Presentation
Concurrent Validity of Noninvasive Coccygeal Motion Palpation and Transabdominal Ultrasound Imaging in the Assessment of Pelvic Floor Function in Women
World Congress of Physiotherapy Meeting 2019
(2019)
Abstract
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/m 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. Chisquare
(X ) tests and Phi coefficient(φ) revealed a significant strong relationship between TAUS
and CM across all testing positions: standing X (1, N = 37) = 17.87, p < .001, φ= .7 sitting X (1,
N = 37) = 15.79, p < .001, φ= .65 and sidelying X (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,
- pelvic floor exercises
Disciplines
Publication Date
Summer May 12, 2019
Location
Geneva, Switzerland
Comments
Platform presentation in Women's & Men's Pelvic Health section
Citation Information
Ruth M Maher and Jenna Iberle. "Concurrent Validity of Noninvasive Coccygeal Motion Palpation and Transabdominal Ultrasound Imaging in the Assessment of Pelvic Floor Function in Women" World Congress of Physiotherapy Meeting 2019 (2019) Available at: http://works.bepress.com/ruth-maher/18/