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.
Subject(s)
Muscle Contraction , Pelvic Floor , Female , Humans , Muscle Contraction/physiology , Pelvic Floor/physiology , Palpation , Observational Studies as TopicABSTRACT
O assoalho pélvico é uma estrutura muscular complexa e as disfunções uroginecológicas desta musculatura são inúmeras. O diagnóstico das disfunções uroginecológicas podem ser realizadas por anamnese, avaliação clínica (palpação digital, perineometria e observação), urodinâmica, ultrassom e ressonância magnética. Os fisioterapeutas utilizam a palpação digital vaginal para obter informações de força da musculatura do assoalho pélvico. O objetivo do presente trabalho foi desenvolver um dispositivo eletromecânico, capaz de simular in vitro o músculo levantador do ânus, a fim de treinar futuros examinadores na sensibilidade do toque digital vaginal. Cinco molas foram fixadas em um modelo anatômico de resina da pelve em uma configuração que poderia representar o músculo elevador do ânus. Uma unidade de tração composta por motor de passo interligado a uma célula de carga foi utilizada para a caracterização da força de tração do sistema mecânico. Uma fisioterapeuta bem treinada realizou quatorze séries de palpação bidigital entre as cinco molas. Neste sentido, foi possível estabelecer valores de força que se correlacionavam com os seis graus da escala modificada de Oxford. As forças médias para todas as palpações bidigitais foram comparadas usando-se o teste de ANOVA de um fator controlável. De acordo com os resultados, o grau zero representou o alongamento nulo das molas. Os graus de 1 a 5 mostraram os seguintes valores médios de força: 1 (55,69 N), 2 (56,17 N), 3 (56,94 N), 4 (59,61 N), 5 (65,36 N). O dispositivo proposto apresentou-se como uma útil ferramenta para estabelecer a relação entre a força das molas e a escala modificada de Oxford.
The pelvic floor is a complex muscular structure and the urogynaecological dysfunctions of this muscular structureare innumerable. The diagnosis of these urogynaecological dysfunctions can be performed by anamnesis, clinical evaluation (digital palpation, perineometry and observation), urodynamics and by ultrasound or magnetic resonance imaging. Physiotherapist relies on vaginal digital palpation to obtain relevant data about pelvic floor strength. The aim of the present application was to develop an electromechanical device able to simulate in vitro the levator ani muscle in order to train the sensitivity of future examiners during a vaginal digital palpation. Five springs were fixed on a resin anatomical model of the human pelvis in a configuration that could represent the levator ani muscle. A traction unit composed by a load cell and a step motor was used to produce the traction of the springs being able to measure the traction force. One well trained physiotherapist executed all the fourteen series of digital palpation procedures between the five springs. It was possible to establish force values that were correlated to the six scores of the modified Oxford scale. The meanforces obtained for the complete digital assessment were compared using one-way ANOVA. According to the results, score 0 of the modified Oxford scale represented no elongation of the springs. Scores 1 to 5 showed the following mean force values: 1 (55.69 N), 2 (56.17 N), 3 (56.94 N), 4 (59.61 N), 5 (65.36 N). The proposed device presented itself as a useful tool which is able to establish a relation between the forces of the springs and the modified Oxford scale.
