Advancing women's pelvic floor muscle function diagnosis: the EFSMAP examination and its reliability evaluation

• Published in: Revista brasileira de fisioterapia (São Carlos (São Paulo, Brazil)) Vol. 28; no. 3; p. 101067
• Main Authors: Saltiel, Fernanda, Miranda-Gazzola, Ana Paula Gonçalves, Vieira, Gabriella Ferreira, Figueiredo, Elyonara Mello
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01.05.2024; Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia
• Subjects: Agreement; Diagnostic; Disability and health (ICF); International classification of functioning; International classification of functioning, disability and health (ICF); Original Research; Pelvic floor muscle; Reliability; Agreement; Diagnostic; Reliability; Exam; International classification of functioning; Pelvic floor muscle; International classification of functioning, disability and health (ICF); Disability and health (ICF)
• ISSN: 1413-3555; 1809-9246; 1809-9246
• DOI: 10.1016/j.bjpt.2024.101067

•The EFSMAP was developed by a panel of nine experts.•The EFSMAP is a valid and reliable exam of the women's PFM using visual observation and digital palpation.•EFSMAP can be used in clinical and research settings.•The EFSMAP set valid diagnostic labels for PFM impairments based on movement systems and ICF/WHO terminology.•The EFSMAP can facilitate standard communication and data gathering. The accurate diagnosis of pelvic floor muscle impairments is essential. The plethora of terms and the lack of evidence to support widely used pelvic floor muscle function (PFMF) measurements hinder diagnostic labels. To structure an examination of PFMF using visual observation and digital palpation and terms consistent with the ICF terminology, and to test its intra and interrater reliability/agreement. A panel of 9 physical therapists applied Delphi method to structure the PFMF exam under ICF terminology and to verify its measurements reproducibility. For reliability and agreement, a convenience sample of women aged 51.2 ± 14.7 years had the sensitivity to pressure, pain, muscle tone, involuntary movement reaction, control of voluntary movement (contraction/relaxation), coordination, strength, and endurance examined by two raters, in the same day for interrater (n = 40), and one week apart, for intrarater reliability (n = 25). Percent agreement, linear weighted kappa, intraclass correlation coefficient, and Bland-Altman's limits of agreement were calculated (alpha = 0.05). Four round Delphi discussion structured the PFMF exam, named EFSMAP (Exame das Funções Sensoriais e Motoras do Assoalho Pélvico/Examination of Pelvic Floor Sensory and Motor Functions), set a list of concepts and instructions targeted at reproducibility and established PFMF diagnostic labels. Reliability, except for pain and tone, were moderate to excellent (Kw= 0.67–1.0 and ICC=0.48–0.82). Agreement was substantial for most PFMF features (0.64–1.00), except pain. The EFSMAP was successfully developed as a valid and reliable exam to be used in research and clinical practice; it provides labels for the diagnosis of pelvic floor muscle impairments. It might be easily adopted worldwide as it uses ICF terminology.