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Barbosa-Silva J, Sato TDO, Homsi Jorge C, Armijo-Olivo S, Driusso P. What are the cut-off points for vaginal manometry to differentiate women with a weak from those with a strong pelvic floor muscle contraction?: Vaginal manometry to classify a pelvic floor muscle contraction. Braz J Phys Ther 2023; 27:100572. [PMID: 38043160 PMCID: PMC10703600 DOI: 10.1016/j.bjpt.2023.100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Vaginal manometry is regarded as an objective method to assess pelvic floor muscles (PFM) function and can measure several variables during contraction. OBJECTIVE To determine which variables could differentiate women with/without a weak/strong PFM contraction and determine their cut-off points. METHODS This is a diagnostic accuracy study performed on 156 women with a mean age of 40.4 (SD, 15.9) years. The reference test was vaginal palpation and the index test was vaginal manometry (Peritron™ manometer). Variables were pressure at rest, pressure achieved with maximal voluntary contraction (MVC), MVC average, duration, gradient, and area under the curve (AUCm). The Receiver Operating Curve (AUC/ROC) and logistic regression were used to analyze the data and obtain cut-off points. RESULTS Excellent ability to discriminate women with a weak/strong PFM contraction was found for MVC average (cut-off: 28.93 cmH2O), MVC (cut-off: 38.61 cmH2O), and the AUCm (cut-off: 1011.93 cm²*s). The gradient variable had good discrimination ability (AUC/ROC=0.81; cut-off: 28.68 cmH2O/s). The MVC average assessed by manometry, menopausal status, and the presence of stress urinary incontinence (SUI) were associated with a weak/strong PFM contraction in the multivariate analysis; however, the most parsimonious model to discriminate weak/strong PFM contraction included only the MVC average (AUC/ROC = 0.95; sensitivity: 0.87; specificity: 0.91). CONCLUSION These results suggest which manometry variables are appropriate to assess and classify PFM function in females. These could be used to help physical therapists to make clinic decisions about the management of female PFM.
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Affiliation(s)
- Jordana Barbosa-Silva
- Women's Health Research Laboratory, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil; Faculty of Business and Social Sciences, University of Applied Sciences - Hochschule Osnabrück, Osnabrück, Germany.
| | - Tatiana de Oliveira Sato
- Preventive Physical Therapy and Ergonomics Laboratory, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Cristine Homsi Jorge
- Pelvic Floor Muscle Function Laboratory, Health Science Departament, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Susan Armijo-Olivo
- Faculty of Business and Social Sciences, University of Applied Sciences - Hochschule Osnabrück, Osnabrück, Germany
| | - Patricia Driusso
- Women's Health Research Laboratory, Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil.
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Aparecida Salbego Lançanova A, Chaida Sonda F, Cristine da Silva Gomes D, Mallmann S, Aurélio Vaz M, Laureano Paiva L, Geraldo Lopes Ramos J. Is there correlation between perineometry and Modified Oxford Scale in women? Systematic review with meta-analysis and grade recommendations. Eur J Obstet Gynecol Reprod Biol 2023; 288:160-169. [PMID: 37549507 DOI: 10.1016/j.ejogrb.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/28/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The International Continence Society (ICS) recommends the use of perineometry and digital palpation to assess the pelvic floor muscles (PFM). Exploring the degree of correlation between both assessment strategies will serve to improve safety for clinical practice. Therefore, we performed a systematic review and meta-analysis on the correlation between assessment strategies. METHODS Observational studies were included. Bias risk assessment based on Downs and Black scale and the evidence's level were assessed using the GRADE. The random effect model measured the correlation values and were quantitatively analyzed through meta-analysis. Registration in PROSPERO database - CRD42021253775. RESULTS Six studies were selected. There was a high positive correlation between perineometry and MOS (r = 0.74; 95%-IC 0.61-0.83; I2: 81%, p < 0.01). Subgroup analysis was performed with 3 studies with continent women, and revealed a high positive correlation (r = 0.80; 95%-IC 0.62-0.90; I2: 90%, p < 0.01), while 2 studies with incontinent women revealed a moderate positive correlation (r = 0.64; 95%-IC 0.48-0.75; I2: 0%, p = 0.40). GRADE analysis revealed a low strength of evidence. CONCLUSION The high positive correlation between perineometry and MOS suggests that if the assessment strategies are applied in a standardized way, these tests can be used together or separately to assess the functionality of PFMs in clinical practice. However, the results should be interpreted with caution due to the low strength of GRADE evidence.
