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Background Adequate neuromuscular control of the knee could be one element to prevent secondary injuries after an anterior cruciate ligament (ACL) injury. To assess neuromuscular control in terms of time, amplitude and activity, electromyography (EMG) is used. However, it is unclear which assessments using EMG could be used for a safe return to sports (RTS). Therefore, we aimed to summarize EMG-related assessments for neuromuscular control of the knee in adult patients after an ACL injury to decide upon readiness for RTS. Methods This systematic review followed guidelines of Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), SPORTDiscus and the Web of Science were searched from inception to March 2019 and updated in November 2020. Studies identifying electromyographic assessments for neuromuscular control during dynamic tasks in adult, physically active patients with an anterior cruciate ligament injury were eligible and qualitatively synthesized. Two independent reviewers used a modified Downs and Black checklist to assess risk of bias of included studies. Results From initially 1388 hits, 38 mainly cross-sectional, case-controlled studies were included for qualitative analysis. Most studies provided EMG outcomes of thigh muscles during jumping, running or squatting. Outcomes measures described neuromuscular control of the knee in domains of time, amplitude or activity. Risk of bias was medium to high due to an unclear description of participants and prior interventions, confounding factors and incompletely reported results. Conclusions Despite a wide range of EMG outcome measures for neuromuscular control, none was used to decide upon return to sports in these patients. Additional studies are needed to define readiness towards RTS by assessing neuromuscular control in adult ACL patients with EMG. Further research should aim at finding reliable and valid, EMG-related variables to be used as diagnostic tool for neuromuscular control. Moreover, future studies should aim at more homogenous groups including adequately matched healthy subjects, evaluate gender separately and use sport-specific tasks. Registration The protocol for this systematic review was indexed beforehand in the International Prospective Register of Systematic Reviews (PROSPERO) and registered as CRD42019122188.

Background High-impact activities are often related to urine leakage in women, so deeper insight into continence mechanisms of pelvic floor muscles (PFMs) while running is needed. Therefore, simultaneous information about the intensity of PFM muscle activity and fibre recruitment behavior at each time point of the gait cycle can help in understanding PFM activity patterns. Objective We aimed to analyse spectral changes of the pre- and post-initial contact phase during running at 3 different speeds and to compare women with stress urinary continence (SUI) to those without SUI by using a wavelet approach. Methods PFM electromyography (EMG) was recorded during 7, 11 and 15 km/h treadmill running and analysed with Morse wavelets. The relative distribution of power was extracted during 6 time intervals of 30 ms, from 30 ms before to 150 ms after initial contact. Results We included 28 women without SUI (mean [SD] age 38.9 [10.3] years) and 21 with SUI (mean age 46.1 [9.9] years). The groups did not differ in power spectra for each time interval. However, we found significantly less EMG intensity in the lower frequency bands but more intensity in the higher frequency bands in the pre-initial contact phase than at post-initial contact. Conclusion Morse wavelets could be used to extract differences between pre- and post-initial contact activation behavior of PFMs during different running speeds as well as spectral changes toward high or low frequencies. This information sheds light on specific differences in involuntary reflexive activation patterns while running. Muscular preparation and adaptation a few milliseconds before initial contact could be helpful.

Running is known to cause urinary leakage in women with stress urinary incontinence (SUI). Task-specific fiber-type recruitment while running can be estimated using wavelets. The aim of this study was to compare the effect of a new physiotherapy program including involuntary, reflexive training with a standard physiotherapy program on pelvic floor muscle (PFM) activation patterns and fiber-type recruitment behavior while running. In this triple-blinded randomized controlled trial, women with SUI were randomly allocated to the control group (CON), which performed a standard physiotherapy program, or the experimental group (EXP), which received additional involuntary, reflexive training. PFM electromyography (EMG) was recorded during 10 s at three running speeds and analyzed using Morse wavelets. The relative distribution of power (%) over the frequencies from 20 to 200 Hz was extracted and analyzed within six-time intervals of 30 ms. Statistical nonparametric mapping was performed to identify power spectra differences. Thirty-nine (CON) and 38 (EXP) women were included. The power spectra showed no statistically significant group differences. The time intervals from 30 ms before to 30 ms after initial contact showed significantly lower intensities than the intervals from 30 to 150 ms after initial contact in the lowest and higher intensities in the highest frequencies for all running speeds and both groups. Power spectra shifts toward higher frequency bands in the pre-initial contact phase could indicate a feed-forward anticipation and a muscle tuning for the expected impact of initial contact event in order to maintain continence.

