OUTCOME MEASURES IN OBG

REVIEW OF LITERATURE
OUTCOME MEASURES:

 An outcome measure is the result of a test that is used to objectively determine the baseline
function of a patient at the beginning of the treatment.

 Once treatment has commenced, the same instrument can be used to determine progress and
treatment efficacy.

 In accordance to Evidence Based Practice (EBP) in the health sciences, objective measures of
outcome are important to provide credible and reliable justification for treatment. The
instrument should also be convenient to apply for the therapist and comfortable for the patient.

 Outcome measures are usually collected at the beginning, middle, & end of the course of
physical therapy course.
USES OF OUTCOME MEASURES:

INDIVIUAL
PATIENT CARE

PATIENT’S COMMON
FUNCTIONING LANGUAGE
 OUTCOME MEASURES

Performanc Clinician
Self report
-e based reported
measures
measures measures
PSYCHOMETRIC PROPERTIES OF AN OUTCOME MEASURE

RELIABILITY

FLOOR & CEILING VALIDITY

EFFECTS

INTERPRETABILITY RESPONSIVENESS

FEASIBILITY
RELIABILITY
 The degree to which an instrument consistently measures an attribute.

INTERNAL TEST- RETEST INTER- RATER

CONSISTENCY RELIABILITY RELIABILITY
VALIDITY
 The extent to which an instrument measures what it intends to measure.

VALIDITY

Content Criterion Construct

Predictive Concurrent Convergent Discriminant

CLINICAL OUTCOME MEASURES TO ASSESS PELVIC FLOOR MUSCLES

 Perineometer
 Pressure biofeedback
 Vaginal dynamometer
 EMG (electromyography)
 Oxford grading
 Pelvic ring clock assessment
PERINEOMETER:

 Invented by Dr. Arnold Kegel, device used to measure pelvic floor muscle strength by reading
the air pressure changes after pelvic contractions.
 It can also assist in retraining PFM.
 Also helps to address the issues of prolapse and incontinence.
 Peritron has a conical vaginal probe which is connected to the perineometer’s main body by a
plastic tube.
 The probe consists of an air filled silicon rubber sensor and measure pressure in cm H2O.
 It gives tactile, visual as well as audio feedback to the pelvic floor contraction.
PROCEDURE
 After inserting the device into vagina or anus, the patient is asked to contract her PFM in such
a way that the muscles are pulled up instead of push down.
 Perineometer measures the electrical activity in the muscles and then reports the measurements
on display.
 Ideally the women should be able to register 10 on scale, hold the contraction for 10 seconds
and repeat 10 times.
 It allows the therapists to monitor the strength of patient’s contractions and create their
exercise programs accordingly.
Perineometers used in this study: a Peritron 9300 perineometer (Laborie, Mississauga,
ON, Canada) with a vaginal probe, 1: Perineometer's main body, 2: Diameter 26–33
(pressurized) mm, 3: Measurable length, 55 mm, 4: Length: 110 mm. b MizCure
perineometer (OWOMED, Seoul, Korea) with a vaginal probe, 5: Perineometer's main
body, 6: Diameter 21–27 (pressurized) mm, 7: Measurable length,50 mm, 8: Length
79 mm. These pictures were taken our devices in our institute. All rights reserved
PRESSURE BIOFEEDBACK
 It is a device used to measure the core strength and also plays a role in rehabilitation.
 It consists of an air pillow and a sensitive pressure gauge.
 Change in pressure will be visually indicated on the gauge.

Intrarater reliability Interrater

reliability
0.94 0.97
PROCEDURE
 The Prone Test for Transversus Abdominis and Internal Oblique
 Training the Corset Action of Transversus Abdominis in Supine
 Training the Corset Action of Transversus Abdominis with Leg Loading
 Title Aim Methodology Results
Inter-rater reliability of To determine the inter-rater This cross-sectional This study found an intra-
pressure biofeedback unit reliability of pressure recruited Sixteen subjects class correlation coefficient
among biofeedback unit among with and without chronic (ICC) = 0.94 for inter-rater
individuals with and individuals with low back pain.(CLBP). reliability in healthy
without chronic low back and without chronic low Inclusion criteria individuals, and an ICC of
pain. back pain included individuals with > 0.97 for
20 years of age with inter-rater reliability in
Muhammad Khan et.al. and without nonspecific CLBP.
low back pain who are
Pakistani Journal of willing to participate in the
Medical Sciences. study and able to hold
the contraction of
2022 transverse abdominus.
VAGINAL DYNAMOMETER
 The vaginal dynamometer consists of a redesigned speculum which is inserted into the vagina
and a sensor for measuring the force.
 The usage of this instrument enables not only the diagnostics of women's pelvic floor
muscle problem, but also the objective monitoring of rehabilitation gynecological medicine
results.

