Laboratory Projects
1. Group-based vs individual pelvic floor physiotherapy to treat urinary incontinence in women over age 60
Investigator: Chantale Dumoulin, PhD
Collaborators: Mélanie Morin, PhD, Marie-Hélène Mayrand, MD, Michel Tousignant, PhD, Michael Abrahamowicz, PhD
Results: In this noninferiority randomized clinical trial of 362 older women with urinary incontinence, the median percentage reduction in incontinence episodes after one year was 70% for participants undergoing individual pelvic floor muscle physiotherapy (PFMT) compared to 74% for those in the group-based intervention. The difference between groups fell below the noninferiority margin of 10%, supporting noninferiority of group-based PFMT. Widespread use in clinical practice could increase urinary incontinence treatment capacity for older women.
Publications:
Dumoulin, C., Morin, M., Mayrand, M.-H., Tousignant, M., & Abrahamowicz, M. (2017). Group physiotherapy compared to individual physiotherapy to treat urinary incontinence in aging women: study protocol for a randomized controlled trial. Trials, 18(1), 544. doi:10.1186/s13063-017-2261-4.
Dumoulin, C., M. Morin, C. Danieli, L. Cacciari, M.-H. Mayrand, M. Tousignant, M. Abrahamowicz, U. Incontinence and A. S. Group (2020). Group-Based vs Individual Pelvic Floor Muscle Training to Treat Urinary Incontinence in Older Women: A Randomized Clinical Trial. JAMA Internal Medicine 180(10): 1284-1293.)
Cacciari L, Morin M, Mayrand M, Tousignant M, Abrahamovick M, Dumoulin C. (2021) Pelvic floor morphometrical and functional changes immediately after pelvic floor muscle training and at 1‐year follow‐up, in older incontinent women. Neurourology and Urodynamics. 2021 Jan;40(1):245-255.
Cacciari L, Kouakou C, Poder T, Vale L, Morin M, Mayrand M, Tousignant M, Dumoulin C. (2022) Group-based pelvic floor muscle training is a more cost-effective approach to treat urinary incontinence in older women : economic analysis of a randomised trial. J of Physiotherapy, 2022 June 23 :1-7.
2. Impact of a pelvic floor muscle training program on symptoms of genitourinary syndrome of menopause in postmenopausal women
Investigators: Joanie Mercier, PhD candidate, Chantale Dumoulin, PhD and Mélanie Morin, PhD
Collaborators: Barbara Rechezter, MD, Dina Zaki, MD, Marie-Claude Lemieux, MD, An Tang, MD, Samir Khalifé, MD
Results: Thirty-two women participated in this cohort study. The study completion rate was high (91%), as was participation in treatment sessions (96%) and in-home exercises (95%). Post-intervention, there were significant reductions in the signs and symptoms of genitourinary syndrome of menopause, as well as on impacts on activities of daily living, quality of life and sexual function. Our findings suggest that pelvic floor muscle training improves blood flow in vulvovaginal tissues, the relaxation capacity of the pelvic floor muscles, and vulvovaginal tissue elasticity in postmenopausal women with genitourinary syndrome of menopause. A randomized clinical trial is necessary.
Publications:
Mercier, J., Morin, M., Lemieux, M.-C., Reichetzer, B., Khalifé, S., & Dumoulin, C. (2016). Pelvic floor muscle training to reduce symptoms and signs of vulvovaginal atrophy: a case study. Menopause (New York, NY).
Mercier, J., Tang, A., Morin, M., Lemieux, M.-C., Khalifé, S., Reichetzer, B., & Dumoulin, C. (2018). Test–retest reliability of internal pudendal artery blood flow using color Doppler ultrasound in healthy women. International Urogynecology Journal, 29(12), 1817-1824.
Mercier, J., Tang, A., Morin, M., Khalifé, S., Lemieux, M. C., Reichetzer, B., & Dumoulin, C. (2018). Test‐retest reliability of clitoral blood flow measurements using color Doppler ultrasonography at rest and after a pelvic floor contraction task in healthy adult women. Neurourology and urodynamics, 37(7), 2249-2256.
Mercier, J., Morin, M., Reichetzer, B., Lemieux, M.-C., Khalifé, S., & Dumoulin, C. (2018). Genitourinary syndrome of menopause symptom severity and impact outcome measures: are they reliable and correlated? Menopause, 26(6), 659-664.
