The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: A reliability and correlation study

Self Cite

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 who had participated in a physical therapy program focused on HEs were recruited.Pelvic floor muscle (PFM) activation was measured using surface electromyography (sEMG) in supine and in the orthostatic position, and vaginal closure force was measured through vaginal dynamometry in supine. Activation of the abdominal, gluteal, and hip adductor muscles was measured using sEMG. Maximum effort voluntary contractions (MVCs) of the PFMs and reference contractions of the abdominal and hip muscles were acquired for normalization purposes. A HE was then performed in a supine position with one leg raised, then in an orthostatic position. Results: During the supine HE, the peak PFM sEMG amplitude was 74.4% to 86.5% (49.6%-109.6%) of MVC, the peak vaginal closure force was between 51.2% and 55.7% (95.5%-382.9%) of MVC, and the muscles of the lateral abdominal wall were activated between 25.4% and 35.3% of the reference contraction. During the orthostatic HE, PFM activation was 61.4% (40.1%-105.6%) of MVC, and the lateral abdominal wall muscles contracted at 22.8% of the reference activation level.Conclusions: The PFMs, abdominal, gluteal, and adductor muscles are activated during the performance of a HE. The activation level of the PFMs and abdominal muscles is likely insufficient to result in strength gains; however, they could have an endurance effect. K E Y W O R D Sdeep abdominal muscles, hypopressive exercises, pelvic floor dysfunction, pelvic floor muscles strength, surface electromyography, therapeutic exercise

Section: Discussionmentioning

confidence: 99%

Pelvic floor and abdominal muscle responses during hypopressive exercises in women with pelvic floor dysfunction

Navarro-Brazález

Sánchez

Prieto-Gómez

et al. 2020

Self Cite

“…However, a possible limitation of the study was that the measurement of PFM function by two evaluators on the same day may have led to muscle fatigue; the learning effect of the contraction between the evaluations may also have influenced the MOS grades found. These factors have already been cited in other studies as possible confounders of the reproducibility analysis of vaginal palpation . To control for these biases, the order of the type of vaginal palpation (unidigital vs bidigital) was randomized as was the order of the evaluators.…”

Section: Discussionmentioning

confidence: 99%

“…However, a higher correlation was observed between bidigital palpation and manometry in the present study than those found in other studies. 11,31 These heterogeneous results can be explained by methodological variations among the studies, such as sample size, participantsʼ characteristics, and evaluation methods, as explained above.…”

Section: Discussionmentioning

confidence: 99%

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

Silva

Sato

Rocha

et al. 2019

Aims: Evaluate the intra-and inter-rater reliability of maximal voluntary contraction (MVC) of pelvic floor muscle (PFM) assessment by unidigital and bidigital vaginal palpation. As a secondary aim, evaluate the construct validity of vaginal palpation and a manometer.Methods: A total of 120 women were recruited and allocated into three groups according to age (group 1 [G1]: 18-35; G2: 36-59; G3: ≥60 years). Examiner A conducted an interview and examiners B and C performed evaluations of PFM function using both unidigital and bidigital vaginal palpation. Seven to 10 days later, examiner B repeated both types of vaginal palpation and measured the MVC pressure with a Peritron. Reliability was analyzed using Cohenʼs linear weighted Kappa (κ w ). The construct validity was calculated using the Spearmanʼs correlation (r s ).Results: Intra-rater reliability of unidigital and bidigital palpation was κ w = 0.75 and κ w = 0.58 in G1, κ w = 0.59 and κ w = 0.73 in G2, and κ w = 0.79 and κ w = 0.86 in G3, respectively. Inter-rater reliability of unidigital and bidigital palpation was κ w = 0.52 and κ w = 0.48 in G1, κ w = 0.47 and κ w = 0.52 in G2, and κ w = 0.50 and κ w = 0.64 in G3, respectively. Spearmanʼs correlation coefficients were significant at r s = 0.79 and r s = 0.80 for unidigital and bidigital vaginal palpation, respectively.Conclusions: Unidigital or bidigital vaginal palpation were indicated to evaluate G1 and G2 but bidigital palpation was more reliable in G3 when two examiners performed the evaluation. For the assessment conducted by one examiner, unidigital palpation was more reliable in G1 while bidigital palpation was more reliable in G2 and G3. Both unidigital and bidigital palpation have high measures of validity. K E Y W O R D S manometry, outcome and process assessment, palpation, pelvic floor, reproducibility of results, strength This study was conducted at Federal University of São Carlos.

“…Dysfunction of the mechanical properties of the female pelvic floor muscles (PFMs) is thought to contribute to a wide array of urogynecological disorders known to impair quality of life such as urinary incontinence, pelvic organ prolapse, and dyspareunia . Intravaginal dynamometry is recognized as an optimal tool to quantify active and passive pelvic floor tissue properties . Relative measures of PFM force generating capacity acquired by intravaginal dynamometry have demonstrated excellent reliability and correlate strongly with manual measures of PFM strength, the current standard for clinical assessment of the female PFMs.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Intravaginal dynamometry is recognized as an optimal tool to quantify active and passive pelvic floor tissue properties. [4][5][6][7] Relative measures of PFM force generating capacity acquired by intravaginal dynamometry have demonstrated excellent reliability 4,6,8,9 and correlate strongly with manual measures of PFM strength, 4,10 the current standard for clinical assessment of the female PFMs. Further, automated intravaginal dynamometry yields objective, continuous, and high-resolution measures-a necessity if clinicians wish to monitor pelvic floor dysfunction arising from injury or improvements in PFM function resulting from physical therapy or other interventions.…”

mentioning

confidence: 99%

The impact of a familiarization session on the magnitude and stability of active and passive pelvic floor muscle forces measured through intravaginal dynamometry

Czyrnyj

Bérubé

Varette

et al. 2019

Self Cite

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 initial task instruction and feedback at the start of the first session, standardized instructions were given while women performed maximal effort voluntary contractions of their PFMs with the dynamometer arms open at two different diameters and kept their PFMs relaxed while the dynamometer arms opened to 40 mm at two speeds. Outcomes included baseline force, peak force, relative peak forces (N), rate of force development (N/s) and stiffness. Between session effects were tested for all outcomes using one‐way ANOVAs. Intra‐class correlation coefficients (ICCs) and minimal detectable change values were computed within each session and between sessions 1 and 2 and sessions 2 and 3. Results Twenty nulliparous women (mean age = 35 ± 15 years) participated. No differences in the mean values were found across the three visits for any outcomes. Within sessions, neither ICC nor minimal detectable change differed among sessions and between‐session ICC values were not different between visits 1 and 2 and visits 2 and 3. Conclusions There is no evidence of a familiarization effect over a two‐week period on the amplitude nor repeatability of dynamometric measures of active or passive PFM properties recorded from nulliparous women.