Correlation of levator ani muscle strength measurement between Modified Oxford Grading Scale and perineometer on pelvic organ prolapse patient

Abstract

Pelvic Organ Prolapse (POP) is a debilitating condition affecting about half of all women aged of more than 60 years globally. Reduced levator ani muscle strength in POP is associated with worse symptoms and prognosis. Measurement of levator ani muscle strength can be done with several tools such as perineometer and digital palpation. However, there is currently no study regarding conformity between tests. The aim of this study is to determine the correlation between tests in POP patients. An analytic observational study using cross sectional design was done to determine conformity between perineometer and digital examination using Modified Oxford Grading Scale (MOS) in Dr Cipto Mangunkusumo National General Hospital, Indonesia during the period of July, 2018 to June, 2020. Correlation between tests was determined using Spearman test. Cut-off of perineometer reading for each MOS score was also determined. A total of 110 subjects examined with both perineometer and digital palpation were recruited to the study. Positive correlation was observed between perineometer reading and Modified Oxford Grading Scale (r = 0.790, p < 0.001). According to the result, values between 0.01 – 9.64 cmH2O correspond to very weak pressure (MOS 1); 9.65 – 22.49 cmH2O represent weak pressure (MOS 2); 22.5 – 35.24 cmH2O represent moderate pressure (MOS 3); ≥ 35.25 cmH2O represent good pressure (MOS 4). There was a strong correlation between MOS and perineometer result for measuring levator ani strength in POP patients.

Evaluation of the factors contributing to success of pelvic floor muscle training in stress urinary incontinence

“…Our population's mean initial strength was 23.10±9.20 cmH 2 O. This mean strength corresponded to moderate strength (Moegni and Ocsilia Wengkang reported that 22.5-35.24 cmH 2 O corresponded to modified Oxford scale 3 or 'moderate strength'), 25 and we expected that the muscle could respond optimally to PFMT. However, initial pelvic floor muscle contraction strength was not found to be significantly associated with PFMT treatment success.…”

“…Among the failed subjects, we found that the their age was mostly above 40 years; 66.67% had an initial contraction strength of 22.5-35.24 cmH 2 O, which corresponded to modified Oxford scale 3 (moderate strength). 25 Therefore, it was expected that the muscles could contract quite well. Most of the subjects had moderate-to-severe SUI, and we know that more severe SUI is associated with PFMT treatment failure.…”

Levator hiatal ballooning prevalence in pelvic organ prolapse patients and its relation to levator ani muscle strength

“…1,5 The overdistension is thought to be a factor further weakening the strength of the levator and pelvic floor muscles. Moegni et al (2021) found lower levator ani contraction strength in POP patients compared to general patients. 6 One of which factors causing the muscle weakness was thought to be hiatal ballooning.…”

“…Digital palpation for LAM strength was done using the Modified Oxford Grading Scale (MOS) criteria with the interval limit being 0 and 5. 7,8 A single urogynecologist acted as the evaluator for all subjects in this study.…”

“…Moreover, clinicians in regions with limited infrastructure may have difficulties in measuring the levator ani contraction strength due to the absence of a perineometer, thus relying on digital examination. 7 It is especially important in Indonesia which has many underdeveloped regions. As of today, the incidence of ballooning in POP cases has never been studied in Indonesia before.…”