Linda Mclean

Linda Mclean
University of Ottawa · School of Rehabilitation Sciences

PhD

About

181
Publications
64,338
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4,188
Citations
Additional affiliations
July 2002 - June 2014
Queen's University
Position
  • Professor (Full)

Publications

Publications (181)
Article
Full-text available
Background: The neuromuscular contribution to increased tone of the pelvic floor muscles (PFMs) observed among those with provoked vestibulodynia (PVD) is unclear. Aim: To determine if PFM activity differs between those with provoked PVD and pain free controls, and if the extent of PFM activation at rest or during activities is associated with pain...
Article
Background The nature of pelvic floor muscle (PFM) involvement in provoked vestibulodynia (PVD) is poorly understood. Aim We aimed to determine if PFM electromyographic (EMG) activity in anticipation of or response to pressure applied to the posterior vaginal fourchette differs between those with and without PVD, and if the magnitude of PFM respon...
Poster
Full-text available
Small animal models have been developed to study aging and ovarian failure to gain an understanding of how muscle composition, structure and function is altered in menopause. This systematic review aimed to determine 1) how aging and ovarian failure have been modeled in small animals to examine changes in the levator ani muscles (LAMs) and the exte...
Article
The aim was to investigate the feasibility of using an intravaginal intra-abdominal pressure (IAP) sensor worn by female runners during running to evaluate pelvic floor loading, and the association between IAP and running-induced stress urinary incontinence (RI-SUI). Twenty-eight female runners participated in this cross-sectional study (15 with RI...
Article
Full-text available
Background Patient‐reported outcome measures (PROMs) are recommended to measure the impact of a health condition or intervention effectiveness as they aim to capture what is most meaningful to patients. Several PROMs are used to evaluate pelvic organ prolapse (POP)‐related domains, yet the measurement properties of these instruments have not been f...
Poster
Full-text available
Active women have reported that running and jogging aggravate urine leakage. Our aim was to develop a theoretical model to describe the relationships among the pathophysiology, symptoms, mitigating factors, management and impact of brisk walking and running induced lower urinary tract symptoms (BRUTS) among active women. A focus group, including re...
Presentation
Full-text available
Through developing new measures, authors have recently shown associations between aging and changes in levator hiatus (LH) shape. Our aim was to assess the test-retest reliability of LH shape at rest and during maximum voluntary contractions (MVCs) in women. To date, six women have been recruited to attend two assessments. Four measures of LH shape...
Article
Full-text available
Objective To systematically review and synthesise what is known about the effectiveness of non‐pharmaceutical conservative interventions for the management of urinary incontinence (UI) experienced by women during physical exercise. Methods A systematic search was performed in the following databases in September 2023: the Medical Literature Analys...
Article
Full-text available
Aims Existing questionnaires provide limited information on the nature, severity and context surrounding lower urinary tract symptoms (LUTS) experienced during running, jogging and brisk walking. The aims of this study were to develop a theoretical model of the experience of LUTS by females participating in gait‐based exercise activities and to use...
Article
Purpose The purpose of this study was to explore the distribution and geographic accessibility of pelvic health physiotherapist services for females in Ontario across an urban–rural gradient. Method A geographic information system-based observational study was conducted. Physiotherapists’ practice locations (supply) were obtained from the Colleg...
Article
To perform a scoping review of the literature in which ultrasound elastography (UE) has been used in benign gynecology and identify avenues for its use in future research and clinical implementations. A structured search of EMBASE, Medline and Cochrane databases was conducted (last search date April 15th, 2022). Eligible studies included adult part...
Article
Full-text available
Objective To describe primary care provider (PCP) practices for the assessment and management of females with urinary incontinence (UI), and appraise these practices relative to recommendations made in high‐quality clinical guidelines. Methods Studies were searched in four databases (MEDLINE, EMBASE, CINAHL, Web of Science) from their respective i...
Article
Full-text available
Introduction and hypothesis The aim of this study was to examine the impact of a single running session on pelvic floor morphology and function in female runners, and to compare those with and without running-induced stress urinary incontinence (RI-SUI). Methods This cross-sectional, observational study involved two groups: female runners who regu...
