ELIZABETH ALVES GONCALVES FERREIRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - Docente
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
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- Comparison of transcutaneous electrical tibial nerve stimulation for the treatment of overactive bladder: a multi-arm randomized controlled trial with blinded assessment(2021) PIERRE, Munick Linhares; FRISO, Beatriz; CASAROTTO, Raquel Aparecida; HADDAD, Jorge Milhem; BARACAT, Edmund Chada; GONC, Elizabeth AlvesOBJECTIVE: To compare the effectiveness of tibial nerve transcutaneous electrical nerve stimulation (TENS) for an overactive bladder, considering the sites of application and frequency of attendance. METHODS: This multi-arm randomized controlled trial enrolled 137 adult women (61.0 +/- 9.0 years) with overactive bladder from a university hospital. They underwent 12 sessions of 30-min TENS application and were assigned to five groups: one leg, once a week (n=26); one leg, twice a week (n=27); two legs, once a week (n=26); two legs, twice a week (n=28); and placebo (n=30). Symptoms of overactive bladder and its impact on quality of life were evaluated before and after 6 or 12 weeks of treatment using the Overactive Bladder Questionnaire-V8 and voiding diary. ClinicalTrials.gov: NCT01912885. RESULTS: The use of one leg, once a week TENS application reduced the frequency of urgency episodes compared with the placebo (1.0 +/- 1.6 vs. 1.4 +/- 1.9; p=0.046) and frequency of incontinence episodes compared with the placebo (0.7 +/- 1.4 vs.1.4 +/- 2.2; p<0.0001). The one-leg, twice a week protocol decreased the urinary frequency compared with the two legs, once a week protocol (8.2 +/- 3.5 vs. 9.0 +/- 5.1; p=0.026) and placebo (8.2 +/- 3.5 vs. 7.9 +/- 2.7; p=0.02). Nocturia improved using the two legs, once a week protocol (1.5 +/- 1.8) when compared with the one leg, twice a week protocol (1.9 +/- 2.0) and placebo (1.7 +/- 1.6) (p=0.005 and p=0.027, respectively). Nocturia also improved using the two legs, twice a week protocol when compared with the one leg, twice a week protocol (1.3 +/- 1.2 vs.1.9 +/- 2.0; p=0.011). CONCLUSION: One-leg stimulation improved the daily urinary frequency, urgency, and incontinence, and the two-leg stimulation once and twice weekly improved nocturia.
- A guide to physiotherapy in urogynecology for patient care during the COVID-19 pandemic(2021) FERREIRA, Cristine Homsi Jorge; DRIUSSO, Patricia; HADDAD, Jorge Milhem; PEREIRA, Simone Botelho; FERNANDES, Ana Carolina Nociti Lopes; PORTO, Debora; REIS, Bianca Manzan; MASCARENHAS, Lilian Rose; BRITO, Luiz Gustavo Oliveira; FERREIRA, Elizabeth Alves GoncalvesIntroduction and aim Physiotherapy in urogynecology faces challenges to safely continuing its work, considering the adoption of social distancing measures during the COVID-19 pandemic. Some guidelines have already been published for urogynecology; however, no specific documents have been produced on physiotherapy in urogynecology. This article aimed to offer guidance regarding physiotherapy in urogynecology during the COVID-19 pandemic. Methods A group of experts in physiotherapy in women's health performed a literature search in the Pubmed, PEDro, Web of Science and Embase databases and proposed a clinical guideline for physiotherapy management of urogynecological disorders during the COVID-19 pandemic. This document was reviewed by other physiotherapists and a multidisciplinary panel, which analyzed the suggested topics and reached consensus. The recommendations were grouped according to their similarities and allocated into categories. Results Four categories of recommendations (ethics and regulation issues, assessment of pelvic floor muscle function and dysfunction, health education and return to in-person care) were proposed. Telephysiotherapy and situations that need in-person care were also discussed. Regionalization is another topic that was considered. Conclusion This study provides some guidance for continuity of the physiotherapist's work in urogynecology during the COVID-19 pandemic, considering the World Health Organization recommendations and the epidemiological public health situation of each region. Telephysiotherapy can also be used to provide continuity of the care in this area during the COVID-19 pandemic, opening new perspectives for physiotherapy in urogynecology.
- Lower urinary tract symptoms and perineal function in women with and without fibromyalgia: a cross-sectional study(2019) FUSCO, Hellen Cristina Souza de Carvalho; PONTES FILHO, Marco Antonio Goncalves; HADDAD, Jorge Milhem; ZANETTI, Miriam Raquel Diniz; MARQUES, Amelia Pasqual; FERREIRA, Elizabeth Alves GoncalvesIntroduction and hypothesis Fibromyalgia (FM) studies have focused on pain, but a 2010 review of the diagnostic criteria pointed to other symptoms including urinary incontinence (UI). Women with FM present pain, fatigue, and reduced muscle strength; the research hypothesis was that pelvic floor (PF) muscles would be weaker; therefore, FM could be associated with lower urinary tract symptoms (LUTS) and compromise quality of life (QoL). The aim of this paper was to compare PF function, urinary symptoms, and their impact on QoL in women with and without FM and to verify if there is association between FM and LUTS. Methods We performed a cross-sectional study with 126 sexually active women aged between 19 and 65 years old, distributed in two groups, women with FM (FG n = 62) and without FM (NFG n = 64). Perineal function was the primary outcome and was assessed by perineometry and bidigital vaginal palpation (PERFECT Scheme). Presence of LUTS was assessed by interview based on international definition, and the impact of UI on QoL was evaluated by the King's Health Questionnaire (KHQ). Results FG presented worse PF function on clinical exam (p < 0.001) and perineometry (p = 0.04). LUTS was more frequent among FG (p < 0.001). In terms of QoL, FG obtained lower KHQ scores for general health perception (p < 0.001) and sleep/energy (p < 0.003) domains. The odds of presenting LUTS is 5.03 (95%CI 2.35-10.75) higher in women with FM. Conclusion Women with FM had worse perineal function, had more LUTS, and presented UI more frequently, which negatively impacts on QoL.
