Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Närhälsan Gibraltar Rehabilitation, Gothenburg, Sweden.
BMJ Open. 2021 Sep 2;11(9):e049082. doi: 10.1136/bmjopen-2021-049082.
Evaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum.
A multicentre inter-rater reliability study.
Three primary care rehabilitation centres in Sweden.
A total of 222 participants were recruited via advertising at Swedish maternity care units and social media. Eligibility for participation included female gender, ≥18 years, at maximum 3 months after childbirth. Exclusion criteria were chronic pelvic girdle pain and/or low back pain and/or pelvic floor tear grade III/IV. At each centre, 2 physiotherapists, with training and experience in pelvic floor assessment, assessed the 222 women according to a standardised protocol in random order.
Inter-rater reliability of the assessment of pelvic floor muscle function (involuntary and voluntary contraction and voluntary relaxation) and diastasis recti abdominis (width, depth and bulging).
Vaginal palpation of maximal voluntary contraction revealed a kappa value of 0.69 (95% CI 0.62 to 0.76). Assessments of involuntary contraction and voluntary relaxation yielded inconsistent results, with slight-to-moderate weighted kappa values ranging from 0.10 to 0.51. After 2 months of training in applying this method, diastasis recti abdominis width measured at the umbilicus by calliper yielded an intraclass correlation coefficient value of 0.83 (95% CI 0.76 to 0.87). Assessments of diastasis recti abdominis depth and bulging showed moderate kappa values, with reservation for some inconsistency between the centres.
Vaginal palpation of pelvic floor muscle strength is a reliable method for the postpartum muscle assessment. Additional research is needed to identify reliable assessment method for other pelvic floor muscle functions like involuntary contraction and voluntary relaxation. With some training, a calliper is a reliable instrument for measuring the postpartum diastasis recti abdominis width. This study provides novel thoughts about how to measure diastasis recti abdominis depth and bulging.
NCT03703804.
评估产后盆底肌和腹直肌分离的临床评估方法的组内可靠性。
多中心组内可靠性研究。
瑞典三个初级保健康复中心。
通过瑞典产妇保健单位和社交媒体的广告共招募了 222 名参与者。参与的条件包括女性、年龄≥18 岁、产后最多 3 个月。排除标准为慢性骨盆带疼痛和/或下腰痛和/或盆底撕裂 3/4 级。在每个中心，2 名接受过盆底评估培训和经验的物理治疗师按照标准化方案以随机顺序评估 222 名女性。
盆底肌功能（随意和不随意收缩及随意放松）和腹直肌分离（宽度、深度和膨出）评估的组内可靠性。
阴道触诊最大随意收缩的kappa 值为 0.69（95%CI 0.62 至 0.76）。不随意收缩和随意放松的评估结果不一致，加权 kappa 值为 0.10 至 0.51，属于轻度至中度。在接受该方法 2 个月的培训后，卡尺测量脐部腹直肌分离宽度的组内相关系数值为 0.83（95%CI 0.76 至 0.87）。腹直肌分离深度和膨出的评估结果为中度 kappa 值，但各中心之间存在一些不一致性。
阴道触诊盆底肌力量是产后肌肉评估的可靠方法。需要进一步研究来确定其他盆底肌功能（如不随意收缩和随意放松）的可靠评估方法。经过一些培训，卡尺是测量产后腹直肌分离宽度的可靠仪器。本研究为如何测量腹直肌分离深度和膨出提供了新的思路。
NCT03703804。