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Affiliation(s)
- Andriéli Aparecida Salbego Lançanova
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Francesca Chaida Sonda
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniele Cristine da Silva Gomes
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Suzana Mallmann
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marco Aurélio Vaz
- Grupo de Pesquisa em Biomecânica e Cinesiologia, Laboratório de Pesquisa do Exercício, Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Luciana Laureano Paiva
- Escola de Educação Física, Fisioterapia e Dança, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José Geraldo Lopes Ramos
- Programa de Pós Graduação em Ciências da Saúde: Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Miotto VG, Fernades ACNL, de la Ossa AMP, Bazanelli GS, Fretta TDB, de Paula NA, Homsi Jorge C. Women with functional constipation have a worse ability to relax their pelvic floor muscle: A cross sectional study. Neurourol Urodyn 2023; 42:123-132. [PMID: 36208110 DOI: 10.1002/nau.25057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Functional intestinal constipation (FIC) has a high prevalence worldwide. It is higher in adult and elderly women, and in those with alterations in the pelvic floor muscle (PFM) structure and function. OBJECTIVE The primary aim of this study was to characterize PFM function, including tone, of women with and without FIC. The secondary aim was to assess and compare the general and symptom-related quality of life (QoL) between participants with and without FIC and its correlation with the assessed PFM function. METHODS This was a cross-sectional observational study, the outcomes were assessed using vaginal palpation, vaginal manometry and validated questionnaires: the Pelvic Floor Impact Questionnaire Short Form 7 (PFIQ-7), the Pelvic Floor Distress inventory (PFDI-20), and the Short-Form Health Survey (SF-36). This study included 60 women, 30 with FIC and 30 without FIC. The mean age of women with FIC was 48.2 years (standard deviation [SD] 12.22) and 51 years (SD 13.47) for those without FIC. Both groups were overweight. There was a significant difference between groups in the bowel domain of the PFIQ-7 (p = 0.016) and in the anal dysfunction domain of the PFDI-20 (p < 0.001), being higher in those women with FIC. Women with FIC presented a significantly worse ability to voluntarily relax their PFM (38.3%) than those without FIC (11.7%; p = 0.008). participants without FIC presented higher values of maximum voluntary contraction (MVC) assessed by vaginal manometry compared to participants without FIC (p = 0.008). PFM tone was not different between groups. CONCLUSION Women with FIC have more difficulty in relaxing their PFM and lower MVC values than women without FIC. FIC negatively impacts women's symptom-related QoL. The main contribution of this study was to reavel the difficulty of the participants with FIC to relax their PFM. This finding is important to guide clinical decision making for an adequate treatment program direct to women with FIC.
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Affiliation(s)
- Viviane G Miotto
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana C N L Fernades
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Aura M P de la Ossa
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Gabriela S Bazanelli
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Tatiana de B Fretta
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Nicole A de Paula
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cristine Homsi Jorge
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Silva JBD, Szkudlarek AC, Gallo RBS, Valadão APM, Avila MA, Driusso P, Korelo RIG. Verbal and Visual Feedback Immediately Affect the Electromyographic Activity of Female Pelvic Floor Muscles. J Manipulative Physiol Ther 2022; 44:743-750. [PMID: 35753882 DOI: 10.1016/j.jmpt.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the immediate effect of verbal and visual feedback on pelvic floor muscles (PFM) in nulliparous women without pelvic floor dysfunction. METHODS In this observational, single-assessor, cross-sectional study, 45 female university students were evaluated using bidigital vaginal palpation and vaginal surface electromyography (EMG). EMG assessments were performed at 2 time points (T1 and T2). According to the protocol, participants performed 5 maximal voluntary contractions (MVC) with 10-second intervals, 5 sustained voluntary contractions (SVC) for 10 seconds, and a 60-second voluntary contraction until fatigue (CUF) before (T1) and after (T2) receiving verbal instructions and visual feedback on PFM contractions. At T2, women received visual feedback on their PFM contraction. Root mean square (RMS) for each repetition (MVC and VCF) was recorded, and mean value was calculated. Compensatory mechanisms during contraction were recorded visually. The difference in mean RMS (mV) for MVC, SVC, and CUF; curve integral for MVC, SVC, and CUF; median frequency (Hz) for CUF between T1 and T2 were analyzed with repeated measures multivariate analysis of variance. RESULTS Before the instructions, most participants (95.6%) performed PFM MVC using at least 1 compensatory mechanism. PFM EMG outcomes changed at T2: RMS and curve integral were reduced in T2 (P < .05) for MVC, SVC, and CUF. The median frequency increased from T1 to T2 in the CUF group (P = .01). CONCLUSION Verbal and visual feedback had an immediate impact on the EMG activity of PFM in nulliparous continent women.
