OBJECTIVE: The aim of this study was to evaluate the intra and inter-rater reliability of pelvic floor muscle (PFM) dynamometric measurements for maximum and average strengths, as well as endurance. METHOD: A convenience sample of 18 nulliparous women, without any urogynecological complaints, aged between 19 and 31 (mean age of 25.4±3.9) participated in this study. They were evaluated using a pelvic floor dynamometer based on load cell technology. The dynamometric evaluations were repeated in three successive sessions: two on the same day with a rest period of 30 minutes between them, and the third on the following day. All participants were evaluated twice in each session; first by examiner 1 followed by examiner 2. The vaginal dynamometry data were analyzed using three parameters: maximum strength, average strength, and endurance. The Intraclass Correlation Coefficient (ICC) was applied to estimate the PFM dynamometric measurement reliability, considering a good level as being above 0.75. RESULTS: The intra and inter-raters' analyses showed good reliability for maximum strength (ICCintra-rater1=0.96, ICCintra-rater2=0.95, and ICCinter-rater=0.96), average strength (ICCintra-rater1=0.96, ICCintra-rater2=0.94, and ICCinter-rater=0.97), and endurance (ICCintra-rater1=0.88, ICCintra-rater2=0.86, and ICCinter-rater=0.92) dynamometric measurements. CONCLUSIONS: The PFM dynamometric measurements showed good intra- and inter-rater reliability for maximum strength, average strength and endurance, which demonstrates that this is a reliable device that can be used in clinical practice.

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ObjectiveTo evaluate the effectiveness of abdominopelvic training by virtual reality compared to pelvic floor muscle training (PFMT) using a gym ball (a previously tested and efficient protocol) on postmenopausal women’s pelvic floor muscle (PFM) strength.MethodA randomized controlled trial was conducted with 60 postmenopausal women, randomly allocated into two groups: Abdominopelvic training by virtual reality – APT_VR (n=30) and PFMT using a gym ball – PFMT_GB (n=30). Both types of training were supervised by the same physical therapist, during 10 sessions each, for 30 minutes. The participants’ PFM strength was evaluated by digital palpation and vaginal dynamometry, considering three different parameters: maximum strength, average strength and endurance. An intention-to-treat approach was used to analyze the participants according to original groups.ResultsNo significant between-group differences were observed in most analyzed parameters. The outcome endurance was higher in the APT_VR group (p=0.003; effect size=0.89; mean difference=1.37; 95% CI=0.46 to 2.28).ConclusionBoth protocols have improved the overall PFM strength, suggesting that both are equally beneficial and can be used in clinical practice. Muscle endurance was higher in patients who trained using virtual reality.

There was a correlation between pelvic floor muscle contractility measured by surface electromyography and by digital palpation. Both methods can be used to validate data in research and clinical setting.

There is co-activation of the transversus abdominis/internal oblique and the pelvic floor muscles in young, asymptomatic nulliparous women. This pattern was modified in primigravid pregnant and primiparous postpartum women regardless of the delivery mode.

Pelvic floor muscle training is an effective means for the increase in its own contractility in both primigravid pregnant and primiparous postpartum women, accompanied with a concomitant decrease in urinary symptoms.

Fourteen percent of women participating were not able to perform active contraction of the PFM. PFM electromyographic activity changed during the female life cycle. PFM electromyographic activity correlated inversely with age, parity, and the presence and severity of urinary symptoms.

This virtual reality program promoted an increase in PFM contractility and a decrease in postmenopausal urinary symptoms.