مقایسه شاخص های تعادل ایستا و پویا در زنان با و بدون بی اختیاری استرسی ادراری

نوع مقاله: مقاله پژوهشی

نویسندگان

1 گروه فیزیوتراپی-دانشکده ی علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی.

2 دانشیار گروه فیزیوتراپی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

3 گروه فیزیوتراپی ، دانشکده ی علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی.

4 گروه آمار زیستی، مرکز تحقیقات پروتئومیکس، دانشکده پیراپزشکی، دانشگاه علوم پزشکی شهید بهشتی ،تهران ،ایران

چکیده

مقدمه و اهداف
بی­ اختیاری ادراری از تظاهرات بالینی ناپایداری عضلات کف لگن است. از آنجایی که این عضلات بخشی از مجموعه عضلات مرکزی بدن بوده و در برقراری ثبات و تعادل نقش دارد، احتمال برهم خوردن تعادل در افراد با اختلالات عملکردی این عضلات مطرح شده است؛ لذا مطالعه حاضر با هدف مقایسه شاخص­های تعادل ایستا و پویا در زنان با و بدون بی­اختیاری استرسی ادراری طراحی و اجرا شد.
مواد و روش­ ها
مطالعه حاضر بر روی 15 زن با بی­ اختیاری استرسی ادراری و 15 زن بدون این عارضه انجام گرفت. پس از تکمیل فرم اطلاعاتی، شاخص­ های تعادل از جمله زمان رسیدن به پایداری، میزان بار اعمالی حین فرود و نیروهای عکس­العمل حین راه رفتن با استفاده از دستگاه صفحه نیرو اندازه­گیری شد. برای تجزیه­و­تحلیل اطلاعات از آزمون تی مستقل با سطح آلفای 0/05 استفاده شد.
یافته­ ها
طول مسیر مرکز فشار در راستای قدامی-خلفی (0/004=p) و جانبی (0/002=p)، سرعت مرکز فشار در راستای قدامی-خلفی (0/004=p)، و جانبی (0/002=p) طول کل مسیر طی­ شده مرکز فشار (0/003=p) با چشم باز در زنان با و بدون بی­ اختیاری ادراری اختلاف معناداری داشت. تمامی شاخص ­های تعادل ایستا با چشم بسته به­ طور معناداری بین دو گروه متفاوت بود (0/05>p). در زمان رسیدن به پایداری راستای عمودی (0/001=p)، قدامی-داخلی (0/008=p) و جانبی (0/044=p) به­ طور معناداری در گروه بدون بی ­اختیاری ادرای کمتر بود.
نتیجه­ گیری
بر اساس یافته ­های مطالعه حاضر، تقریبا تمامی شاخص ­های تعادل ایستا و پویا در زنان با بی­ اختیاری استرسی ادراری ضعیف تر از زنان بدون این عارضه بود. می­توان نتیجه گرفت که عضلات کف لگن به­ عنوان بخشی از عضلات مرکزی بدن، نقش مهمی در برقراری ثبات پوسچرال دارند.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Static and Dynamic Balance in Women with and without Stress Urinary Incontinence

نویسندگان [English]

  • Marzieh Ahmadi 1
  • Farideh Dehghan Manshadi 2
  • Abbas Rahimi 3
  • Alireza Akbarzadeh Baghban 4
1 Physiotherapy Department, School of Rehabilitation Shahid Beheshti University of Medical Sciences
2 Ph.D, Associate professor in Physiotherapy , Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Physiotherapy Department, School of Rehabilitation Shahid Beheshti University of Medical Sciences
4 Department of Biostatistics,.Proteomics Research Center, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده [English]

Background and Aims: Urinary incontinence is one of the clinical symptoms of pelvic floor muscle instability whose potential role in the body balance has been suggested. The present study aimed to compare static and dynamic balance indices in women with and without Stress Urinary Incontinence (SUI).
Materials and Methods: In the present cross-sectional analytic study, 15 women with and 15 women without SUI were enrolled. After collecting demographic data, the static balance indices, time to stability, rate of loading during landing, and ground reaction force during walking were measured using the force plate device. Independent t tests were used for data analysis and the significance level was set at p≤0. 05. Results: The length of the route of the center of pressure in the anterior-posterior (p=0.004) and lateral (p=0.002) directions, the velocity of the center of pressure in the anterior-posterior (p=0.004) and lateral (p=0.002) directions, and length of total path traveled with open eyes in women with and without SUI had significant difference. All of the static balance indices were significantly different between the two groups (p< 0.05). Time for stability in the vertical (p=0.001), anterior-posterior (p=0.008), and lateral (p=0.044) directions in the group without SUI was significantly less than that of the group with SUI.
Conclusion: Based on our results, almost all static and dynamic balance indices were weaker in women with SUI than in women without SUI. Therefore, it can be concluded that pelvic floor muscles, as a part of core muscles, play an important role in postural control.