Intrarater reliability Interrater reliability

0.94 0.93
PROCEDURE:
 Participants Position : crook lying position with hip and knees flexed and abducted or
lithotomy position.
 The speculum branches of the dynamometer should be disinfected and covered with a female
condom.
 The dynamometric speculum is inserted into the vagina and the strength exerted is recorded.
 Title Aim Methodology Results
Reliability and Assess the intrarater and A test-retest reliability study Intra-rater reliability of the
diagnostic accuracy of interrater reliabilities and including 152 female patients. dynamometer was 0.94 and
a new vaginal diagnostic accuracy of a new history of urge urinary inter rater reliability was
dynamometer to vaginal dynamometer to incontinence, prolapse of found to be 0.93.
measure pelvic floor measure pelvic floor muscle pelvic The results suggested that
muscle strength. (PFM) organ, pregnancy, previous the new vaginal
strength in incontinent and uro-gynecological surgery, dynamometer is a reliable
Georgia Romero- continent women. severe vaginal atrophy, and valid
Culleres et.al or neurological conditions instrument for quantifying
were excluded. The PFM strength.
Journal of Female examination comprised digital
Pelvic Medicine and assessment
Reconstructive Surgery using the modified Oxford
scale (MOS) and
August 2020 dynamometry measurements
with a new prototype hand-
held dynamometer.
ELECTROMYOGRAPHY (EMG)

Intrapelvic surface electromyography (sEMG) as an easy and non-invasive method

for PFM evaluation.
The reliability of sEMG was found to be 0.72-0.81
 Title Aim Methodology Results

The Reliability of Pelvic The aim of the study was to The bioelectrical activity of Between trial reliability for
Floor Muscle Bioelectrical determine the between-trial PFM was collected using Glazer protocol:
Activity and between-day reliability an endovaginal electrode in ICC= 0.68
(sEMG) Assessment Using a of 30 young, Caucasian,
Multi-Activity Measurement the Glazer protocol and our nulliparous women (age 22– Between day reliability for
Protocol in Young Women multi-activity surface 27, 168.6 ± 5.1 cm, Glazer protocol:
electromyography (sEMG) 57.1 ± 11.8 kg). The between- ICC= 0.54-0.75
Łukasz Oleksy et.al. measurement protocol trial and between-day
for pelvic floor muscle reliability of the original Between trial reliability for
International Journal of (PFM) evaluation. Glazer protocol and Multiactivity sEMG:
Environmental and Public the new multi-activity sEMG ICC=0.80-0.95
Research protocol were assessed
during the following phases: Between day reliability for
18 January 2021 pre-baseline sEMG:
rest, phasic (flick) ICC= 0.62-0.80
contractions, tonic
contractions, endurance
contraction, and post-
baseline rest.
MODIFIED OXFORD GRADING
 The Modified Oxford scale is commonly used to manually assess muscle strength – and can
help diagnose problems in which weakness plays a role.
 According to the Modified Oxford scale, muscle strength is graded 0 to 5 (0 being no muscle
contraction –> 5 being movement through a full range against full resistance).
 Vaginal Palpation using MOG scale is presently the gold standard.
PELVIC RING CLOCK ASSESSMENT
CLINICAL OUTCOME MEASURES TO ASSESS SEXUAL DYSFUNCTION

 Female Sexual Function Index

 LAMONT classification for vaginismus
FEMALE SEXUAL DYSFUNCTION INDEX

The Female Sexual Functioning Index (FSFI; Rosen et al, 2000) is a self-report measure of sexual
functioning.
It a brief, 19-item self-report measure of female sexual function that provides scores on six
domains of sexual function as well as a total score.
They include: desire (2 items), arousal (4 items), lubrication (4 items), orgasm (3 items),
satisfaction (3 items), and pain (3 items).

The test- retest reliability of FSFI is 0.79- 0.86

LAMONT CLASSIFICATION FOR VAGINISMUS
CLINICAL OUTCOME MEASURE TO ASSESS PELVIC ORGAN PROLAPSE

 Pelvic Floor Distress Inventory

 Pelvic Floor Impact Questionnaire
 Pelvic Organ Prolapse Quantification (POP-Q) System
PELVIC FLOOR DISTRESS INVENTORY

 The Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20) is the short-form version of
the Pelvic Floor Distress Inventory (PFDI) is a health-related quality of life questionnaire for
women with pelvic floor conditions to fill out.
 It includes 20 questions. Each question begins with a "yes" or "no" response. If "yes," the
patient must indicate how much bowl, bladder, or pelvic symptoms have been bothering them
in the past 3 months on a 4-point scale that ranges from "not at all" (0) to "quite a bit" (4).
 Its test retest reliability is 0.84-0.93
PELVIC FLOOR IMPACT QUESTIONNAIRE