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Affiliation(s)
- Jordana Barbosa da Silva
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Ariani Cavazzani Szkudlarek
- Department of Prevention and Rehabilitation in Physiotherapy, Biological Sciences Sector, Federal University of Paraná - UFPR, Curitiba, Paraná, Brazil
| | - Rubneide Barreto Silva Gallo
- Department of Prevention and Rehabilitation in Physiotherapy, Biological Sciences Sector, Federal University of Paraná - UFPR, Curitiba, Paraná, Brazil
| | - Ana Paula Massuda Valadão
- Department of Prevention and Rehabilitation in Physiotherapy, Biological Sciences Sector, Federal University of Paraná - UFPR, Curitiba, Paraná, Brazil
| | - Mariana Arias Avila
- Laboratory of Research on Electrophysical Agents (LAREF) and Research Nucleus on Electrophysical Agents (NUPE), Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Patricia Driusso
- Women's Health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Raciele Ivandra Guarda Korelo
- Department of Prevention and Rehabilitation in Physiotherapy, Biological Sciences Sector, Federal University of Paraná - UFPR, Curitiba, Paraná, Brazil
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Yakıt Yeşilyurt S, Özengin N, Topçuoğlu MA. Comparing the efficacy of the Knack maneuver on pelvic floor muscle function and urinary symptoms using different teaching methods: a prospective, nonrandomized study. Int Urogynecol J 2022; 33:2895-2903. [PMID: 35501571 PMCID: PMC9060846 DOI: 10.1007/s00192-022-05213-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at comparing the efficacy of Knack maneuver training taught using different techniques on pelvic floor muscle (PFM) function, urinary symptoms, and perception of improvement in women with stress urinary incontinence (SUI). METHODS We conducted a prospective nonrandomized study of 46 women with SUI. Assessments included: PFM functions (secondary outcome, SO) using a Myomed 932 EMG biofeedback device, urinary incontinence symptoms using the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form (ICIQ-SF; primary outcome), the Urogenital Distress Inventory-6 (UDI-6; SO), and the Incontinence Severity Index (ISI; SO), and perception of improvement using the Global Perceived Impact scale. The women were divided into three groups according to their preference: group 1 (Knack maneuver training with electromyography biofeedback), group 2 (Knack maneuver training with verbal instruction), and group 3 (Knack maneuver training with vaginal palpation). An education program was also given to all women individually. The training program was 1 day per week for 4 weeks. RESULTS There was an improvement in UDI-6, ICIQ-SF, and ISI scores in all groups (p<0.05). The maximum voluntary contraction (MVC) of the PFMs increased in group 2 (p=0.002), whereas both the MVC of PFMs and PFM contraction during Valsalva increased in group 3 (p=0.011 and p=0.042). CONCLUSIONS Regardless of the teaching methods, the Knack maneuver and education programs were effective on urinary symptoms in women with mild to moderate SUI. The Knack maneuver training with vaginal palpation and verbal instruction improved MVC of PFMs. All three different teaching methods might be used in SUI treatment programs.
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Affiliation(s)
- Seda Yakıt Yeşilyurt
- Vocational School of Health Services, Physiotherapy, Izmir University of Economics, Izmir, Turkey.