کلیدواژه‌ها [English]

  • Stress Urinary Incontinence
  • Static balance
  • dynamic Balance
  • women
1.Haylen BT, De Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics: Official Journal of the International Continence Society. 2010; 29(1):4-20.##

2.Milsom I, Gyhagen M. The prevalence of urinary incontinence. Climacteric. 2019; 22(3):217-22. ##

3.Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nature Reviews Disease Primers. 2017; 3:17042. ##

4.Mckellar K, Abraham N. Prevalence, risk factors, and treatment for women with stress urinary incontinence in a racially and ethnically diverse population. Neurourology and urodynamics. 2019; 38(3):934-40. ##

5.McGuire EJ. Pathophysiology of stress urinary incontinence. Rev Urol 2004; 6(Suppl 5):S11-7##

6.Sapsford R. The pelvic floor: a clinical model for function and rehabilitation. Physiotherapy. 2001;87(12):620-30##

7.Madill SJ, McLean L. Relationship between abdominal and pelvic floor muscle activation and intravaginal pressure during pelvic floor muscle contractions in healthy continent women. Neurourology and Urodynamics: Official Journal of the International Continence Society. 2006; 25(7):722-30. ##

8.Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. International Urogynecology Journal. 2002; 13(2):125-32. ##

9.Smith MD, Coppieters MW, Hodges PW. Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurourology and urodynamics. 2007; 26(3):377-85. ##

10.Hodges P, Sapsford R, Pengel L. Postural and respiratory functions of the pelvic floor muscles. Neurourology and urodynamics. 2007;26(3):362-71. ##

 

11.Winter DA, Patla AE, Frank JS. Assessment of balance control in humans. Med prog technol. 1990 ;16(1-2):31-51. ##

12. Bryant EC.,  Trew,  ME. Bruce AM.; Kuisma RM. And Smith AW. “Gender differences in balance performance at the time of retirement “. Clinical Biomechanics, 2005; 20, (3): 330-335##

 

13.Melam G, Buragadda S, Alhusaini A, Ibrahim AI, Kachanathu SJ. Gender differences in static and dynamic postural stability parameters in community dwelling healthy older adults. Middle East J Sci Res. 2014; 22:1259-64. ##

14.Özmen T, Gafuroğlu Ü, Aliyeva A, Elverici E. Relationship between core stability and dynamic balance in women with postmenopausal osteoporosis. Turkish Journal of Physical Medicine and Rehabilitation. 2018; 64(3):239-46. ##

15.Brown JS, Vittinghoff E, Wyman JF, et al. Urinary incontinence: Does it increased risk for falls and fractures? J Am Geriatr Soc 2000; 48:721–5. ##

 

16.Smith MD, Coppieters MW, Hodges PW. Is balance different in women with and without stress urinary incontinence? Neurourology and Urodynamics: Official Journal of the International Continence Society. 2008; 27(1):71-8. ##

 

17.Chiarelli P.,Mackenzie L., Osmotherly P. Urinary incontinence is associated with an increase in falls: A systematic review. The Australian journal of physiotherapy. 2009 ;55. 89-95. ##

 

18.Jácomo RH, Alves AT, Garcia PA, Amatuzzi F, de Campos-Lobato LF, Carvalho GA, de Sousa JB. Old Women Body Balance: Does the Pelvic Organ Prolapse Matter?. Topics in Geriatric Rehabilitation. 2016;32(4):E10-5. ##

 

19.Manshadi FD, Ghanbari Z, Miri ES, Azimi H. Postural and musculoskeletal disorders in women with urinary incontinence: A research report. Journal of Clinical Physiotherapy Research. 2016; 1(1):27-31. ##

20.Rondini, Samantha K. Is postural stability compromised in women with urinary incontinence? (2013). Graduate Theses, Dissertations, and Problem Reports. 3617. HYPERLINK. https://researchrepository.wvu.edu/etd/3617 https://researchrepository.wvu.edu/etd/3617. ##

21. Chmielewska D, Stania M, Słomka K, Błaszczak E, Taradaj J, Dolibog P, Juras G. Static postural stability in women with stress urinary incontinence: Effects of vision and bladder filling. Neurourology and urodynamics. 2017;36(8):2019-27. ##

 

22. Chmielewska D, Sobota GS, Stania M, Błaszczak E, Słomka K, Juras G. A comparison of a step‐initiation task in women with and without urinary incontinence. A case‐control study. Neurourology and urodynamics. 2018;37(8):2571-7. ##

 

23. ARRUDA, Guilherme Tavares de et al. Static postural control and risk of falls in older women with and without urinary incontinence. Fisioter. Pesqui. [online]. 2019;26(3):285-290. ##

24.Karlsson A, Frykberg G. Correlations between force plates measures for assessment of balance. Clinical Biomechanics. 2000; 15(5):365-9. ##

 

25.Mansfield A, Inness EL. Force plate assessment of quiet standing balance control: Perspectives on clinical application within stroke rehabilitation. Rehabilitation Process and Outcome. 2015;4:RPO-S20363. ##

 

26.Ruhe A, Fejer R, Walker B. Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature. European Spine Journal. 2011; 20(3):358-68. ##

 

27.Hertel J, Gay MR, Denegar CR. Differences in postural control during single –Leg stance among healthy individuals with different foot types. Journal of Athletic Training. 2002; 37(2):129-132##

 

28.Baig S, Dansereau RM, Chan AD, Remaud A, Bilodeau M. Cluster analysis of center-of-pressure measures. International Journal of Electrical and Computer Systems (IJECS). 2013; 1(1):9-17##

 

29.Gribble PA, Hertel J. Consideration for normalizing measures of the star excursion balance test. Measurement in physical Education and Exercise science. 2003; 7(2):89-100. ##

30..Willson JD, Dougherty CP, Ireland ML, et al.: Core stability and its relationship to lower extremity function and injury. J Am Acad Orthop Surg, 2005; 13(17):316-25##

 

31.Hsu SL, Oda H, Shirahata S, Watanabe M, Sasaki M. Effects of core strength training on core stability. Journal of physical therapy science. 2018; 30(8):1014-8##