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Maher R1, Iberle J1
1Creighton University, Physical Therapy, Omaha, United States
Background: Currently, no gold standard exists for assessing pelvic floor muscle (PFM) function, though digital palpation is used clinically. A significant correlation exists between digital palpation and transabdominal ultrasound imaging (TAUS) in PFM assessment and recent MRI studies indicate that the coccyx is mobile during PFM contractions and defecation.Additionally, a significant correlation exists between the Modified Oxford Scale and the magnitude of coccyx motion (CM) in the sagittal plane. Furthermore, palpation of CM has been shown to be useful in identifying women who can volitionally contract their PFM versus those who cannot.
Purpose: The purpose of this study was to compare palpation of coccyx motion (CM) with simultaneous TAUS to determine the formers validity in assessing PFM function in women.
Methods: 64 women were screened and only those who could perform a PFM contraction as assessed via TAUS were enrolled in this study. 37 women aged 21 - 72 years (mean 32 years) with a mean BMI of 24 kg/m2 participated in this study. A single examiner was assigned to each method of assessment: TAUS or CM. Investigators were blinded as subjects were randomly assigned to perform either a PFM contraction, a bearing down/straining maneuver or nothing under 3 randomly assigned testing positions: standing, sitting and sidelying. Subjects were instructed to “squeeze and relax” 3 times in 10 seconds while TAUS cine-loops were acquired simultaneous to palpation of CM over light clothing. Investigators were blinded to each other's assessment and subjects were blinded to TAUS. Data were then dichotomized into “able to contract” or “not able to contract” (bearing down/straining or nothing) and the data were analyzed. A correct pelvic floor muscle contraction was defined as bladder base elevation on TAUS and ventral motion of the coccyx assessed via palpation while the converse represented bearing down/straining.
Results: Palpation of CM correctly identified 51/54 observations when no PFM contraction occurred (94% sensitivity) compared to 12/45 observations during a contraction (specificity 79%) with positive (PPV) and negative (NPV) predictive values of 94% and 81% respectively. Chi-square (X2) tests and Phi coefficient(φ) revealed a significant strong relationship between TAUS and CM across all testing positions: standing X2 (1, N = 37) = 17.87, p .001, φ= .7 sitting X2 (1, N = 37) = 15.79, p .001, φ= .65 and sidelying X2 (1, N = 37) = 17.88, p .001), φ= .7 respectively.
Conclusion(s): This study confirms that palpating CM is a valid method of assessing PFM function across a variety of positions in women when compared to TAUS.
Implications: A salient finding was that 42% of the those screened could not perform a PFM contraction, Consequently, it is important that physical therapists screen for pelvic floor function even in healthy women regardless of the clinical setting. Additionally, teaching women to palpate their coccyx while performing PFM contractions may also provide valuable biofeedback as part of a home exercise program.
Keywords: Coccygeal motion, Pelvic floor function, Ultrasound imaging
Funding acknowledgements: NONE
Purpose: The purpose of this study was to compare palpation of coccyx motion (CM) with simultaneous TAUS to determine the formers validity in assessing PFM function in women.
Methods: 64 women were screened and only those who could perform a PFM contraction as assessed via TAUS were enrolled in this study. 37 women aged 21 - 72 years (mean 32 years) with a mean BMI of 24 kg/m2 participated in this study. A single examiner was assigned to each method of assessment: TAUS or CM. Investigators were blinded as subjects were randomly assigned to perform either a PFM contraction, a bearing down/straining maneuver or nothing under 3 randomly assigned testing positions: standing, sitting and sidelying. Subjects were instructed to “squeeze and relax” 3 times in 10 seconds while TAUS cine-loops were acquired simultaneous to palpation of CM over light clothing. Investigators were blinded to each other's assessment and subjects were blinded to TAUS. Data were then dichotomized into “able to contract” or “not able to contract” (bearing down/straining or nothing) and the data were analyzed. A correct pelvic floor muscle contraction was defined as bladder base elevation on TAUS and ventral motion of the coccyx assessed via palpation while the converse represented bearing down/straining.
Results: Palpation of CM correctly identified 51/54 observations when no PFM contraction occurred (94% sensitivity) compared to 12/45 observations during a contraction (specificity 79%) with positive (PPV) and negative (NPV) predictive values of 94% and 81% respectively. Chi-square (X2) tests and Phi coefficient(φ) revealed a significant strong relationship between TAUS and CM across all testing positions: standing X2 (1, N = 37) = 17.87, p .001, φ= .7 sitting X2 (1, N = 37) = 15.79, p .001, φ= .65 and sidelying X2 (1, N = 37) = 17.88, p .001), φ= .7 respectively.
Conclusion(s): This study confirms that palpating CM is a valid method of assessing PFM function across a variety of positions in women when compared to TAUS.
Implications: A salient finding was that 42% of the those screened could not perform a PFM contraction, Consequently, it is important that physical therapists screen for pelvic floor function even in healthy women regardless of the clinical setting. Additionally, teaching women to palpate their coccyx while performing PFM contractions may also provide valuable biofeedback as part of a home exercise program.
Keywords: Coccygeal motion, Pelvic floor function, Ultrasound imaging
Funding acknowledgements: NONE
Topic: Women's & men's pelvic health; Musculoskeletal
Ethics approval required: Yes
Institution: Creighton University, Omaha, Nebraska, USA
Ethics committee: Creighton University Institutional Review Board (IRB)
Ethics number: 646492-9
All authors, affiliations and abstracts have been published as submitted.
