Electromyographic analysis of maximal voluntary contraction of female pelvic floor muscles: Intrarater and interrater reliability study

Abstract Background Pregnancy and childbirth often result in alterations of core muscles, and women may require postpartum assessment of pelvic floor muscle function and abdominal wall changes, e.g. diastasis recti abdominis (DRA). However, there is currently no gold standard for postpartum assessment of these muscles´ function. Here we aimed to evaluate the reliability of clinically applicable methods for assessing pelvic floor muscles and DRA after pregnancy. Methods We recruited 222 postpartum women from Swedish antenatal and childbirth centers, and via social media. Pelvic floor and DRA assessment were performed via observation and palpation at three rehabilitation centers in Sweden. At each center, two independent physiotherapists performed the assessments in random order. Results Assessment of the maximal voluntary contraction and pelvic floor muscle endurance revealed kappa values ranging from 0.49–0.69. Assessments of voluntary contraction by observation, involuntary contraction, and voluntary relaxation yielded inconsistent results, with slight-to-moderate weighted kappa values ranging from 0.10–0.51. DRA assessment by caliper yielded ICC values of 0.73–0.83 after physiotherapists underwent 2 months of training in applying this assessment method. The standard error of measurements for this method was about 4 mm, and the minimal detectable change was 12 mm. Assessments of DRA depth and bulging showed moderate kappa values of 0.43–0.51, with reservation for some inconsistency between the centers. Conclusions Palpation of maximal voluntary contraction and pelvic floor muscle endurance are reliable postpartum assessment methods. With some experience and training, a caliper is a reliable instrument for assessing the postpartum DRA width. Additional research is needed to identify a reliable assessment method for pelvic floor muscle functions other than voluntary contraction, and for DRA depth and bulging.

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FUNCTIONAL ASPECTS OF THE FEMALE PELVIC FLOOR MUSCLES IN URINARY CONTINENCE

European Urology Supplements ◽

10.1016/s1569-9056(08)60971-9 ◽

2008 ◽

Vol 7 (3) ◽

pp. 314

Author(s):

C. Wallner ◽

N.F. Dabhoiwala ◽

M.C. Deruiter ◽

W.H. Lamers

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Muscles ◽

Urinary Continence ◽

Female Pelvic Floor ◽

Functional Aspects

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Optimization of hyperelastic constitutive parameters for the female pelvic floor muscles

BioMedWomen ◽

10.1201/9781315644622-59 ◽

2016 ◽

pp. 223-226

Keyword(s):

Pelvic Floor ◽

Pelvic Floor Muscles ◽

Female Pelvic Floor ◽

Constitutive Parameters

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Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

BioMed Research International ◽

10.1155/2014/437867 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Carla Dellabarba Petricelli ◽

Ana Paula Magalhães Resende ◽

Julio Elito Júnior ◽

Edward Araujo Júnior ◽

Sandra Maria Alexandre ◽

...

Keyword(s):

Pelvic Floor ◽

Electrical Activity ◽

Maternal Age ◽

Surface Emg ◽

Voluntary Contraction ◽

Pelvic Floor Muscles ◽

Third Trimester ◽

The Third ◽

Nulliparous Women ◽

Multiparous Women

Objective.The objective of this study was to compare the role of the pelvic floor muscles between nulliparous and multiparous women in the third trimester of pregnancy, by analyzing the relationship between electrical activity (surface electromyography—EMG), vaginal palpation (modified Oxford scale), and perineal distensibility (Epi-no).Methods.This was an observational cross-sectional study on a sample of 60 healthy pregnant women with no cervical dilation, single fetus, gestational age between 35 and 40 weeks, and maternal age ranging from 15 to 40 years. The methods used were bidigital palpation (modified Oxford scale, graded 0–5), surface EMG (electrical activity during maximal voluntary contraction), and perineal distensibility (Epi-no device). The Pearson correlation coefficient (r) was used to analyze the Epi-no values and the surface EMG findings. The Kruskal-Wallis test was used to compare the median values from surface EMG and Epi-no, using the modified Oxford scale scores.Results.Among the 60 patients included in this study, 30 were nulliparous and 30 multiparous. The average maternal age and gestational age were 26.06 (±5.58) and 36.56 (±1.23), respectively. It was observed that nulliparous women had both higher perineal muscle strength (2.53 ± 0.57versus2.06 ± 0.64;P = 0.005) and higher electrical activity (45.35 ± 12.24 μV versus35.79 ± 11.66 μV;P = 0.003), while among the multiparous women, distensibility was higher (19.39 ± 1.92versus18.05 ± 2.14;P = 0.013). We observed that there was no correlation between perineal distensibility and electrical activity during maximal voluntary contraction (r = -0.193;P = 0.140). However, we found a positive relationship between vaginal palpation and surface electromyography (P = 0.008), but none between Epi-no values (P = 0.785).Conclusion.The electrical activity and muscle strength of the pelvic floor muscles of the multiparous women were damaged, in relation to the nulliparous women, while the perineal distensibility was lower in the latter group. There was a positive relationship between surface EMG and the modified Oxford scale.

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