Mercier, J., Morin, M., Zaki, D., Reichetzer, B., Lemieux, M.-C., Khalifé, S., & Dumoulin, C. (2019). Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause: a single-arm feasibility study. Maturitas, 125, 57-62.
Mercier J, Tang A, Morin M, Lemieux M-C, Khalifé S, Reichetzer B, Dumoulin C (2020). Impact d’un programme d’exercices des muscles du plancher pelvien sur la vascularisation pelvi-périnéale de femmes avec syndrome génito-urinaire de la ménopause. Revue Physio-Québec, automne 2019-hiver 2020; 46(2):28-31
Mercier, J., Morin, M., Tang, A., Reichetzer, B., Lemieux, M. C., Samir, K., ... & Dumoulin, C. (2020). Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause. Climacteric, Oct;23(5):468-473.
Mercier J, Dumoulin C, Carrier-Noreau G. (2023) Pelvic floor muscle rehabilitation for genitourinary syndrome of menopause: why, how and when? Climateric. Apr 5;1-7. doi: 10.1080/13697137.2023.2194527
3. The effects of a strong desire to void on gait in incontinent and continent older community‐dwelling women at risk of falls
Investigators: Marie‐Hélène Paquin, Master’s student, Chantale Dumoulin, PhD, Cyril Duclos, PhD
Collaborators: Nolween Lapierre, PhD, Lucie Dubreucq, MSc, Melanie Morin, PhD, Jean Meunier, PhD, Jacqueline Rousseau, PhD
Results: This quasi-experimental pilot study included 32 older women who experienced falls (incontinent : n=15; continent: n=17). Strong desire to void reduced gait velocity and stride width regardless of continence status in older women at risk of falls. Furthermore, urinary incontinence severity in incontinent women was correlated to reduced gait velocity and increased variability. Our findings could explain the higher fall rate in this population.
Publications:
Lapierre N, Meunier J, Filiatrault J, St-Arnaud A, Paquin M-H, Duclos C, Dubreucq L, Moffet H, Morin M, Milot M-H, Dumoulin C, Rousseau J. (2016). A methodology of implementing a videomonitoring system in community-dwelling elderly. Gerontechnology, 15(0): 87-87.
Lapierre N, Meunier J, St-Arnaud A, Filiatrault J, Paquin MH, Duclos C, Dumoulin C, Rousseau J. (2018). Older women’s perceptions of a programmable video monitoring system at home: a pilot study. Gerontechnology Journal, 17(4): 245-254.
Paquin, M. H., Duclos, C., Lapierre, N., Dubreucq, L., Morin, M., Meunier, J., . . . Dumoulin, C. (2019). The effects of a strong desire to void on gait for incontinent and continent older community‐dwelling women at risk of falls. Neurourology and Urodynamics. Feb;39(2):642-649
Paquin MH, Duclos C, Dubreucq L, Lapierre N, Rousseau J, Meunier J, Filiatrault J, Morin M, Dumoulin, C. (2021) L’effet d’une envie pressante d’uriner sur les paramètres de marche des femmes âgées ayant des antécédents de chute, qu’elles soient continentes ou incontinentes. Physio-Québec, November 2021.
4. Characteristics of lower limb muscle strength, balance, mobility and function in older women with urge and mixed urinary incontinence: an observational pilot study
Investigators: Mélanie Le Berre, Master’s student, Chantale Dumoulin, PhD
Results: The results from this pilot study including 40 older women suggest that high-functioning older women with urge or mixed urinary incontinence have balance and mobility impairments. More studies are needed to confirm these results. By reporting power calculations for sample size, this pilot study provides a useful foundation for the design and administration of larger studies.
Publications:
Le Berre M, Dumoulin C. (2019). Characteristics of Lower Limb Muscle Strength, Balance, Mobility, and Function in Older Women with Urge and Mixed Urinary Incontinence: An Observational Pilot Study. Physiotherapy Canada, 2019 summer;71(3):250-260.
Le Berre M, Dumoulin C. (2020) Force, équilibre, mobilité et fonction des femmes âgées avec incontinence urinaire: une revue de littérature. Kinésithérapie, la revue, Oct;20(226): 3-20.
