Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging

Abstract

Aims-Defects in the pubovisceral portion of the levator ani muscle are seen with MR imaging. This study aims to determine interrater reliability of physical examination in detecting these defects, and to validate findings from physical examination using comparisons with MR images Methods-Two examiners palpated the pubovisceral muscles of 29 women to assess for defects in this muscle. Each examiner was blinded to the others findings. MR scans were acquired on a further 24 women after structured clinical examination by one examiner. These images were read to determine pubovisceral muscle defects, blinded to patient identifiers. Agreement between raters and between MR imaging and clinical examination were calculated.Results-The two examiners had positive agreement (presence of a defect) of 72.7% and negative agreement (absence of a defect) of 83.3%. The positive agreement between physical examination and MR imaging was 27.3% and the negative agreement 86.5% Conclusion-The structured physical examination to detect defects in the pubovisceral portion of the levator ani muscle can be learned as shown by good interrater agreement. However, examination alone underestimates these defects compared with MR imaging.

Levator ani abnormality 6 weeks after delivery persists at 6 months

“…We also intend to pursue confirmation of the validity of assessment of pelvic floor MR by a single experienced reader, which has received only limited attention in published literature. [14] Our understanding of the relationship between vaginal birth and pelvic floor damage is currently incomplete, and this study demonstrates some of the difficulties inherent in imaging this anatomy. However, if pelvic MR proves to be a suitable diagnostic technique for identifyingv pelvic floor injury, it may aid in understanding the mechanisms of injury and thereby allow us to target preventative and reparative strategies to those at risk.…”

Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound

“…Digital examination may detect remnants of muscle that were missed on imaging, and this may explain why, on average, imaging diagnoses more avulsions than palpation [23]. However, palpation requires a longer learning curve and is probably less repeatable [16,17].…”

“…Avulsion may also be a predictor of prolapse recurrence [14,15], implying that identification of women with avulsion may be of importance for pelvic reconstructive surgery. While this condition can be diagnosed by palpation, this requires substantial training [16,17]. Diagnosis by magnetic resonance imaging and pelvic floor ultrasound is highly repeatable [1,18].…”

Pelvic floor muscle trauma

“…As mentioned previously, diagnosis of levator muscle tears is possible by palpation, although this requires substantial teaching, and the learning curve seems to be quite long [18][19][20][21]. The main challenge is the distinction between partial and complete trauma, especially in women with poor muscle function and/ or atrophy.…”