Hundley Andrew F, Wu Jennifer M, Visco Anthony G
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 27599-7570, USA.
Am J Obstet Gynecol. 2005 May;192(5):1583-91. doi: 10.1016/j.ajog.2004.11.015.
The Brink scale is a commonly used digital assessment of pelvic floor muscle strength. The Peritron perineometer, a compressible vaginal insert that records pressure in centimeters of water, offers an objective method for this evaluation. This study evaluates the inter- and intrarater reliability of perineometry measurements and correlates those values with Brink scores.
Subjects were prospectively enrolled and underwent pelvic floor muscle strength assessment by 2 examiners each using a perineometer and the Brink scale. Perineometer measurements of maximum pressure, average pressure, and total duration were recorded for 3 consecutive pelvic floor muscle contractions (Kegels). The Brink assessment was performed by placing 2 fingers vaginally during a single Kegel contraction. Brink scores consisted of 3 separate 4-point rating scales for pressure, vertical finger displacement, and duration. The order of the examiners and the 2 assessment methods were randomized, and each examiner was blinded to the results of the other. Pearson and Spearman correlation coefficients were used for analysis as appropriate. Repeated-measures analysis of variance was used to assess intrarater reliability between repeated perineometer measurements.
One hundred women were consecutively enrolled and completed the study. Interrater reliability for the perineometer maximum squeeze pressure (r = 0.88) and baseline resting pressure (r = 0.78) was high. Maximum squeeze pressure correlation was unaffected by the presence or absence of estrogen (r = 0.89 versus r = 0.85), nulliparity versus parity (0.85 versus 0.88), or genital hiatus 4 or greater or less than 4 (r = 0.96 versus r = 0.86). Total Brink score and each individual submeasurement showed good correlations (total: r = 0.68; pressure: r = 0.68; displacement: r = 0.58; duration: r = 0.44). The correlation between maximum squeeze pressure and total Brink score during the first and second exams was good (r = 0.68 versus r = 0.71). For intrarater reliability, there were no significant differences among the 3 maximum squeeze pressures recorded during the first exam (P = .11), but for the second exam, the first squeeze was significantly stronger than the successive 2 (P = .009) attempts.
Perineometer measurements of pelvic floor muscle contractions show very good inter- and intrarater reliability. The Brink total and pressure scores had a slightly lower interrater reliability. Variables such as estrogen status, parity, and genital hiatus did not appear to affect correlation. There was good correlation between the maximum perineometer pressure and the total Brink score, suggesting that these 2 methods of assessment have similar levels of reproducibility. Additionally, the perineometer demonstrated good short-term test-retest reliability.
布林克量表是一种常用的评估盆底肌肉力量的数字式方法。Peritron会阴压力计是一种可压缩的阴道插入物，能以厘米水柱记录压力，为该评估提供了一种客观方法。本研究评估了会阴压力测量的评分者间及评分者内信度，并将这些值与布林克评分相关联。
前瞻性纳入受试者，由两名检查者分别使用会阴压力计和布林克量表对其进行盆底肌肉力量评估。记录连续3次盆底肌肉收缩（凯格尔运动）时的最大压力、平均压力和总持续时间的会阴压力计测量值。在单次凯格尔收缩期间通过阴道放置两根手指进行布林克评估。布林克评分由压力、手指垂直位移和持续时间3个独立的4分制评分量表组成。检查者顺序和两种评估方法随机安排，且每位检查者对另一位的结果不知情。酌情使用Pearson和Spearman相关系数进行分析。采用重复测量方差分析评估重复会阴压力计测量之间的评分者内信度。
连续纳入100名女性并完成研究。会阴压力计最大挤压压力（r = 0.88）和基线静息压力（r = 0.78）的评分者间信度较高。最大挤压压力相关性不受雌激素存在与否（r = 0.89对r = 0.85）、未生育与经产（0.85对0.88）或生殖裂孔≥4或＜4（r = 0.96对r = 0.86）的影响。布林克总分及各单项测量显示出良好的相关性（总分：r = 0.68；压力：r = 0.68；位移：r = 0.58；持续时间：r = 0.44）。第一次和第二次检查期间最大挤压压力与布林克总分之间的相关性良好（r = 0.68对r = 0.71）。对于评分者内信度，第一次检查记录的3次最大挤压压力之间无显著差异（P = 0.11），但对于第二次检查，第一次挤压明显强于随后的2次（P = 0.009）尝试。
盆底肌肉收缩的会阴压力计测量显示出非常好的评分者间及评分者内信度。布林克总分及压力评分的评分者间信度略低。雌激素状态、经产情况和生殖裂孔等变量似乎不影响相关性。会阴压力计最大压力与布林克总分之间存在良好相关性，表明这两种评估方法具有相似的可重复性水平。此外，会阴压力计显示出良好的短期重测信度。
