التفاصيل البيبلوغرافية
| العنوان: |
経腟触診による骨盤底筋訓練の有用性―褥婦からの評価. (Japanese) |
| Alternate Title: |
The utility of teaching women pelvic floor muscle training with vaginal palpation: Evaluation by postpartum women. (English) |
| المؤلفون: |
池田真弓 |
| المصدر: |
Journal of Japan Academy of Midwifery; 2019, Vol. 33 Issue 2, p185-199, 15p |
| مصطلحات موضوعية: |
PSYCHOLOGY of puerperium, STATISTICAL correlation, EMOTIONS, MUSCLE contraction, MUSCLES, PALPATION, PELVIC floor, PUERPERIUM, VAGINA, KEGEL exercises |
| Abstract (English): |
Purpose The purpose of this study was to evaluate the utility of pelvic floor muscle training using vaginal palpation in postpartum period from the change of pelvic floor muscle contraction before and after teaching and the postpartum women's reactions. Methods 14 postpartum women who had vaginal deliveries in a maternity home and had a good postpartum progress participated in the study. Midwives implemented pelvic floor muscle training using vaginal palpation on women's fourth postpartum day. In order to evaluate the utility of teaching muscle contractions using vaginal palpation, the change of pelvic floor muscle contraction before and after teaching and the postpartum women's reactions were used as indices. Pelvic floor muscle contraction force was measured using the Oxford scale to quantify changes before and after teaching of pelvic floor muscle contraction. In addition, three observation indices evaluated: (1) movement of the vaginal and anal muscles; (2) presence or absence of substitute muscle contraction and (3) sensation of muscle contraction. Interview data from participants' reactions were analyzed qualitatively after practice as well as an anonymous questionnaire one month later. Results After the training, the majority of participants' weak pelvic floor muscle contractility disappeared, their use of substitute muscle contractions decreased and participants increased their understanding of the muscle contraction sensation. Five participants who did not understand how to contract the pelvic floor muscles before the training showed improvement on the Oxford scale after training. This change seemed to be due to increased awareness of contraction site and contraction sensation particularly through the midwives' use of vaginal palpation with pelvic floor muscle training. Pearson's correlation analysis indicated a strong significant correlation between Oxford scale score and the "movement of the vaginal and anal muscles", "substitute contraction", and "sensation of contraction"; these three variables proved to be a valid evaluation index of pelvic floor muscle contraction. Based on the interviews and an anonymous questionnaire, participants had no negative opinions on the pelvic floor muscle training using vaginal palpation. Two categories were extracted as evaluation from the postpartum women: Comprehension of pelvic floor muscle contraction, and Requirements for vaginal palpation. Comprehension of pelvic floor muscle contraction were supported by three subcategories: (1) understanding of the contraction site, (2) direct sensation of contraction, and (3) confirmation of correct muscle group contraction. Requirements for vaginal palpation were supported by three subcategories: (1) trust in providers of practice, (2) painless implementation and (3) consideration for shame. Conclusion Vaginal palpation was used as a teaching method for pelvic floor muscle training in the early postpartum period because it helped to confirm the contraction site, the direct sensation and the correct contraction. We suggest that vaginal palpation may have good utility for teaching postpartum women pelvic floor muscle training who have difficulty in understanding and feeling proper pelvic floor muscle contraction. [ABSTRACT FROM AUTHOR] |
| Abstract (Japanese): |
目 的 本研究の目的は，産褥期に経腟触診で指導する骨盤底筋訓練の有用性について，骨盤底筋収縮の指導 前後の変化と，褥婦の反応から評価することである。 方 法 助産所で分娩した経過の順調な褥婦14名を対象に，産褥4日目に助産師が経腟触診で骨盤底筋訓練を 指導した。この指導法の有用性を評価するために，骨盤底筋収縮の指導前後の変化と褥婦の反応を指標 とした。骨盤底筋収縮の指導前後の変化は，Oxford scaleを用いて骨盤底筋収縮力を測定した。併せて， 外陰部の動き・代替収縮の有無・収縮感覚の3つを観察した。褥婦の反応は，実施直後のインタ ビューと1か月後の無記名式質問紙による質的データを分析した。 結 果 骨盤底筋収縮力の弱い褥婦の多くは，指導後に代替収縮が消失し，指導前よりも収縮感覚がわかるよ うになった。骨盤底筋の動かし方がわからなかった5名は指導後にOxford scaleの改善がみられ，経腟触 診によって収縮部位や収縮感覚が理解できた為の変化と思われた。ピアソンの相関係数において，Oxford scaleと外陰部の動き・代替収縮・収縮感覚との間に強い正の相関がみられ，骨盤底筋収縮の評価指標に なることがわかった。インタビューと質問紙による記述からは否定的な意見はみられなかった。褥婦か らの評価として，【骨盤底筋収縮の体得】【経腟触診に対するニーズ】の2つのカテゴリが抽出された。 【骨盤底筋収縮の体得】では，〈収縮部位の理解〉〈収縮の実感〉〈自分ができているかの確認〉のサブカ テゴリが抽出され，【経腟触診に対するニーズ】では，〈実施者への信頼〉〈痛くない触診と羞恥心への配 慮〉のサブカテゴリが抽 出された。 結 論 産褥期に経腟触診で指導する骨盤底筋訓練は，収縮部位の理解・収縮の実感・自分が正しくできてい るかの確認ができ，有用な指導法である。特に骨盤底筋収縮のわかりにくい褥婦に有用であることが示 唆された。 [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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