Low-Value Practices for Pelvic Floor Dysfunction-Choosing Wisely Recommendations from the Brazilian Association of Physiotherapy in Women's Health: Observational Study.

INTRODUCTION AND HYPOTHESIS: The Choosing Wisely campaign is an international initiative that is aimed at promoting a dialog between professionals, helping the population to choose an evidence-based, truly necessary and risk-free care. The aim of the study was to develop the Choosing Wisely Brazil list on Women's Health Physiotherapy in the area of the pelvic floor. METHODS: A observational study was carried out between January 2022 and July 2023, proposed by the Brazilian Association of Physiotherapy in Women's Health, and developed by researchers working in the area of the pelvic floor. The development of the list consisted of six stages: a panel of experts, consensus building, national research, a review by the Choosing Wisely Brazil team, preparation of the list, and publication of the recommendations. Descriptive and content analyses were carried out in order to include evidence-based recommendations with over 80% agreement by physiotherapists in Brazil. RESULTS: The expert panel was made up of 25 physiotherapists who submitted 63 recommendations. Seven physiotherapists/researchers carried out a critical analysis of the literature and refined the recommendations, resulting in 11 recommendations that were put to a national vote, in which 222 physiotherapists took part. After a review by the Choosing Wisely Brazil team, five recommendations with an average agreement of 88.2% agreement were chosen for publication. CONCLUSIONS: The Choosing Wisely Brazil team in Physiotherapy in Women's Health/Pelvic Floor proposed a list of five recommendations that showed a high agreement among Brazilian physiotherapists working in the area.

Sleep disorders and regular physical exercise in primary health care: an observational study / Distúrbios do sono e exercício físico regular na atenção primária à saúde: estudo observacional

Physical exercise is currently considered a non-pharmacological alternative to improve sleep quality, but due to the lack of knowledge of some professionals, it is not widely used for this purpose. Thus, the objective of this study was to compare sleep quality, the presence of sleep disorders and insomnia, and the quality of life in patients who practice regular physical exercise (PG) and those who did not practice regular physical exercise (NPG), attended in Basic Health Units (BHUs) in the municipality of Divinópolis, Minas Gerais, Brazil. The study was a cross-sectional observational study carried out with 49 patients recruited from BHUs in the city of Divinópolis, Minas Gerais. They were divided into two groups constituted by those who practiced regular physical exercise (PG) and those who did not practice regular physical exercise (NPG), and then evaluated for sleep quality and the presence of sleep disorders, perception of insomnia, and quality of life addressed according to the respective questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index and SF-36 Quality of Life Questionnaire. When comparing the groups, there was a statistically significant difference regarding the items good sleep quality, presence of severe insomnia, general health status, social aspects and mental health. Thus, it is suggested that patients who practiced regular physical exercise attended in BHUs have a higher prevalence of good sleep quality, lower rate of severe in-somnia and better quality of life

O exercício físico é considerado atualmente como alternativa não farmacológica para melhora da qualidade do sono, porém pela falta de conhecimento de alguns profissionais o mesmo não é muito utilizado para essa finalidade. Dessa forma, o objetivo deste estudo foi comparar a qualidade do sono, a presença de distúrbios do sono e insônia, e a qualidade de vida em pacientes praticantes de exercício físico regular (PEFR) e não praticantes de exercício físico regular (NPEFR), assistidos em UBS ́s do município de Divinópolis, Minas Gerais. O estudo foi do tipo observacional transversal, realizado com 49 pacientes recrutados a partir de Unidades Básicas de Saúde (UBS ́s) do município de Divinópolis, Minas Gerais. Foram divididos em dois grupos, os PEFR e NPEFR, e em seguida avaliados quanto a qualidade e presença de distúrbios do sono, percepção da insônia, e qualidade de vida, abordados de acordo com os respectivos questionários: Índice de Qualidade de Sono de Pittsburgh (IQSP), Índice de Gravidade de Insônia e Questionário de Qualidade de Vida SF-36. Quando comparado os grupos, houve diferença estatisticamente significativa quanto aos itens boa qualidade do sono, presença de insônia severa, qualidade de vida sob os domínios estado geral de saúde, aspectos sociais e saúde mental. Desta forma, sugere-se que os pacientes que praticam exercício físico regular assistidos em UBS's apresentam maior prevalência de boa qualidade do sono, menor índice de insônia severa e melhor qualidade de vida

Impact of pelvic floor muscle strength on female sexual function: retrospective multicentric cross-sectional study.