Poster
Full-text available
Hypothesis / aims of study Although intravaginal dynamometry (IVD) is recommended as the best approach to assess levator ani muscle (LAM) function in research settings, it may not be accessible nor acceptable in some populations, including older females, children/adolescents, or transgender men. Transperineal ultrasound imaging (USI) may be a more...
Article
Objective: To investigate the differences in pelvic floor muscle (PFM) morphology and function between female runners with and without running-induced stress urinary incontinence (RI-SUI). Design: This was a cross-sectional, observational study. Methods: Experienced female runners were recruited into two groups: runners who regularly experienc...
Conference Paper
HYPOTHESIS / AIMS OF STUDY Urinary incontinence (UI) is a common healthcare problem that is recognized as a worldwide concern, having a substantial medical and economic burden on healthcare systems. Primary care providers (PCPs) are in a perfect position to uncover, triage and/or initiate first-line therapy for females living with UI. However, it h...
Conference Paper
This is a systematic review to describe and to synthesize the available evidence on the effectiveness of conservative interventions used to manage UI experienced by females during physical exercise.
Article
Full-text available
Objective: Urinary incontinence (UI) and pelvic organ prolapse (POP) are prevalent pelvic floor disorders (PFDs) among the female population. In the military environment, being a Non-commissioned member (NCM), and physically demanding occupations are factors associated with higher PFD risk. This study seeks characterize the profile of female Canad...
Presentation
Introduction: There is disagreement in the literature regarding the impact of body position on measurements of pelvic floor muscle (PFM) function, with studies showing greater [1], smaller [2] and no difference [3] in vaginal closure force when supine and standing positions are compared. The aim of this study was to evaluate the impact of body posi...
Article
Questions: Do women with stress urinary incontinence (SUI) who receive instruction to perform the knack maneuver as part of a 12-week pelvic floor muscle training (PFMT) program perform it during voluntary coughing without specific instruction to do so, and are subjective and objective outcomes better among those who do than among those who do not...
Article
Study Objective To synthesize the literature in which ultrasound elastography (UE) has been used in benign gynecology and identify avenues for future research and clinical implementation. Design A structured search of EMBASE and Medline databases, last conducted on April 15th, 2022. Setting N/A. Patients or Participants Eligible studies included...
Conference Paper
Full-text available
HYPOTHESIS / AIMS OF STUDY Physical activities such as running, jogging and brisk walking can trigger urinary incontinence (UI), but our ability to assess the relationship between the nature and duration of activity and the experience of UI is limited. Recommended UI symptoms questionnaires include a limited number of items that address physical ac...
Poster
Introduction The key functions of the human pelvic floor muscles (PFMs) are to support the pelvic organs and to provide closure forces to maintain urinary and faecal continence. Although many females experience pelvic floor dysfunction as they age, the impact of aging and menopause on PFMs is not well understood [1]. Small animals (i.e., rodents a...
Article
There is an increasing interest in the applications of 3D ultrasound imaging of the pelvic floor to improve the diagnosis, treatment, and surgical planning of female pelvic floor dysfunction (PFD). Pelvic floor biometrics are obtained on an oblique image plane known as the plane of minimal hiatal dimensions (PMHD). Identifying this plane requires t...
Article
Objective The purpose of this study was to determine the acute effect of an abdominal hypopressive exercise (AHE) on linea alba morphology among women who are primiparous and to compare this effect to that of other common abdominal exercise modalities. Methods A cross-sectional study of 46 women 3 months after first delivery was conducted. B-mode...
Poster
Full-text available
Introduction: “The knack” is described as a pre-contraction of the pelvic floor muscles (PFMs) during tasks that increase intra-abdominal pressure (IAP), and is taught to women with stress urinary incontinence (SUI) as a means to reduce urine leakage1. It is not known whether women who are taught the knack adopt it into their everyday activities....
