Publications by authors named "Juan Carlos Fernández-Domínguez"

15 Publications

  • Page 1 of 1

Health Sciences-Evidence Based Practice Questionnaire (HS-EBP): Normative Data and Differential Profiles in Spanish Osteopathic Professionals.

Int J Environ Res Public Health 2020 11 15;17(22). Epub 2020 Nov 15.

Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Sevilla, Spain.

The main goal of this study was to obtain normative data of the scores of the Health-Sciences Evidence Based Practice (HS-EBP) questionnaire, and to analyse evidence-based practice (EBP) among potential clusters of osteopathy professionals in Spain. An online descriptive cross-sectional study has been applied. A total number of 443 Spanish practicing osteopaths answered a survey including the 5 dimensions of the HS-EBP questionnaire and sociodemographic, training, and practice variables using the "LimeSurvey" online platform. Results point out that the median scores for each five HS-EBP questionnaire dimensions were 95.00, 86.00, 78.00, 84.00 and 62.00 considering that the range of possible scores in each of the dimensions was: from 12 to 120 in dimensions 1, 4 and 5; from 14-140 in dimension 2; and from 10-100 in dimension 3. A clustering algorithm extracted 6 different profiles across the five HS-EBP latent dimensions: low scores in all dimensions (cluster 1); low scores in all dimensions but with medium scores in dimension 1 (cluster 2); mixed pattern of scores, low in dimensions 2 and 5 and medium in the rest of the dimensions; medium scores in all dimensions (cluster 4); high scores in all dimensions and low scores in dimension 5 (cluster 5); and high scores in all dimensions (cluster 6). Significant relationship was found among the response patterns in the clusters and: academic degree level, EBP training and training level, and work time invested in healthcare activity, research and teaching activity. These results allow a description of the actual level of EBP and differential profiles of Osteopathy care practice in Spain. Knowledge of normative scores of the HS-EBP questionnaire and identification of different predictors of Spanish osteopaths' EBP, e.g., academic degree, EBP training and training level, work time invested in healthcare activity, research, and teaching activity, and having a working relationship with an accredited educational centre, enable a comprehensive evaluation of the EBP of osteopathic professionals and can also be useful for developing and implementing formative intervention programs for improving EBP practice in osteopathic practice.
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November 2020

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

J Adv Nurs 2021 Jan 15;77(1):448-460. Epub 2020 Oct 15.

Faculty of Nursing and Physiotherapy, Balearic Islands University, Palma de Mallorca, Spain.

Aim: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice.

Design: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines.

Methods: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials.

Discussion: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme.

Impact: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.
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January 2021

Assessing the concurrent validity and reliability of an iPhone application for the measurement of range of motion and joint position sense in knee and ankle joints of young adults.

Phys Ther Sport 2020 Jul 16;44:136-142. Epub 2020 May 16.

Nursing and Physiotherapy Department, University of the Balearic Islands, E-07122, Palma de Mallorca, Spain. Electronic address:

Objective: To analyze the concurrent validity and reliability of an iPhone application for assessing range of motion (ROM) and joint position sense (JPS) in ankle and knee joints.

Design: Cross-sectional study.

Setting: Sport laboratory.

Participants: Twenty healthy and physically active volunteers.

Interventions: All participants performed a ROM and a JPS test in ankle and knee joints, which were simultaneously evaluated with photo-analysis and the iPhone application.

Main Outcomes Measures: A total of 80 angles were obtained with the iPhone app and the photo-analysis and compared for concurrent validity. Reliability was evaluated through re-scoring of images with the iPhone app by two different testers.

Results: Very high correlation was observed between both methods for ankle and knee ROM and knee JPS (r > 0.90), and high correlation for ankle JPS (r = 0.71-0.90), while Bland-Altman plots showed absolute agreement for all the variables. Inter- and intra-tester reliability was perfect for all the variables (ICC > 0.81), except for the inter-tester reliability of ankle JPS, which was substantial (ICC = 0.61-0.81).

