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Published in: BMC Urology 1/2015

Open Access 01-12-2015 | Research article

Reliability of pelvic floor muscle strength assessment in healthy continent women

Authors: Dulcegleika VB Sartori, Monica O Gameiro, Hamilto A Yamamoto, Paulo R Kawano, Rodrigo Guerra, Carlos R Padovani, João L Amaro

Published in: BMC Urology | Issue 1/2015

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Abstract

Background

The aim of this study was to compare pelvic floor muscle (PFM) strength using transvaginal digital palpation in healthy continent women in different age groups, and to compare the inter- and intra-rater reliability of examiners performing anterior and posterior vaginal assessments.

Methods

We prospectively studied 150 healthy multiparous women. They were distributed into four different groups, according to age range: G1 (n = 37), 30–40 years-old; G2 (n = 39), 41–50 years-old; G3 (n = 39), 51–60 years-old; and G4 (n = 35), older than 60 years-old. PFM strength was evaluated using transvaginal digital palpation in the anterior and posterior areas, by 3 different examiners, and graded using a 5-point Amaro’s scale.

Results

There was no statistical difference among the different age ranges, for each grade of PFM strength. There was good intra-rater concordance between anterior and posterior PFM assessment, being 64.7%, 63.3%, and 66.7% for examiners A, B, and C, respectively. The intra-rater concordance level was good for each examiner. However, the inter-rater reliability for two examiners varied from moderate to good.

