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Trial registered on ANZCTR
Registration number
ACTRN12617000667314p
Ethics application status
Submitted, not yet approved
Date submitted
26/04/2017
Date registered
9/05/2017
Date last updated
14/07/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
Impact of high-heeled shoes on pelvic floor muscle activity in women with stress urinary incontinence
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Scientific title
Impact of high-heeled shoes induced ankle plantar flexion on pelvic floor muscle activity in women with stress urinary incontinence
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Secondary ID [1]
291130
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None
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Universal Trial Number (UTN)
U1111-1192-6648
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Trial acronym
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Linked study record
Nil
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Health condition
Health condition(s) or problem(s) studied:
Stress Urinary Incontinence
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Condition category
Condition code
Renal and Urogenital
301609
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0
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Other renal and urogenital disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Non-pregnant women with stress urinary incontinence will attend a 3-hour testing session.
Resting and functional activity of pelvic floor muscles (PFM) using transperenial ultrasound (TPS), intra-vaginal pressure measurement using vaginal manometer and evaluation of lumbar lordosis and pelvic tilt using spinal mouse will be done in standing with ankle in four positions including: neutral ankle position (bare feet); 10-degree dorsiflexion with a wedge under toes; and two ankle plantar flexion positions.
Initially assessments using vaginal manometry, TPS and spinal mouse will be done in ankle neutral position condition for approximately 10-20 minutes. Following this, assessments will be repeated with ankle in 10-degree dorsiflexion, assessment lasting for about 10-20 minutes. Women will then be made to stand or walk (at participant’s discretion) around with 5.08 cm (2 inches) high-heeled shoes for 30 minutes (for possible postural adjustments) before measurements are repeated. Participants will then be made to wear the 7.62 cm (3 inches) high-heeled shoes for 30 minutes during which time they decide to stand or walk around following which measurements will be repeated. Between the two plantar flexion positions a 10-minute rest period will be provided. In each ankle position women will undergo 3D- (for resting PFM activity) and 4D-TPS (for obtaining images at maximum PFM (2) contraction) using the GE Healthcare/Logiq TPS system with a 2-5.5 HMz probe. A five-minute rest period will be allowed between measurements in the consecutive ankle neutral and dorsiflexion conditions.
All assessments will be done at the physiotherapy Department of Kwong Wah Hospital by a physiotherapist with specialist experience in Women's health and assisted by another physiotherapist with expertise in TPS.
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Intervention code [1]
297885
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Other interventions
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Comparator / control treatment
Ankle neutral (barefeet) will be considered as the control condition.
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Control group
Active
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Outcomes
Primary outcome [1]
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Transperenial ultrasound (TPS)
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Assessment method [1]
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Timepoint [1]
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Each participant will be requested to void prior to testing. In each ankle position women will undergo 3D- (for resting PFM activity) and 4D-TPS (for obtaining images at maximum PFM (2) contraction) using the GE Healthcare/Logiq TPS system with a 2-5.5 HMz probe. In total TPS recording will not last for more than 5 minutes.
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Primary outcome [2]
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Vaginal manometer will be used to measure intra-vaginal closure pressure
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Assessment method [2]
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Timepoint [2]
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Each participant will be requested to void prior to testing. Once participant is ready their intra-vaginal closure pressure will be measured using a vaginal manometer. In total vaginal manometer measurements will not last for more than 5 minutes.
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Secondary outcome [1]
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Spinal mouse for measurement of lumbar lordosis. The spinal mouse is an hand-held computer aided electromechanical instrument used to measure spinal curvatures in sagittal plane
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Assessment method [1]
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Timepoint [1]
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Lumbar lordosis will be measured in standing with ankles in four different positions: neutral (neutral), dorsiflexion and two plantar flexion). In each ankle position testing will be done for 5-10 minutes.
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Secondary outcome [2]
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Spinal mouse for pelvic tilt. Besides spinal curvature, the spinal mouse also measures pelvic tilt in sagittal plane
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Assessment method [2]
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Timepoint [2]
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Pelvic tilt will be measured in standing with ankles in four different positions: neutral (neutral), dorsiflexion and two plantar flexion). In each ankle position testing will be done for 5-10 minutes.
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Secondary outcome [3]
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Feasibility measure: recruitment rate
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Assessment method [3]
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Timepoint [3]
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Recruitment rate: time frame needed to recruit the required number of participants
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Secondary outcome [4]
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Feasibility measure: compliance with study protocol
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Assessment method [4]
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Timepoint [4]
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Participants willingness for assessment of PFM activity using TPS and vaginal manometer and wearing high-heeled shoes for 30 minutes
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Eligibility
Key inclusion criteria
Non-pregnant women with stress urinary incontinence in the age group of 18-49 years will be included.
