Assessing multifactorial etiology of IC/BPS using a novel PFM-Hip-Trunk muscle network analysis

摘要 间质性膀胱炎/膀胱疼痛综合征（IC/BPS）是最令人衰弱的慢性盆腔疼痛之一 (CPP)对生活质量和性活动产生负面影响的情况占2.7%至6.5%， 美国的女人。骨盆底肌肉（PFM）过度活动，其特征是增加 紧张性肌肉活动，是一种与肌筋膜疼痛相关的疾病，出现在大多数CPP中 条件，包括高达85%的IC/BPS妇女。然而，骨盆底疼痛本质上是一种 归因于姿势问题、肌筋膜触发点和异常的多因素功能障碍 肌肉张力肌筋膜治疗，包括特定的盆底肌肉软组织动员和 肌肉拉伸是IC/BPS伴PFM患者的标准治疗 温柔不幸的是，即使在检查时有PFM压痛的IC/BPS患者中， 59%的患者报告肌筋膜治疗后症状改善。盆底肌筋膜 然而，治疗不能解决躯干和臀部的运动障碍，这也是 与骨盆疼痛有关。骨盆底肌肉表型框架将允许IC/BPS 对患者进行分类，以便于进行个性化治疗。不幸的是，没有技术 目前可用于定量和客观地评估PFM的病因因素与 IC/BPS，否则，将促进对潜在机制的理解， 允许对患者进行表型分析以进行适当的干预。 我们的团队已经成功开发出一种新型的阴道内高密度表面 肌电图（HD-sEMG）技术，以可靠和定量地评估PFM过度活动， 患有IC/BPS的女性和2）开发了一种新的肌肉网络分析技术， 第一次，肌间连接模式改变的患者， 神经肌肉疾病，和3）证明了IC/BPS患者集群的可行性 根据潜在的机制分为表型亚组。本研究旨在 综合评估PFM过度活动、髋/躯干肌肉活动改变、PFM-髋/ 躯干肌间连接和IC/BPS中不同的PFM表型亚型。本研究 代表了第一次全面评估PFM过度活动，髋关节/躯干肌肉活动 改变，PFM-髋关节/躯干肌间连接，以及不同的PFM表型亚型， IC/BPS。这些多因素评估的整合将促进我们的理解 IC/BPS的多因素病理学。这些相对重要性的量化 病理学贡献者将允许IC/BPS患者表型。PFM的识别 表型亚型可以促进个性化的物理疗法治疗。

Abstract Interstitial cystitis/ bladder pain syndrome (IC/BPS) is one of the most debilitating chronic pelvic pain (CPP) conditions that negatively impacts the quality of life and sexual activities in 2.7% to 6.5% of women in the US. Pelvic floor muscle (PFM) overactivity, characterized by an increase in the tonic muscle activity, is a condition related to myofascial pain that presents in the majority of CPP conditions, including up to 85% of women with IC/BPS. However, pelvic floor pain is intrinsically a multifactorial dysfunction that is attributed to postural issues, myofascial trigger points, and abnormal muscle tone. Myofascial therapy, including specific pelvic floor muscle soft tissue mobilization and muscle stretching, is standard treatment for patients with IC/BPS and concomitant PFM tenderness. Unfortunately, even among IC/BPS patients with PFM tenderness on exam, only 59% of patients report symptom improvement after myofascial therapy. Pelvic floor myofascial therapy, however, does not address movement impairments of the trunk and hips, which are also associated with pelvic pain. A pelvic floor muscle phenotyping framework would allow IC/BPS patients to be categorized to facilitate individualized treatment. Unfortunately, no technology is currently available for quantitatively and objectively assessing PFM etiologic factors associated with IC/BPS, which, otherwise, would advance the understanding of the underlying mechanisms and allow for phenotyping patients for appropriate intervention. Our team has successfully 1) developed a novel intra-vaginal high-density surface electromyography (HD-sEMG) technique to reliably and quantitatively assess PFM overactivity in women with IC/BPS and 2) developed a novel muscle network analysis technique to reveal, for the first time, the inter-muscular connectivity pattern alterations among patients with neuromuscular conditions, and 3) demonstrated the feasibility to cluster patients with IC/BPS into phenotypic subgroups, depending on the underlying mechanism. This study aims to comprehensively assess the PFM overactivity, hip/trunk muscle activity alteration, PFM-to-Hip/ Trunk inter-muscular connectivity, and distinct PFM phenotypic subtypes in IC/BPS. This research represents the first effort to comprehensively assess the PFM overactivity, hip/trunk muscle activity alteration, PFM-to-Hip/Trunk inter-muscular connectivity, and distinct PFM phenotypic subtypes in IC/BPS. The integration of these multifactorial assessments will advance our understanding of the multifactorial pathology of IC/BPS. The quantification of relative importance of these pathological contributors will allow for IC/BPS patient phenotyping. Identification of PFM phenotypic subtypes may facilitate personalized physical therapy treatments.