Is there correlation between perineometry and Modified Oxford Scale in women? Systematic review with meta-analysis and grade recommendations.

BACKGROUND: The International Continence Society (ICS) recommends the use of perineometry and digital palpation to assess the pelvic floor muscles (PFM). Exploring the degree of correlation between both assessment strategies will serve to improve safety for clinical practice. Therefore, we performed a systematic review and meta-analysis on the correlation between assessment strategies. METHODS: Observational studies were included. Bias risk assessment based on Downs and Black scale and the evidence's level were assessed using the GRADE. The random effect model measured the correlation values and were quantitatively analyzed through meta-analysis. Registration in PROSPERO database - CRD42021253775. RESULTS: Six studies were selected. There was a high positive correlation between perineometry and MOS (r = 0.74; 95%-IC 0.61-0.83; I2: 81%, p < 0.01). Subgroup analysis was performed with 3 studies with continent women, and revealed a high positive correlation (r = 0.80; 95%-IC 0.62-0.90; I2: 90%, p < 0.01), while 2 studies with incontinent women revealed a moderate positive correlation (r = 0.64; 95%-IC 0.48-0.75; I2: 0%, p = 0.40). GRADE analysis revealed a low strength of evidence. CONCLUSION: The high positive correlation between perineometry and MOS suggests that if the assessment strategies are applied in a standardized way, these tests can be used together or separately to assess the functionality of PFMs in clinical practice. However, the results should be interpreted with caution due to the low strength of GRADE evidence.

Are there neuromuscular differences on proximal and distal joints in patellofemoral pain people? A systematic review and meta-analysis.

We aim to determine the neuromuscular differences in proximal and distal joints between patellofemoral pain (PFP) and healthy participants. Relevant articles were selected through seven databases. Studies comparing electromyography (EMG) or morphology parameters of trunk, hip, ankle/foot joints in PFP people compared to a healthy control group (CG) were included. 1458 studies were identified, from which 36 were included in the systematic review [PFP, n = 655; CG, n = 649] (31 involving EMG) and 32 in the meta-analysis (27 involving EMG). 75% of studies presented moderate to high methodological quality. The meta-analysis demonstrated that, compared to CG, PFP have: (i) similar transversus abdominis/internal oblique and erector spinae muscle onset, independently of sex; (ii) similar EMG amplitude of gluteus medius and gluteus maximus, independently of sex or task performed; (iii) similar gluteus medius muscle onset, independently of sex or task performed; (iv) similar gluteus maximus muscle onset, independently of sex; (v) a small effect for a shorter activation duration of gluteus medius (0.50; 95% CI [0.07; 0.93]; p = 0.02); (vi) a medium effect for a shorter activation duration of gluteus medius during stair/step down task (0.81; 95% CI [0.18; 1.45]; p = 0.01); (vii) similar external oblique, gluteus maximus, tensor fascia latae, tibialis anterior and fibularis muscle thickness and (viii) a small effect for a smaller gluteus medius muscle thickness (0.52; 95% CI [0.22; 0.82]; p = 0.007). We were not able to perform meta-analysis for EMG at distal joints. Neuromuscular differences in PFP seems to occur only in the gluteus medius muscle. Due to high heterogeneity and several methodological concerns observed, mainly in EMG studies, the interpretation of these results needs caution.

Echo intensity reliability between two rectus femoris probe sites.

INTRODUCTION: The ultrasound technique has been extensively used to measure echo intensity, with the goal of measuring muscle quality, muscle damage, or to detect neuromuscular disorders. However, it is not clear how reliable the technique is when comparing different days, raters, and analysts, or if the reliability is affected by the muscle site where the image is obtained from. The goal of this study was to compare the intra-rater, inter-rater, and inter-analyst reliability of ultrasound measurements obtained from two different sites at the rectus femoris muscle. METHODS: Muscle echo intensity was quantified from ultrasound images acquired at 50% [RF50] and at 70% [RF70] of the thigh length in 32 healthy subjects. RESULTS: Echo intensity values were higher (p = 0.0001) at RF50 (61.08 ± 12.04) compared to RF70 (57.32 ± 12.58). Reliability was high in both RF50 and RF70 for all comparisons: intra-rater (ICC = 0.89 and 0.94), inter-rater (ICC = 0.89 and 0.89), and inter-analyst (ICC = 0.98 and 0.99), respectively. However, there were differences (p < 0.05) between raters and analysts when obtaining/analyzing echo intensity values in both rectus femoris sites. CONCLUSIONS: The differences in echo intensity values between positions suggest that rectus femoris's structure is not homogeneous, and therefore measurements from different muscle regions should not be used interchangeably. Both sites showed a high reliability, meaning that the measure is accurate if performed by the same experienced rater in different days, if performed by different experienced raters in the same day, and if analyzed by different well-trained analysts, regardless of the evaluated muscle site.