Papers by chantale dumoulin
International urogynecology journal, Feb 8, 2024
Involuntary pelvic floor muscle (PFM) contractions are thought to occur during an increase in int... more Involuntary pelvic floor muscle (PFM) contractions are thought to occur during an increase in intra-abdominal pressure (IAP). Although no studies have assessed their presence in women with normal pelvic floor (PF) function, existing literature links the absence of involuntary PFM contractions to various PF dysfunctions. This study rectifies this lacuna by evaluating involuntary PFM contractions during IAP in healthy nulliparous women with no PF dysfunction, using visual observation and vaginal palpation. Results were compared with the literature and the IUGA/ICS Terminology Reports. Methods Nulliparous (n=149) women performed three sets of three maximal coughs. Visual observation and vaginal palpation were conducted in the standing and supine positions. The women were not instructed to contract their PFMs. Occurrence rates were calculated for each assessment method and position; differences between positions were analyzed using the Chi-squared test. Results Rates of occurrence of involuntary PFM contraction were low across both assessments and positions (5-17%). Significant differences were found between standing (5%) and supine (15%) positions for visual observation, but not vaginal palpation (15%, 17% respectively). Occurrence rates also differed compared with the literature and terminology reports. Conclusions Contrary to clinical expectations, rates of occurrence of involuntary PFM contraction among our cohort of nulliparous women were extremely low. Digital palpation results showed high agreement with the terminology reports, but only partial agreement was observed for the visual observation results. Our study underscores the need for more research aimed at defining normal involuntary PF functions, a review of our understanding of involuntary PFM contractions, and better standardized guidelines for involuntary PFM assessment methods.
JAMA Internal Medicine, Oct 1, 2020
IMPORTANCE Urinary incontinence is one of the most prevalent health concerns experienced by older... more IMPORTANCE Urinary incontinence is one of the most prevalent health concerns experienced by older women (aged Ն60 years). Individual pelvic floor muscle training (PFMT) is the recommended first-line treatment for stress or mixed urinary incontinence in women, but human and financial resources limit its delivery. Whether group-based PFMT performs as well as individual PFMT in this population remains unclear. OBJECTIVE To assess the efficacy of group-based PFMT relative to individual PFMT for urinary incontinence in older women. The Group Rehabilitation or Individual Physiotherapy (GROUP) study is a single-blind, randomized, noninferiority trial conducted in 2 Canadian research centers, from July 1, 2012, to June 2, 2018. A total of 362 community-dwelling women aged 60 years or older with symptoms of stress or mixed urinary incontinence were enrolled. INTERVENTIONS After an individual session conducted to learn how to contract pelvic floor muscles, participants completed 12-week PFMT as part of a group of 8 women (n = 178) or in individual sessions (n = 184). The primary outcome measure was the percentage reduction in urinary incontinence episodes at 1 year, as reported in a 7-day bladder diary and relative to pretreatment baseline. Secondary outcomes included lower urinary tract-related signs, symptoms, and quality of life immediately following treatment and at 1 year. Per-protocol analysis was used. RESULTS Among 362 women who were randomized (mean [SD] age, 67.9 [5.8] years), 319 women (88%) completed the 1-year follow-up and were included in the per-protocol analysis. Median percentage reduction in urinary incontinence episodes was 70% (95% CI, 44%-89%) in individual PFMT compared with 74% (95% CI, 46%-86%) in group-based PFMT. The upper boundary of the 95% CI for the difference in the percentage reduction in urinary incontinence episodes at 1 year was lower than the prespecified margin for noninferiority of 10% (difference, 4%; 95% CI, -10% to 7%; P = .58), confirming noninferiority. Individual PFMT and group-based PFMT had similar effectiveness for all secondary outcomes at 1 year. Adverse events were minor and uncommon. Results of the GROUP study suggest that group-based PFMT is not inferior to the recommended individual PFMT for the treatment of stress and mixed urinary incontinence in older women. Widespread use in clinical practice may help increase continence-care affordability and treatment availability.