AIMS The aim of this study was to identify the problems and resources of women with urinary or fecal incontinence based on the International Classification of Function and Health (ICF) framework and detecting the impact on the personal environment and quality of life. This study forms part of a project with an overall goal to enable standardized planning and evaluation of interventions in multi-professional settings. METHODS To answer the study question a mixed-method sequential design with a priority to the quantitative approach was considered appropriate. Regarding methods, focus groups were chosen to collect data. Transcripts were analyzed with content analysis and identified concepts linked to the corresponding ICF categories by two different raters. Cohen's kappa was calculated for interrater reliability. RESULTS Thirteen women with a mean age of 69.9 years were recruited. Four focus groups were conducted, whereas saturation was reached after two focus groups. Overall transcripts 99 defined ICF categories at second level could be linked (body functions = 31, body structures = 5, activities and participation = 33, and environmental factors = 30) whereas 4 categories were not sufficiently covered by the ICF (3 = personal factors, 1 = not covered). CONCLUSIONS This study has determined 103 resources and problems based on the ICF model of women with urinary and/or fecal incontinence. In spite of these results, it was shown that four concepts are not fully covered by the ICF framework. The current data highlight the importance of an extension of the ICF model, especially towards the personal factors of patients.

Objectives Electromyography (EMG) is a well-established method to quantify the relative pelvic floor muscle (PFM) activity. PFM EMG has shown good reliability in healthy women. However, its reliability has not been tested in women with PFM dysfunction. The reliability of EMG analysis methods concerning EMG normalization needs to be determined to assess specific therapeutic interventions. Therefore, the aim of this study was to investigate the intra-session reliability of PFM EMG variables by using 3 different analysis methods in women with PFM dysfunction. Methods EMG data analysis involved women who were healthy, had weak PFM and had stress urinary incontinence (SUI). We evaluated the reliability of EMG during rest and maximum voluntary contraction and compared muscle activity onset by visual determination and by calculation. All variables were checked for normality (Shapiro-Wilk). Descriptive statistics (mean, SD), systematic error within repeated measures (Wilcoxon) and reliability indexes were tested and presented descriptively (intraclass correlation coefficient [ICC], standard error of measurement [SEM], SEM%, minimal difference [MD], MD%). Results For 20 women who were healthy, 17 with weak PFM and 50 with SUI, ICC values were high for all variables (0.780–0.994), and SEM and MD values were relatively high (SEM%: 7.5–15.7; MD%: 21.0–43.8). Conclusion We need reliable methods to analyse clinical intervention studies. PFM EMG variables had high ICCs, but relatively high SEM and MD values modified the reliability. All EMG analysis methods were comparable in healthy women, but only the visual-onset determination was dependable in women with PFM dysfunction.

Purpose Surface electromyography (sEMG) using intravaginal probes is of widespread use for assessing pelvic floor muscles (PFM) activity in women. Although considered as a reliable method, its validity has been called into question due to the presence of a phenomenon called crosstalk. Crosstalk is described as the recording of sEMG activity originating from neighboring muscles rather than coming exclusively from the muscles being investigated. The purpose of this review was to provide an overview of existing literature about crosstalk during intravaginal surface electromyographic recordings. Methods A scoping review was performed according to the Arksey and O’Malley framework. An electronic search was conducted on six relevant databases. Additionally, authors were directly contacted to identify grey literature. Data extraction consisted of descriptive numeric analysis as well as thematic analysis, which were conducted by two independent reviewers. Results Forty-nine references written by 34 authors coming from 13 different countries constitute the body of evidence of the present review. Eight main themes have been identified through the thematic analysis. The included material varies greatly in terms of methodology, approach to the crosstalk problem and depth of analysis. Conclusions A gap in knowledge affecting the validity of the current sEMG investigation methods was identified. Literature addressing the crosstalk problem is scarce and often flawed. Definitive conclusions are regularly drawn from an insufficient basis of evidence. Further research is, therefore, deeply necessary, although it remains unclear whether this issue can be solved at all with current technology. Keywords Urinary incontinence Diagnosis Intravaginal probes Biofeedback Physical therapy Modalities

