Intra- and inter-raters reliability and concordance in the evaluation of perineal pressure in nulliparous
AIMS: To verify intra and inter-rater reliability and concordance in the assessment of perineal pressure in nulliparous women.
METHODS: Young, healthy, nulliparous, non-pregnant women who had had sexual intercourse and had a correct contraction of the perineal musculature on physical examination were included. Women were excluded if they used other muscles in a visually perceptible way during the perineal contraction; with changes in the pelvic muscles tone; with urinary incontinence; with cognitive alterations; with disease that could affect the muscular and nervous tissues; or practitioners of high-impact physical activity. The participants were submitted to two assessments of perineal pressure on the same day, with different evaluators. After one week the protocol was repeated. Perineal pressure was determined by means of a perineometer and obtained by the difference between the maximum pressure (Pmax) and the minimum pressure (Pmin) recorded by the device, in millimeters of mercury. Sustained contraction (SC) was evaluated by the time in seconds. In order to determine reliability, the intraclass correlation coefficient (ICC) was used. Bland-Altman test was used for the concordance analysis. Comparison of means was performed by the Wilcoxon test. A value of p≤0.05 was considered significant.
RESULTS: Ten participants were included, with a mean age of 23.8±2.9 years and a body mass index of 22.2±1.8 kg / m². The evaluator A obtained excellent intra-rater reliability for Pmin (ICC=0.86, p<0.01) and Pmax (ICC=0.92, p<0.01); very good reliability for perineal pressure (ICC=0.65, p=0.01); and no statistical significance for SC. For evaluator B, there was no statistical significance for Pmin and Pmax, but there was very good reliability for perineal pressure (ICC=0.78, p<0.01) and SC (ICC = 0.70, p<0.01). In the inter-rater analysis (A vs B), on day 1 there was no statistical significance for Pmin, Pmax and perineal pressure; but there was very good reliability for SC (ICC=0.71, p<0.01). On day 2, there was no statistical significance for Pmin and Pmax, but there was very good reliability for perineal pressure (ICC=0.62, p=0.02) and good for SC (ICC=0.56, p=0.03). There was agreement between intra and inter-rater measurements.
CONCLUSIONS: Perineal pressure measurements showed very good intra-rater reliability and good to very good inter-rater reliability, with intra and inter-rater concordance.
Menta S, Schirmer J. Relação entre a pressão muscular perineal no puerpério e o tipo de parto. Rev Bras Ginecol Obstet. 2006;28(9):523-9. https://doi.org/10.1590/S0100-72032006000900004
Bo K, Berghmans B, Morkved S, KampenMV.Evidence-based physical therapy for the pelvic floor – bridging science and clinical practice. 2. ed. Edinburgh: Elsevier Churchill Livingstone; 2015.
Bo K, Raastad R, Finckenhagen HB. Does the size of the vaginal probe affect measurement of pelvic floor muscle strength? Acta Obstet Gynecol Scand. 2005;(84):129-33. https://doi.org/10.1111/j.0001-6349.2005.00676.x
Figueiredo EM, Velloso FSB, Vieira GF, Vitória RO, Cruz MC. Avaliação e Diagnóstico Fisioterapêuticos de Mulheres com Disfunções do Assoalho Pélvico. In: Baracho, E. Fisioterapia Aplicada à Saúde da Mulher: 6. ed. Rio de Janeiro: Guanabara Koogan Ltda; 2018. Cap. 29, p. 269-89.
Vodusek DB. Electromyography. In: Bo K, Berghmans B, Morkved S, Kampen MV. Evidence based physical therapy for the pelvic floor. Bridging science and clinical practice. London: Churchill Livingstone/Elsevier; 2007. p. 53-63.
Vodusek DB. The role of electrophysiology in the evaluation of incontinence and prolapse. Curr Opin Obstet Gynecol. 2002;14(5):509-14. https://doi.org/10.1097/00001703-200210000-00012
Amaro JL, Gameiro MO, Kawano PR, Padovani CR. Intravaginal electrical stimulation: a randomized, double-blind study on the treatment of mixed urinary incontinence. Acta Obstet Gynecol Scand. 2006;85(5):619-22. https://doi.org/10.1080/00016340500495058
Barbosa PB, Franco MM, Souza FO, Antônio FI, Montezuma T, Ferreira CHJ. Comparison between measurements obtained with three different perineometers. Clinics. 2009;64(6):527-33. https://doi.org/10.1590/S1807-59322009000600007
Laycock J, Jerwood D. Pelvic Floor Muscle Assessment: The PERFECT Scheme. Physiotherapy. 2001;87(12):631-42. https://doi.org/10.1016/S0031-9406(05)61108-X
Ibramed. Manual de Operação – Neurodyn Evolution. Aparelho de Terapia por Eletro Estimulação. 2009.
