title: Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging.
abstract: OBJECTIVE
  Defects in the pubovisceral portion of the levator ani muscle are seen with MR imaging. This study aims to determine interrater reliability of physical examination in detecting these defects, and to validate findings from physical examination using comparisons with MR images.
  
  
  METHODS
  Two examiners palpated the pubovisceral muscles of 29 women to assess for defects in this muscle. Each examiner was blinded to the others findings. MR scans were acquired on a further 24 women after structured clinical examination by one examiner. These images were read to determine pubovisceral muscle defects, blinded to patient identifiers. Agreement between raters and between MR imaging and clinical examination were calculated.
  
  
  RESULTS
  The two examiners had positive agreement (presence of a defect) of 72.7% and negative agreement (absence of a defect) of 83.3%. The positive agreement between physical examination and MR imaging was 27.3% and the negative agreement 86.5%.
  
  
  CONCLUSIONS
  The structured physical examination to detect defects in the pubovisceral portion of the levator ani muscle can be learned as shown by good interrater agreement. However, examination alone underestimates these defects compared with MR imaging.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA. rkearney@doctors.net.uk
authors.forename: Rohna
authors.initials: R
authors.lastname: Kearney
authors.forename: Janis M
authors.initials: JM
authors.lastname: Miller
authors.forename: John O L
authors.initials: JO
authors.lastname: Delancey
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D015588:Observer Variation; D010173:Palpation; D010298:Parity / Q000502:physiology; D017773:Pelvic Floor / Q000473:pathology*; D010808:Physical Examination; D011247:Pregnancy; D015203:Reproducibility of Results; D014596:Uterine Prolapse / Q000473:pathology