“Comparative intra‐ and inter‐rater reliability of maximal voluntary contraction with unidigital and bidigital vaginal palpation and construct validity with Peritron manometer”

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Aims To assess the effects of individual pelvic floor muscle (PFM) training vs individual training (IT) progressing to group training (GT) vs group‐only training in women with stress urinary incontinence (SUI). Methods Randomized controlled and pragmatic clinical trials with 90 women with SUI. Participants were randomly allocated to one of three groups: IT, GT, or four individual sessions progressing to group training (IPGT). The intervention included 12 sessions, once a week, with direct supervision by a physical therapist. Primary outcome: severity according to the King's Health Questionnaire. Secondary outcomes: PFM function by palpation and manometer, bladder and exercise diaries, PFM training adherence, and self‐efficacy. Reassessments were conducted at the end of the intervention, 3 and 6 months after the intervention. Intra‐ and intergroup analysis for all outcomes was performed using a multivariate analysis of variance. In the mixed‐effects model used, the evaluation groups and times and their interactions were considered. A significance level of 5% was adopted. Results After the intervention, the severity measure improved in all three groups (P < .001), without difference between them (P = .56). The benefits of the intervention were maintained 3 and 6 months after the end of the supervised training (P < .001). The IPGT group had a significant improvement in PFM function when compared to the other groups posttreatment (P < .001). Conclusion PFM training improved the severity of urinary incontinence in all groups after 12 sessions of training supervised by a physical therapist. IT progressing to GT improved the function of upper PFM when compared to the other groups.

Section: Secondary Outcomes 271 | Pfm Functionmentioning

confidence: 99%

Effects of individual pelvic floor muscle training vs individual training progressing to group training vs group training alone in women with stress urinary incontinence: A randomized clinical trial

Figueirêdo

Nascimento²,

Martinez

et al. 2020

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“…Heterogenous results for interrater and intrarater reliability of vaginal examination and manometry examination are reported. 7,[17][18][19] Many factors are thought to affect the reliability of results and can be divided into patient characteristics and examination methods. Patient factors include patient age, 12 parity, 20 intra-abdominal pressure, 21 and ability to carry out a PFMC correctly.…”

Section: Discussionmentioning

confidence: 99%

“…Patient factors include patient age, 12 parity, 20 intra-abdominal pressure, 21 and ability to carry out a PFMC correctly. Examination outcomes can be affected by unidigital or bidigital examination, 18 patient positioning, frequency of examination which can affect patient fatigability, the experience of the examiner and manometry apparatus. 8 To our knowledge reliability studies for manometry or digital vaginal examination have not considered assessing the impact of the LH size directly.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Afshari et al 23 report a PFMC strength range of 20 to 85 cm H 2 O for 96 nulliparous women. Da Silva et al 24 compared perineometer readings in 114 women by age. They report a positive correlation between unidigital and bidigital palpation modified Oxford scale scores and manometry pressures (r s = .79, r s = .81, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…They did not discuss results by parity however a large overall standard deviation of 21.4 is described. 24 These studies did not formerly assess the impact of the LH to manometry.…”

Section: Discussionmentioning

confidence: 99%

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Does size matter? Perineometer and digital examination of a model levator hiatus

Tailor

Bhide

Fernando

et al. 2020

Introduction Evaluation of the female pelvic floor muscles is commonly carried out with digital examination and assigning a modified Oxford scale score or vaginal manometry. Racial differences can influence the size of the levator hiatus (LH) with “black” or African nulliparous women having a significantly larger LH compared to Caucasian women. The aim of this study was to assess the impact of LH size on manometry readings of simulated pelvic floor muscle contractions (PFMCs) using a small and large model LH. Methods Small and large LH models were created using published data for size. Inflation of a pressure cuff placed circumferentially in the LH model represented a simulated PFMC. The models were examined in a supine position by three examiners and a perineometer twice each at varying simulated PFMC strength. Results Positive correlation was found between increasing simulated PFMC strength with a higher Oxford score following digital examination and manometry readings for both the small (rs = .87, rs = .98) and large (rs = .95, rs = .87) models. There was good to excellent inter and intraobserver correlation for digital assessment of both models. The manometry measurements showed a much larger incremental rise from baseline in the small model compared with the large model (P < .05). Conclusion This study demonstrates that perineometer readings are affected by natural variations in LH size and PFMC strength. Therefore improvement to pelvic floor strength cannot be interpreted and measurements cannot be compared with others unless the LH size is known or digital examination is carried out.

Inter‐ and intrarater reliability of unidigital and bidigital vaginal palpation to evaluation of maximal voluntary contraction of pelvic floor muscles considering risk factors and dysfunctions

Silva¹,

Sato

Rocha³

et al. 2020

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Aims: To evaluate inter-and intrarater reliability of unidigital and bidigital vaginal palpation of pelvic floor muscle (PFM) maximal voluntary contraction (MVC) according to PFM risk factors and dysfunctions. Methods: A total of 187 women were recruited and evaluated by two examiners. Both performed the evaluation of MVC with unidigital and bidigital palpation, graded by Modified Oxford Scale. After 7-10 days, one examiner repeated the assessment. To analyze reliability by Cohenʼs linear Kappa (κw), participants were allocated into different groups according to: body mass index (BMI), menopause, parity, type of delivery and PFM dysfunctions, as pelvic organ prolapse (POP), constipation, urgency, urgency urinary incontinence, pelvic pain, and stress urinary incontinence. Results: Inter-rater reliability of unidigital palpation was considered fair (κw = 0.21-0.40) to moderate (κw = 0.41-0.60) according to BMI, postmenopausal status, parity, type of delivery, and PFM dysfunctions. Inter-rater reliability of bidigital palpation varied from none (κw = 0.00-0.20) to moderate for all risk factors and PFM dysfunctions. Intra-rater reliability of unidigital palpation was considered fair only for women with POP (κw = 0.37) and moderate to substantial (κw = 0.61-0.80) to all other variables. Intra-rater reliability of bidigital palpation ranged from moderate to almost perfect (κw = 0.81-1.00). Conclusions: When performing vaginal palpation, physiotherapists must consider the way that is performing the evaluation, as some PFM risk factors and dysfunctions could influence the inter-and intrarater reliability of unidigital and bidigital palpation.