Le Berre M, Morin M, Corriveau H, Hamel M, Dupuis K, Filiatrault J, Lefebvre I, Nadeau S, Dumoulin C. (2020) Force musculaire des membres inférieurs, équilibre, locomotion et fonction des femmes âgées avec incontinence urinaire d’urgence ou mixte et des femmes âgées sans incontinence. In Press in Physio-Québec.
5. Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence: a feasibility study
Investigators: Valérie Elliott, Master’s student, Chantale Dumoulin, PhD, Eling D. de Bruin, PhD
Results: Twenty-four women participated in this feasibility study. 91% of participants attended the weekly treatment sessions, 92% adhered to home exercise and 96% completed the three evaluations. Post-intervention, the frequency and quantity of urine leakage decreased and patient-reported symptoms and quality of life improved significantly. Most participants (91%) were very satisfied with treatment .
Publications:
Lussier M, Renaud M, Chiva-Razavi S, Bherer L, Dumoulin C. (2013) Are stress and mixed urinary incontinence associated with impaired executive control in community-dwelling older women? Journal of Clinical and Experimental Neuropsychology, 35(5): 445-454.
Fraser, S. A., Elliott, V., de Bruin, E. D., Bherer, L., & Dumoulin, C. (2014). The effects of combining videogame dancing and pelvic floor training to improve dual-task gait and cognition in women with mixed-urinary incontinence. Games for health Journal 3(3), 172-178.
Elliott, V., de Bruin, E. D., & Dumoulin, C. (2015). Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence: a feasibility study. Neurourology and Urodynamics, 34(3), 236-243.
6. Effects of pelvic floor muscle rehabilitation on pelvic floor muscle function and morphology in older women
Investigators: Chantale Dumoulin, PhD, Stephanie Madill, PhD, Stéphanie Pontbriand-Drolet, MSC, An Tang, MD
Results: Older women with symptoms of stress or mixed urinary incontinence presented different morphological defects at rest during magnetic resonance imaging compared to continent older women. After a pelvic floor muscle training (PFMT) program, fewer urine leakage episodes occurred along with improvements in pelvic floor muscle coordination, motor control and pelvic organ support. Finally, results showed that a urethro-vesical junction height of at least 11.4 mm at rest appears to be predictive of a response to PFMT in older women with urinary incontinence.
Publications :
Madill, S., Tang, A., Pontbriand‐Drolet, S., & Dumoulin, C. (2011). Comparison of two methods for measuring the pubococcygeal line from sagittal‐plane magnetic resonance imaging. Neurourology and Urodynamics, 30(8), 1613-1619.
Madill, S. J., Pontbriand‐Drolet, S., Tang, A., & Dumoulin, C. (2013). Effects of PFM rehabilitation on PFM function and morphology in older women. Neurourology and Urodynamics, 32(8), 1086-1095.
Madill, S. J., Pontbriand-Drolet, S., Tang, A., & Dumoulin, C. (2015). Changes in urethral sphincter size following rehabilitation in older women with stress urinary incontinence. International Urogynecology Journal, 26(2), 277-283.
Pontbriand‐Drolet, S., Tang, A., Madill, S. J., Tannenbaum, C., Lemieux, M. C., Corcos, J., & Dumoulin, C. (2016). Differences in pelvic floor morphology between continent, stress urinary incontinent, and mixed urinary incontinent elderly women: An MRI study. Neurourology and Urodynamics, 35(4), 515-521.
Dumoulin, C., Tang, A., Pontbriand-Drolet, S., Madill, S. J., & Morin, M. (2017). Pelvic floor morphometry: a predictor of success of pelvic floor muscle training for women with stress and mixed urinary incontinence. International Urogynecology Journal, 28(8), 1233-1239.
7. Transperineal ultrasound to study pelvic floor morphometry and pelvic floor trauma in women with and without urinary incontinence
Investigators: Jenny Kruger, Postdoctoral Fellow, Chantale Dumoulin, PhD
Results: Using 3D/4D TPU imaging, we found that adding the parameter "width between insertion sites" during digital evaluation to detect the presence of levator ani muscle avulsion gave the best results. This was achieved without the expensive equipment costs (ultrasound), additional expertise, and time.
In another 3D/4D TP imaging study, we observed statistically significant differences between incontinent and continent older women. At rest, the levator hiatal area and transverse diameter were larger and the pelvic floor muscles position was lower in the incontinent group. During maximal voluntary contraction, all axial plane parameters were bigger in the incontinent group. In the sagittal plane, pelvic floor muscles position was lower in the group with mixed urinary incontience. During Valsalva, the anorectal angle was wider in the women with stress urinary incontinence.