| | - Nuriye Özengin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - M Ata Topçuoğlu
- Department of Obstetrics and Gynecology, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Soundararajan K, Dilruksha Chandrasiri M, Balchandra P. Staff awareness of pelvic floor muscle training (PFMT) in tertiary care - a qualitative cross-sectional study. J OBSTET GYNAECOL 2022; 42:2282-2286. [PMID: 35290148 DOI: 10.1080/01443615.2022.2040966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pelvic floor muscle training (PFMT) is proven to protect against pelvic-floor weakness in the form of urinary incontinence (UI) and pelvic organ prolapse (POP). National Institute for Health and Care Excellence (NICE) guidelines advise supervised PFMT as first-line treatment of stress or mixed UI and POP. Healthcare professionals play a crucial role in educating patients. Our aim is to study the extent of awareness of PFMT amongst healthcare professionals by a single-centre cross-sectional study of voluntarily participating 44 healthcare professionals. The term 'pelvic floor exercise' had varied explanations; 53% staff thought they knew how to undertake pelvic-floor assessment, although there was no standard method or terminology to describe the technique or outcome. Staff were unaware of PERFECTR method, Modified Oxford Grading, slow and fast contractions which form the basic criteria of standardised pelvic floor assessment and training. Only 43% staff were aware of online resources.Impact StatementWhat is already known on this subject? There have been many studies confirming the effectiveness of pelvic floor muscle training (PFMT) in the prevention and treatment of long-term morbidities like urinary incontinence, pelvic organ prolapse and sexual dysfunction. However, there have been no studies in the published literature about staff awareness of this important evidence based health intervention in women's health services.What do the results of this study add? We believe the awareness among health care staff about PFMT is still limited. Our study is the first of its kind in literature to highlight that staff awareness about this health intervention is still poor which in turn means staff are not well equipped to offer the support and guidance the patients need.What are the implications of these findings for clinical practice and/or further research? The lack of awareness of staff needs addressing on an urgent basis. Knowledge of PFMT is essential for health care staff to provide appropriate patient education and support. We recommend including information of PFMT and assessment methods in local and national guidelines to help increase awareness of staff and patients alike and help achieve better global pelvic health.
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Affiliation(s)
| | | | - Pooja Balchandra
- Hull and East Yorkshire University Teaching Hospitals NHS Trust, Kingston Upon Hull, UK
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Padilha JF, Passos KKA, Silva JBD, Driusso P. Electrostimulation and pelvic floor muscle training: immediate effect after one single session. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract Introduction: Pelvic floor muscle training (PFMT) and neuromuscular electrical stimulation (NMES) are physiotherapeutic conservative treatments to prevent and to treat pelvic floor dysfunctions. Objective: To investigate the immediate effect of one session of PFMT versus NMES associated to pelvic floor muscle (PFM) contraction on the PFM function in nulliparous women. Methods: This is a cross-sectional experimental study. Twenty women were randomized into the “PFMT Group” and “NMES Group”. PFM function evaluation was performed by vaginal palpation and manometry before and after a single session. PFMT was composed by one series of eight sustained contractions of 6 seconds and one series of four fast contractions, in four different positions. NMES parameters were: biphasic pulsed current; frequency: 50 Hz; pulse duration: 0.7 ms; cycle on:off 4:8s; rise/decay: 2/2s, time: 20 minutes; and intensity: participant' sensibility. Data was analyzed by the ANOVA two-way for repeated measures to verify the difference between groups, within group and the interactions for PFM function. A 5% probability was considered in all tests. Results: There were no significant differences between groups. At intra-group analysis, there was a significant decrease in the maximal voluntary contraction (p = 0.01), by manometry, between pre- and post-session for both groups. Conclusion: The immediate effects of a single session of PFMT and NMES associated with voluntary PFM contraction are similar on PFM function, that is, no difference was found between groups.