Participants need not be habitual high-heeled shoes users to participate in the study.
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Minimum age
18
Years
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Maximum age
49
Years
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Women with previous pelvic surgeries, body mass index over 30 kg/m2, diabetes, smoking, chronic lung diseases, neurological problems, and urinary tract infection will be excluded from the study.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
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Type of endpoint/s
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Statistical methods / analysis
Within group data of vaginal pressure and TPS activity of PFM in dorsiflexion and neutral positions will be compared with two plantar flexion positions using one-way analysis of variance (ANOVA) for parametric data. Kruskal Wallis analysis will be used for non-parametric data. Statistical significance will be achieved as a=0.05.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
18/06/2019
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
10
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
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Hong Kong
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State/province [1]
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Kowloon
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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The Hong Kong Polytechnic University
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Address [1]
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QT512, 5/F, Core T,
Hung Hom
Kowloon
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Country [1]
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Hong Kong
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Primary sponsor type
Individual
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Name
Dr Priya Kannan
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Address
QT512, 5/F, Core T,
Department of Rehabilitation Sciences
The Hong Kong Polytechnic University
Hung Hom
Kowloon
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Country
Hong Kong
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
295200
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
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Human Subjects Ethics Sub-committee
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Ethics committee address [1]
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The Hong Kong Polytechnic University 404, 4/F, Block Z Hung Hom Kowloon Hong Kong
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Ethics committee country [1]
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Hong Kong
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Date submitted for ethics approval [1]
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10/05/2017
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Approval date [1]
297513
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Ethics approval number [1]
297513
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Summary
Brief summary
Use of high-heeled footwear began more than 1000 years back, and resulted in the development of changes in gait, posture and the kinematics and kinetics of the spine, hip, knees, and ankle. High-heeled shoes force the ankle into plantar flexion which leads to changes in lumbar spine, pelvic tilt, and other joints. High-heeled shoes induced plantar flexion has also been found to alter the activity of pelvic floor muscles (PFM) through its effect on lordosis of the lumbar spine and pelvic inclination (tilt). Several studies have evaluated the influence of high-heeled shoes on lumbar lordosis however, results are controversial. Some studies found an increase lumbar lordosis angle and some found a decrease or no change with increased heel height. It is reported that there might be an epidemiological association between lumbopelvic posture and urinary incontinence in women. Assuming a hyper or hypolordotic posture is thought to distort the PFM activity; hyperlordosis resulted in lengthening and hypolordosis resulted in a shortening of the PFM. The proposed mechanism is, in hypo-lordosis the pelvis tilts posteriorly causing the sacrum to move in an anterior and inferior direction and pubis in a posterior and superior direction drawing closer the attachment of the key PFMs, resulting in shortening of the muscle; and in hyperlordosis the reverse of this is thought to occur causing a stretch of the muscle. The evidence for the effect of various ankle positions on PFM activity is limited. To our knowledge only three studies have evaluated the effect of various ankle positions on PFM activity with controversial results. We hypothesize that passive plantar flexion induced by high-heeled shoes might decrease the activity of PFM through its effect on lumbar spine and pelvis in women. If women habitually wear high-heeled shoes, this might have the potential to reduce the activity and length of the PFM and deconditioning which might contribute to stress urinary incontinence. Paucity of literature and contradicting results of available literature on the impact of various ankle positions on lumbar spine, pelvis and PFM activity has led the authors to conduct this study. This study will determine the effect of four ankle positions (two plantar flexion positions induced by 5.08 cm (2 inches) and 7.62 cm (3 inches) high-heeled shoes; a neutral and a dorsiflexion position) on bioelectric and contractile activity of PFM. The primary aim of this study is to assess the influence of high-heeled shoes induced plantar flexion on bioelectrical and contractile activity of PFM and compare it to ankle neutral and dorsiflexion positions. The secondary aim is to assess the effect the four ankle positions on lumbar lordosis and pelvic tilt.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Priya Kannan
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Address
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ST 532, Core S
Department of Rehabilitation Sciences
The Hong Kong Polytechnic University
Hung Hom
Kowloon
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Country
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Hong Kong
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Phone
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+852 3400 3277
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Priya Kannan
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Address
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ST 532, Core S
Department of Rehabilitation Sciences
The Hong Kong Polytechnic University
Hung Hom
Kowloon
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Country
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Hong Kong
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Phone
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+852 3400 3277
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Priya Kannan
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Address
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ST 532, Core S
Department of Rehabilitation Sciences
The Hong Kong Polytechnic University
Hung Hom
Kowloon
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Country
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Hong Kong
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Phone
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+852 3400 3277
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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