Aims
The purposes of this study were: (i) to evaluate the reliability of vaginal palpation, vaginal manometry, vaginal dynamometry; and surface (transperineal) electromyography (sEMG), when evaluating pelvic floor muscle (PFM) strength and/or activation; and (ii) to determine the associations among PFM strength measured using these assessments.

Methods
One hundred and fifty women with pelvic floor disorders participated on one occasion, and 20 women returned for the same investigations by two different raters on 3 different days. At each session, PFM strength was assessed using palpation (both the modified Oxford Grading Scale and the Levator ani testing), manometry, and dynamometry; and PFM activation was assessed using sEMG.

Results
The interrater reliability of manometry, dynamometry, and sEMG (both root-mean-square [RMS] and integral average) was high (Lin's Concordance Correlation Coefficient [CCC] = 0.95, 0.93, 0.91, 0.86, respectively), whereas the interrater reliability of both palpation grading scales was low (Cohen's Kappa [k] = 0.27-0.38). The intrarater reliability of manometry (CCC = 0.96), and dynamometry (CCC = 0.96) were high, whereas intrarater reliability of both palpation scales (k = 0.78 for both), and of sEMG (CCC = 0.79 vs 0.80 for RMS vs integral average) was moderate. The Bland-Altman plot showed good inter and intrarater agreement, with little random variability for all instruments. The correlations among palpation, manometry, and dynamometry were moderate (coefficient of determination [r2] ranged from 0.52 to 0.75), however, transperineal sEMG amplitude was only weakly correlated with all measures of strength (r2 = 0.23-0.30).

Conclusions
Manometry and dynamometry are more reliable tools than vaginal palpation for the assessment of PFM strength in women with pelvic floor disorders, especially when different raters are involved. The different PFM strength measures used clinically are moderately correlated; whereas, PFM activation recorded using transperineal sEMG is only weakly correlated with PFM strength. Results from perineal sEMG should not be interpreted in the context of reporting PFM strength.

The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: A reliability and correlation study.

To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. For the data sources, a structured search of the peer-reviewed literature (English language; 1960–April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses. Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI. The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.

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The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

This paper presents a numerical test for the closure properties (force closure and form closure) of multifingered grasps For three-dimensional (3-D) grasps with frictional point contacts or soft contacts, the numerical test is formulated as a convex constrained optimization problem without linearization of the friction cone For 3-D frictionless grasps, it can be calculated by solving a single linear program The proposed numerical test (along with the rank of the grasp matrix) provides an efficient tool for the analysis of the force-closure property and the relative force-closure property

A numerical test for the closure properties of 3-D grasps.

Aim Physiotherapists typically use digital palpation to determine residual tension in a muscle, referred to as muscle stiffness or tone. These assessments are subjective, and little is known about their accuracy or repeatability. Despite this, it is standard practice to base clinical treatment on these findings. The aim of this study was to assess physiotherapists' ability to assign a seven-point palpation scale to quantitative stiffness values generated by a novel device. Methods Prospective observational study involving 125 musculoskeletal and pelvic floor physiotherapists. A novel device was developed that replicates the haptic feedback that clinicians assess as muscle stiffness. Measurements of displacement, force, and stiffness were recorded. Results There was wide overlap between each scale category assigned to the stiffness values, from low stiffness at -3 (119 [106, 132] N/m) to moderate stiffness at 0 (462 [435,489] N/m); to high stiffness at +3 (897 [881,913] N/m). Consistency in applying the scale was poor, and the probability of a similar value of stiffness being assigned to the same scale category by different participants was low. Conclusions While palpation is used globally by physiotherapists as a readily available and low-cost method of assessing muscle stiffness, these results indicate that it should be used with caution in diagnosing and defining patient care. Clinical assessment of muscle stiffness requires a validated and reliable palpation scale if this metric is to be used to diagnose pathology and develop treatment protocols. Training in this scale should then be recommended to improve reliability in patient assessment.

Is it time to rethink using digital palpation for assessment of muscle stiffness

Novel instrumented probe for measuring 3D pressure distribution along the vaginal canal.