Introduction Two thirds of women suffering from stress urinary incontinence (SUI) reported a negative impact on quality of life (QoL). SUI can also lead to less physical activity and more comorbidities. SUI may result in a substantial economic burden on health care services but numbers are not clear. Therefore, the aim of this study was to estimate the health status, the comorbidities and the health costs of women with SUI living in the Canton of Bern (Switzerland). Methods This cost-of-illness (COI) study was embedded in an RCT (n = 96) exploring the effect of two pelvic floor muscle training protocols in women with SUI. A prevalence-based COI study with a societal perspective and a bottom-up approach was applied. Baseline demographics, comorbidities and cost data were collected prospectively during 16 weeks. Descriptive statistics, a frequency and a one-way sensitivity analysis were performed. Results Thirty-seven participants volunteered in this COI study. About 95 % had at least one comorbidity. The most commonly reported problem was back pain (47.6 %). Fifty-one percent consulted a medical doctor, the prevalence of drug consumption was 70 %, 11 % reported less efficiency whilst working and 30 % less physical activity. Mental stress was mentioned by 59.5 % of the participants. The average health costs were CHF 2256. Discussion This COI study provided data on health status, comorbidities, QoL, health care use, productivity losses and costs of SUI. The high prevalence of comorbidities observed in this study was comparable to obese females of a similar age group. The high economic burden of SUI requires cost-effective preventive actions and clinical treatment concepts.

Although tubists describe ailments, their causes have not yet been investigated. Therefore, the aim of this study was to use focus groups to assess the ergonomics of the tuba, musculoskeletal complaints of professional tubists, their preventive or rehabilitative coping strategies and the impact of the instrument on the musician.This study forms part of a project with an overall goal to measure and digitize the human-tuba system and uses a survey to record typical patterns of stress. To answer the study question it was considered appropriate to apply a phenomenological design with an idealistic perspective. Focus groups were chosen to collect data, whereas knowledge mapping technics were used to evaluate the focus groups. One woman and 11 men were recruited. Saturation was reached after three focus groups. From all of the transcripts 7 main categories and 7 subcategories could be extracted: Individual factors, performance as a goal (physical and emotional, mental performance), external factors (concert, social), instrument (influenceable factors, tuba construction, suggestions for improvement), physical aids, physical problems, coping strategies and other factors. Both the high impact of playing a tuba and the importance of finding solutions to adapt the tuba to the tubist could be shown.

The aim of this study was to identify the problems and resources of women with urinary or fecal incontinence based on the International Classification of Function and Health (ICF) framework and detecting the impact on the personal environment and quality of life. This study forms part of a project with an overall goal to enable standardized planning and evaluation of interventions in multi-professional settings.To answer the study question a mixed-method sequential design with a priority to the quantitative approach was considered appropriate. Regarding methods, focus groups were chosen to collect data. Transcripts were analyzed with content analysis and identified concepts linked to the corresponding ICF categories by two different raters. Cohen's kappa was calculated for interrater reliability.Thirteen women with a mean age of 69.9 years were recruited. Four focus groups were conducted, whereas saturation was reached after two focus groups. Overall transcripts 99 defined ICF categories at second level could be linked (body functions = 31, body structures = 5, activities and participation = 33, and environmental factors = 30) whereas 4 categories were not sufficiently covered by the ICF (3 = personal factors, 1 = not covered).This study has determined 103 resources and problems based on the ICF model of women with urinary and/or fecal incontinence. In spite of these results, it was shown that four concepts are not fully covered by the ICF framework. The current data highlight the importance of an extension of the ICF model, especially towards the personal factors of patients.