Cochrane Database of Systematic Reviews, Jan 20, 2010
Neurourology and Urodynamics, Nov 18, 2014
Pelvic floor muscle training (PFMT) is a commonly used physical therapy for women with urinary in... more Pelvic floor muscle training (PFMT) is a commonly used physical therapy for women with urinary incontinence (UI). Objectives To determine the effects of PFMT for women with UI in comparison to no treatment, placebo or other inactive control treatments. Cochrane Incontinence Group Specialized Register, (searched 15 April 2013). Selection Criteria Randomized or quasi-randomized trials in women with stress, urgency or mixed UI (based on symptoms, signs, or urodynamics). At least two independent review authors carried out trial screening, selection, risk of bias assessment and data abstraction. Trials were subgrouped by UI diagnosis. The quality of evidence was assessed by adopting the (GRADE) approach. Twenty-one trials (1281 women) were included; 18 trials (1051 women) contributed data to the meta-analysis. In women with stress UI, there was high quality evidence that PFMT is associated with cure (RR 8.38; 95% CI 3.68 to 19.07) and moderate quality evidence of cure or improvement (RR 17.33; 95% CI 4.31 to 69.64). In women with any type of UI, there was also moderate quality evidence that PFMT is associated with cure (RR 5.5; 95% CI 2.87-10.52), or cure and improvement (RR 2.39; 95% CI 1.64-3.47). The addition of seven new trials did not change the essential findings of the earlier version of this review. In this iteration, using the GRADE quality criteria strengthened the recommendations for PFMT and a wider range of secondary outcomes (also generally in favor of PFMT) were reported. no urine loss or 'dry'. 'incontinence is now unproblematic'. no leakage in a urinary diary. Participant reported cure or improvement was defined as: much better and somewhat better.[26] '75% or more perceived improvement'.[21] 'dry' or 'improved'.[27] 'continent' or 'almost continent'.[20] Primary outcome measures: Symptom and condition specific quality of life measures
International Urogynecology Journal
Introduction and hypothesis High-intensity physical activity and exercise have been listed as pos... more Introduction and hypothesis High-intensity physical activity and exercise have been listed as possible risk factors for pelvic organ prolapse (POP). The aim of the present study is to conduct a literature review on the prevalence and incidence of POP in women who engage in regular physical activity. In addition, we review the effects of a single exercise or a single session of exercise on pelvic floor support. Finally, the effect of exercises on POP in the early postpartum period is reviewed. Methods This is a narrative scoping review. We searched PubMed and Ovid Medline, the Physiotherapy Evidence Database (PEDro), and the Cochrane Database of Systematic Reviews up to May 2022 with the following MeSH terms: “physical activity” AND “exercise” AND “pelvic floor” AND “pelvic organ prolapse”. Results Eight prevalence studies were retrieved. Prevalence rates of symptomatic POP varied between 0 (small study within different sports) and 23% (Olympic weightlifters and power lifters). Parit...
International Urogynecology Journal
Introduction and hypothesis Pelvic floor muscle training (PFMT) is effective for the treatment of... more Introduction and hypothesis Pelvic floor muscle training (PFMT) is effective for the treatment of pelvic organ prolapse (POP), but other exercise programs have also been promoted and used. The aim of this review was to evaluate the effect of hypopressive and other exercise programs besides PFMT for POP. Methods A literature search was conducted on Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro, and Scopus databases from January 1996 to 30 December 2021. Only randomized controlled trials (RCTs) were included. The keywords were combinations of “pelvic organ prolapse” or “urogenital prolapse,” and “exercise therapy,” “hypopressive exercise,” “Kegel,” “pelvic floor muscle training,” “pelvic floor muscle exercises,” “Pilates,” “treatment,” “yoga,” “Tai Chi.” Methodological quality was assessed using the PEDro rating scale (0–10). Results Seven RCTs containing hypopressive exercise, yoga or breathing and hip muscle exercises in an inverted position were retrieved and analyzed. PEDro score ...