Conclusions

Age has no effect on PFM strength profiles, in multiparous continent women. There is good concordance between anterior and posterior vaginal PFM strength assessments, but only moderate to good inter-rater reliability of the measurements between two examiners.
Literature
1.
go back to reference Brown JS, Seeley DG, Fong J, Black DM, Ensrud KE, Grady D. Urinary incontinence in older women: who is at risk? Study Osteoporotic Fractures Research Group. Obstet Gynecol. 1996;87:715.CrossRefPubMed Brown JS, Seeley DG, Fong J, Black DM, Ensrud KE, Grady D. Urinary incontinence in older women: who is at risk? Study Osteoporotic Fractures Research Group. Obstet Gynecol. 1996;87:715.CrossRefPubMed
2.
go back to reference Amaro JL, Macharelil CA, Yamamoto H, Kawano PR, Padovani CR, Agostinho AD. Prevalence and risk factors for urinary and fecal incontinence in Brazilian women. Int Braz J Urol. 2009;35:592–8.CrossRefPubMed Amaro JL, Macharelil CA, Yamamoto H, Kawano PR, Padovani CR, Agostinho AD. Prevalence and risk factors for urinary and fecal incontinence in Brazilian women. Int Braz J Urol. 2009;35:592–8.CrossRefPubMed
3.
go back to reference Amaro JL, Moreira EC, De Oliveira OGM, Padovani CR. Pelvic floor muscle evaluation in incontinent patients. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:352–4.CrossRefPubMed Amaro JL, Moreira EC, De Oliveira OGM, Padovani CR. Pelvic floor muscle evaluation in incontinent patients. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:352–4.CrossRefPubMed
4.
go back to reference Shishido K, Peng Q, Jones R, Omata S, Constantinou CE. Influence of pelvic floor muscle contraction on the profile of vaginal closure pressure in continent and stress urinary incontinent women. J Urol. 2008;179:1917–22.CrossRefPubMed Shishido K, Peng Q, Jones R, Omata S, Constantinou CE. Influence of pelvic floor muscle contraction on the profile of vaginal closure pressure in continent and stress urinary incontinent women. J Urol. 2008;179:1917–22.CrossRefPubMed
5.
go back to reference Gameiro MO, Moreira EC, Ferrari RS, Kawano PR, Padovani CR, Amaro JL. A comparative analysis of pelvic floor muscle strength in women with stress and urge urinary incontinence. Int Braz J Urol. 2012;38:661–6.CrossRefPubMed Gameiro MO, Moreira EC, Ferrari RS, Kawano PR, Padovani CR, Amaro JL. A comparative analysis of pelvic floor muscle strength in women with stress and urge urinary incontinence. Int Braz J Urol. 2012;38:661–6.CrossRefPubMed
6.
go back to reference Bo K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85:269–82.PubMed Bo K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85:269–82.PubMed
7.
go back to reference Brink CA, Sampselle CM, Wells TJ, Diokno AC, Gillis GL. A digital test for pelvic muscle strength in older women with urinary incontinence. Nurs Res. 1989;38:196–9.CrossRefPubMed Brink CA, Sampselle CM, Wells TJ, Diokno AC, Gillis GL. A digital test for pelvic muscle strength in older women with urinary incontinence. Nurs Res. 1989;38:196–9.CrossRefPubMed
8.
go back to reference Incontinence LJ. Pelvic floor re-education. Nursing. 1991;4:15–7. Incontinence LJ. Pelvic floor re-education. Nursing. 1991;4:15–7.
9.
go back to reference Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society. Neurourol Urodyn. 2009;28:295. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society. Neurourol Urodyn. 2009;28:295.
10.
go back to reference Kerschan-Schindl K, Uher E, Wiesinger G, Kaider A, Ebenbichler G, Nicolakis P, et al. Reliability of pelvic floor muscle strength measurement in elderly incontinent women. Neurourol Urodyn. 2002;21:42–7.CrossRefPubMed Kerschan-Schindl K, Uher E, Wiesinger G, Kaider A, Ebenbichler G, Nicolakis P, et al. Reliability of pelvic floor muscle strength measurement in elderly incontinent women. Neurourol Urodyn. 2002;21:42–7.CrossRefPubMed
11.
go back to reference Bo K, Finckenhagen HB. Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand. 2001;80:883.CrossRefPubMed Bo K, Finckenhagen HB. Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand. 2001;80:883.CrossRefPubMed
12.
go back to reference Ferreira CH, Barbosa PB, de Oliveira SF, Antônio FI, Franco MM, Bø K. Inter-rater reliability study of the modified Oxsford Grading scale and the Peritron manometer. Physiotherapy. 2011;97:132–8.CrossRefPubMed Ferreira CH, Barbosa PB, de Oliveira SF, Antônio FI, Franco MM, Bø K. Inter-rater reliability study of the modified Oxsford Grading scale and the Peritron manometer. Physiotherapy. 2011;97:132–8.CrossRefPubMed
13.
go back to reference Amaro JL, Oliveira Gameiro MO, Padovani CR. Treatment of urinary stress incontinence by intravaginal electrical stimulation and pelvic floor physiotherapy. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:204–8.CrossRefPubMed Amaro JL, Oliveira Gameiro MO, Padovani CR. Treatment of urinary stress incontinence by intravaginal electrical stimulation and pelvic floor physiotherapy. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:204–8.CrossRefPubMed
14.
go back to reference World Health Organization [homepage on the Internet]. BMI Classification. 2006. Geneva: WHO [cited 2008 nov1 12]. Available from: www.who.int/bmi. World Health Organization [homepage on the Internet]. BMI Classification. 2006. Geneva: WHO [cited 2008 nov1 12]. Available from: www.​who.​int/​bmi.
15.
go back to reference Norman GR, Streiner DL. Biostatistics: the bare essentials. 3rd ed. St. Louis: Mosby Year Book; 2008. p. 393. Norman GR, Streiner DL. Biostatistics: the bare essentials. 3rd ed. St. Louis: Mosby Year Book; 2008. p. 393.
16.
go back to reference Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.CrossRef Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.CrossRef
17.
