CONFERENCE: Women's, men's, and pelvic health
International Keynote Speaker Chantale Dumoulin will present on her research in pelvic floor muscle training in older women populations.
The ultimate goal of my research program is to improve continence care in women, speciﬁcally in older women. I want to increase accessibility by understanding urinary incontinence pathophysiology, ensuring that ﬁrst-line interventions are improved, cost-effective, better-targeted and implemented.
The area where I have learned the most is probably the study of the pathophysiology of urinary incontinence in ageing women. The purpose of any physiotherapy intervention aimed at urinary incontinent women is to restore pelvic floor muscle (PFM) function. Until recently, however, physiotherapists had to work almost intuitively because instruments providing direct measurements of the PFM function were non-existent. To achieve this goal, as part of my doctoral studies, I designed and built a pelvic floor dynamometer: the Montreal Dynamometer. I then undertook psychometric evaluation of the new instrument and conducted various dynamometric studies to document pelvic floor muscle dysfunction in women with urinary incontinence (post- natal, post-menopausal or elderly women, and more recently, those with genitourinary syndrome of menopause or gynaecological cancer survivors with urinary incontinence).
Overall, our research group was able to identify PFM functional dysfunctions in incontinent afflicted women compared to continent women; deﬁcits speciﬁc to different urinary incontinence types and different population in addition to possible associations between mixed urinary incontinence and executive control deﬁcits, and balance and mobility deﬁcits in older incontinent women. These ﬁndings support the complexity of urinary incontinence pathophysiology in different female populations and more speciﬁcally in older women, hence the need for further research. In recent years, these ﬁndings have led to the development of more targeted PFM training programs for urinary incontinence.
I also learnt a lot through an earlier study I conducted as an independent researcher. A ‘citizens’ jury’ is a mechanism of participatory action research, which draws on the symbolism, and some of the practices, of a legal trial by jury. In May 2011, I organised a citizens’ jury to identify priority research issues and outcome measures that were most signiﬁcant for older women with urinary incontinence. Fifty women, 65 and over, with urinary incontinence participated in the jury. Experts in urinary incontinence presented the women with the latest evidence- based literature on urinary incontinence, and then women met in small groups to identify research priority in urinary incontinence.
Self-management through low-cost conservative management interventions was given the highest priority by older women with stress and mixed urinary incontinence. The citizens’ jury results data has, and is still, guiding my research program.
The research areas that will contribute the most are probably those that I will be presenting at the conference and those that are presently being conducted. First, our large randomised control trial on pelvic floor muscle training in older women: the GROUP program (based on both pathophysiology of urinary incontinence and our citizens’ jury). A less costly intervention supported by an economic analysis, which will impact positively to continence-care accessibility and for which implementation in clinical practice is currently being studied.
Other areas of research that will impact clinical practice in physiotherapy are our research on the effects of a strong desire to void on gait in older community-dwelling women at risk of falls, and our studies on the impact and mechanism of action of pelvic floor physiotherapy on the genitourinary syndrome of menopause signs and symptoms. Once more, these will be presented at conference.
I have been involved in teaching since the beginning of my postgraduate education. I see teaching as a natural extension of my research. I developed Canada’s only postgraduate university-based program in pelvic floor rehabilitation to ensure postgraduates and clinicians have access to cutting-edge research. I am currently the director of this six-course 15-credit program, which is given 4–6 times a year to physiotherapists as four six-day modules. The postgraduate student has six (2.5 years) to eight (4 years) semesters to complete the program.
Through theoretical/practical sessions and exams, the program aims to develop the required knowledge, technical skills and clinical reasoning to achieve competence in evaluations and treatments of various pelvic floor muscle dysfunctions in different populations while employing ethical and evidence-based practices. Presently, more than 60 students are enrolled in the program and 172 have completed it. In a recently presented abstract at the Canadian Physiotherapy Association, preliminary results of an ongoing clinical impact web-based survey supported physiotherapists’ perceived direct impact on their clinical practice one year after completion of the program, with a signiﬁcant increase in the number/type of patients seen and a signiﬁcant increase in the percentage of their practice dedicated to pelvic floor rehabilitation. The overall goal of our research program is to improve continence care in women.
Chantale Dumoulin is a professor at the School of Rehabilitation, University of Montreal, where she developed the only postgraduate university-based pelvic floor rehabilitation program for physiotherapists in Canada.
Q&A: Invited speaker Jennifer Kruger will present on her research to-date with the pressure sensor array.
What projects are you currently working on to improve women’s, men’s and pelvic health physiotherapy?
As the lead of a pelvic floor research group, based at the Auckland Bioengineering Institute, we have a diverse range of projects but at the moment are focusing on instrumentation development.
We are particularly interested in quantifying the vaginal pressure proﬁle during exercise. To this end, we have developed a pressure sensor array, which is capable of measuring pressures along the length of the vagina, including abdominal pressure. We hope that knowing both pelvic floor muscle pressure and abdominal pressure simultaneously will be useful for women, and clinicians to better advise on pelvic floor muscle activation, and what happens to that pressure proﬁle during other types of exercise.
Can you tell us a bit about what you will be addressing in your presentation?
I will be talking about measuring pressures, in particular vaginal pressures. I will talk a briefly on the history of pressure measurement, and some assumptions that we make, but the focus of the talk will be on our research to date with the pressure sensor array.
What do you hope attendees of your presentation will come away with?
I hope that those attending will get a better understanding of what a vaginal pressure proﬁle is and how to potentially apply that knowledge when making clinical decisions. I also hope that those attending will give me their thoughts on our research. I am also hugely looking forward to a great line up of conference speakers.
Dr Jennifer Kruger is a senior research fellow at the Auckland Bioengineering Institute, University of Auckland. She leads the pelvic floor research group, where the focus of the research is pelvic floor muscle function and dysfunction in women.
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