[page 6] [Urogynaecologia 2021; 33:268] Correlation of levator ani muscle strength measurement between Modified Oxford Grading Scale and perineometer on pelvic organ prolapse patient Fernandi Moegni, Ingrid Felicia Ocsilia Wengkang Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia Abstract Pelvic Organ Prolapse (POP) is a debili- tating condition affecting about half of all women aged of more than 60 years globally. Reduced levator ani muscle strength in POP is associated with worse symptoms and progno- sis. Measurement of levator ani muscle strength can be done with several tools such as perineometer and digital palpation. However, there is currently no study regarding conform- ity between tests. The aim of this study is to determine the correlation between tests in POP patients. An analytic observational study using cross sectional design was done to determine conformity between perineometer and digital examination using Modified Oxford Grading Scale (MOS) in Dr Cipto Mangunkusumo National General Hospital, Indonesia during the period of July, 2018 to June, 2020. Correlation between tests was determined using Spearman test. Cut-off of perineometer reading for each MOS score was also determined. A total of 110 subjects examined with both perineometer and digital palpation were recruited to the study. Positive correlation was observed between perineome- ter reading and Modified Oxford Grading Scale (r = 0.790, p < 0.001). According to the result, values between 0.01 – 9.64 cmH 2 O cor- respond to very weak pressure (MOS 1); 9.65 – 22.49 cmH 2 O represent weak pressure (MOS 2); 22.5 – 35.24 cmH 2 O represent mod- erate pressure (MOS 3); ≥ 35.25 cmH 2 O rep- resent good pressure (MOS 4). There was a strong correlation between MOS and peri- neometer result for measuring levator ani strength in POP patients. Introduction Pelvic Organ Prolapse (POP) together with urinary incontinence and fecal inconti- nence are known collectively as pelvic floor disorders and are a common and important medical condition estimated to affect up to half of all female populations. 1 The annual incidence of POP surgery is stated to range from 1.5 to 1.8 cases per 1000 female-years, with the incidence peaking in women between 60 and 69 years. 2 Although many risk factors have been identified, weakness of the endopelvic fascia and levator ani is the major factor in the etiol- ogy of POP and all known risk factors actual- ly cause weakness and damage to the fascia and levator ani, leading to organ herniation and prolapse. 3,4 The levator ani muscle plays a very important role as a pelvic organ sup- port system. 3,4 Therefore, measuring the func- tion and strength of the levator ani will play a very important role in determining manage- ment and prognosis for POP patients. Many techniques and methods have been developed to assess the function and integrity of the pelvic floor muscles in POP. Some examples are perineometry, ultrasonography, Magnetic Resonance Imaging (MRI), Electromyography (EMG), digital palpation, dynamometry, vaginal cones and others. These methods have advantages and disad- vantages according to their clinical utility, aim, and cost. 5-7 The choice of levator ani strength meas- urement primarily depends on the infrastruc- ture available on the health service center. Unfortunately, most of the health facilities in Indonesia take place in suburban and rural areas, where such tools might not be readily available. Thus, digital palpation is currently the most widely used examination in order to determine levator ani muscle strength in POP patients. To date, there is no study regarding corre- lation between perineometer result and digital examination using Modified Oxford Grading Scale (MOS) in POP patients in Indonesia, although it is important to ascertain that digi- tal examination would prove to be sufficient. This study aimed to determine correlation between perineometer result and digital examination using Modified Oxford Grading Scale (MOS) in POP patients. Materials and Methods This study was an analytic observational study using cross sectional design was done to determine conformity between perineome- ter and digital examination using Modified Oxford Grading Scale (MOS) in Dr Cipto Mangunkusumo National General Hospital, Indonesia during the period of July, 2018 to June, 2020. The inclusion criteria for this research were all pelvic organ prolapse patients exam- ined with both perineometer and digital pal- pation. Subjects with secondary gynecologic problems such as anatomical deformity or gynecologic cancer and those unable to be examined using perineometer probe were excluded from the study. MOS was recorded during the examination with the interval limit being 0 and 5. Perineometer used in this study was Peritron TM hand-held clinical biofeed- back Perineometer with range of pressure of 0 to 300 cmH 2 O. A single obstetrician acted as the evaluator for all patients in this study. Subjects were evaluated using one of the tests during the first visit and the other during the second visit with one day interval. The first test performed on subjects was randomized using computer program. This study used 5% error bound and 95% confidence interval limit, with power of the Urogynaecologia 2021; volume 33:268 Correspondence: Ingrid Felicia Ocsilia Wengkang, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Jalan Salemba Raya No. 6, 10430 Jakarta, Indonesia. E-mail: ing.felicia26@gmail.com Key words: Levator ani muscle strength; Modified Oxford Grading Scale, pelvic organ prolapse; perineometer. Acknowledgements: Authors would also like to express sincere gratitude to all participating patients and staffs on the Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo National General Hospital who willingly support this study. Conflict of interest: The authors have no con- flict of interest to declare. Availability of data and materials: The data used in this study can be requested from cor- responding author upon reasonable request. Ethics approval and consent to participate: The present study had been approved by the Research Ethics Committee of Faculty of Medicine, University of Indonesia with ethical clearance letter numbered ND.340/UN2.F1.DEPT.25/PDP.01/2020. All patients who were included in this study had given the informed consent prior to the study. Informed consent: Written informed consent was obtained from a Research Ethics Committee of Faculty of Medicine, University of Indonesia for anonymized patient informa- tion to be published in this article. Received for publication: 28 February 2021. Revision received: 16 May 2021. Accepted for publication: 15 June 2021. This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0). ©Copyright: the Author(s), 2021 Licensee PAGEPress, Italy Urogynaecologia 2021; 33:268 doi:10.4081/uij.2021.268 Non-commercial use only