Conclusions: This new iPhone application is valid and reliable for measuring ankle and knee ROM and JPS, although special attention is needed during ankle evaluation to avoid errors.
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July 2020

Cluster Analysis of Health-Related Lifestyles in University Students.

Int J Environ Res Public Health 2020 03 9;17(5). Epub 2020 Mar 9.

Department of Nursing and Physiotherapy, Balearic Islands University, Cra. de Valldemossa, Km 7.5, 07122 Palma, Illes Balears, Spain.

Health-related lifestyles in young adults are a public health concern because they affect the risk for developing noncommunicable diseases. Although unhealthy lifestyles tend to cluster together, most studies have analyzed their effects as independent factors. This study assessed the prevalence, association, and clustering of health-related lifestyles (smoking, alcohol consumption, physical activity, and quality of diet) among university students. This cross-sectional study examined a sample of student participants from the University of the Balearic Islands (n = 444; 67.8% females; mean age: 23.1 years). A self-reported questionnaire was used to assess health-related lifestyles. Men that consumed more alcohol, had less healthy diets, were more likely to be overweight, and performed more physical activity. Women had a higher prevalence of low weight and performed less physical activity. Physical activity had a negative association with time using a computer (OR: 0.85; 95% CI: 0.76, 0.95) and a positive association with adherence to the Mediterranean diet (OR: 1.16; 95% CI: 1.02, 1.32). Adherence to the Mediterranean diet had a negative association with tobacco consumption (OR: 0.52; 95% CI: 0.30, 0.91), and positive associations with having breakfast every day (OR: 1.70; 95% CI: 1.05, 2.76) and consuming more daily meals (OR: 1.43; 95% CI: 1.10, 1.87). Cluster analysis indicated the presence of three distinct groups: Unhealthy lifestyles with moderate risk; unhealthy lifestyles with high risk; and healthy lifestyles with low risk. Health promotion interventions in the university environment that focus on multiple lifestyles could have a greater effect than interventions that target any single lifestyle.
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March 2020

Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review.

Diagnostics (Basel) 2019 Nov 12;9(4). Epub 2019 Nov 12.

Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain.

The diagnosis of neck pain is challenging. Many visceral disorders are known to cause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis. However, the absence of suspicion of any cause impedes one from establishing that specific aetiology as the final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematic search of trials about neck pain was carried out to evaluate their selection criteria. The search yielded 309 eligible articles, which were screened by two independent reviewers. The PEDro scale score was used to assess the methodological quality of the studies. The following information was retrieved: number of authors affiliated to a clinical or non-clinical institution, number of citations in the Web of Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most cited trials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartile journals of the Journal Citation Reports, were selected. Females represented 67.5% of participants. A single study was of poor methodological quality (4/10). Based on the eligibility criteria of the articles that were systematically reviewed, it would appear that visceral aetiology was not considered in eighty percent of the trials on neck pain, showing a low level of suspicion both in research and clinical settings.
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November 2019

Effectiveness of an Osteopathic Abdominal Manual Intervention in Pain Thresholds, Lumbopelvic Mobility, and Posture in Women with Chronic Functional Constipation.

J Altern Complement Med 2018 Aug 21;24(8):816-824. Epub 2018 May 21.

1 Escuela de Osteopatía de Madrid, Alcalá de Henares , Madrid, Spain .

Objectives: To assess the effect of an osteopathic abdominal manual intervention (AMI) on pressure pain thresholds (PPTs), mobility, hip flexibility, and posture in women with chronic functional constipation.

Design: Randomized, double-blind placebo-controlled trial.

Setting/location: Subjects were recruited for the study by referral from different gastroenterology outpatient clinics in the city of Madrid (Spain).

Subjects: Sixty-two patients suffering from chronic functional constipation according to the guidelines of the Congress of Rome III.

Interventions: The experimental group (n = 31) received an osteopathic AMI, and the control group (n = 31) received a sham procedure.