go back to reference Panatopoulos G, Raison J, Ruiz JC, Guy-Grand B, Basdevant A. Weight gain at the time of menopause. Hum Reprod. 1997;12:126–33.CrossRef Panatopoulos G, Raison J, Ruiz JC, Guy-Grand B, Basdevant A. Weight gain at the time of menopause. Hum Reprod. 1997;12:126–33.CrossRef
18.
go back to reference Lins APM, Sichieri R, Coutinho WF, Ramos EG, Peixoto MVM, Fonseca VM. Healthy eating, schooling and being overweight among low-income women.Cien Saude Colet. 2013;18:357–66. Lins APM, Sichieri R, Coutinho WF, Ramos EG, Peixoto MVM, Fonseca VM. Healthy eating, schooling and being overweight among low-income women.Cien Saude Colet. 2013;18:357–66.
19.
go back to reference Kearney R, Miller JM, Ashton-Miller JA, De Lancey JO. Obstetric factors associated with levatorani muscle injury after vaginal birth. Obstet Gynecol. 2006;107:144–9.CrossRefPubMedPubMedCentral Kearney R, Miller JM, Ashton-Miller JA, De Lancey JO. Obstetric factors associated with levatorani muscle injury after vaginal birth. Obstet Gynecol. 2006;107:144–9.CrossRefPubMedPubMedCentral
20.
go back to reference Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6.CrossRefPubMedPubMedCentral Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6.CrossRefPubMedPubMedCentral
21.
go back to reference Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of International Continence Society. NeurourolUrodyn. 2002;21:167–78. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of International Continence Society. NeurourolUrodyn. 2002;21:167–78.
22.
go back to reference Messelink B, Benson T, Berghmans B, Bø K, Corcos J, Fowler C, et al. Standardization of Terminology of Pelvic Floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. NeurourolUrodyn. 2005;24:374–80. Messelink B, Benson T, Berghmans B, Bø K, Corcos J, Fowler C, et al. Standardization of Terminology of Pelvic Floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. NeurourolUrodyn. 2005;24:374–80.
23.
go back to reference Worth A, Dougerty M, Mokey P. Development and testing of the circunvaginal muscles rating scale. Nurs Res. 1986;35:166–8.CrossRefPubMed Worth A, Dougerty M, Mokey P. Development and testing of the circunvaginal muscles rating scale. Nurs Res. 1986;35:166–8.CrossRefPubMed
24.
go back to reference Brink CA, Wells TJ, Sampselle CM, Faillie ER, Mayer R. A digital test for pelvic muscle strengh in women with urinary incontinence. Nurs Res. 1994;43:352–6.CrossRefPubMed Brink CA, Wells TJ, Sampselle CM, Faillie ER, Mayer R. A digital test for pelvic muscle strengh in women with urinary incontinence. Nurs Res. 1994;43:352–6.CrossRefPubMed
25.
go back to reference Laycock J, Jerwood D. Pelvic floor muscle assessment: The PERFECT Scheme. Physiotherapy. 2001;87:631–42.CrossRef Laycock J, Jerwood D. Pelvic floor muscle assessment: The PERFECT Scheme. Physiotherapy. 2001;87:631–42.CrossRef
26.
go back to reference Thompson LV, O’Sullivan PB, Briffa NK, Neumann P. Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J Pelvic Floor Dysfunc. 2006;17:624–30.CrossRef Thompson LV, O’Sullivan PB, Briffa NK, Neumann P. Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J Pelvic Floor Dysfunc. 2006;17:624–30.CrossRef
27.
go back to reference FitzGerald MP, Burgio KL, Borello-France DF, Menefee SA, Schaffer J, Kraus S, et al. Pelvic-floor strength in women with incontinence as assessed by the brink scale. Phys Ther. 2007;87:1316–24.CrossRefPubMed FitzGerald MP, Burgio KL, Borello-France DF, Menefee SA, Schaffer J, Kraus S, et al. Pelvic-floor strength in women with incontinence as assessed by the brink scale. Phys Ther. 2007;87:1316–24.CrossRefPubMed
28.
go back to reference Bø K, Finckenhagen HB. Is there any difference in measurement of pelvic floor muscle strength in supine and standing position. Acta ObstetGynecol Scand. 2003;82:1120–4.CrossRef Bø K, Finckenhagen HB. Is there any difference in measurement of pelvic floor muscle strength in supine and standing position. Acta ObstetGynecol Scand. 2003;82:1120–4.CrossRef
29.
go back to reference Frawley H, Galea M, Phillips B, Sherburn M, Bø K. Effect of test position on pelvic floor muscle assessment. Int Urogynecol J. 2006;17:365–71.CrossRef Frawley H, Galea M, Phillips B, Sherburn M, Bø K. Effect of test position on pelvic floor muscle assessment. Int Urogynecol J. 2006;17:365–71.CrossRef
30.
go back to reference Morin M, Dumoulin C, Bourbonnais D, Gravel D, Lemieux MC. Pelvic floor maximal strength using vaginal digital assessment compared to dynamometric measurements. Neurourol Urodynamics. 2004;23:336–41.CrossRef Morin M, Dumoulin C, Bourbonnais D, Gravel D, Lemieux MC. Pelvic floor maximal strength using vaginal digital assessment compared to dynamometric measurements. Neurourol Urodynamics. 2004;23:336–41.CrossRef
31.
go back to reference Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society. Neurourol Urodyn. 2009;28:295–300.CrossRefPubMed Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society. Neurourol Urodyn. 2009;28:295–300.CrossRefPubMed
32.
go back to reference McArdle WD, Katch FI, Katch VL. Fisiologia do exercícioEnergia, nutrição e desempenho do corpo humano. 5th ed. Rio de Janeiro: Guanabara Koogan; 2008. cap. 31:p.902-3. McArdle WD, Katch FI, Katch VL. Fisiologia do exercícioEnergia, nutrição e desempenho do corpo humano. 5th ed. Rio de Janeiro: Guanabara Koogan; 2008. cap. 31:p.902-3.
Metadata
Title
Reliability of pelvic floor muscle strength assessment in healthy continent women
Authors
Dulcegleika VB Sartori
Monica O Gameiro
Hamilto A Yamamoto
Paulo R Kawano
Rodrigo Guerra
Carlos R Padovani
João L Amaro
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2015
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/s12894-015-0017-6

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