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Reliability and validity of pelvic floor muscle displacement measurements during voluntary contractions

  • Helene MoserEmail author
  • Helena Luginbuehl
  • Jean-Pierre Baeyens
  • Lorenz Radlinger
Original Article
  • 11 Downloads

Abstract

Introduction and hypothesis

Understanding the functioning of pelvic floor muscles (PFM) is crucial in female PFM rehabilitation. The aim of this study was to determine the intra-session retest reliability and validity to evaluate the quantity of PFM displacement.

Methods

This cross-sectional observational study examined the PFM displacement of 17 young healthy nulliparous women in the midsagittal plane. Three maximal voluntary contractions (MVCs) and five fast voluntary contractions (FVCs) were simultaneously examined with an electromagnetic tracking system (ETS) and transabdominal ultrasound (TAUS) and expressed in millimeters (mean, SD). To evaluate reliability and validity, the analysis of variance, intraclass coefficient (2,1), standard error of measurement (SEM), and minimal detectable difference (MDD) were calculated.

Results

Maximal voluntary contractions and FVCs in supine position measured by an ETS (TAUS) showed a displacement of MVC: 3.5 ± 1.9 mm (7.8 ± 4.5 mm), FVC: 3.5 ± 2.4 mm (7.6 ± 5.3 mm), and during standing of MVC: 5.2 ± 1.6 mm (9.4 ± 3.8 mm) and FVC: 4.8 ± 2.5 mm (9.7 ± 4.1 mm). Intraclass correlation for the ETS (TAUS) measurement varied between 0.79 and 0.89 (0.61 and 0.74), SEM 0.52 and 1.03 mm (1.54 and 3.2 mm), and MDD 1.54 and 3.2 mm (6.64 and 7.53 mm). The correlation between an ETS and TAUS varied between 0.53 and 0.67.

Conclusions

For MVC and FVC, ETS measurements are highly reliable and TAUS measurements are moderately reliable for both contraction types. The correlation between the TAUS and ETS measurements is moderate. An ETS seems to be a reliable and valid measurement tool for evaluating PFM displacement during voluntary contractions. In future studies, the reproducibility and validity of ETS measurements need to be investigated in impact activities.

Keywords

Ultrasound Reproducibility of results Movement Gynecology Rehabilitation 

Abbreviations

PFM

Pelvic floor muscles

MVC

Maximal voluntary contraction

FVC

Fast voluntary contraction

ETS

Electromagnetic tracking system

TAUS

Transabdominal ultrasound

MRI

Magnetic resonance imaging

EMG

Electromyography

Notes

Acknowledgements

The authors thank Dr Martin Mueller and Dr Katja Duffe, Women’s Hospital, Urogynaecology, University Hospital and University of Bern, Switzerland, for the execution of the ultrasound measurements, Jean-Daniel Pourroy, private office of physical education and physiotherapy, Bern, Switzerland for assistance during the measurements, Michala Cadova, engineer, Centre of Dental Medicine, University of Zürich, Switzerland for setting up the custom-made MATLAB program, and Parsenn-Produkte AG (Küblis, Switzerland) for providing the vaginal surface EMG probes.

Authors’ contributions

H Moser: project development, data collection, manuscript writing; H Luginbuehl: project development, support of data collection, support of final draft; J-P Baeyens: adviser, support of final draft; L Radlinger: project development, contribution to study design, technical support, support of final draft.