Outcome Measures: PPTs at different levels, including vertebral levels C7, T3, T10, T11, and T12, trunk flexion range of motion (ROM), hip flexibility, and posture, were measured before and immediately after the intervention. A comparison between the difference between the pre- and postintervention values using the Student's t test for independent samples or nonparametric U-Mann-Whitney test depending on the distribution normality of the analyzed variables was perfomed.

Results: In the intergroup comparison, statistically significant differences were found in PPT at T11 (p = 0.011) and T12 (p = 0.001) and also in the trunk flexion ROM (p < 0.05). Moreover, women showed no adverse effects with acceptable pain tolerance to the intervention.

Conclusion: The application of an osteopathic AMI is well tolerated and improves pain sensitivity in areas related to intestinal innervation, as well as lumbar flexion.
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August 2018

Efficacy of the Otago Exercise Programme to reduce falls in community-dwelling adults aged 65-80 years old when delivered as group or individual training.

J Adv Nurs 2018 Jul 3;74(7):1700-1711. Epub 2018 Jun 3.

Grup de Recerca de Cures de Salut, GRECS, Institut de Recerca Biomèdica, Lleida, Spain.

Aim: This study will compare how falls can be reduced in non-institutionalized older Spanish adults aged 65-80 years by providing group or individual exercise sessions using the Otago Exercise Programme.

Background: The Otago Exercise Programme is a progressive home-based exercise programme, where trained health professionals help people engage in strength, balance and endurance exercises. Its format is based on the evidence from four clinical trials. The benefits of the Otago Exercise Programme are the same for people who have and have not suffered falls and it can also be used for visually impaired people.

Design: A multicentre, simply blinded, randomized, non-inferiority clinical trial, with two arms-group training and individual training-that started in January 2017 and will continue until December 2019.

Methods: Each study group has 364 subjects, who will take part in four individual or group sessions delivered mainly by nurses over an 8-week period, with a reinforcement session 6 months later. Data will be collected at baseline and after 6 and 12 months. The fall percentage will be the most relevant clinical variable and we will also consider safety, viability, compliance, economic analysis and therapeutic value. Approval and funding was granted in December 2016 for this 3-year study by the Spanish Health Research Fund (PI16CIII/00031).

Discussion: Older people from 65-80 years old tend to be more isolated and tackling worries about falls can improve social activities and independence. It has been shown that group training provides better adherence to exercise than individual training and this study will test that hypothesis for the Otago Exercise Programme.
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July 2018

Validity and Reliability of a Digital Inclinometer to Assess Knee Joint Position Sense in an Open Kinetic Chain.

J Sport Rehabil 2019 May 12;28(4):332-338. Epub 2018 Dec 12.

New methods are being validated to easily evaluate the knee joint position sense (JPS) due to its role in the sports movement and the risk of injury. However, no studies to date have considered the open kinetic chain (OKC) technique, despite the biomechanical differences compared with closed kinetic chain movements. To analyze the validity and reliability of a digital inclinometer to measure the knee JPS in the OKC movement. The validity and intertester and intratester reliability of a digital inclinometer for measuring knee JPS were evaluated. Sports research laboratory. A total of 18 athletes (11 males and 7 females; 28.4 [6.6] y; 71.9 [14.0] kg; 1.77 [0.09] m; 22.8 [3.2] kg/m) voluntary participated in this study. Absolute angular error (AAE), relative angular error (RAE), and variable angular error (VAE) of knee JPS in an OKC. Intraclass correlation coefficient (ICC) and standard error of the mean (SEM) were calculated to determine the validity and reliability of the inclinometer. Data showed excellent validity of the inclinometer to obtain proprioceptive errors compared with the video analysis in JPS tasks (AAE: ICC = .981, SEM = 0.08; RAE: ICC = .974, SEM = 0.12; VAE: ICC = .973, SEM = 0.07). Intertester reliability was also excellent for all the proprioceptive errors (AAE: ICC = .967, SEM = 0.04; RAE: ICC = .974, SEM = 0.03; VAE: ICC = .939, SEM = 0.08). Similar results were obtained for intratester reliability (AAE: ICC = .861, SEM = 0.1; RAE: ICC = .894, SEM = 0.1; VAE: ICC = .700, SEM = 0.2). The digital inclinometer is a valid and reliable method to assess the knee JPS in OKC. Sport professionals may evaluate the knee JPS to monitor its deterioration during training or improvements throughout the rehabilitation process.
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May 2019