IEEE Journal of Translational Engineering in Health and Medicine
Objective: In attempts to improve the quality of life of women, continuous projects are sought be... more Objective: In attempts to improve the quality of life of women, continuous projects are sought between rehabilitation intervention and engineering. Using the knowledge of the pelvic floor muscle (PFM) physiology, assessment and training methods are developed to reduce lower urinary tract symptoms such as urinary incontinence. Therefore, this paper covers the design and implementation of a portable vaginal dynamometer. Methods: A PFM probe is designed, 3D printed, assembled, and tested in ten women to assess its acceptability and usability. The feedback from the usability study is used to optimize the PFM probe design. A vaginal dynamometer is developed based on the designed PFM probe, then tested for linearity, repeatability, hysteresis, noise and heat effect, and power consumption. The variability between the different produced PFM probe prototypes is evaluated. Results: Force measurements are made using a load cell. Wireless communication is performed through a Bluetooth low energy transceiver v5.0, with a corresponding interface on both computer and smartphone. The device operates at a 3.3V supply and achieves a power consumption of 49.5 mW in operating mode. Two PFM probe sizes are designed to accommodate different vaginal hiatus sizes, based on usability study feedback. The proposed system allows the physiotherapist to wirelessly monitor variation in pelvic floor muscle force during assessment and/or training. Discussion/Conclusion: The testing results showed that the newly designed system has the potential to measure the PFM function in functional conditions such as the standing position.
International Journal of Environmental Research and Public Health, Sep 4, 2022
Pelvic floor muscle (PFM) training is the first-line treatment for women of all ages with urinary... more Pelvic floor muscle (PFM) training is the first-line treatment for women of all ages with urinary incontinence (UI), but evidence supporting its effects on the functional anatomy of the pelvic floor is scarce in older women. We aimed to evaluate the long-term (one-year) effects of PFM training on the shape of the levator hiatus (LH) in older women with UI and its association with PFM force, incontinence severity, and potential effect modifiers (age, UI severity, BMI, and UI type). This is a secondary analysis of the GROUP study, a non-inferiority RCT assessing the effects of a structured and progressive 12-week PFM training program to treat UI in older women. Data were available from 264/308 participants at the one-year follow-up. PFM training resulted in reduced LH size toward a more "circular" shape, which was consistently associated with greater PFM force and reduced UI severity. Further, no significant interactions were found between LH shape changes and any of the potential effect modifiers, suggesting that women will potentially benefit from PFM training, regardless of age, UI severity, BMI, and UI type (stress or mixed), with changes that can be observed in the functional anatomy of the pelvic floor and sustained in the long-term.
Hypothesis / aims of study Pelvic floor muscle (PFM) training programs are delivered in either on... more Hypothesis / aims of study Pelvic floor muscle (PFM) training programs are delivered in either one-on-one treatment sessions or group exercise classes. Both protocols have shown to be effective in reducing stress and mixed female urinary incontinence (UI) in young and middle aged women. Group therapy, however, seems to offer additional benefits such as social interaction, group support and greater motivation to do the exercises. In addition, group therapy is less time-consuming for heath professionals in contexts where resources are lacking. Although RCTs on one-on-one PFM training program have shown good results in aging women, with up to 64% of women satisfied and wanting no further treatment, no study has yet evaluated the effect of group PFM exercise classes in this population.
Neurourology and Urodynamics, 2009
Study design, materials and methods This was a prospective, single-blind randomized controlled tr... more Study design, materials and methods This was a prospective, single-blind randomized controlled trial. Fifty-seven postnatal women with clinically-demonstrated persistent SUI three months or more after delivery participated in eight weeks of either pelvic floor muscle training (PFMT) alone (28) or with deep abdominal muscle training (PFMT+Tra) (29). Both groups had a pelvic floor or pelvic floor∕abdominal exercise program to follow at home, once a day, five days a week, in addition to a weekly physical therapy session for the eight-week period. Physical therapy sessions for the PFMT group consisted of a 15-minute period of electrical stimulation followed by 25 minutes of PFMT exercises. The PFMT+Tra group received an additional 10-minute session of deep abdominal muscle exercises (1). Seven year post-treatment, participants were contacted by telephone and invited to participate in a follow-up study. They were asked to do a 20-minute pad test with standardized volume and complete thre...
