Presentation Authors: Lauren Tennyson*, Esther Han, Jason Gilleran, Kenneth M Peters, Larry T Sirls, Royal Oak, MI
Introduction: The pelvic floor exam is an integral part of the evaluation of pelvic floor disorders, including palpation to assess for hypertonicity, banding and pain. Different levels of pressure may result in different pain thresholds and variability exists amongst examiners. The aim of this study was to determine the reproducibility of the pelvic floor exam using a quantitative approach.
Methods: Study participants included FPMRS fellows, FPMRS faculty, urology residents, nurse practitioners (NP) and pelvic floor physical therapists (PT). A gram scale and foam vagina model were used to record pressure measurements. Standardized â€œmildâ€ and â€œmoderateâ€ pressure ranges were first established a priori (280-424 gm for mild; 442-906 gm for moderate). Participants were blinded and asked to apply mild and moderate pressure, and these values were recorded. Then they were unblinded and in-serviced on the expected range for mild and moderate. They were immediately re-blinded and asked to reproduce mild and moderate pressure. The same third-party member recorded three mild and three moderate pressure values from each participant. ANOVA repeated measures were used to test for the significance in the difference between the measurements with and without teaching. Significance level was set to 0.025 for each comparison within a given group of providers.
Results: For mild pressure both residents and NP/PT were outside of the range without teaching, and applied greater pressure than the desired range, but with teaching fell within the established range. (see table). For moderate pressure, both residents and NP/PT applied significantly greater pressure without teaching compared to with teaching, but were always within an acceptable range (see table). Faculty/fellows applied appropriate mild and moderate pressure both without and with teaching. Unlike the resident and NP/PT groups, faculty/fellows tended to apply lighter pressure without teaching.
Conclusions: An accurate exam is critical to diagnosing pelvic floor disorders and there is a need for a more standardized and objective approach. A quantitative method is both teachable and reproducible. This holds true for practitioners that do not routinely perform pelvic floor exams.