Short-Term Changes in Algometry, Inclinometry, Stabilometry, and Urinary pH Analysis After a Thoracolumbar Junction Manipulation in Patients with Kidney Stones.

J Altern Complement Med 2017 Aug 24;23(8):639-647. Epub 2017 May 24.

1 Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain .

Objectives: To determine the efficacy of a high-velocity low-amplitude manipulation of the thoracolumbar junction in different urologic and musculoskeletal parameters in subjects suffering from renal lithiasis.

Design: Randomized, controlled blinded clinical study.

Settings/location: The Nephrology departments of two hospitals and one private consultancy of physiotherapy in Valencia (Spain).

Subjects: Forty-six patients suffering from renal lithiasis.

Interventions: The experimental group (EG, n = 23) received a spinal manipulation of the thoracolumbar junction, and the control group (CG, n = 23) received a sham procedure.

Outcome Measures: Pressure pain thresholds (PPTs) of both quadratus lumborum and spinous processes from T10 to L1, lumbar flexion range of motion, stabilometry, and urinary pH were measured before and immediately after the intervention. A comparison between pre- and postintervention phases was performed and an analysis of variance for repeated measures using time (pre- and postintervention) as intrasubject variable and group (CG or EG) as intersubject variable.

Results: Intragroup comparison showed a significant improvement for the EG in the lumbar flexion range of motion (p < 0.001) and in all the PPT (p < 0.001 in all cases). Between-group comparison showed significant changes in PPT in quadratus lumborum (p < 0.001), as well as in the spinous processes of all of the evaluated levels (p < 0.05). No changes in urinary pH were observed (p = 0.419).

Conclusion: Spinal manipulation of the thoracolumbar junction seems to be effective in short term to improve pain sensitivity, as well as to increase the lumbar spine flexion.
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August 2017

Health Sciences-Evidence Based Practice questionnaire (HS-EBP) for measuring transprofessional evidence-based practice: Creation, development and psychometric validation.

PLoS One 2017 9;12(5):e0177172. Epub 2017 May 9.

Department of Psychology, University of the Balearic Islands, Palma de Mallorca, Balearic Islands, Spain.

Introduction: Most of the EBP measuring instruments available to date present limitations both in the operationalisation of the construct and also in the rigour of their psychometric development, as revealed in the literature review performed. The aim of this paper is to provide rigorous and adequate reliability and validity evidence of the scores of a new transdisciplinary psychometric tool, the Health Sciences Evidence-Based Practice (HS-EBP), for measuring the construct EBP in Health Sciences professionals.

Methods: A pilot study and a subsequent two-stage validation test sample were conducted to progressively refine the instrument until a reduced 60-item version with a five-factor latent structure. Reliability was analysed through both Cronbach's alpha coefficient and intraclass correlations (ICC). Latent structure was contrasted using confirmatory factor analysis (CFA) following a model comparison aproach. Evidence of criterion validity of the scores obtained was achieved by considering attitudinal resistance to change, burnout, and quality of professional life as criterion variables; while convergent validity was assessed using the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ-19).

Results: Adequate evidence of both reliability and ICC was obtained for the five dimensions of the questionnaire. According to the CFA model comparison, the best fit corresponded to the five-factor model (RMSEA = 0.049; CI 90% RMSEA = [0.047; 0.050]; CFI = 0.99). Adequate criterion and convergent validity evidence was also provided. Finally, the HS-EBP showed the capability to find differences between EBP training levels as an important evidence of decision validity.

