery were included. Motion analysis was performed 3 consecutive times during walking to estimate the anterior pelvic tilt (Ant-PT) angle, trunk kyphosis (TK) angle, and distance of the center of gravity (CoG) from the center of mass (CoM) of the pelvic segment, and hip and knee joint angles during gait. The patients were classified into Ant-PT+/Ant-PT-, TK+/TK-, and CoG+/CoG- groups according to the changes in Ant-PT angle, TK angle, and distance of the CoG from the CoM of the pelvic segment. Increases and decreases in the values of the variables from the first trial to the third trial were indicated with "+" and "-" signs, respectively.
RESULTS
The mean Ant-PT angle, TK angle, and distance of the CoG from the CoM of the pelvic segment increased progressively, and the differences in the values of these variables from the first to the third trials were statistically significant (P = 0.046, P = 0.004, and P = 0.007 for the Ant-PT angle, TK angle, and distance of the CoG from the CoM of pelvic segment, respectively). Among the 44 patients, 27 and 34 were classified into the Ant-PT+ and CoG+ groups, respectively. Older age and higher body mass index (BMI) were significantly associated with the Ant-PT+ group. The CoG+ group demonstrated a significantly higher height and weight than the CoG- group.
CONCLUSIONS
Higher BMI, height, and weight are risk factors for progressive worsening of dynamic sagittal imbalance. These slides can be retrieved under Electronic Supplementary Material.
Topics: Disease Progression; Humans; Kyphosis; Lower Extremity; Pelvis; Posture; Walking
PubMed: 31938943
DOI: 10.1007/s00586-019-06267-9 -
BJU International Nov 2019To evaluate the effects of surgeon experience, body habitus, and bony pelvic dimensions on surgeon performance and patient outcomes after robot-assisted radical...
OBJECTIVES
To evaluate the effects of surgeon experience, body habitus, and bony pelvic dimensions on surgeon performance and patient outcomes after robot-assisted radical prostatectomy (RARP).
PATIENTS, SUBJECTS AND METHODS
The pelvic dimensions of 78 RARP patients were measured on preoperative magnetic resonance imaging and computed tomography by three radiologists. Surgeon automated performance metrics (APMs [instrument motion tracking and system events data, i.e., camera movement, third-arm swap, energy use]) were obtained by a systems data recorder (Intuitive Surgical, Sunnyvale, CA, USA) during RARP. Two analyses were performed: Analysis 1, examined effects of patient characteristics, pelvic dimensions and prior surgeon RARP caseload on APMs using linear regression; Analysis 2, the effects of patient body habitus, bony pelvic measurement, and surgeon experience on short- and long-term outcomes were analysed by multivariable regression.
RESULTS
Analysis 1 showed that while surgeon experience affected the greatest number of APMs (P < 0.044), the patient's body mass index, bony pelvic dimensions, and prostate size also affected APMs during each surgical step (P < 0.043, P < 0.046, P < 0.034, respectively). Analysis 2 showed that RARP duration was significantly affected by pelvic depth (β = 13.7, P = 0.039) and prostate volume (β = 0.5, P = 0.024). A wider and shallower pelvis was less likely to result in a positive margin (odds ratio 0.25, 95% confidence interval [CI] 0.09-0.72). On multivariate analysis, urinary continence recovery was associated with surgeon's prior RARP experience (hazard ratio [HR] 2.38, 95% CI 1.18-4.81; P = 0.015), but not on pelvic dimensions (HR 1.44, 95% CI 0.95-2.17).
CONCLUSION
Limited surgical workspace, due to a narrower and deeper pelvis, does affect surgeon performance and patient outcomes, most notably in longer surgery time and an increased positive margin rate.
Topics: Aged; Humans; Male; Middle Aged; Pelvis; Postoperative Complications; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Surgeons; Treatment Outcome; Urinary Incontinence
PubMed: 31265207
DOI: 10.1111/bju.14857 -
Gait & Posture Feb 2020One in four pregnant women falls at least once during her pregnancy. During pregnancy, the body undergoes tremendous vascular, hormonal, physiological, and psychological...