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Reis BM, da Silva JB, Rocha APR, Liebano RE, Driusso P. Intravaginal electrical stimulation associated with pelvic floor muscle training for women with stress urinary incontinence: study protocol for a randomized controlled trial with economic evaluation. Trials 2021; 22:823. [PMID: 34801063 PMCID: PMC8606065 DOI: 10.1186/s13063-021-05781-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/01/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Pelvic floor muscle training (PFMT) exercises and neuromuscular electrical stimulation (NMES) are described as conservative interventions to prevent or treat female stress urinary incontinence (SUI). However, it has not been described yet the effect of PFMT associated to intravaginal NMES which evaluated the cost-effectiveness and cost-utility of treating. AIMS To evaluate the effects of intravaginal NMES associated with the PFMT protocol on urinary loss and quality of life in women with SUI and to evaluate the cost-effectiveness and cost-utility and pelvic floor muscle in women with SUI. METHODS Randomized controlled trial study with economic evaluation. Inclusion criteria are woman (biological), aged ≥ 18 years old and with a report of SUI ≥ once/week. Exclusion criteria are presence of vaginal or urinary infection, virginity, being in the gestational or puerperium period, or neurological disease. Participants will undergo physical therapy assessment and intervention: anamnesis, pelvic floor muscle assessment by vaginal palpation and manometry (PeritronTM), questionnaires (Short-Form 6 Dimensions-Brazil (SF-6D), King's Health Questionnaire (KHQ) and King´s Health Questionnaire for Scoring Algorithm), health costs, and voiding diary. Participants will be randomly allocated into 3 groups: CG (control group), IG 1 (intervention group 1, PFMT), and IG2 (intervention group 2, PFMT + NMES). The statistical analysis will be performed by intention to treat, and multivariate analysis of mixed effects will be used to compare outcomes. Effect size measurements will be calculated and will be provided by Cohen's d test. A significance level of 5% will be adopted. Additionally, the incremental cost-effectiveness and incremental cost-utility ratios will be used. DISCUSSION This protocol can corroborate with the literature in order to identify the effect of techniques, based on the possibility of confirming the hypothesis that the NMES associated with PFMT performed concurrently will be the best treatment option; considering the effectiveness, cost-effectiveness, and cost-utility analysis, it will be used as an option for optimization of the treatment of SUI. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-6gtzg4 . Registered on September 3, 2019.
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Affiliation(s)
- Bianca Manzan Reis
- Women’s Health Research Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, Rod. Washington Luis, km 235, CEP, São Carlos, SP 13565-905 Brazil
| | - Jordana Barbosa da Silva
- Women’s Health Research Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, Rod. Washington Luis, km 235, CEP, São Carlos, SP 13565-905 Brazil
| | - Ana Paula Rodrigues Rocha
- Women’s Health Research Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, Rod. Washington Luis, km 235, CEP, São Carlos, SP 13565-905 Brazil
| | - Richard Eloin Liebano
- Physioterapeutics Resources Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP Brazil
| | - Patricia Driusso
- Women’s Health Research Laboratory, Physical Therapy Post-Graduate Program, Federal University of São Carlos, Rod. Washington Luis, km 235, CEP, São Carlos, SP 13565-905 Brazil
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da Silva JB, Rocha APR, Sato TDO, Driusso P. Is there agreement between the preference of examiner and women for unidigital and bidigital vaginal palpation? A qualitative study. Int Urogynecol J 2021; 32:3293-3299. [PMID: 34331079 DOI: 10.1007/s00192-021-04935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The International Continence Society recommends vaginal palpation as a method for assessing pelvic floor muscle (PFM) function. Our aim was to analyze the agreement between preferences of examiner and participants according to unidigital and bidigital vaginal palpation during PFM assessment. The second aim was to investigate qualitatively women's perception of vaginal palpation. METHODS Maximal voluntary contractions (MVCs) were requested during both types of vaginal palpation and were classified by the Modified Oxford Scale (MOS). Examiner and participants answered if they had preferences regarding vaginal palpation. Women answered qualitatively what they felt during the assessment. Cohen's linear kappa (κ) evaluated the agreement after allocation of the women with a weaker and stronger MVC and qualitative analysis was performed by transcription considering age range (18-35; 36-59; ≥60 years). RESULTS Agreement was almost zero for women with weaker and stronger MVC at unidigital (κ = 0.06 and κ = -0.12) and bidigital vaginal palpation (κ = 0.008 and κ = 0.005). Participants associated bidigital palpation with more perception and an easier way of contracting the PFMs. Women between 36 and 59 years associated unidigital palpation with a harder but comfortable way of contracting the PFMs. Subjects aged ≥60 years associated bidigital palpation with an uncomfortable, harder way of contracting PFM, with less space into the vagina. CONCLUSIONS Agreement between preferences was almost zero neither between women with a weaker and stronger PFM contraction, nor between the types of vaginal palpation. Bidigital palpation increased women's perception, made the contraction easier, and was associated with less space in the vaginal canal and less comfort.