The first choice treatment in urinary incontinence (UI) is rehabilitation of the pelvic floor in order to improve muscle strength. However, no entirely reliable instruments for quantifying pelvic floor muscle (PFM) strength are currently available. Our aim was to test the intra-rater reliability and diagnostic accuracy of a new vaginal dynamometer
for measuring PFM strength. Methods: Test-retest reliability study. One hundred and four women with stress urinary incontinence (SUI) were recruited. Patients were excluded if they had a history consistent with urge urinary incontinence or pelvic organ prolapse, pregnancy, previous urogynecological surgery, severe vaginal atrophy, or neurological conditions. The examination comprised digital palpation quantified by the modified Oxford scale and by two consecutive
dynamometry measurements obtained using a new prototype dynamometer. This instrument comprises a speculum in
which an inductive displacement sensor (LVDTSM210.10.2.KTmodel, Schreiber) is attached to a spring of known stiffness constant (k). The intraclass correlation coefficient (ICC) was calculated to assess intra-rater reliability.
Diagnostic accuracy was assessed using Receiver Operating Characteristics (ROC) curves analysis. Results: Of the 104 subjects included, 59.6% presented scores between 0–2 on the Oxford scale. Intra-rater reliability was 0.98 (95%CI: 0.97– 0.99). In the Bland & Altman plot, the distribution of disagreements was similar in the lowest and the highest strength values. The diagnostic accuracy of the dynamometer with regard to digital palpation showed an area under the curve of 0.85 (95%CI: 0.77–0.93). Conclusions: Our results suggest that this new vaginal dynamometer is a reliable and valid
instrument for quantifying PFM strength.

Intra-rater reliability and diagnostic accuracy of a new vaginal dynamometer to measure pelvic floor muscle strength in women with urinary incontinence

AIMS Assess the intrarater and interrater reliabilities and diagnostic accuracy of a new vaginal dynamometer to measure pelvic floor muscle (PFM) strength in incontinent and continent women. METHODS A test-retest reliability study including 152 female patients. EXCLUSION CRITERIA history of urge urinary incontinence, prolapse of pelvic organ, pregnancy, previous urogynecological surgery, severe vaginal atrophy, or neurological conditions. The examination comprised digital assessment using the modified Oxford scale (MOS) and dynamometry measurements with a new prototype hand-held dynamometer. The MOS score ranges from 0 to 5: 0, no contraction; 1, flicker; 2, weak; 3, moderate; 4, good; 5, strong. Examinations were performed by a physiatrist, a physiotherapist and a midwife. The rest period between each rater measurement was 5 minutes. Assessment of intrarater and interrater reliability was calculated with the intraclass correlation coefficient. RESULTS One hundred twenty-two incontinent women and 30 continent women were included. Scores between 0 and 2 in MOS were recorded in 72% of incontinent women versus 20% in continent patients (P < 0.001). Intrarater reliability of the dynamometer was 0.942 (95% confidence interval [CI], 0.920-0.958) and the interrater reliability was 0.937 (95% CI, 0.913-0.954). The analysis of variance analysis showed significant differences in PFM strength across digital assessment categories. The post-hoc analysis showed statistical differences between adjacent categories of MOS 1-2 and 2-3. The diagnostic accuracy showed an area under the curve of 0.82 (95% C,: 0.75-0.89), 0.87 (95% CI, 0.81-0.92), and 0.83 (95% CI, 0.77-0.90) for the physiatrist, midwife, and physiotherapist, respectively. CONCLUSIONS The results obtained show a good reliability and validity of this new vaginal dynamometer to quantify PFM strength.