Martins M, Moraes EB, Dreher DZ. O desempenho da escala de Oxford e do biofeedback manométrico perineal na avaliação da incontinência urinária de esforço em mulheres no período do climatério. Sci Med. 2016;26(1):ID22969. https://doi.org/10.15448/1980-6108.2016.1.22969
Baracho E, Botelho S, Nagib ABL. Atuação da Fisioterapia no Tratamento Conservador da Incontinência Urinária Feminina. In: Baracho, E. Fisioterapia Aplicada à Saúde da Mulher: 6. ed. Rio de Janeiro: Guanabara Koogan Ltda; 2018. Cap. 40, p. 369-76.
Seleme M, Valentin EK, Bertotto A, Berghmans B, Uchoa S. Biofeedback Perineal. In: BARACHO, E. Fisioterapia Aplicada à Saúde da Mulher: 6. ed. Rio de Janeiro: Guanabara Koogan Ltda, 2018. Cap. 30, p.290-300.
Kraemer WJ, Fleck SJ, Deschenes MR. Fisiologia do exercício: teoria e prática. 1. ed. Rio de Janeiro: Guanabara Koogan; 2013.
VanMaanen CJ, Zonnenberg AJ, Elvers JW, Oostendorp RA. Intra/interraterreliability of measurements on body posture photographs. Cranio. 1996;14(4):326-31. https://doi.org/10.1080/08869634.1996.11745985
Hobart JC, Lamping DL, Thompson AJ. Evaluating neurological outcome measures: the bare essentials. J Neurol Neurosurg Psychiatry. 1996 Feb;60(2):127-30. https://doi.org/10.1136/jnnp.60.2.127
Weir JP. Quantifying test-retest reliability using the interclass correlation coefficient and the SEM. J Strength Com Res. 2005;19(1):231-40.
Kottner J, Audigé L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, Roberts C, Shoukri M, Streiner DL. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol. 2011;64(1):96-106. https://doi.org/10.1016/j.jclinepi.2010.03.002
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307-10. https://doi.org/10.1016/S0140-6736(86)90837-8
Hundley AF, Wu JM, Visco AG. A comparison of perineometer to brink score for assessment of pelvic floor muscle strength. Am J Obstet Gynecol. 2005;(192):1583-91. https://doi.org/10.1016/j.ajog.2004.11.015
Rahmani N, Mohseni-Bandpei MA. Application of perineometer in the assessment of pelvic floor muscle strength and endurance: A reliability study. J Bodyw Mov Ther. 2011;(15):209-14. https://doi.org/10.1016/j.jbmt.2009.07.007
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):883-7. https://doi.org/10.1034/j.1600-0412.2001.801003.x
Dietz HP, Jarvis SK, Vancaillie TG. The Assessment of Levator Muscle Strength: A Validation of Three Ultrasound Techniques. Int Urogynecol J. 2002;(13):156-9. https://doi.org/10.1007/s192-002-8346-5
Kerschan-Schindl K, Uher E, Wiesinger G, Kaider A, Ebenbichler G, Nicolakis P, Kollmitzer J, Preisinger E, Fialka-Moser V. Reliability of pelvic floor muscle strength measurement in elderly incontinent women. Neurourol Urodyn. 2002;(21):42-7. https://doi.org/10.1002/nau.2099
Frawley HC, Galea MP, Phillips BA, Sherburn M, Bo K. Reliability of Pelvic Floor Muscle Strength Assessment Using Different Test Positions and Tools. Neurourol Urodyn. 2006;(25):236-42. https://doi.org/10.1002/nau.20201
Ferreira CHJ, Barbosa PB, Souza FO, Antônio FI, Franco MM, Bo K. Inter-rater reliability study of the modified Oxford Grading Scale and the Peritron manometer. Physiother. 2011;(97):132-8.
Martinho NM, Marques J, Silva VR, Silva SLA, Carvalho LC, Botelho S. Intra and inter-rater reliability study of pelvic floor muscle dynamometric measurements. Braz J Phys Ther. 2015;19(2):97-104. https://doi.org/10.1590/bjpt-rbf.2014.0083
Dabbadie L, Seleme M. Biofeedback Perineal. In: Baracho E. Fisioterapia aplicada à Obstetrícia, Urologia e aspectos de Mastologia. Rio de Janeiro: Guanabara Koogan; 2007.
Macêdo LC, Lemos A, Vasconcelos DA, Katz L, Amorim MMR. Correlation between electromyography and perineometry in evaluating pelvic floor muscle function in nulligravidas: A cross-sectional study. Neurourol Urodyn. 2018;37(5):1658-66. https://doi.org/10.1002/nau.23402
Button KS, Ioannidis JPA, Mokrysz C, Nosek BA, Flint J, Robinson ESJ, Munafò MR. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013;14(5):365-76. https://doi.org/10.1038/nrn3475
Copyright (c) 2019 Scientia Medica
This work is licensed under a Creative Commons Attribution 4.0 International License.
The submission of originals to Scientia Medica implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Scientia Medica as the site of original publication.
Creative Commons License
Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.