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Affiliation(s)
- Jordana Barbosa da Silva
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos, Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil.
| | - Ana Paula Rodrigues Rocha
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos, Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil
| | - Tatiana de Oliveira Sato
- Preventive Physical Therapy and Ergonomics Laboratory, Physical Therapy Department, Federal University of São Carlos, Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil
| | - Patricia Driusso
- Women's Health Research Laboratory, Physical Therapy Department, Federal University of São Carlos, Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil
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Franco MM, Pena CC, de Freitas LM, Antônio FI, Lara LAS, Ferreira CHJ. Pelvic Floor Muscle Training Effect in Sexual Function in Postmenopausal Women: A Randomized Controlled Trial. J Sex Med 2021; 18:1236-1244. [PMID: 37057416 DOI: 10.1016/j.jsxm.2021.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/18/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prevalence of sexual dysfunction is high in postmenopausal women and pelvic floor muscle training (PFMT) could improve sexual function during this period. AIM To assess the effect of a PFMT protocol on sexual function in postmenopausal women and to investigate the effect of this protocol on pelvic floor muscle function. METHODS This is an assessor blinded randomized controlled trial including 77 postmenopausal women. The study was registered in ReBEC Trial: RBR-3s3ff7. The intervention group (n = 40) received an intensive supervised PFMT protocol during 12 weeks and the control group (n = 37) received no intervention. OUTCOMES The primary outcome of the study was assessed by the Female Sexual Function Index (FSFI) questionnaire and the secondary outcome was the evaluation of pelvic floor muscle function performed by digital palpation using the modified Oxford scale at baseline and after 12 weeks. RESULTS No difference between groups was found in the FSFI domains and total score at baseline and in the second evaluation after 12 weeks. However, after 12 weeks, a higher percentage of women without sexual dysfunction was found in the intervention group (95% CI = 27.97-72.03) when compared to the control group (95% CI = 7.13-92.87). No difference was found between groups in relation to the pelvic floor muscle function at the baseline (P = .2) and after 12 weeks (P = .06). CLINICAL IMPLICATIONS PFMT is a conservative intervention that can lead women to have less sexual dysfunction. STRENGTHS & LIMITATIONS The protocol provided a reduced number of women with sexual dysfunction, the strength of this research is the study design and the limitation is to have used only one tool to assess sexual function although it is a validated questionnaire. CONCLUSION PFMT decreases sexual dysfunction in postmenopausal women. MM Franco, CC Pena, LM de Freitas, et al. Pelvic Floor Muscle Training Effect in Sexual Function in Postmenopausal Women: A Randomized Controlled Trial. J Sex Med 2021;18:1236-1244.
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Affiliation(s)
- Maíra M Franco
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Caroline C Pena
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Leticia M de Freitas
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Flávia I Antônio
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lucia A S Lara
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Pena CC, Bø K, de la Ossa AMP, Fernandes ACNL, Aleixo DN, de Oliveira FMF, Ferreira CHJ. Are visual inspection and digital palpation reliable methods to assess ability to perform a pelvic floor muscle contraction? An intra-rater study. Neurourol Urodyn 2021; 40:680-687. [PMID: 33476075 DOI: 10.1002/nau.24609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022]
Abstract
AIMS To investigate the intrarater reliability of visual inspection and digital palpation to classify women's ability to perform a voluntary pelvic floor muscle (PFM) contraction and the association between the two methods. METHODS This was a test-retest clinical study including 44 women. The ability to perform a PFM voluntary contraction was evaluated two times in all participants using visual inspection and digital palpation. All analyzed participants were assessed with a 7-day interval between the two assessments and by the same examiner. Kappa's agreement coefficient was used to estimate the intrarater reliability, and Fisher's exact test was used to analyze association between the two methods. RESULTS This study found a substantial intrarater reliability of visual inspection (k = 0.73; p < .001) and digital palpation (k = 0.74; p < .001). A significant association between visual inspection and digital palpation was found at both time points (p < .001). CONCLUSION Both visual inspection and digital palpation have substantial intrarater reliability and visual inspection can be recommended when vaginal palpation is not tolerated.