Neurourology and Urodynamics, 2017
Ruella Y1, Saint-Onge K2, Fraser S3, Southall K1, Fréchette-Chaîné É4, Morin M5, Dumoulin C6 1. R... more Ruella Y1, Saint-Onge K2, Fraser S3, Southall K1, Fréchette-Chaîné É4, Morin M5, Dumoulin C6 1. Research Centre of the Institut Universitaire de Gériatrie de Montréal, 2. Faculte des sciences humaines, département de psychologie, UQAM, 3. Faculty of Health Sciences, University of Ottawa, Reserach center of the Institut de Geriatrie de l'Universite de Montreal, 4. School of Rehabilitation, Faculty of Medicine, Université de Montréal, 5. School of Rehabilitation, Faculty of Medicine, University of Sherbrooke, Research Centre of the Centre hospitalier universitaire de Sherbrooke, 6. School of Rehabilitation, Faculty of Medicine, Université de Montréal and Research Centre of the Institut Universitaire de Gériatrie de Montréal
Hypothesis/aims of study The pelvic floor musculature (PFM) is recognized as playing a major role... more Hypothesis/aims of study The pelvic floor musculature (PFM) is recognized as playing a major role in continence since it participates in urethral occlusion. It has been suggested that an involuntary PFM contraction precedes the increase in intra-abdominal pressure (IAP) in continent women during a cough [1] in order to prevent urinary leakage. Therefore, impairments in the involuntary pre-activation of the PFM may lead to stress urinary incontinence (SUI) during coughing. The purpose of the study was to compare the characteristics of PFM involuntary response occurring during coughing between continent and SUI postmenopausal women.
Neurourology and Urodynamics, 2012
Hypothesis / aims of study Most studies on urinary incontinence (UI) are initiated by clinicians,... more Hypothesis / aims of study Most studies on urinary incontinence (UI) are initiated by clinicians, researchers or the pharmaceutical industry. Women with UI are rarely involved in developing the research questions or methodology. However, recent studies show that the needs of women with UI may in fact differ from those perceived by both health and industry professionals.(1) The failure to include beneficiaries in research discussions could limit research or, worse, result in poorly-designed research questions and poor prioritization of research (interventions & diagnostic tools); the ultimate consequence being minimally applicable research results, hence less transferable, to targeted populations. We hypothesized that elderly women with UI would prioritizes research on less invasive UI interventions, e.g., lifestyle changes and pelvic floor exercises, and outcome measures that focused on quality of life. Further, these priorities would not differ significantly between women, irrespec...
Hypothesis / aims of study The 72-hour bladder diary is a simple tool in which symptoms of urinar... more Hypothesis / aims of study The 72-hour bladder diary is a simple tool in which symptoms of urinary incontinence are measured and quantified: micturitions, incontinence episodes, pad usage and other information (fluid intake, degree of urgency and/or incontinence, etc.) (1). However, because of its complexity and time commitment, the bladder diary is often associated with poor compliance in older adults. The Urogenital Distress Inventory (UDI) measures the presence or absence of a symptom and the degree to which symptoms associated with incontinence are troubling to the respondent. An abridged version of the form, UDI-6, has also been shown to be valid and reliable when used with older adults (2). The aim of this study was to evaluate the relationship between the bladder diary and the UDI forms among women aged 60 and over suffering from mixed urinary incontinence.
Hypothesis / aims of study Pelvic floor disorders, such as stress urinary incontinence (SUI) and ... more Hypothesis / aims of study Pelvic floor disorders, such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP), are costly in both psychosocial and economic terms and affect more than 25% of the female population [1]. Although the exact mechanisms of POP and SUI are poorly understood, the development of such conditions are likely to alter the pressures acting on the vaginal wall, and thus change the vaginal pressure profile. There is little research on the change in the vaginal pressure profile in response to either surgical correction of POP or as a consequence of pelvic floor muscle training. Recent reviews suggest that pelvic floor muscle training (PFMT) is an effective first line treatment for women with stress urinary incontinence, and mild POP [2]. However, more than 30 % of women are unable to effectively contract their pelvic floor muscles and PFMT is contingent on the exercises being performed correctly [3]. This means increasing the pressure in the region of ...
The Cochrane database of systematic reviews, 2018
BACKGROUND Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatme... more BACKGROUND Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI).This is an update of a Cochrane Review first published in 2001 and last updated in 2014. OBJECTIVES To assess the effects of PFMT for women with urinary incontinence (UI) in comparison to no treatment, placebo or sham treatments, or other inactive control treatments; and summarise the findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register (searched 12 February 2018), which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings, and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised cont...