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Thompson JA, O’Sullivan PB, Briffa NK, Neumann P. Comparison of transperineal and transabdominal ultrasound in the assessment of voluntary pelvic floor muscle contractions and functional manoeuvres in continent and incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(7):779–86.CrossRefGoogle Scholar
  2. 2.
    Constantinou CE. Dynamics of female pelvic floor function using urodynamics, ultrasound and Magnetic Resonance Imaging (MRI). Eur J Obstet Gynecol Reprod Biol. 2009;144(Suppl 1):S159–65.CrossRefGoogle Scholar
  3. 3.
    Lovegrove Jones RC, Peng Q, Stokes M, Humphrey VF, Payne C, Constantinou CE. Mechanisms of pelvic floor muscle function and the effect on the urethra during a cough. Eur Urol. 2010;57(6):1101–10.CrossRefGoogle Scholar
  4. 4.
    Dumoulin C, Glazener C, Jenkinson D. Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence. Neurourol Urodyn. 2011;30(5):746–53.CrossRefGoogle Scholar
  5. 5.
    Bo K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85(3):269–82.Google Scholar
  6. 6.
    Frawley HC, Galea MP, Phillips BA, Sherburn M, Bo K. Effect of test position on pelvic floor muscle assessment. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(4):365–71.CrossRefGoogle Scholar
  7. 7.
    Talasz H, Himmer-Perschak G, Marth E, Fischer-Colbrie J, Hoefner E, Lechleitner M. Evaluation of pelvic floor muscle function in a random group of adult women in Austria. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):131–5.CrossRefGoogle Scholar
  8. 8.
    Messelink B, Benson T, Berghmans B, Bo 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. Neurourol Urodyn. 2005;24(4):374–80.CrossRefGoogle Scholar
  9. 9.
    Crotty K, Bartram CI, Pitkin J, Cairns MC, Taylor PC, Dorey G, et al. Investigation of optimal cues to instruction for pelvic floor muscle contraction: a pilot study using 2D ultrasound imaging in pre-menopausal, nulliparous, continent women. Neurourol Urodyn. 2011;30(8):1620–6.CrossRefGoogle Scholar
  10. 10.
    Sherburn M, Murphy CA, Carroll S, Allen TJ, Galea MP. Investigation of transabdominal real-time ultrasound to visualise the muscles of the pelvic floor. Aust J Physiother. 2005;51(3):167–70.CrossRefGoogle Scholar
  11. 11.
    Arab AM, Behbahani RB, Lorestani L, Azari A. Correlation of digital palpation and transabdominal ultrasound for assessment of pelvic floor muscle contraction. J Man Manip Ther. 2009;17(3):e75–9.CrossRefGoogle Scholar
  12. 12.
    Thompson JA, O’Sullivan PB, Briffa K, Neumann P, Court S. Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(4):285–92.CrossRefGoogle Scholar
  13. 13.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.Google Scholar
  14. 14.
    Leitner M, Moser H, Taeymans J, Kuhn A, Radlinger L. Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review. Int Urogynecol J. 2015;26(11):1587–98.CrossRefGoogle Scholar
  15. 15.
    Unger CA, Weinstein MM, Pretorius DH. Pelvic floor imaging. Obstet Gynecol Clin N Am. 2011;38(1):23–43 vii.CrossRefGoogle Scholar
  16. 16.
    Chehrehrazi M, Arab AM, Karimi N, Zargham M. Assessment of pelvic floor muscle contraction in stress urinary incontinent women: comparison between transabdominal ultrasound and perineometry. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(12):1491–6.CrossRefGoogle Scholar
  17. 17.
    Leitner M, Moser H, Eichelberger P, Kuhn A, Baeyens JP, Radlinger L. Evaluation of pelvic floor kinematics in continent and incontinent women during running: an exploratory study. Neurourol Urodyn. 2018;37(2):609–18.CrossRefGoogle Scholar
  18. 18.
    Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87:631–42.CrossRefGoogle Scholar
  19. 19.
    Franco AV, Lee F, Fynes MM. Is there an alternative to pad tests? Correlation of subjective variables of severity of urinary loss to the 1-h pad test in women with stress urinary incontinence. BJU Int. 2008;102(5):586–90.CrossRefGoogle Scholar
  20. 20.
    Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19(1):231–40.Google Scholar
  21. 21.
    Portney LG, Watkins MP. Foundations of clinical research: applications to practice. 3rd ed. Upper Saddle River: Pearson/Prentice Hall; 2009.Google Scholar
  22. 22.
    Kelly M, Tan BK, Thompson J, Carroll S, Follington M, Arndt A. Healthy adults can more easily elevate the pelvic floor in standing than in crook-lying: an experimental study. Aust J Physiother. 2007;53(3):187–91.CrossRefGoogle Scholar
  23. 23.
    Junginger B, Vollhaber H, Baessler K. Submaximal pelvic floor muscle contractions: similar bladder-neck elevation, longer duration, less intra-abdominal pressure. Int Urogynecol J. 2018;29(11):1681–7.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Health Professions, Division of PhysiotherapyBern University of Applied SciencesBernSwitzerland
  2. 2.Faculty of Physical Education and PhysiotherapyVrije Universiteit BrusselBrusselsBelgium

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