RESUMO
Purpose: The authors sought to determine the interrater reliability among novice raters of intra-vaginal manual assessment of pubococcygeus muscle tone in women using the Reissing tone scale (RTS). Method: Three graduating physiotherapy students (novice raters) and one experienced pelvic floor physiotherapist assessed 31 female participants (aged 20-66 y). Assessors gave RTS scores for pubococcygeus tone at three intra-vaginal locations (6:00, 9:00, and 3:00). Interrater reliability was determined for the novice raters using a two-way random single-measures absolute agreement intra-class correlation coefficient (ICC). Spearman rank correlation (SRC) analysis determined the correlation between the novice and expert scores. Results: The ICC values for the novice raters were 0.523, 0.274, and 0.336 at 6:00, 9:00, and 3:00, and the SRC values between the novice and expert raters were 0.580, 0.320, and 0.340. Conclusions: The novice raters demonstrated low to moderate interrater reliability for intra-vaginal manual assessment of pubococcygeus tone. This result indicates that manual assessment of pelvic floor muscle tone is not reliable enough to use as a stand-alone test to guide treatment, at least for physiotherapists with limited clinical experience.
Objectif : déterminer la fiabilité interévaluateur des évaluateurs novices qui procèdent à l'évaluation intravaginale manuelle du tonus musculaire pubo-coccygien au moyen du score de tonus de Reissing (STR). Méthodologie : trois étudiants en physiothérapie finissants (les évaluateurs novices) et un physiothérapeute périnéal d'expérience ont évalué 31 participantes (âgées de 20 à 66 ans). Ils ont attribué un STR au tonus pubo-coccygien à trois foyers intravaginaux (à 6, 9 et 3 heures). Les chercheurs ont déterminé la fiabilité interévaluateur des évaluateurs novices au moyen d'un coefficient intraclasse de corrélation (CIC) à concordance absolue des mesures simples bidirectionnelles randomisées. Les chercheurs ont analysé la corrélation de Spearman (CdS) pour établir le lien entre les scores des novices et de l'expert. Résultats : la CIC des évaluateurs novices s'élevait à 0,523, 0,274 et 0,336 à 6, 9 et 3 heures, respectivement, et la CdS entre les évaluateurs novices et expert s'établissait à 0,580, 0,320 et 0,340. Conclusion : les évaluateurs novices ont démontré une fiabilité interévaluateur faible à modérée lors de l'évaluation intravaginale manuelle du tonus pubo-coccygien. Ainsi, l'évaluation manuelle du tonus périnéal n'est pas assez fiable si elle est utilisée seule pour orienter le traitement, du moins chez les physiothérapeutes ayant une expérience clinique limitée.
RESUMO
This retrospective study evaluated the effectiveness of physical therapy in relieving painful intercourse and improving sexual function in women diagnosed with vulvar vestibulitis. This syndrome is a frequent cause of premenopausal dyspareunia and is characterized by a sharp, burning pain located within and limited to the vulvar vestibule (vaginal entry) and elicited primarily via pressure applied to the area. Participants were 35 women with vulvar vestibulitis who took part in physical therapy treatment for an average of 7 sessions. We conducted telephone interviews to assess whether physical therapy or other subsequent treatments impacted on pain during intercourse and sexual functioning. Length of treatment follow up ranged from 2 to 44 months, with a mean of 16 months. Physical therapy yielded a complete or great improvement for 51.4% of participants, a moderate improvement for 20.0% of participants, and little to no improvement for the other 28.6%. Treatment resulted in a significant decrease in pain experienced both during intercourse and gynecological examinations; it also resulted in a significant increase in intercourse frequency and levels of sexual desire and arousal. Successful patients were significantly less educated than nonsuccessful patients. Findings demonstrate that physical therapy is a promising treatment modality for dyspareunia associated with vulvar vestibulitis.