Introduction L’electromyographie de surface utilisant des sondes intra-vaginales est d’usage largement repandu pour evaluer l’activite des muscles du plancher pelvien chez la femme. Bien qu’elle soit consideree comme une methode fiable, sa validite a ete remise en question du fait de la presence d’un phenomene denomme diaphonie. La diaphonie est definie comme le fait d’enregistrer une activite electromyographique de surface provenant de muscles voisins plutot que celle provenant des muscles consideres. Le but de cette etude etait de recenser la litterature existante sur la diaphonie pendant les enregistrements electromyographiques de surface intra-vaginaux. Methode Une etude de portee a ete realisee selon le cadre de travail d’Arksey et O’Malley. Une recherche electronique a ete faite dans six bases de donnees : MEDLINE/Pubmed, EMBASE, CINAHL, PEDro, Cochrane et Google Scholar. De plus, les auteurs ont ete directement contactes pour identifier la documentation parallele ou « litterature grise ». L’extraction de donnees a consiste en une analyse numerique descriptive et en une analyse thematique ; elles ont ete realisees par deux evaluateurs independants. Resultats Quarante-neuf references ecrites par 34 auteurs venant de 13 pays constituent les elements de reference de cette recherche. L’analyse thematique a permis d’identifier 8 themes principaux. Les materiaux inclus varient fortement en termes de methodologie, d’approche du probleme de diaphonie et de profondeur d’analyse. Conclusions Une lacune affecte notre connaissance quant a la validite des methodes actuelles de recherche electromyographique de surface. La documentation traitant du probleme de diaphonie est rare et souvent sujette a caution. Des conclusions definitives sont regulierement tirees a partir de preuves insuffisantes. Signification De hauts niveaux de diaphonie jettent des doutes sur la validite des etudes experimentales qui mesurent l’efficacite des interventions sur le muscle du plancher pelvien. Des recherches complementaires sont necessaires, bien qu’il ne soit pas certain que la technologie actuelle permette de trancher ce probleme.

Introduction L’approche par ondelettes de l’electromyographie permet de fournir des informations de duree, de frequence et d’intensite simultanement. Ces informations sont necessaires pour une meilleure comprehension des schemas d’activite des muscles. Le but de cette etude etait de trouver des approches par ondelettes extraites des muscles des extremites inferieures pour explorer, dans des etudes ulterieures, le potentiel d’une approche par ondelettes pour l’analyse des schemas electromyographies des muscles du plancher pelvien d’une femme executant des activites qui impliquent des impacts dynamiques telles que la marche ou la course. Methode Cette revue systematique est mentionnee dans PROSPERO (CRD42016035986). La composition de la question a ete basee sur le modele PICO et la liste de verification PRISMA. Onze bases de donnees, proces-verbaux de congres et listes de reference ont ete examines jusqu’au 1er fevrier 2017. Les donnees suivantes ont ete extraites : Premier auteur, annee, caracteristiques du sujet, intervention, mesures et variables sur les resultats, resultats et specification « ondelettes ». Resultats Dix-huit etudes portaient sur l’electromyographie des muscles des extremites inferieures a l’aide d’ondelettes. Trois parametres ont ete analyses : (1) Le taux de reconnaissance varie de 68,4 % a 100 %. (2) Le rythme neuromusculaire est moins precisement controle en marchant qu’en courant. Les patientes presentent un pic d’activite retarde dans la phase initiale, mais une activation prolongee en posture mediane. (3) Les muscles atrophies ne contiennent pas de composants de fibres de frequence de type II, mais plus d’energie dans leurs frequences basses. Conclusions Les ondelettes derivees des extremites inferieures refletent les composants signaletiques lies aux activites de type I lent, aux fibres de type II rapides, au delai des muscles et aux caracteristiques de l’intensite. Une approche de type ondelettes serait un avantage substantiel pour analyser la nature non-stationnaire des signaux electromyographiques du muscle du plancher pelvien. Elle offrirait des informations valables sur le comportement du muscle, la pre-activation et l’activation reflexe a diverses vitesses de marche et de course ainsi que sur des modifications de spectre vers de hautes ou basses frequences a chaque point du cycle de la marche. Signification Une approche en ondelettes ferait la lumiere sur les differences specifiques des schemas d’activation du muscle du plancher pelvien. Cette connaissance permettrait d’optimiser les protocoles d’entrainement de readaptation de ce muscle. Par consequent, la physiotherapie, traitement de premiere ligne internationalement accepte, pourrait devenir plus efficace en relation avec le traitement de l’incontinence urinaire liee a l’effort. Par ailleurs, elle serait susceptible de distinguer entre femmes en bonne sante et femmes atteintes de troubles du plancher pelvien, ce qui offrirait un outil de diagnostic utile. Par consequent, l’analyse des ondelettes electromyographiques du muscle du plancher pelvien lors d’activites a impact devrait etre realisee dans de futurs projets.