Article
Background While cumulative loading of the pelvic floor during exercise appears to increase the risk of developing pelvic floor disorders, the pathophysiologic role of pelvic floor loading is poorly understood. The aim of this exploratory study was to present a method for evaluating vibrational frequency damping of the female pelvic floor and to in...
Article
Full-text available
Introduction and hypothesis There is a high prevalence of urinary incontinence among endometrial cancer survivors. They are also known to present with pelvic floor muscle alterations. Evidence on the effects of conservative interventions for the management of UI is scarce. This study aims at verifying the effects of an in-home rehabilitation progra...
Article
Introduction and hypothesisThe objectives were to determine whether levator ani muscle (LAM) motor function is associated with female stress urinary incontinence (SUI) severity, and whether changes in LAM motor function induced through pelvic floor muscle training (PFMT) are associated with improvements in SUI signs and symptoms.Methods Pelvic morp...
Article
We aimed to investigate the impact of time on fine-wire (fw) electromyography (EMG) signal amplitude, and to determine whether any attenuation is confounded by task type. Twenty healthy participants were instrumented with fw and surface (s) EMG electrodes at the biceps brachii bilaterally. Participants held a weight statically with one arm and with...
Conference Paper
Background: The role of levator ani muscle (LAM) dysfunction in female stress urinary incontinence (SUI) is not known. Purpose: To determine whether LAM function is associated with SUI severity, and whether changes in LAM function induced through pelvic floor muscle training (PFMT) are associated with improvements in SUI in females. Methods: Female...
Article
Full-text available
https://doi.org/10.1007/s00192-020-04622-9 The article “The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis”, written by Kobra Falah-Hassani, Joanna Reeves, Rahman Shiri, Duane Hickling, and Linda McLean, was originally published Online First without Open Access. After publication in volume 32, issue 3, page 5...
Conference Paper
Full-text available
Background: Corticomotor excitability can be assessed through motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS). While TMS has been used extensively to probe the distal extremity musculature, very little effort has been made to explore the more proximal motor representations, notably those of the pelvic floor muscle...
Presentation
Full-text available
ABSTRACT Background: As we have observed unfortunately during the recent COVID-19 pandemic, all healthcare professionals are at a high risk of both acquiring and spreading infections. This includes physiotherapists working in pelvic health. If proper guidelines for infection control measures are lacking, there may be an increased risk of infection...
Article
Aims To investigate the intra‐ and inter‐rater reliability of two‐dimensional (2D) transperineal ultrasound imaging (USI) measures of bladder wall thickness (BWT), urethral length (UL), and parameters related to levator plate length (LP) and transient changes in LP during pelvic floor muscle (PFM) contraction, and on Valsalva in women who received...
Article
Introduction and hypothesis: This single-blind, randomised controlled trial was aimed at determining whether peri-operative physiotherapist-supervised pelvic floor muscle (PFM) training was superior to standard care (handout) in terms of improvements in stress urinary incontinence (SUI) symptoms, cure rate, and/or post-operative filling or voiding...
Article
Full-text available
Introduction and hypothesisTo evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women.Methods For the data sources, a structured search of the peer-reviewed literature (English language; 1960–April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed...
Article
Aims (1) To present the design of a novel intravaginal dynamometer (IVD) capable of measuring vaginal closure force on both the anterior and posterior arms, (2) to use bench testing to validate the force, speed of arm opening, and positional accuracy of load measurement along the IVD arms, and (3) to present in vivo force measurements made with thi...
Chapter
With life expectancy increasing globally, older adults around the world want to live active lifestyles with improved health and higher quality of life. Physiology of Exercise and Healthy Aging, Second Edition, examines the effects of the aging process on the major physiological systems and identifies the positive impacts of physical activity and re...
Article
Full-text available
Introduction and hypothesis The aim of this study was to prospectively identify aspects of baseline demographic, clinical, and pelvic morphology of women with stress urinary incontinence (SUI) that are predictive of cure with physiotherapist-supervised pelvic floor muscle training (PFMT). Methods Women ≥18 years old with SUI were recruited from ur...
