| Abstract | Cilj istraživanja: Glavni cilj ovog istraživanja bio je utvrditi učinkovitost dva kineziološka programa vježbanja na dobivena stanja ginekoloških nalaza, funkcionalnih testova, kvalitete života i subjektivne vitalnosti prije i nakon programa kod žena s urinarnom inkontinencijom (UI). Pretpostavke su bile kako će oba programa polučiti pozitivne učinke na ginekološke nalaze, funkcionalnost testova, kvalitetu života i vitalnosti, ali će novi kineziološki pristup Body tehnike imati značajnije učinke na promatrane parametre u odnosu na konzervativni pristup treninga jačanja zdjeličnog dna (PFMT).
Metode istraživanja: U ovom randomiziranom, kontroliranom istraživanju je sudjelovalo 46 ispitanica ženskog spola prosječne dobi 51±7 godina, koje su prije provođenja istraživanja bile podvrgnute ginekološkom nalazu i patile su od UI. Od 46 ispitanica, slučajnim odabirom je njih 23 sudjelovalo u eksperimentalnom programu Body tehnike, dok je preostalih 23 sudjelovalo u programu konzervativnog pristupa PFMT-a u trajanju od 8 tjedana. Uključujući kriteriji su bili dob između 35 i 65 godina, pozitivan test na UI, rezultati upitnika o UI-u kod inicijalnog pregleda 6 ili više, trajanje simptoma duže od 6 mjeseci, najmanje 12 mjeseci od vaginalnog poroda, normalna tjelesna težina, dok su isključujući kriteriji bili prethodna kirurška korekcija UI-a, trudnoća, urodinamski verificirani prekomjerno aktivni detruzor, stupanj genitalnog prolapsa > 2, neurološke bolesti i kronična terapija lijekovima koji izravno utječu na mehanizme kontinencije. Za utvrđivanje ginekološkog nalaza koristili su se sljedeći parametri: perineometar, upitnik za smanjenje simptoma inkontinencije ICIQ-UI SF, PAD test te dnevnik mokrenja. Antropometrijska mjerenja su uključivala mjerenje bikristalnog raspona zdjelice, mjerenje promjene opsega prsnog koša na mamilarnoj razini, mjerenje promjene opsega na razini 10. rebra te mišićni test samoprocjene svjesnosti aktivacije mišića zdjelice (TAMZ). Na kraju, kvaliteta života i vitalnost su izmjereni upitnicima ICIQ-LUTSqol i SVS. Za utvrđivanje učinkovitosti oba programa se koristila analiza varijance za ponovljena mjerenja.
Rezultati istraživanja: Oba programa, Body tehnika i PFMT, pokazala su statistički značajne vremenske utjecaje i pozitivne promjene na parametre ginekološkog statusa i antropometrijskih mjera te kvalitete života. Naime, uvidjelo se sljedeće: značajno povećanje snage zdjeličnog dna mjerene perineometrom (F1,44 = 23.064, p < 0.001) te smanjenje stupnja samoprocjene inkontinecije (F1,44 = 27.515, p < 0.001), vrijednosti mase predloška u PAD testu (F1,44 = 8.362, p = 0.006) i manji broj epizoda mokrenja (F1,44 = 17.749, p < 0.001) u parametrima
ginekološkog nalaza, značajno povećanje mjera bikristalnog raspona zdjelice (F1,44 = 133.263; p < 0.001), promjena opsega prsnog koša na mamilarnoj razini (F1,44 = 33.939; p < 0.001), promjena opsega na razini 10. rebra (F1,44 = 15.248; p < 0.001) te mišićnog testa TAMZ (F1,44 = 40.815; p < 0.001), kao i značajno poboljšanje kvalitete života (F1,44 = 35.368; p < 0.001), dok se vrijednosti u području vitalnosti nisu značajno promijenile kod obje grupe (F1,44 = 0.436; p = 0.512). Interakcija vremena i grupe je pokazala kako je eksperimentalna grupa Body tehnike imala značajnije pozitivne i veće učinke na mjere bikristalnog raspona zdjelice (F1,44 = 66.341; p < 0.001) i procjene mišićne svjesnosti TAMZ (F1,44 = 26.544; p < 0.001) u usporedbi s PFMT grupom, dok se u ostalim varijablama pokazala tendencija boljih rezultata bez statistički značajnih interakcija. Ispitanice u grupi Body tehnike su postigle širenje od 2 mm bikristalnog raspona zdjelice pri udisaju, dok su ispitanice u kontrolnoj skupini postigle širenje za 1 mm. Kod TAMZ testa, grupa Body tehnike je poboljšala ocjenu samoprocjene s 0.70 na 2.52 boda, dok je PFMT skupina poboljšala samoprocjenu s 1.20 na 1.39 bodova, od maksimalna 3 ponuđena na skali.