- Content and functionality features of voiding diary applications for mobile devices in Brazil: a descriptive analysis(2020) VACCARI, Natalie Alves; SILVEIRA, Leda Tomiko Yamada da; BORTOLINI, Maria Augusta Tezelli; HADDAD, Jorge Milhem; BARACAT, Edmund Chada; FERREIRA, Elizabeth Alves GoncalvesIntroduction and hypothesis A voiding diary is a method to investigate lower urinary tract symptoms. The purpose was to elaborate a descriptive analysis of nonpaid voiding diaries for mobile applications and to compare them regarding their quality. Methods We searched the platforms of iTunes (Apple Inc., Brazil) and Google Play (Google Inc., Brazil) using the keywords: ""voiding diary,"" ""bladder diary,"" ""urinary diary,"" ""urinary incontinence,"" and ""pelvic floor."" Inclusion criteria were: apps free of charge and specific for voiding diaries in the Portuguese, Spanish, French, or English language. Exclusion criteria were: access or technical problems and pediatric apps. We quantitatively analyzed and compared the apps with each other according to their functionality features and voiding diary topics (type and volume of fluid intake, voiding episodes and volume, type and episodes of incontinence, amount of leakage, urgency, and use of pads and nocturia). We rated the apps using the Mobile App Rating Scale (MARS), whose scores for each feature vary from 1 (worst score) to 5 (best score). Results Fifty-five apps were eligible; 16 were included for analyses. None presented all 11 topics of the voiding diary, and the median number of available features was 6 (3.75-7). ""Incontinence episodes"" was present in eight apps, and ""nocturia"" was present in five. The mean score of apps ranged between 1.7 and 4.5. Conclusion There is variation in the content of voiding topics among the apps. Patients and professionals should choose the app based on the topics of most or particular interest.
- A randomized trial comparing vaginal laser therapy and pelvic floor physical therapy for treating women with stress urinary incontinence(2023) FONSECA, Lucilia C. da; GIARRETA, Fernanda Bacchi Ambrosano; PETERSON, Thais V.; LOCALI, Priscila Katsumi Matsuoka; BARACAT, Edmund C.; FERREIRA, Elizabeth A. Goncalves; HADDAD, Jorge MilhemIntroductionFemale stress urinary incontinence (SUI) is considered a major public health issue. Physical therapy is an important conservative treatment; however, it is primarily limited by poor long-term compliance. Furthermore, surgical treatment entails significant risks. Therefore, new treatment techniques must be identified. ObjectiveTo compare the use of laser therapy and pelvic floor (PF) physical therapy for treating postmenopausal women with SUI. MethodsThis pilot study enrolled 40 women with a clinical and urodynamic diagnosis of SUI who were randomized into two groups: those who received erbium-doped yttrium-aluminum-garnet (Er:YAG) laser therapy implemented over three sessions with a 1-month interval (n = 20) and those who received physical therapy with supervision twice a week for 3 months (n = 20). In total, 16 women completed the treatment in each group. The patients were assessed for PF function using the modified Oxford scale and for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System. The 1-h pad test and quality of life questionnaires, King's Health Questionnaire (KHQ), and Incontinence Quality of Life (IQOL) were also administered. Patients were re-evaluated at 1, 3, 6, and 12 months after treatment. ResultsThe mean patient age was 62.7 & PLUSMN; 9.1 and 57.9 & PLUSMN; 6.1 years, median Oxford score at baseline was 3 (2-4.5) and 4 (3-4), mean IQOL score was 79.8 & PLUSMN; 17 and 74.6 & PLUSMN; 18 for physical therapy group (PTG) and laser group (LG), respectively. For the amount of urine leak in the 1-h pad test evaluation, we found significance for the interaction of group and time points only for the Laser intragroup. The cure rate, that is, the rate of reaching an insignificant score in the pad test, at 6 and 12 months was 43.75% and 50% in PTG and 62.5% and 56.25% in the LG, respectively (p > 0.05). IQOL scores demonstrated considerable improvement in both groups (p > 0.05). Upon comparing the initial and follow-up results, the LG showed an improvement at all consultations, whereas the PTG showed improvements at 1, 3, and 6 months but not at 12 months after treatment. KHQ analysis revealed a considerable improvement in the quality of life (QOL) of patients over time, with no substantial difference between the groups. QOL comparison before and after treatment revealed that the vaginal LG improved more consistently in some domains. Only the PTG showed a significant increase in the mean Oxford score from pretreatment to 1 and 3 months after treatment (p < 0.001 and p = 0.002, respectively). However, no statistically significant difference was observed between the groups. ConclusionBoth treatments are safe and have a positive influence on the impact of UI on patients' QOL. The laser caused a greater reduction in the urinary loss, as measured using the weight of pad test, at 6-month and 12-month after treatment without difference with PTG at the end of the follow-up.