Conference Paper
Objective: To determine whether the amplitude of pelvic floor muscle (PFM) electromyographic responses (EMGrs) recorded from the pubovisceralis(PV), external anal sphincter(EAS) or bulbocavernosus(BC) muscles differ based on the intensity (low vs moderate) or site [vaginal fourchette (VF) vs the posterior thigh (PT)] of applied pressure. Study des...
Conference Paper
Full-text available
Introduction: Provoked vestibulodynia (PVD) is a chronic pain condition characterized by severe sharp and/or burning pain at the vulvar vestibule when pressure is applied to this area. Although it affects roughly one in five women, and has a negative impact on quality of life for approximately half of them, PVD remains poorly understood. The litera...
Chapter
In addition to self‐report measures of pain, objective measures have been used to assess and quantify pain and pelvic floor muscle (PFM) function in women with provoked vestibulodynia (PVD). This chapter focuses on objective measures used to test the sensation of the vestibule and the involvement of the pelvic floor musculature. The cotton‐swab tes...
Article
Introduction The assessment of pelvic floor muscle (PFM) overactivity is part of a comprehensive evaluation including a detailed history (medical, gynecological history/antecedent), appraisal of the psychosocial contexts of the patient, as well as a musculoskeletal and a neurological examination. Objectives The aims of this article are to review (...
Article
Aims Reliability and validity of force measurement and task detection by the Elvie Trainer were evaluated against an intravaginal dynamometer (IVD) and ultrasound (US) imaging. Methods Women were recruited from local physiotherapy clinics. At the first visit, pelvic floor muscle (PFM) strength and tone were assessed manually. Women performed two s...
Article
Full-text available
The displacement of tumor bed walls during oncoplastic breast surgery (OBS) decreases the accuracy of using surgical clips as the sole surrogate for tumor bed location. This highlights the need for better communication of OBS techniques to radiation oncologists. To facilitate OBS practice and investigate clip placement reliability, a realistic sili...
Article
Full-text available
Hypopressive exercises have emerged as a conservative treatment option for pelvic floor dysfunction (PFD). The aim of this study was to compare the effects of an eight-week hypopressive exercise program to those of an individualized pelvic floor muscle (PFM) training (PFMT) program, and to a combination of both immediately after treatment and at fo...
Article
Introduction Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and ps...
Article
Background Responsive patient-reported outcome measures (PROMs) are able to detect change induced by a treatment. It is unknown whether PROMs on urinary incontinence (UI) are responsive in a conservative management setting. Objective To systematically review the responsiveness of recommended PROMs (grade A) for the assessment of health-related qua...
Article
Full-text available
Aim: To measure the neuromuscular activation of the pelvic floor and abdominal muscles concurrently with vaginal closure forces induced during a hypopressive exercise (HE) and to identify the contribution of the HEs sequences (posture and maneuver) in the muscle's activation. Methods: A cross-sectional study design was employed. Sixty-six women...
Article
Full-text available
Context: Pelvic floor muscle training (PFMT) is strongly recommended for the management of mild to moderate urinary incontinence (UI) in women, yet the specific elements of PFMT that lead to improvement have not been identified. This gap in knowledge may be related, at least in part, to the lack of detail provided on intervention parameters report...
Article
Study Objective This preliminary investigation aimed to evaluate the feasibility of using ultrasound elastography (UE) to evaluate the myometrial and uterine leiomyoma stiffness. Our objectives were to (1) assess the reliability of UE stiffness measures of non-neoplastic myometrium, and (2) compare UE stiffness measures of non-neoplastic myometrium...
Article
Full-text available
Purpose: To explore the feasibility of two physiotherapy interventions for the management of diastasis recti abdominis (DrA): abdominal binding and targeting trunk exercises. Methods: A pilot randomized controlled trial (RCT) design was used to compare the effectiveness of exercise therapy and/or abdominal binding to no intervention on thirty-two p...