BACKGROUND
One in four pregnant women falls at least once during her pregnancy. During pregnancy, the body undergoes tremendous vascular, hormonal, physiological, and psychological changes to accommodate the growing fetus. The pregnancy-induced mass gain of 10 to 25 kg is not evenly distributed and results in a large change in mass distribution and shift in segmental centers of mass. To accurately understand how the change in mass distribution leads to an increase in fall events, a musculoskeletal model of the pregnant body is necessary. Generic musculoskeletal models cannot accurately represent the morphology of pregnant women and the study of postural stability of pregnant women is limited by the lack of adapted musculoskeletal models.
RESEARCH QUESTION
Could a model reflecting the change in segmental inertia during pregnancy explain the pregnancy-related risk of falling?
METHODS
We built a musculoskeletal model of the pregnant women, combining literature anthropomorphic measurements with generic models. We optimized the dimensions of the anthropomorphic model shapes to fit the average measurements of 25 pregnant women. The mass, center of mass, and inertia of each segment are then computed throughout pregnancy. Finally, the stance phase of a gait cycle was modeled using the pregnancy-specific and the generic models. The ankle, knee, hip and lumbar joint moments during gait were compared between the two models.
RESULTS
The built musculoskeletal model of the pregnant woman includes changes in mass and geometry of the thorax, pelvis, thighs, and legs. The model reproduces the change in lumbar curvature during pregnancy. Gait simulation results show a limited impact of pregnancy on the ankle, knee, and hip moment, but a large impact on the lumbar moment.
SIGNIFICANCE
Such a musculoskeletal model will help elucidate the mechanisms leading to falls or low back pain during pregnancy.
Topics: Accidental Falls; Ankle Joint; Biomechanical Phenomena; Computer Simulation; Female; Gait; Hip Joint; Humans; Knee Joint; Lumbar Vertebrae; Pelvis; Postural Balance; Pregnancy; Thorax
PubMed: 31927359
DOI: 10.1016/j.gaitpost.2019.12.024 -
Fertility and Sterility Jun 2022To identify metabolites in presurgical blood associated with risk of persistent postsurgical pelvic pain 1 year after endometriosis surgery in adolescent and young adult... (Observational Study)
Observational Study
OBJECTIVE
To identify metabolites in presurgical blood associated with risk of persistent postsurgical pelvic pain 1 year after endometriosis surgery in adolescent and young adult patients.
DESIGN
Prospective observational study within the Women's Health Study: From Adolescence to Adulthood, a US-based longitudinal cohort of adolescents and women enrolled from 2012-2018.
SETTING
Two tertiary care hospitals.
PATIENT(S)
Laparoscopically confirmed endometriosis patients (n = 180) with blood collected before their endometriosis surgery. Of these, 77 patients additionally provided blood samples 5 weeks to 6 months after their surgery. We measured plasma metabolites using liquid chromatography tandem mass spectrometry, and a total of 390 known metabolites were included in our analysis.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
Persistent postsurgical pelvic pain, defined as severe, life-impacting pelvic pain 1 year after endometriosis surgery.
RESULT(S)
Most patients (>95%) were at stage I/II of the revised American Society for Reproductive Medicine classification. Their average age at diagnosis was 18.7 years, with 36% reporting persistent postsurgical pelvic pain. Of the 21 metabolites in presurgical blood that were associated with risk of persistent postsurgical pelvic pain, 19 metabolites, which were mainly lipid metabolites, were associated with increased risk. Only 2 metabolites-pregnenolone sulfate (odds ratio = 0.64, 95% confidence interval = 0.44-0.92) and fucose (odds ratio = 0.69, 95% confidence interval = 0.47-0.97)-were associated with decreased risk. Metabolite set enrichment analysis revealed that higher levels of lysophosphatidylethanolamines (false discovery rate = 0.01) and lysophosphatidylcholines (false discovery rate = 0.01) in presurgical blood were associated with increased risk of persistent postsurgical pelvic pain.
CONCLUSION(S)
Our results suggest that dysregulation of multiple groups of lipid metabolites may play a role in the persistence of pelvic pain postsurgery among young endometriosis patients.