Introduction L’entrainement des muscles du plancher pelvien est efficace et recommande comme traitement de premiere intention pour les femmes atteintes d’incontinence urinaire liee a l’effort. Cependant, l’entrainement habituel du muscle du plancher pelvien se concentre sur les contractions volontaires alors que les situations qui provoquent l’incontinence liee a l’effort necessitent des contractions reflexes involontaires des muscles du plancher pelvien. Jusqu’a present, la recherche sur la fonction du muscle du plancher pelvien s’est concentree sur l’action concentrique et isometrique du muscle menant a soulever et a serrer, mais aucune lumiere n’a ete faite sur la force involontaire reflexe. Or, ces procedures sont largement mises en œuvre en readaptation et en sport, mais pas encore dans la readaptation des muscles du plancher pelvien. Le but de cette etude etait de developper un protocole d’entrainement du muscle du plancher pelvien comprenant la physiotherapie standard et, en plus de cela, de se concentrer sur les contractions involontaires reflexes du muscle et de preparer un protocole d’etude randomisee controlee comparant cet entrainement (groupe experimental) avec l’entrainement standard du muscle du plancher pelvien (groupe de controle) pour controler les effets sur l’incontinence feminine liee a l’effort. Methode Le protocole d’entrainement suit la progression de l’entrainement des phases de l’apprentissage moteur, de la puissance, de l’hypertrophie et de la force-vitesse selon la variation des principes d’entrainement/periodisation, action musculaire, velocite de l’action musculaire, charge, volume, selection d’exercices, periodes de repos et frequence pour les deux groupes. L’intervention dure 16 semaines, avec 9 seances individuelles de physiotherapie et 78 seances d’entrainement court a la maison, suivies de 6 mois de seances a la maison uniquement. L’hypothese est une amelioration de l’incontinence mesuree par l’International Consultation on Incontinence Modular Questionnaire Urinary Incontinence short form et, comme resultat secondaire, une activite electromyographique superieure du muscle du plancher pelvien pendant les activites provoquant l’incontinence (courir, sauter), de meilleurs resultats au pad test, une meilleure qualite de vie et plus de force intravaginale du muscle du plancher pelvien (teste digitalement) dans le groupe experimental entre le debut et la fin de l’intervention. Il s’agit d’une etude randomisee controlee en triple aveugle, avec deux groupes d’intervention d’entrainement du muscle du plancher pelvien (48 personnes dans chaque groupe) et 6 mois de suivi. Resultats Le protocole d’etude randomisee controlee a ete enregistre ( NCT02318251 ) et a recu l’approbation du comite d’ethique (249/14) ; l’inclusion du premier participant a ete effectuee en mars 2015. Conclusions Cette etude comble une lacune car elle presente une nouvelle routine de traitement de l’incontinence urinaire liee a l’effort comprenant l’entrainement reflexe involontaire du muscle du plancher pelvien. Signification Les recommandations de bonne pratique actuelles pour le traitement de l’incontinence urinaire liee a l’effort ne contiennent pas d’entrainement reflexe involontaire du muscle du plancher pelvien. Par la suite, si ce nouveau protocole s’averait plus efficace que l’entrainement standard, il serait pertinent d’un point de vue clinique et pratique de le mettre en œuvre immediatement.