Chapters authored
Efficacy of Physical Therapy in the Management of Reproductive Disorders
Several textbooks and anecdotal reports exist on the management of reproductive disorders by physical therapy (PHT). However, the recommendations from these sources are often not supported by recent empirical outcome evidence. Thus, there is a need for a comprehensive, up-to-date appraisal of the effectiveness of PHT in the management of reproductive disorders. An exhaustive review of the relevant articles published between 1988 and 2019 was undertaken on the primary electronic databases. The search produced 352 “hits,” but only 47 of them met the stated purpose of the review and subsequently classified into nine disease domains. The overwhelming majority (91%) of the 47 articles reviewed found the PHT modalities being investigated to be effective. The credibility of the work ranges from “poor” (for the case reports) to “strong” (for the meta-analysis). The pubococcygeus contraction exercise training (PCET), aka Kegel’s exercise, was the most studied modality, followed by aerobic exercise. Although substantial evidence suggests that PCET and transvaginal electrical stimulation are effective for reducing the symptoms of stress urinary incontinence (UI), the data on adjunctive techniques (EMG biofeedback, and vaginal cones) are less consistent. There is presently no reliable evidence to support the use of PCET in combination with EMG biofeedback and electrical stimulation to relieve overactive bladder and improve sexual function in men. The conflicting findings are because many of the published studies are heterogeneous in methodology with variant time frame follow-up; therefore, making firm conclusion difficult. There is a need for more randomized controlled trials (RCT) with adequate sample sizes and the use of sensitive, reproducible, and valid outcome measures. In conclusion, systematic reviews and meta-analyses are needed to bolster the rationale for recommending PHT in the management of chronic pelvic diseases in women. Similarly, RCT is required to support the recommendation for using PCET, electric stimulation, and EMG biofeedback to treat ejaculatory/orgasmic dysfunction, prostatitis, UI and erectile dysfunction in men. The information in this chapter will be useful to physical therapist students, frontline clinicians, and healthcare policymakers.
Part of the book: Physical Therapy Effectiveness