Zaključak istraživanja: Novi kineziološki pristup Body tehnike pokazuje značajno bolje učinke na određene parametre antropometrijskog statusa, poput mjera bikristalnog raspona zdjelice i procjene mišićne svjesnosti TAMZ, s obzirom na PFMT grupu. Iako su vrijednosti promjena u ginekološkim parametrima perineometra, simptoma inkontinencije, PAD testa te dnevnika mokrenja, antropometrijskih mjera promjena opsega prsnog koša na mamilarnoj razini i opsega na razini 10. rebra, kao i kvalitete života i vitalnosti pokazale tendenciju prema boljim rezultatima u programu Body tehnike, nisu bile značajno bolje od PFMT programa. S obzirom na to, može se zaključiti kako novi sustav Body tehnike polučuje nešto bolje učinke nasuprot konzervativnog pristupa PFMT te se može koristiti u preventivne i rehabilitacijske svrhe kod žena koje pate od UI-a. |
| Abstract (english) | Research goal: The main goal of this research was to determine the effectiveness of two kinesiological exercise programs on the obtained conditions of gynecological findings, functional tests, quality of life and subjective vitality before and after interventions in women with urinary incontinence (UI). With regard to the main goal, the assumptions were that both programs had equal positive effects on gynecological findings, test functionality, quality of life and vitality, and the new kinesiological approach of the Body technique had more significant effects on the observed parameters, considering the conservative approach to pelvic floor muscle training (PFMT).
Research methods: Forty-six female respondents with an average age of 51±7 years participated in this randomized, controlled study, who had undergone a gynecological examination before the study and suffered from UI. Out of 46 subjects, 23 of them were randomly selected to enter the experimental program of Body techniques, while the remaining 23 entered the program of conservative approach of PFMT for 8 weeks. The inclusion criteria were: age between 35-65 years, duration of symptoms more than 6 months, positive test for UI, minimum 12 months since vaginal delivery, normal body weight, and patients who at the initial examination had UI questionnaire results of 6 or more, while exclusion criteria were previous surgical correction of UI, pregnancy, urodynamically verified overactive detrusor, degree of genital prolapse >2, neurological diseases and chronic therapy with drugs that directly affect continence mechanisms. To determine the gynecological findings, the following parameters were used: perineometer, ICIQ-UI SF incontinence symptom reduction questionnaire, PAD test, and urination diary. Anthropometric measurements included measurement of bicrystalline pelvic span, measures of changes in chest circumference at the mammillary level, measures of changes in circumference at the level of the 10th rib, and a muscle self-assessment test of awareness of pelvic muscle activation (TAMZ). Finally, quality of life and vitality were measured with the ICIQ-LUTSqol and SVS questionnaires. Analysis of variance for repeated measurements was used to determine the effectiveness of both programs.
Research results: Both Body technique and PFMT programs showed statistically significant temporal effects and positive changes on parameters of gynecological status and anthropometric measures, as well as quality of life. Namely, there was a significant increase in the strength of the pelvic floor measured with a perineometer (F1,44 = 23.064, p < 0.001), and a decrease in the
degree of self-assessment of incontinence (F1,44 = 27.515, p < 0.001), the value of the mass of the template in the PAD test (F1,44 = 8.362, p = 0.006) and a lower number of urination episodes (F1,44 = 17.749, p < 0.001) in the parameters of gynecological findings, significant increases in measures of bicrystalline pelvic range (F1,44 = 133.263; p < 0.001), measures of changes in chest circumference bone at the mammillary level (F1,44 = 33.939; p < 0.001), measure of changes in circumference at the level of the 10th rib (F1,44 = 15,248; p < 0.001), and the TAMZ muscle test (F1,44 = 40.815; p < 0.001) ), and a significant improvement in the quality of life (F1,44 = 35.368; p < 0.001), while values in the field of vitality did not change significantly in both groups (F1,44 = 0.436; p = 0.512). The interaction of time and group showed that the experimental group of the Body technique had significant positive and greater effects on the measurements of the bicrystalline range of the pelvis (F1,44 = 66.341; p < 0.001) and the TAMZ muscle awareness assessment (F1,44 = 26.544; p < 0.001), with regard to the PFMT group, while in other variables it showed a tendency for better results without statistically significant interactions. Subjects in the Body technique group achieved an expansion of 2 mm in the bicrystalline range of the pelvis during inhalation, while subjects in the control group achieved an expansion of 1 mm. In the TAMZ test, the Body technique group improved their self-assessment from 0.70 to 2.52 points, while the PFMT group improved their self-assessment from 1.20 to 1.39 points out of the maximum 3 offered on the scale.
Research conclusion: The new kinesiology approach of the Body technique shows significantly better effects on certain parameters of anthropometric status, such as the measurement of the bicristal range of the pelvis and the assessment of muscle awareness TAMZ, with regard to the PFMT group. Although the values of changes in the gynecological parameters of the perineometer, incontinence symptoms, PAD test, and urination diary, anthropometric measures of changes in chest circumference at the mammillary level and circumference at the level of the 10th rib, as well as quality of life and vitality showed a tendency towards better results in the program of Body technique, they were not significantly better than the PFMT program. With this in mind, it can be concluded that the new Body technique system shows slightly better effects against the conservative PFMT approach, and it can be used for preventive and rehabilitation purposes in women suffering from UI. |