Topics: Adolescent; Adult; Endometriosis; Female; Humans; Laparoscopy; Lipids; Pain, Postoperative; Pelvic Pain; Pelvis; Young Adult
PubMed: 35367064
DOI: 10.1016/j.fertnstert.2022.02.012 -
Clinical Biomechanics (Bristol, Avon) Jan 2020Many researchers emphasize adaptations following pregnancy. Our purpose was to get more insight into how morphology interacts with the pelvic walking pattern - the...
BACKGROUND
Many researchers emphasize adaptations following pregnancy. Our purpose was to get more insight into how morphology interacts with the pelvic walking pattern - the segment most prone to the adaptation following altered body demands.
METHODS
Thirty women were enrolled. Three experimental sessions were arranged according to the same protocol in the first, second and third trimesters of pregnancy. First, the anthropometric measures were taken, then walking trials at a self-selected speed were registered. At the end of the experimental session the subjects were asked to fill out a questionnaire on pain.
FINDINGS
The sagittal plane pelvic range of motion (RoM) significantly increased throughout pregnancy. There were significant positive correlations between pelvic anthropometric dimensions and pelvic tilt and rotation primarily in the third trimester of pregnancy. Significant positive correlations were found between pelvic RoM and thigh circumference. Indicators associated with body mass increase were positively correlated with pelvic obliquity in the second trimester and pelvic tilt and rotation in late pregnancy. It is also worth noting that the individual differences were not related to back pain and that the reported correlations were observed in some but not in all trimesters.
INTERPRETATION
Morphological changes following the fetus growth induced increased pelvic tilt and rotation, however, pelvis movements were not associated with back pain. Overall, the results highlight correlations between morphology and pelvis kinematic patterns in some but not in all trimesters.
Topics: Adaptation, Physiological; Adult; Anthropometry; Back Pain; Biomechanical Phenomena; Female; Gait; Humans; Movement; Pain Measurement; Pelvis; Posture; Pregnancy; Range of Motion, Articular; Rotation; Walking; Young Adult
PubMed: 31743885
DOI: 10.1016/j.clinbiomech.2019.11.001 -
Clinical Biomechanics (Bristol, Avon) Dec 2021Pelvic floor muscle training can cure or alleviate stress urinary incontinence. This study aimed to evaluate maximum voluntary contractions of the pelvic floor muscle in...
BACKGROUND
Pelvic floor muscle training can cure or alleviate stress urinary incontinence. This study aimed to evaluate maximum voluntary contractions of the pelvic floor muscle in sportswomen and verify the association with leg stiffness and muscle power, both maximal and submaximal.
METHODS
The sample consisted of 41 sportswomen between 18 and 42 years of age. Pelvic floor muscle strength was measured by the manometer. The sportswomen were instructed to perform 3 maximum voluntary contractions of the perineum, held for 3 seconds. Maximal and submaximal leg stiffness and muscle power were measured with a force platform, in two conditions: 1st condition was the sub-maximal, double leg hop test, which was performed allowing sportswomen to self-select their preferred frequency and 2nd condition was the maximal double leg hop test, which was performed asking athletes to maximize hop height and minimize contact time on the top of the force platform for 6 consecutive hops.
FINDINGS
Maximal and submaximal leg stiffness values increase with increasing age, weight, height, and body mass index, showing positive and significant (p <0.05) or close correlations. There are strong positive correlations between maximal and submaximal leg stiffness (r = 0.759) and between maximal and submaximal muscle power. Maximum voluntary contractions values decrease with increasing leg stiffness: the correlation is significant with maximal leg stiffness.
INTERPRETATION
Maximum voluntary contractions values decrease with increasing leg stiffness and increase with increasing muscle power values. If the training program aims to increase muscle power, it may also increase maximum voluntary contractions.
Topics: Athletes; Humans; Leg; Muscle Contraction; Pelvic Floor; Urinary Incontinence, Stress
PubMed: 34610505
DOI: 10.1016/j.clinbiomech.2021.105471 -
Physiotherapy Mar 2022Reduced pelvic floor muscle (PFM) contraction strength is a common condition in elderly female patients with urinary incontinence (UI). However, little data exist to...