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Affiliation(s)
- Caroline C Pena
- Department of Health Science, Graduation Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Kari Bø
- Department of Sport Sciences, The Norwegian School of Sport Sciences and Akershus University Hospital, Oslo, Norway
| | - Aura M P de la Ossa
- Department of Health Science, Graduation Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana C N L Fernandes
- Department of Health Science, Graduation Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Devechio N Aleixo
- Department of Health Science, Graduation Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Flávia M F de Oliveira
- Department of Health Science, Graduation Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Cristine H J Ferreira
- Department of Health Science, Graduation Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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12
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Reliability of the PERFECT scheme assessed by unidigital and bidigital vaginal palpation. Int Urogynecol J 2021; 32:3199-3207. [PMID: 33416969 DOI: 10.1007/s00192-020-04629-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the present study was to evaluate the inter- and intra-rater reliability of the PERFECT scheme assessed by uni- and bidigital vaginal palpation in young nulligravid women. METHODS Forty healthy women [median age 22 (19-34) years] were evaluated by unidigital vaginal palpation by both Examiners A and C, while the other 40 participants [median age 23.5 (19-35) years] were assessed by Examiners B and C by bidigital vaginal palpation. Inter- and intra-rater reliability of all items of the PERFECT scheme were evaluated: P = power (Modified Oxford Scale); E = endurance; R = repetitions; F = fast contractions. Cohen's linear weighted kappa (κw) was used to assess the reliability of the power, while the intraclass correlation coefficient (ICC) was applied for the other items. A priori sample size calculation found that 40 participants would be adequate. RESULTS Inter-rater reliability of unidigital palpation was considered fair for power (κw = 0.34) and poor for other items (ICC < 0.50); bidigital inter-rater reliability was considered moderate (power: κw = 0.57; endurance: ICC = 0.53; fast contractions: ICC = 0.65, respectively) and low (repetitions: ICC = 0.27). Intra-rater reliability was substantial for power (κw = 0.73 and 0.62), moderate for fast contractions (ICC = 0.63 and 0.51) and poor for repetitions (ICC < 0.50), respectively, for uni- and bidigital palpation. Endurance showed poor (ICC < 0.50) and moderate (ICC = 0.61) reliability for uni- and bidigital palpation. CONCLUSIONS The PERFECT scheme carried out by bidigital vaginal palpation presents higher reliability when two examiners carry out the physical examination. When one examiner is responsible for PFM assessment, both types of palpation are recommended for evaluation of power and fast contraction; endurance should be evaluated using bidigital palpation. Examiners should be careful during the assessment of repetition of sustained contractions because inter- and intra-reliabilities for both types of palpation were classified as poor.
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da Silva JB, de Oliveira Sato T, Rocha APR, Driusso P. 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. Neurourol Urodyn 2020; 40:348-357. [PMID: 33152173 DOI: 10.1002/nau.24566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 01/05/2023]
Abstract
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 Cohen's 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.
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Affiliation(s)
- Jordana B da Silva
- Department of Physical Therapy, Women's Health Research Laboratory, São Carlos, São Paulo, Brazil
| | - Tatiana de Oliveira Sato
- Department of Physical Therapy, Preventive Physical Therapy and Ergonomics Laboratory, São Carlos, São Paulo, Brazil
| | - Ana P R Rocha
- Department of Physical Therapy, Women's Health Research Laboratory, São Carlos, São Paulo, Brazil
| | - Patricia Driusso
- Department of Physical Therapy, Women's Health Research Laboratory, São Carlos, São Paulo, Brazil
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Tailor VK, Bhide AA, Fernando R, Digesu GA, Khullar V. Does size matter? Perineometer and digital examination of a model levator hiatus. Neurourol Urodyn 2020; 39:1338-1344. [PMID: 32394457 DOI: 10.1002/nau.24384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Visha K Tailor
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, London, UK
| | - Alka A Bhide
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, London, UK
| | - Ruwan Fernando
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, London, UK
| | - Giuseppe A Digesu
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, London, UK
| | - Vik Khullar
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, London, UK
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Figueiredo VB, Nascimento SL, Martínez RFL, Lima CTS, Ferreira CHJ, Driusso P. 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. Neurourol Urodyn 2020; 39:1447-1455. [PMID: 32353206 DOI: 10.1002/nau.24370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/05/2020] [Accepted: 04/14/2020] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Vilena B Figueiredo
- Physical Therapy Department, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil.,Physical Therapy Department, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | | | - Renata F L Martínez
- Physical Therapy Department, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Clara T S Lima
- Physical Therapy Department, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Cristine H J Ferreira
- Department of Health Sciences, Health Science Department, University of São Paulo (USP), Ribeirão Preto-SP, São Paulo, Brazil
| | - Patricia Driusso
- Physical Therapy Department, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
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