Hypothesis / aims of study Urinary incontinence (UI) has been associated with an increased risk o... more Hypothesis / aims of study Urinary incontinence (UI) has been associated with an increased risk of falls in the elderly. Very few trials have suggested the association between UI and mobility restrictions [1;2]. Moreover, until now, no studies have investigated the relations between UI and lower limb strength, balance performance and balance confidence and mobility using standardized and comprehensive assessment tools. It should be highlighted that this unexplored link corresponds to a research priority proposed by the International Consultation on Incontinence 2009 [3]. The aim of this study was to investigate and compare deficits in lower limb muscle strength, balance confidence/performance and mobility in elderly women with or without urge or mixed UI.
International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain
International Urogynecology Journal, 2021
This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ... more This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) establishes the prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP. An international group of nine urogynecologists/urologists and one medical student performed a search of the literature using pre-specified search terms in Ovid, MEDLINE, Embase and CINAHL from January 2000 to March 2019. Publications were eliminated if not relevant or they did not include clear definitions of POP or the symptoms associated with POP. Definitions of POP needed to include both a physical examination finding using a validated examination technique and the complaint of a bothersome vaginal bulge. Symptoms were categorized into symptom groups for ease of evaluation. The Specialist Unit for Review Evidence (SURE) was used to evaluate for quality of the included articles. The resulting list of articles was used to determine the prevalence of various symptoms in women with POP. Cohort studies were used to evaluate for possible causation of POP as either causing or worsening the symptom category. The original search yielded over 12,000 references, of which 50 were used. More than 50% of women with POP report lower urinary tract symptoms. Cohort studies suggest that women with POP have more obstructive lower urinary tract symptoms than women without POP. Pain described in various ways is frequently reported in women with POP, with low back pain being the most common pain symptom reported in 45% of women with POP. In cohort studies those with POP had more pain complaints than those without POP. Sexual dysfunction is reported by over half of women with POP and obstructed intercourse in 37–100% of women with POP. Approximately 40% of women have complaints of bowel symptoms. There was no difference in the median prevalence of bowel symptoms in those with and without POP in cohort studies. The prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP are common but inconsistently reported. There are few data on incidence of associated symptoms with POP, and cohort studies evaluating causality are rare or inconsistent. Obstructive voiding, lower abdominal and pelvic pain, and sexual dysfunction are most frequently associated with POP.
Menopause, 2018
Objective: The Most Bothersome Symptom Approach (MBSA) assesses symptom severity of genitourinary... more Objective: The Most Bothersome Symptom Approach (MBSA) assesses symptom severity of genitourinary syndrome of menopause (GSM), and identifies the symptom with the greatest burden. The Atrophy Symptoms Questionnaire (ASQ) assesses the impact of GSM symptoms on the activities of daily living. The psychometric properties of these outcomes remain to be completely assessed. This study aimed to assess the test-retest reliability of the MBSA and the ASQ and their convergent validity. Method: One evaluator administered the outcomes twice 2 weeks apart to postmenopausal women with GSM and urinary incontinence. MBSA reliability was assessed with the graphical analysis of paired differences, Kappa coefficients and intraclass correlation coefficient (ICC), and the ASQ reliability, with paired t test and ICC. The convergent validity of both outcomes was investigated through their association with the Pearson correlation coefficient. Results: Thirty-one women participated in the study. For the MBSA, the severity of the most bothersome symptom obtained a good reliability with 80% observed agreement between sessions, a substantial kappa (0.67 AE 0.12) and excellent ICC (0.88 [95% confidence interval 0.75-0.94]). For the ASQ, no significant difference was found between sessions (P ¼ 0.146) and ICC indicated excellent reliability (0.85 [95% confidence interval 0.69-0.93]). There was a large, positive correlation between the severity of the most bothersome symptom selected by the participants in the MBSA and the ASQ total score for the two measurement sessions (T1: r ¼ 0.587, P ¼ 0.001 and T2: r ¼ 0.601, P < 0.001). Conclusions: The MBSA and the ASQ are reliable outcome measures in postmenopausal women with GSM and urinary incontinence. Our findings support good convergent validity of those two outcomes as they showed a significant positive correlation between the severity of GSM symptoms and their impact on activities of daily living.
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Papers by chantale dumoulin