BACKGROUND
Reduced pelvic floor muscle (PFM) contraction strength is a common condition in elderly female patients with urinary incontinence (UI). However, little data exist to demonstrate the importance of appropriate PFM activation during exhaling and coughing.
OBJECTIVES
To analyse breathing and coughing patterns in elderly female inpatients with UI, and to assess PFM activation patterns during exhalation and coughing.
DESIGN
Retrospective chart data analysis.
PATIENTS AND METHODS
Data from 177 elderly female inpatients with UI were analysed to determine voluntary PFM contraction strength, as well as PFM activation and displacement of the pelvic floor (PF) and abdominal wall during forced exhalation and coughing. Clinical data were obtained by means of inspection and digital palpation in the course of a routine clinical UI assessment. Data collected were correlated with age, body mass index and number of childbirths, and categorised by predominant UI symptoms, history of previous hysterectomy and history of PFM training.
RESULTS
Independent of voluntary PFM contraction strength, nearly all patients (n=168) demonstrated bulging of the abdominal wall and PF during forced exhalation and coughing instead of contracting the PFMs and consequently lifting the PF, which would be in accordance with physiological breathing synergies. None of the nine women who reflexively contracted the PFM physiologically in accordance with an expiratory breathing pattern complained of symptoms of stress UI alone.
CONCLUSION
A high percentage of elderly females with UI do not activate their PFMs appropriately during forced exhalation and coughing, possibly contributing to or exacerbating UI.
Topics: Aged; Exhalation; Female; Humans; Inpatients; Muscle Contraction; Muscle Strength; Pelvic Floor; Retrospective Studies; Urinary Incontinence
PubMed: 35066420
DOI: 10.1016/j.physio.2021.04.003 -
International Urogynecology Journal Apr 2022Supervised pelvic floor muscle training (PFMT), weight loss and exercise are recommended for overweight/obese women with urinary incontinence (UI). This study aimed to...
INTRODUCTION AND HYPOTHESIS
Supervised pelvic floor muscle training (PFMT), weight loss and exercise are recommended for overweight/obese women with urinary incontinence (UI). This study aimed to implement and evaluate the feasibility, acceptability and effectiveness of a 12-week group exercise and healthy eating program (ATHENA) for overweight/obese women with UI.
METHODS
This study, using an implementation-effectiveness hybrid type 3 design, was conducted within a Women's Health Physiotherapy outpatient service at an Australian tertiary public hospital. Intervention feasibility and acceptability were assessed through process evaluation of implementation, while clinical effectiveness was assessed via pre-/post-clinical and quality of life surveys. Process data were analyzed using descriptive statistics and effectiveness data were compared pre-/post-intervention using inferential statistics.
RESULTS
Of 156 eligible patients, 37 (24%) agreed to participate; 29 (78%) completed the ATHENA program. Median (IQR) age and body mass index were 53 (47-65) years and 30.8 (29.1-34.8) kg/m respectively. ATHENA was feasible to implement, with all components delivered as intended and high participant satisfaction. Ninety-seven percent of participants reported improved UI symptoms (global rating of change) and significant improvements in overall pelvic floor dysfunction and quality of life utility scores (p = 0.001). While weight did not change, significant improvements were found in body-food choice congruence (intuitive eating scale-2; p < 0.01).
CONCLUSIONS
The ATHENA intervention was feasible, acceptable and clinically effective for overweight and obese women with urinary incontinence at a tertiary public hospital in Australia. Further research into longer term outcomes and the cost effectiveness of this group intervention is recommended.
TRIAL REGISTRATION
N/A. Ethics approval, HREC/2018/QGC/46582, date of registration 14/11/2018.
Topics: Australia; Exercise Therapy; Female; Humans; Male; Obesity; Overweight; Pelvic Floor; Quality of Life; Treatment Outcome; Urinary Incontinence; Urinary Incontinence, Stress
PubMed: 33733697
DOI: 10.1007/s00192-021-04743-9 -
Ginekologia Polska 2023The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in...