Conclusions: Reliability and validity evidence obtained regarding the HS-EBP confirm the adequate operationalisation of the EBP construct as a process put into practice to respond to every clinical situation arising in the daily practice of professionals in health sciences (transprofessional). The tool could be useful for EBP individual assessment and for evaluating the impact of specific interventions to improve EBP.
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September 2017

Advanced Practice Nursing Competency Assessment Instrument (APNCAI): clinimetric validation.

BMJ Open 2017 02 23;7(2):e013659. Epub 2017 Feb 23.

Nursing and Physiotherapy Department, Universitat de les Illes Balears, Palma, Spain.

Objective: To describe the development and clinimetric validation of the Advanced Practice Nursing Competency Assessment Instrument (APNCAI) through several evidence sources about reliability and validity in the Spanish context.

Design And Setting: APNCAI development was based on a multisequential and systematic process: literature review, instrument content consensus through qualitative Delphi method approach (a panel of 51 Advanced Practice in Nursing -APN- experts was selected) and the clinimetric validation process based on a sample of 600 nurses from the Balearic Islands public healthcare setting.

Methods: An initial step for tool's content development process based on Delphi method approach of expert consensus was implemented. A subsequent phase of tool validation started from the analysis of APN core competencies latent measurement model, including exploratory and confirmatory techniques. Reliability evidence for each latent factor was also obtained. Items' scores were submitted to descriptive analysis, plus univariate and multivariate normality tests.

Results: An eight-factor competency assessment latent model obtained adequate fit, and it was composed by 'Research and Evidence-Based Practice', 'Clinical and Professional Leadership', 'Interprofessional Relationship and Mentoring', 'Professional Autonomy', 'Quality Management', 'Care Management', 'Professional Teaching and Education' and 'Health Promotion'.

Conclusions: Adequate empirical evidence of reliability and validity for APNCAI makes it useful for application in healthcare policy programmes for APN competency assessment in Spain.
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February 2017

Content validity of a health science evidence-based practice questionnaire (HS-EBP) with a web-based modified Delphi approach.

Int J Qual Health Care 2016 Dec;28(6):764-773

Faculty of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma de Mallorca  (Balearic Islands), Spain.

Objective: To develop a tool for measuring evidence-based practice (EBP) and to evaluate its content validity by Delphi technique. A five-factor/dimensions latent structure for the EBP construct was defined a priori and operationalized.

Design: Online Delphi technique.

Setting And Participants: A group of 32 national EBP experts from different health professions.

Intervention: The experts rated the initial questionnaire items according to adequacy and relevance criteria using four-point Likert scales and including open fields for suggestions, with basic and supplementary criteria consensus established a priori.

Main Outcome Measure: Level of consensus in the Content Validity Index Item.

Results: An EBP construct solution was designed with the elements that constitute the operationalization proposal of the EBP. This initial version consisted of 76 items, whereas the version arising from the Delphi study was made up of 73 items. In the first round, 13 items did not reach the minimum level of consensus, and 12 of these were reformulated. Three additional items were removed in the second round.

Conclusions: A new psychometric tool forms measuring EBP with a five-factor structure, and 73 items obtained adequate content validity evidence based on expert opinion.
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December 2016

Validity and reliability of instruments aimed at measuring Evidence-Based Practice in Physical Therapy: a systematic review of the literature.

J Eval Clin Pract 2014 Dec 22;20(6):767-78. Epub 2014 May 22.

Enfermería y Fisioterapia, Universidad de las Islas Baleares, Palma de Mallorca, Islas Baleares, Spain.

Rationale, Aims And Objectives: Our goal is to compile and analyse the characteristics - especially validity and reliability - of all the existing international tools that have been used to measure evidence-based clinical practice in physiotherapy.

Methods: A systematic review conducted with data from exclusively quantitative-type studies synthesized in narrative format. An in-depth search of the literature was conducted in two phases: initial, structured, electronic search of databases and also journals with summarized evidence; followed by a residual-directed search in the bibliographical references of the main articles found in the primary search procedure. The studies included were assigned to members of the research team who acted as peer reviewers. Relevant information was extracted from each of the selected articles using a template that included the general characteristics of the instrument as well as an analysis of the quality of the validation processes carried out, by following the criteria of Terwee.