 It is intended in women over 18 with pelvic floor condition including urinary incontinence,
Pelvic Organ Prolapse and fecal incontinence.
 It includes scales from the Urinary Impact Questionnaire (UIQ-7), Pelvic Organ Prolapse
Impact Questionnaire (POPIQ-7), and the Colorectal-Anal Impact Questionnaire-7 (CRAIQ-7).
 The scales scores are then added together to get the total PFIQ-7 score, which ranges from 0-
300.
 A lower score means there is lesser effect.
The test-retest reliability, represented by intraclass correlation coefficients (ICC):
 PFIQ-7 ICC=0.77
 UIQ-7 ICC=0.81
 POPIQ-7 ICC=0.70
 CRAIQ-7 ICC=0.81
PELVIC ORGAN PROLAPSE QUANTIFICATION (POP-Q) SYSTEM

 Pelvic Organ Prolapse Quantification system (POP–Q) refers to an objective, site–specific system for
describing, quantifying, and staging pelvic support in women.
 It provides a standardized tool for documenting, comparing, and communicating clinical findings
with proven intra observer reliability.

 Patient with an empty bladder and if feasible an empty is

positioned supine, standing or in a birthing chair at
45 degree angle.
CLINICAL OUTCOME MEASURES TO ASSESS ABNORMAL
MENSTRUATION

 WALIDD score for DYSMENORRHEA

 Premenstrual Symptom Screening tool (PSST)
 Samatha scale for heavy menstrual bleeding
WaLIDD SCORE FOR DYSMENORRHEA

 A scale-type survey (working ability, location, intensity, days of pain, dysmenorrhea

[WaLIDD] score) was designed, which integrated features of dysmenorrhea such as: 1) number
of anatomical pain 2) Wong–Baker pain range 3) number of days of pain during menstruation
and 4) frequency of disabling pain to perform their activities.
 Each tool’s variable provided a specific score between 0 and 3, and the final score ranged from
0 to 12 points.
 The reliability of the WaLIDD score was 0.95
PREMENSTRUAL SYMPTOMS SCREENING TOOL

 The PSST is a 19-item instrument consisting of two domains: the first domain includes 14
items related to psychological, physical, and behavioral symptoms and the second domain (five
items) evaluates the impact of symptoms on women’s functioning.
 Each item is rated on a four-point scale (not at all=0, mild= 1, moderate=2, severe=3)
 According to the instruction of the PSST devised by Steiner et al. (2003) for diagnosis of
PMS, from the following 14 symptoms women must report at least five symptoms as moderate
or severe where at least one should be from symptoms numbers 1–4 (namely core symptoms).
 Also, they must report if their symptoms interfere moderately or severely with their ability to
function in at least one of five items in the second domain.
 For diagnosis of PMDD, the following criteria must be present: (1) at least one of the
symptoms (1 to 4) as severe; (2) in addition, at least four of the symptoms (1 to 14) as
moderate to severe; and (3) at least one of a, b, c, d, and e as severe
 The reliability of PSST was found to be 0.93
SAMANTA QUESTIONNAIRE

 The SAMANTA questionnaire, which is a six item questionnaire that gathers information on
the duration and the quantity of menstrual bleeding, the bother and inconvenience caused by
the heavy blood loss, and the impact on daily activities.
 Affirmative answers to items 1 and 3 are assigned a score of greater than or equal to 3 points
each, whereas items 2, 4, 5, and 6 are assigned 1 point each.
 Negative answers are scored 0.
 The total score ranges from 0 to 10,with a score of 3 points being indicative of HMB.
SAMANTHA QUESTIONNAIRE
CLINICAL OUTCOME MEASURES TO ASSESS MENOPAUSE
 Menopause Rating Scale
 Greene Climacteric Scale
 Menopause- Quality of Life (MEN-QOL)
MENOPAUSE RATING SCALE
 It is a self administered scale to assess the symptoms of aging women under different
conditions, to evaluate the severity of symptoms over time and to measure pre and post
menopause HRT.

 Test retest reliability of the scale is 0.8-0.9.

GREENE CLIMATERIC SCALE
The GCS is an effective tool to identify the transition to menopause stage and provides a
symptom checklist for menopause.
COMPONENT
1. Psychological (items 1-11).
2. Physical (items 12-18).
3. Vasomotor (items 19, 20).

The reliability of the scale is 0.91.

MENOPAUSE- QUALITY OF LIFE (MEN-QOL)
The Menopause-Specific Quality of Life instrument was developed as a self-administered
condition specific tool to measure health-related quality of life in middle-aged women in the
years immediately beyond the onset of menopause, defined as one year with no menses.