OBJECTIVES
The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in pelvic magnetic resonance imaging (MRI).
MATERIAL AND METHODS
This is a retrospective study. Pelvic MR images of 38 vaginal deliveries and 62 cesarean section patients who met the study criteria were analyzed. Pubococcygeal line, H line, M line were marked on MR images, uterus cervix, cervix upper vagina, upper and middle vagina, middle and lower vagina angles, urogenital hiatus width, levator hiatus width, obturator internus muscle area, levator ani defect was measured. The urinary incontinence and pelvic organ prolapse examination findings were recorded. The patients' age, body mass index (BMI), parity, delivery type, maximum birth weight questions were asked. The data of both groups were compared.
RESULTS
Uterocervical angle and levator ani muscle defect was significantly higher in the vaginal delivery group (p < 0.001). In the vaginal delivery group, a significant positive correlation was found between the parity and the levator ani muscle defect (r = 0.552), (p = 0.000). A significant negative correlation was found between the parity and the uterocervical angle (r = -0.337), (p = 0.039). A significant negative correlation was found between maximum birth weight and cervix upper vagina angle (r = -0.365) (p = 0.024). In the vaginal delivery group, a negative significant correlation was found between birth weight and obturator internus muscle area (r = -0.378), (p = 0.019).
CONCLUSIONS
These results show that cesarean section exposes the pelvic floor to less trauma and suggest that cesarean section may protect the pelvic floor.
Topics: Pregnancy; Humans; Female; Cesarean Section; Retrospective Studies; Pelvic Floor; Birth Weight; Magnetic Resonance Imaging
PubMed: 36477780
DOI: 10.5603/GP.a2022.0140 -
Annals of Biomedical Engineering Nov 2021Previous studies involving whole-body post-mortem human surrogates (PHMS) have generated biomechanical response specifications for physically simulated accelerative...
Previous studies involving whole-body post-mortem human surrogates (PHMS) have generated biomechanical response specifications for physically simulated accelerative loading intended to reproduce seat and floor velocity histories occurring in under-body blast (UBB) events (e.g.,. References 10, 11, 21 These previous studies employed loading conditions that only rarely produced injuries to the foot/ankle and pelvis, which are body regions of interest for injury assessment in staged UBB testing using anthropomorphic test devices. To investigate more injurious whole-body conditions, three series of tests were conducted with PMHS that were equipped with military personal protective equipment and seated in an upright posture. These tests used higher velocity and shorter duration floor and seat inputs than were previously used with the goal of producing pelvis and foot/ankle fractures. A total of nine PMHS that were approximately midsize in stature and mass were equally allocated across three loading conditions, including a 15.5 m/s, 2.5 ms time-to-peak (TTP) floor velocity pulse with a 10 m/s, 7.5 ms TTP seat pulse; a 13 m/s, 2.5 ms TTP floor pulse with a 9.0 m/s, 5 ms TTP seat pulse; and a 10 m/s, 2.5 ms TTP floor pulse with a 6.5 m/s, 7.5 ms TTP seat pulse. In the first two conditions, the seat was padded with a ~ 120-mm-thick foam cushion to elongate the pulse experienced by the PMHS. Of the nine PMHS tests, five resulted in pelvic ring fractures, five resulted in a total of eight foot/ankle fractures (i.e., two unilateral and three bilateral fractures), and one produced a femur fracture. Test results were used to develop corridors describing the variability in kinematics and in forces applied to the feet, forces applied to the pelvis and buttocks in rigid seat tests, and in forces applied to the seat foam in padded seat tests. These corridors and the body-region specific injury/no-injury response data can be used to assess the performance and predictive capability of anthropomorphic test devices and computational models used as human surrogates in simulated UBB testing.
Topics: Acceleration; Adult; Aged; Biomechanical Phenomena; Blast Injuries; Cadaver; Explosions; Foot Injuries; Fractures, Bone; Humans; Male; Middle Aged; Military Personnel; Models, Biological; Pelvis; Stress, Mechanical; Young Adult
PubMed: 34142277
DOI: 10.1007/s10439-021-02803-1