INTRODUCTION AND HYPOTHESIS: The female pelvic floor muscles (PFM) play an important role in sexual function. We hypothesize that there is a relation between PFM strength and sexual function in women with and without sexual dysfunction. METHODS: Retrospective multicentric cross-sectional study including women with and without sexual dysfunction [Female Sexual Function Index (FSFI) cutoff point < 26.55], analyzed by age range, considering demographic, clinical, anthropometric and PFM strength [Modified Oxford Scale (MOS)] data. Chi-square, Mann-Whitney test and linear regression (ranks) were used, with 5% significance (SAS 9.4). RESULTS: Out of 1013 medical records, 982 women with an average age of 45.76 (± 15.25) were included in the study. Of these, 679 (69.14%) presented FSFI score < 26.55, while 303 (30.86%) presented FSFI ≥ 26.55. It was identified that the higher scores were among white women, < 45 years old, single, with higher education, family income > 4 minimum wages, body mass index < 25 kg/m2, lower parity, regular physical activity practitioner and higher PFM strength (MOS: 4-5). Desire, arousal, lubrication and orgasm domains were higher among women with MOS 4-5, while satisfaction and pain domains were higher among those with MOS 3-5. CONCLUSION: Demographic, clinical and anthropometric conditions can influence both PFM strength and female sexual function. Our findings demonstrate that women with higher PFM strength present fewer complaints about sexual dysfunction.

Effect of a home-based exercise program on functional mobility and quality of life in elderly people: protocol of a single-blind, randomized controlled trial.

BACKGROUND: Elderly people have high rates of functional decline, which compromises independence, self-confidence, and quality of life (QoL). Physical exercise leads to significant improvements in strength, balance, functional mobility, and QoL, but there is still reduced access to this therapeutic strategy due to difficulties in locomotion to training centers or lack of adaptation to the exercise environment. METHODS/DESIGN: The purpose of this clinical trial will be to verify the effect of a progressive and semi-supervised, home-based exercise program on the functional mobility, and in the QoL of sedentary elderly people. This is a protocol of a consecutive, single-center, single-blind, and randomized controlled trial. The design, conduct, and report follows the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. Sedentary elderly people will be enrolled, and randomly allocated into two groups. The intervention group will perform exercises in their own home and the control group will not perform exercises. The evaluations will occur at study enrollment and after 3 months of intervention, and will be performed using the functional mobility Timed Up & Go (TUG) test and sociodemographic and QoL questionnaires. In the statistical analysis, comparisons of mean and correlation analyses will be performed. The primary expected outcome is the improvement in functional mobility verified through the TUG test and the secondary outcome is the improvement in QoL verified by the WHOQOL-OLD. DISCUSSION: The lack of scientific evidence demonstrating the benefits of semi-supervised home exercise on functional mobility and QoL in elderly people represents an obstacle to the development of guidelines for clinical practice and for policy-makers. The World Health Organization highlighted the importance of musculoskeletal health programs for elderly people, and the exercise program described in this protocol was designed to be viable, easy to implement, and inexpensive, and could be performed at the home of elderly subjects after receiving only guidelines and follow-up via periodic visits. Based on these facts, we hope that this study will demonstrate that a well-structured, home-based exercise program can be effective in improving functional mobility and QoL of sedentary elderly people, even without constant supervision during exercise. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos (ReBEC), Identifier: RBR-3cqzfy . Registered on 2 December 2016.