It was developed by Lewis et.al.

Items forming domains of MENQOL intervention:

Vasomotor 1–3
Psychosocial 4–10
Physical 11–26,30–32
Sexual 27–29

The test-retest reliability of MENQOL range from 0.72- 0.88

CLINICAL OUTCOME MEASURES TO ASSESS POSTNATAL CONDITIONS
 Edinberg postnatal depression scale
 REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation)
 6 point engorgement scale
 Patient assessment of constipation symptoms (PAC-SYM)
 Breastfeeding self efficacy scale
 LATCH score
 DRAM- Caliper
EDINBURGH POSTNATAL DEPRESSION SCALE
 It is used to screen as well as an outcome in assessing post natal depression in clinical practice
for obstetrics and midwives.
 It is a set of 10 screening questions that can indicate a parent has a symptoms that are common
with depression and anxiety during pregnancy and in the year following childbirth.
 The maximum score is 30, each question having score from 0-3, a total score of 13 or more is
considered as a flag to follow up for possible depressive symptoms.
 Test- retest reliability of EPDS is 0.92
REEDA SCALE
 It is a tool that assess the inflammatory process and tissue healing in the perineal trauma.
 The REEDA scale consists of 5 major assessment area i.e. redness, edema, ecchymosis,
discharge, approximation.
 Each area is given a minimum score of 0 and maximum score of 3.
 The total score is 15.
 The reliability of REEDA scale was found to be 0.88.
SIX POINT ENGORGEMENT SCALE
 This scale is used to assess the severity of breast engorgement.
 The minimum score is 1 and maximum score is 6.
 The reliability has been recorded to be 0.84 (Hill and Humenick, 1994).
PATIENT ASSESSMENT OF CONSTIPATION SYMPTOMS

The Patient Assessment of Constipation – Symptom (PAC-SYM) was developed as a brief, easily
administered tool to assess symptom frequency and severity of chronic constipation.
This 12-item self report measure is divided into three symptom subscales (i.e. abdominal, rectal
and stool). Items are scored on a four-point Likert scale, with 4 indicating the worst symptom
severity.
A total score for the PAC-SYM can range from 0 to 48. No cut-off score was reported.

The reliability of the scale is 0.98

BREASTFEEDING SELF EFFICACY SCALE- SHORT FORM

 The conceptual definition of breastfeeding self-efficacy refers to a mother’s

confidence in her ability to breastfeed her infant (Dennis, 1999).
 Breastfeeding Self-Efficacy Scale-short form (BSES-SF). The BSES-SF is a 14-
item Likert-type scale, where 1= “not at all confident” and 5= “always
confident.” Scores range from 14 to 70.
 Higher scores are indicative of higher levels of breastfeeding self-efficacy.
 The reliability of BSES-SF was found to be 0.92
LATCH SCORE

LATCH is a breastfeeding charting system that provides a systematic method for

gathering information about the dividual breastfeeding sessions.
The system assigns a numerical score, 0, 1, or 2, to five key components of
breastfeeding.
 L- how well the infant latches onto the breast.
 A- the amount of audible swallowing noted.
 T- the mother’s nipple type
 C- mother’s level of comfort.
 H- amount of help the mother needs to hold her infant to the breast.
DRAM CALIPER
Patient position : Hook-lying, arms down by the side, with 1 pillow placed behind the head.
The assessor should palpate the medial borders of the right and left rectus abdominis muscle
bellies at the marked locations.
The inside measurement jaws of the digital nylon calipers should be positioned at the locations of
the palpating fingers, perpendicular to the direction of the muscles, and adjusted to the perceived
IRD (Intra recti distance) width.
To measure the IRD with abdominal muscles contracted, each participant crosses the arms over
the chest and raised the head until the spine of the scapulae was off the table surface.
The participant maintained this partial curl-up while the examiner palpated and measured the IRD
with the calipers.
 Title Aim Methodology Results
Assessment of pelvic floor To evaluate the reliability 222 postpartum mothers ICC values of 0.73–0.83
and abdominal muscles of clinically applicable through social media and were obtained. Assessments
three months postpartum: A methods for assessing prenatal and delivery of DRA depth and bulging
reliability study pelvic floor muscles and centres in Sweden were showed moderate kappa
DRA after pregnancy taken for the study where 3 values of 0.43–0.51, with
Sabine Vesting et.al. rehabilitation institutes in reservation for some
Sweden used observation inconsistency between the
British Medical Journal and palpation to examine centers. With some
the pelvic floor and DRA. experience and training, a
September 2021 The examinations were caliper is a reliable
carried out by independent instrument for assessing the
physiotherapists in a postpartum DRA width.
random order after taking a
proper training in using the
caliper to quantify DRA.
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