Publications :
Kruger JA, Dietz HP, Budgett SC, Dumoulin C. (2014) Comparison between transperineal ultrasound and digital dectection of levator ani trauma. Can we improve the odds? Neurourology and Urodynamics, 33(3): 307-311.
Fradet S, Morin M, Kruger J, Dumoulin C. (2018). Pelvic floor morphometric differences in elderly women with or without urinary incontinence. Physiotherapy Journal, 70(1): 49-56.
8. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a systematic review
Investigators: Chantale Dumoulin, PhD, Licia Cacciari, PhD, Jean Hay-Smith, PhD
Results: Based on the data available, we can be confident that pelvic floor muscle training (PFMT) can cure or improve symptoms of stress urinary incontinence and all other types of urinary incontinence. It may reduce the number of leakage episodes, the quantity of leakage on the short pad tests in the clinic, as well as symptoms on urinary incontinence‐specific symptom questionnaires. The authors of an economic evaluation identified for the Brief Economic Commentary reported that the cost‐effectiveness of PFMT looks promising. The findings of the review suggest that that PFMT could be included in first‐line conservative management programs in women with urinary incontinence. The long‐term effectiveness and cost‐effectiveness of PFMT requires further research.
Publications:
Hay-Smith EJ, Dumoulin C.(2006) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD005654.
Dumoulin C, Hay-Smith J. (2008) Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review. European Journal of Physical and Rehabilitation Medicine, 44: 47-63.
Dumoulin C, Hay-Smith J. (2010) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Systematic Reviews, 20;(1): CD005654.
Dumoulin C, Hay-Smith J, MacHabbée Séguin G. (2014) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database System Review. 2014 May 14;5:CD005654.
Dumoulin C, Hay-Smith J, MacHabée-Séguin G, Mercier J. (2015) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: A short version Cochrane systematic review with meta-analysis. Neurourology and Urodynamics, 2015 Apr; 34(4): 300-308.
Dumoulin C, Cacciari LP, Hay-smith EJC. (2018) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database System Review, 2018 Oct 4; 10: 1465-1858. CD005654.
Cacciari, L. P., Dumoulin, C., & Hay-Smith, E. J. (2019). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a cochrane systematic review abridged republication. Brazilian Journal of Physical Therapy 23(2):93-107.
9. Physiotherapy for persistent postnatal stress urinary incontinence: A randomized controlled trial
Investigators: Chantale Dumoulin, PhD, Marie-Claude Lemieux, MD, Daniel Bourbonnais, PhD
Results: Sixty-four women with stress urinary incontinence were randomly assigned to 8 weeks of either multimodal pelvic floor rehabilitation (n = 21), multimodal pelvic floor rehabilitation with abdominal muscle training (n = 23), or non-pelvic floor rehabilitation (n = 20) (control). Post-intervention, more than 70% of the women in the treatment groups (14/20 in the pelvic floor and 17/23 in the pelvic floor plus abdominal group) were continent on pad testing compared with 0% of women in the control group. Scores on the pad test, Visual Analog Scale, Urogenital Distress Inventory, and Incontinence Impact Questionnaire improved significantly in both treatment groups, whereas no changes were observed in the control group. Pelvic floor muscle function, however, did not improve significantly in either active group. Moreover, results showed that the benefits of physiotherapy for postpartum stress urinary incontinence were still present 7 years post-treatment, although not as pronounced as immediately after the initial intervention.
Publications:
Dumoulin, C., Lemieux, M.-C., Bourbonnais, D., Gravel, D., Bravo, G., & Morin, M. (2004). Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial. Obstetrics & Gynecology, 104(3), 504-510.
Dumoulin, C., Martin, C., Elliott, V., Bourbonnais, D., Morin, M., Lemieux, M. C., & Gauthier, R. (2013). Randomized controlled trial of physiotherapy for postpartum stress incontinence: 7‐year follow‐up. Neurourology and Urodynamics, 32(5), 449-454.
Multicenter projects
1. Muscular properties of the pelvic floor in endometrial cancer survivors with urogenital symptoms who were treated with radiotherapy
Investigators: Stéphanie Bernard, Master’s student, Hélène Moffet, PhD and Chantale Dumoulin, PhD
Results:
There is some evidence that radiation therapy has detrimental impacts on pelvic floor muscle structure and function. A better understanding of muscle damage and dysfunction following radiotherapy treatment may prevent of its detrimental impacts and improve pelvic floor rehabilitation.
