The postpartum period is a time when pelvic floor dysfunctions (PFD) are common. In fact, approximately 30% of women experience symptoms of urinary incontinence (UI), 10% experience anal incontinence (AI), and between 40-91% suffer from other dysfunctions such as pain, sexual dysfunctions, or pelvic organ prolapse (POP) (1).

Individualised specific training of the pelvic floor muscles (PFM) is the first option in the prevention and treatment of these PFD (2). However, due to the relationships that various studies have established between the PFM and the different muscle groups that make up the abdominopelvic cavity and other adjacent muscles related to the erect position, postural sensorimotor control methods are becoming an option of interest for physiotherapeutic treatments, as they are less invasive and allow for group sessions that could improve therapeutic adherence.

One of the most used is the unstable semi-concave oak wood surface 5P LOGSURF, based on sagittal alignment, axial self-elongation, and stability of the scapular and pelvic girdles (3). However, no studies have been found that demonstrate the effects of several sessions of this method in the prevention of PFD.
Therefore, the aim of this study is to evaluate the clinical impact of a 5P-LOGSURF intervention on the tone and strength of the PFM, PFD symptoms, sexual function, and health literacy on PFD in postpartum women.

This study is a quasi-experimental single-group pre-test-post-test design. 

Population:
The sample consisted of healthy primiparous women with eutocic delivery who were between 6-8 weeks postpartum.

Intervention:
The treatment was based on 8 individual sessions (1 weekly session of 45 minutes) of an exercise program with the 5P LOGSURF method, complemented by therapeutic education. This treatment was applied by 2 independent physiotherapists.

This method was developed on a semi-concave oak wood surface, with one concave (unstable) and one smooth (stable) support side. The method was composed of 3 phases in which the duration was progressively increased between the first and the eighth week: a static phase on the stable side (0-20 minutes), a second static phase on the unstable side (0-15 minutes), and a dynamic phase (5 minutes), also performed on the unstable side by performing shoulder flexion resisted by an elastic band. In all phases, the participants had to maintain the position on which the method is based.

During the in-person sessions, a physiotherapist supervised correct posture. After each face-to-face session, the participants followed the same pattern all week at home until the next session. 

Therapeutic education included as content: the anatomy and physiology of the pelvic floor, correct urination and defecatory habits, and individualised risk factors for the PFD and its different forms of prevention.

Outcomes:
Data collected during the basal assessment included demographics, pregnancy, childbirth, physical and occupational activity, medical history, and PFD symptoms. The tone of the pelvic floor muscles (dynamometry), the maximum strength of the pelvic floor muscles (dynamometry and Modified Oxford scale), the presence of PFD symptoms (Pelvic Floor Distress Inventory short form, PFDI-20), the impact of these symptoms (Pelvic Floor Impact Questionnaire, PFIQ), female sexual health (Female Sexual Function Index) and knowledge about UI and POP (Prolapse and Incontinence Knowledge Questionnaire, PIKQ) were assessed before and after the intervention.

Data analysis:
Descriptive statistics were obtained for demographics and clinical data. T-test, and Wilcoxon signed-rank test were used to compare pre-post clinical data. The p-value threshold was 0,05.

33 primiparous postpartum women were recruited for this study. The mean age was 33.37 years (SD: 5.51), the median BMI was 24.97 (IQR: 28.67-22.10) kg/m2, and the mean baby weight was 3.17 kg (IQR: 3.4-3). 51.52% of the women were engaged in low-impact physical exercise, and 30.3% of the women were engaged in high-impact physical exercise. 57.58% of the sample claimed to be constipated. Regarding PFD symptoms, 18.18% reported having experienced them during pregnancy, and 18.18% reported their presence after childbirth (15.5% Stress UI, 3.03% urgency UI, 6.06 % mixed UI, 6.06% AI), but none presented a medical diagnosis of PFD. 

Seven women left the study after their initial assessment. 26 women completed the physical assessment after the intervention, but only 19 completed all self-reported questionnaires. The results are presented according to these considerations. 
In the physical assessment, both the basal tone (236.04 to 240.88 g, dynamometry) and the maximum strength of the PFM (333.33 to 564.50 g, dynamometry; 3 to 4 points, Modified Oxford Scale) increased after the intervention, but the change was only significant for maximum force. 

Regarding the results of the self-reported questionnaires, both PFD symptoms (17.71 to 11.46 points, PFDI-20) and sexual function (6.2 to 30.7 points, FSFI) improved significantly, although the improvement in the impact of these symptoms (0 to 0 points, PFIQ) was not significant. The change in sexual function was also above the threshold for minimal clinically important difference. Finally, the participants' knowledge of incontinence and prolapse (14.58 to 18.53 points, PIKQ) improved significantly.

To our knowledge, this is the first study to investigate the effect of an 8-session protocol of postural sensorimotor control through the 5P LOGSURF method in postpartum women.

Of the 33 participants initially assessed, only 26 completed the intervention, which represents 21.21% dropouts. This figure indicates that short-term therapeutic adherence to this treatment was low.

We found an improvement in all the outcome assessed, which was significant for all measures, except for baseline tone (dynamometry) and the impact of PFD symptoms (PFIQ-7). Furthermore, the improvement in female sexual function (FSFI) exceeded the threshold for minimal clinically important difference (MCID). However, the improvement of PFD symptoms (PFDI-20) and the impact of these symptoms (PFIQ-7) did not reach this difference. For the rest of the study variables, the MCID has not yet been established.

These results suggest that individualised sessions of the 5P LOGSURF method may be a useful alternative to train PFM in postpartum women, with the consequent effect on the prevention and/or treatment of PFD. Therefore, it would be interesting for future research studies to compare this intervention with the current gold standard (Individualised specific training of the PFM), also considering adherence to both treatments in the short and long term.

A protocol of 8 individualised 5P-LOGSURF sessions may be helpful in improving tone, strength, PDF symptoms, sexual function, and PFD health literacy in postpartum women. Therefore, this may be a useful intervention in the prevention and treatment of PFD in the postpartum period. However, randomised controlled trials and larger sample sizes are needed to validate these findings.

Sigurdardottir T, Steingrimsdottir T, Geirsson RT, Halldorsson TI, Aspelund T, Bø K. Can postpartum pelvic floor muscle training reduce urinary and anal incontinence?: An assessor-blinded randomized controlled trial. Am J Obstet Gynecol. 2020 Mar;222(3):247.e1-247.e8. doi: 10.1016/j.ajog.2019.09.011. Epub 2019 Sep 14.
Villa del Pino I, Chillón Martínez R. La adherencia al entrenamiento muscular del suelo pélvico en las mujeres con incontinencia urinaria. Revisión sistemática de la literatura. Fisioterapia 2019;41(4):227-236.
Fuentes-Aparicio L, Arranz-Martín B, Navarro-Brazález B, Bailón-Cerezo J, Sánchez-Sánchez B, Torres-Lacomba M. Postural sensorimotor control on anorectal pressures and pelvic floor muscle tone and strength: effects of a single 5P®LOGSURF session. A cross-sectional preliminary study. Int J Environ Res Public Health. 2021;18(7):3708

Continence 12S (2024) 101388
DOI: 10.1016/j.cont.2024.101388