Conference Paper
Objective: Using three different intervention reporting instruments : the Consensus on Exercise Reporting Template (CERT), the template for intervention description and replication (TIDieR), and the CONTENT scale for therapeutic validity of therapeutic exercise programs, the purpose of this study was to assess the completeness of exercise reporting...
Article
Introduction and hypothesis The objective was to appraise the current use of mobile technologies for the conservative self-management of urinary incontinence (UI). Moreover, we aimed to explore whether they integrate recommended features for the use of mobile technologies in healthcare and recognized parameters for optimal conservative UI treatment...
Article
Full-text available
Study design: Cross-sectional, observational cohort. Background: The biomechanical implications of diastasis recti abdominis (DRA) are unknown. Objectives: (1) To investigate the impact of DRA, measurement site and task on inter-rectus disstance (IRD), linea alba (LA) stiffness and LA distortion measured at rest, and during head lift and semi-...
Article
Aims The aim of this study was to investigate the impact of task familiarization on (1) the magnitude and (2) the repeatability of active and passive properties of the female pelvic floor muscles (PFMs) measured using automated intra‐vaginal dynamometry. Methods Women attended three laboratory sessions at one‐week intervals. After receiving initia...
Article
Background: A separation of the abdominal muscles at the linea alba, known as diastasis recti abdominis (DRA), can occur after childbirth. However, the impact of DRA on abdominal muscle function is not clear. Objective: The objective was to determine if differences exist in trunk muscle function and self-reported pain and low back dysfunction be...
Article
Aims (1) To determine the reliability of an automated dynamometer designed to assess pelvic floor muscle (PFM) strength and resistance to passive elongation. (2) To evaluate the impact of PFM length and rate of tissue elongation on dynamometric outcomes. Methods At each of two sessions, twenty nulliparous women performed three maximum voluntary co...
Article
Background: Digital intravaginal palpation remains the favored method for clinical assessment of pelvic floor muscle (PFM) function in women; however, there is growing interest in using transperineal ultrasound imaging (TPUSI). TPUSI does not involve vaginal penetration, making it particularly relevant for PFM assessment in women with genito-pelvi...
Article
Full-text available
Transperineal ultrasound (TPUS) allows for objective quantification of mid-sagittal urogenital mechanics, yet current practice omits dynamic motion information in favor of analyzing only a rest and a peak motion frame. This work details the development of UROKIN, a semi-automated software which calculates kinematic curves of urogenital landmark mot...
Article
Background: Diastasis recti abdominis (DrA) is associated with negative body image, musculoskeletal pain and dysfunction, and perhaps urogynecological complaints. The severity of DrA has traditionally been determined by measuring the inter-rectus distance (IRD); however, the relationship between IRD and symptoms in women with DrA is unclear. Obje...
Article
Aims: The purpose of this study was to investigate the relationship between pelvic floor muscle (PFM) electromyographic (EMG) activation and urogenital landmark motion measured using 2D transperineal ultrasound (US) imaging. Methods: Eight healthy, nulliparous women performed maximum voluntary PFM contractions while EMG and transperineal US imag...
Article
Aims: The purposes of this study were: (i) to evaluate the reliability of vaginal palpation, vaginal manometry, vaginal dynamometry; and surface (transperineal) electromyography (sEMG), when evaluating pelvic floor muscle (PFM) strength and/or activation; and (ii) to determine the associations among PFM strength measured using these assessments....
Article
Full-text available
Purpose: An increased inter-rectus distance (IRD) can persist after a pregnancy and may be associated with lumbopelvic dysfunction. Ultrasound imaging (USI) is currently the gold standard for measuring IRD; however, no study has explored the need to standardize the transducer angle during these evaluations. The purpose of this study was to determi...
Article
Introduction: Emergent evidence suggests that pelvic floor muscle (PFM) dysfunction contributes to dyspareunia, the experience of pain on vaginal penetration. Electromyography (EMG) is a valuable tool for the assessment of neuromuscular control and could be very useful in enhancing our understanding of PFM involvement in sexual function and in con...
Article
Objective: To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs fo...
Article
Objective: To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exerci...
Article
Full-text available
Objectives: To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for...