Results: Twenty-four instruments were found to comply with the review screening criteria; however, in all cases, they were found to be limited as regards the 'constructs' included. Besides, they can all be seen to be lacking as regards comprehensiveness associated to the validation process of the psychometric tests used.

Conclusion: It seems that what constitutes a rigorously developed assessment instrument for EBP in physical therapy continues to be a challenge.
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December 2014

[Preliminary study on the action of hypopressive gymnastics in the treatment of idiopathic scoliosis].

Enferm Clin 2011 Nov-Dec;21(6):354-8. Epub 2011 Oct 22.

Universidad de Castilla La Mancha, Toledo, España.

Our goal is to describe the results of a hypopressive gymnastics (HG) program applied to 3 children with idiopathic scoliosis. Three children (ages ranging from 8 to 15 years) suffering from idiopathic scoliosis were recruited for this study. Thoracic or thoracolumbar curves showed between 15° and 40° Cobb degrees. The evolutionary character of the curves had been confirmed. A study of different clinical and radiological parameters was carried out to compare the measurements before and after (3 months later) the application of a 5 HG daily exercises programme: A radiological study of the spine was carried out to compare the measurements of the vertebral rotation. A radiological study, a plumb line and a measuring tape were used to assess the vertebral tilt in this study. A Scoliometer was used to measure the deformation of the rib cage (gibbosity). The most significant results were: a trend to reach stabilisation in the vertebral tilt and rotation, and stabilisation of gibbosity, which probably might improve the respiratory function of these subjects. Finally, the performance of an ordinary HG exercise program shows a trend to control and stabilise dorsal idiopathic scoliosis progression.
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May 2012

[Contribution to the anatomical-morphological study of the pelvic floor in the asymptomatic female: the use of MRI imaging].

Arch Esp Urol 2006 Sep;59(7):675-89

Université Libre de Bruxelles, Bruxelles, Belgique.

Objectives: To confirm the results of previous studies demonstrating the morphology of the levator ani muscle in the living subject is different to that described in classic anatomical works; to evaluate the anatomical-morphological differences of the pelvic floor between nulliparous and multiparous women in order to analyze the influence of pregnancy and delivery.

Methods: Comparative study of the morphological variations of the iliococcigeous fascicle of the levator ani muscle between two groups of females using T2 MRI.: the first group included 11 nulliparous women and the second group 9 multiparous women. The curvature radium of the fascicles was calculated in the frontal projections. The differences in height were also calculated. The anterior limit of the iliococcygeal muscle dome was determined in the sagittal plane. The software Image Tool 3.0 was employed for the measurements. The Kolmogorov-Smirnov test was employed to analyze the distribution of the study populations; mean value comparisons between groups were performed by the Student's t test. Finally, the various morphological measurements were compared in relation to various parameters: parity, side, body mass index (BMI), sports practice, menstrual cycle phase, and presence or absence of episiotomy. Data obtained were analyzed using the Fisher's exact test, with a statistical significance of p < 0.05.

Results: Morphological measurements: We observed that the concavity of the iliococcygeal fascicle dome is larger in nulliparous women (p = 0.03 for the right side and p = 0.04 for the left). Moreover, these women have the domes significantly more anterior (p < 0.001 for both sides). Comparisons between other variables: an association between nulliparous status and the presence of a higher and more anterior left dome, and multiparous status and a higher and more anterior right dome were (p = 0.02).

Conclusions: The hypothesis of the pelvic floor morphology being a double dome with inferior-posterior concavity in the living asymptomatic female is confirmed. We also demonstrate the existence of anatomical-morphological differences in the iliococcygeal muscle of the levator ani between nulliparous and multiparous females, which seems to confirm a relationship with pregnancy and/or delivery.
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September 2006