Publications :
Bernard S, Ouellet MP, Moffet H, Roy JS, Dumoulin C. (2015) Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review. Journal of Cancer Survivorship: Research and Practice, 2016 Apr; 10(2): 351-62.
Bernard S, Moffet H, Ouellet M-P, Plante M, Leblond J, Dumoulin C. (2016) Les propriétés fonctionnelles du plancher pelvien de femmes souffrant d'incontinence urinaire à la suite d’un cancer de l'endomètre traité par chirurgie et radiothérapie : une étude exploratoire. Physio-Québec, Ordre Professionnel de la physiothérapie du Québec. Automne-Hiver 2016; 43(2): 26-27.
Bernard S, Moffet H, Plante M, Ouellet MP, Dumoulin C. (2017) Pelvic floor properties in women reporting urinary incontinence after surgery and radiotherapy for endometrial cancer. Physical Therapy, 97(4): 438-448.
2. Feasibility study evaluating the effect of physiotherapy treatments in gynecological cancer survivors with dyspareunia
Investigators: Marie-Pierre Cyr, PhD candidate, Mélanie Morin, PhD and Chantale Dumoulin, PhD
Results:
Pain intensity, pain quality, sexual function, pelvic floor dysfunction symptoms and quality of life were measured at baseline and post-treatment. The adherence rate was 88%. 29/31 (94%) women attended ≥10 treatment sessions, and the dropout rate was 3%. Moreover, participants experienced significant improvements in all outcomes after the intervention (p ≤ 0.044). They also reported being highly satisfied with the treatment (9.3/10), and 90% of them stated that they were “very much” or “much improved”.
Publications :
Cyr MP, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH, Morin M.(2020) Feasibility, acceptability and effects of multimodal pelvic floor physical therapy for gynecological cancer survivors suffering from painful sexual intercourse: A multicenter prospective interventional study. Gynecol Oncol. 2020 Dec;159(3):778-784.
Cyr MP, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Morin M. (2021). Characterizing pelvic floor muscle function and morphometry in survivors of gynecological cancer who have dyspareunia: a comparative cross-sectional study. Phys Ther. April 2021; 101(4). 5y-IF: 4.4
Cyr MP, Dumoulin C, Bessette P, Pina A, Gotlieb W, Lapointe-Milot K, Mayrand MH, Morin M. (2021) A prospective single-arm study evaluating the effects of a multimodal physical therapy intervention on psychosexual outcomes in women with dyspareunia after gynecologic cancer. Journal of Sexual Medicine. May 2021; 18(5): 946-954.
Morin M, Cyr MP, Dostie R, Camden C, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH. (2022) Improvements following multimodal pelvic floor physical therapy in gynecological cancer survivors suffering from pain during sexual intercourse: Results from a one-year follow-up mixed-method study. PLOS ONE. January 25; 17(1):e0262844.
Cyr MP, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand M, Morin M. (2022) Changes in pelvic floor morphometry and muscle function after multimodal physiotherapy for gynaecological cancer survivors suffering from dyspareunia: a prospective interventional study. Physiotherapy. 2022 Mar;114:54-62.
Cyr MP, Camden C, Dumoulin C, Dostie R, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH, Morin M. (2023). Gynecological Cancer Survivors' Experiences of Dyspareunia and Factors Influencing Care-Seeking Behavior: A Qualitative Study. Archives of sexual behavior, Apr 14. doi: 10.1007/s10508-023-02589-4
3. Efficacy of physiotherapy for stress urinary incontinence in women with known puborectalis muscle avulsion injuries: A randomized controlled trial
Investigators: Mélanie Morin, PhD, Chantale Dumoulin, PhD
Results: This study confirms that pelvic floor muscle morphometry and function were impaired in primiparous women with puborectalis avulsion in the early postpartum period. Moreover, it highlights specific muscle parameters that are altered, such as passive properties, strength, speed of contraction, and endurance.
Publications:
Cyr MP, Kruger J, Wong V, Dumoulin C, Girard I, Morin M (2017) Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period Article reference. American Journal of Obstetrics and Gynecology, 2017 Mar; 216(3): 274.e1-274.e8.