/pdf/reliability-and-diagnostic-accuracy-of-a-new-vaginal-yvghea1gql.pdf

Reliability and Diagnostic Accuracy of a New Vaginal Dynamometer to Measure Pelvic Floor Muscle Strength.

espanolOBJETIVO: El tratamiento de primera eleccion en la incontinencia urinaria de esfuerzo es la rehabilitacion del suelo pelvico con el fin de mejorar la fuerza muscular. Sin embargo, actualmente no se dispone de instrumentos totalmente fiables para cuantificar la fuerza de la musculatura del suelo pelvico. Nuestro objetivo fue determinar la fiabilidad interobservador de la Escala de Oxford Modificada (MOS) utilizada como el patron oro para medir la fuerza. METODOS: Estudio de fiabilidad test-retest. Se reclutaron ciento veintidos mujeres con Incontinencia Urinaria de Esfuerzo y treinta mujeres continentes. Las pacientes fueron excluidas si presentaban: prolapso de organos pelvicos, embarazo, cirugia uroginecologica previa, o enfermedades neurologicas. La palpacion bidigital cuantificada con la Escala de Oxford Modificada fue realizada por tres examinadores independientes. Cada sujeto respondio a un cuestionario en dos partes: caracteristicas demograficas y clinicas y el International Consultation on Incontinence Questionnaire-Forma abreviada (ICIQ-SF). Se utilizo el indice de Kappa de Cohen con ponderacion cuadratica (Kw) para evaluar el acuerdo entre evaluadores. RESULTADOS: El MOS oscilo entre 0 y 2 en el 72,2% de incontinentes y el 19,5% de las mujeres continentes. El grado de concordancia fue considerable en el grupo de mujeres incontinentes (Kw entre 0,73 y 0,81) y moderado en el grupo de mujeres continentes (Kw entre 0,55 y 0,72). CONCLUSION: Nuestros resultados sugieren que la fiabilidad interobservador de la MOS es mejorable, especialmente en las mujeres continentes. EnglishOBJECTIVE: The first choice treatment in stress urinary incontinence (SUI) is rehabilitation of the pelvic floor in order to improve muscle strength. However, no entirely reliable instruments for quantifying pelvic floor muscle (PFM) strength are currently available. Our aim was to test the inter-rater reliability of the Modified Oxford Scale (MOS) used as the gold standard for measuring PFM strength. METHODS: Test-retest reliability study. One hundred and twenty-two women with SUI and thirty continent women were recruited. Patients were excluded if they had a history consistent with pelvic organ prolapse, pregnancy, previous urogynaecological surgery, or neurological conditions. Bidigital palpation quantified by the MOS was carried out by three independent examiners. Each subject answered a two-part questionnaire: demographic and clinical characteristics and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The Cohen’s Kappa index with quadratic (Kw) weighting was used to assess the inter-rater agreement. RESULTS: 122 incontinent and 30 continent women were included. MOS ranged between 0 and 2 in 72.2% incontinent and 19.5% of continent women. The degree of agreement was substantial in the group of incontinent women (Kw between 0.73 and 0.81) and moderate in the group of continent women (Kw between 0.55 and 0.72). CONCLUSIONS: Our results suggest that the inter-observer reliability of MOS is improbable, especially in continent women.

Inter-rater reliability of the digital palpation of pelvic floor muscle by the modified Oxford Grading Scale in continent and incontinent women.

Several groups are working on the design of a new generation of robots and haptics for the activities of daily life or rehabilitation of elderly people or patients with some pathology. Sometime their forces in power grasping are different from healthy people. This paper is focused on the study of grasp forces of these patients with different pathologies and presents a new methodology to calculate grasp forces applied by virtual human hand when grasping any object with power. The Denavit-Hartenberg method is implemented to analyze the 25-degree-of-freedom (DOF) hand model of the virtual humans. Human performance measures (joint torques and joint displacements) are criteria for the design of joysticks in the material handling machines. Finally we compare these analytical results with experiments where n =3D 16 persons. Based on a comfortable position for the hand a new model is proposed to design joysticks for patients or the elderly.

Georgia Romero-Cullerés

Papers

Intra-rater reliability and diagnostic accuracy of a new vaginal dynamometer to measure pelvic floor muscle strength in women with urinary incontinence

Reliability and Diagnostic Accuracy of a New Vaginal Dynamometer to Measure Pelvic Floor Muscle Strength.

Inter-rater reliability of the digital palpation of pelvic floor muscle by the modified Oxford Grading Scale in continent and incontinent women.

Tools to design new devices for rehabilitation or robotics