Author Names
Deodato, M., Grosso, G., Drago, A., Martini, M., Dudine, E., Murena, L., & Buoite Stella, A.
Reviewer Name
Roxanne Ruther, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Physical Therapy Division
Paper Abstract
Background: Primary dysmenorrhea represents one of the most common causes of pelvic and low back pain. Pharmacological treatment can present some side effects, and non-pharmacological treatments should be considered to improve the symptoms of primary dysmenorrhea. The aim of this study was to evaluate the efficacy of manual therapy (MT), pelvic floor exercises (PFE), and their combination (MT + PFE) to improve clinical outcomes and pain sensitivity in women with primary dysmenorrhea. Methods: A prospective observational study was conducted. Thirty females (age 25.0 ± 6.1 y) with history of primary dysmenorrhea participated to 8 sessions of 60 min of either MT, PFE or MT + PFE, twice per week. They participated to the different treatments according to the different services offered by the school of physiotherapy. A 0–10 numeric rating scale (NRS) was administered to assess subjective pain, while short-form 36 (SF-36) was used to evaluate quality of life. The pressure pain threshold (PPT) was assessed with a portable algometer on different pelvic and lumbar areas. Results: Independently from the treatment, significant improvements were reported for general pain NRS (p < 0.001; pη2 = 0.511), as well as most the domains of the SF-36, although the general health domain did not reach statistical significance (p = 0.613; pη2 = 0.010). PPT revealed a general improvement in all tested body areas, although on the quadratus lumborum, the PFE treatment did not induce a significant improvement compared to the MT and MT + PFE protocols (p = 0.039). Conclusions: These findings highlight the importance of proposing physiotherapy treatments to females with primary dysmenorrhea to improve symptoms, with manual therapy combined with active pelvic floor exercise providing the best outcomes including an improvement of lumbar pain thresholds.
NIH Risk of Bias Tool
Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies
- Was the research question or objective in this paper clearly stated?
- Yes
- Was the study population clearly specified and defined?
- Yes
- Was the participation rate of eligible persons at least 50%?
- Yes
- Were all the subjects selected or recruited from the same or similar populations (including the same time period)? Were inclusion and exclusion criteria for being in the study prespecified and applied uniformly to all participants?
- Yes
- Was a sample size justification, power description, or variance and effect estimates provided?
- Cannot Determine, Not Reported, Not Applicable
- For the analyses in this paper, were the exposure(s) of interest measured prior to the outcome(s) being measured?
- Yes
- Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed?
- Yes
- For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as continuous variable)?
- No
- Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
- Yes
- Was the exposure(s) assessed more than once over time?
- Yes
- Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
- Yes
- Were the outcome assessors blinded to the exposure status of participants?
- Yes
- Was loss to follow-up after baseline 20% or less?
- Yes
- Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)?
- Yes
Key Finding #1
According to an analysis of subjective rating of pain, improvements in pelvic, lumbar and general pain were unanimous for all three treatment groups, pelvic floor exercises, manual therapy and combination of both.
Key Finding #2
Use of the pain pressure threshold revealed that pelvic floor exercises were less effective than the other treatment groups in reducing pain threshold in lumbar muscles.
Key Finding #3
The largest magnitude of change in symptoms was indicated in the combination treatment group, despite the treatment time split evenly between manual therapy and pelvic floor exercises.
Please provide your summary of the paper
Women with a history of primary dysmenorrhea were randomly assigned to pelvic floor exercise, manual therapy and combination treatment groups. Treatment was provided twice a week for four weeks. Manual therapy treatment included diaphragm mobilization, myofascial release on the internal side of the ischial tuberosities, and post-isometric release exercise with tender point therapy of TFL, piriformis, and lumbar paravertebrals. Exercise was focused on improving proprioception and isolated control of the pelvic floor, as well as improving respiratory muscle control. Pain and quality of life were evaluated using the numeric rating scale and SF-36, in combination with the pain pressure threshold for pelvic and lumbar areas. Pelvic floor exercises and manual therapy treatment significantly improve symptoms of pain and quality of life. Every treatment group demonstrated reduction of pain in overall rating, as well as pelvic and lumbar regions. The combination of both treatment techniques contributes to the best outcomes in the reduction of lumbar pain.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
The use of pelvic floor exercise and manual therapy is relevant to the treatment of lumbar and pelvic pain resulting from primary dysmenorrhea. Both manual therapy techniques and pelvic floor exercise should be utilized to target the lumbopelvic region and respiratory musculature. A multi-faceted approach to pelvic and lumbar pain is most effective in reduction of symptoms and patient perception of pain. Because the duration was four weeks, additional data are required to draw conclusions about long-term improvements for women with primary dysmenorrhea.
