Publication: Evaluación del comportamiento dinámico de la musculatura del suelo pélvico mediante ecografía en modo M diferencia entre sexos y grupos de edad
Authors
Martínez Fernández, Maravillas
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Escuela Internacional de Doctorado
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Baño Aledo, María Elena del
Publisher
Universidad de Murcia
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
Introducción: La musculatura del suelo pélvico (MSP) desempeña un papel clave en el mantenimiento de la continencia y la posición de los órganos abdominopélvicos. La ecografía transabdominal en modo B ha demostrado ser una herramienta válida para cuantificar el desplazamiento de la MSP, con la ventaja de ser una técnica no invasiva aplicable a toda la población. Sin embargo, el uso del modo M, ampliamente empleado para valorar el diafragma toracoabdominal, no ha sido previamente explorado en el estudio del diafragma pélvico.
Objetivos: Evaluar la fiabilidad intraobservador e interobservador de las medidas ecográficas obtenidas mediante ecografía en modo M con abordaje transabdominal para el estudio dinámico de la MSP, describir la capacidad de estas variables para caracterizar su comportamiento funcional y analizar diferencias por sexo y edad, tanto en contracción voluntaria como ante maniobras hiperpresivas.
Material y métodos: En este estudio participaron voluntarios adultos sanos de ambos sexos y distintos grupos etarios. Se les realizó una exploración ecográfica transabdominal de la MSP en modo M y se recogieron datos demográficos, de salud y hábitos de vida. El protocolo de exploración incluyó contracciones voluntarias de la MSP de distinta duración y dos maniobras hiperpresivas, flexión concéntrica de tronco y tos forzada, con y sin activación anticipada mediante knack perineal. Las variables ecográficas analizadas fueron dirección, magnitud, y velocidad del desplazamiento, y tiempo de contracción. Se realizó un análisis de reproducibilidad intra e interobservador de las mediciones ecográficas, un estudio piloto y un descriptivo transversal con comparaciones por sexo y grupos de edad, empleando pruebas no paramétricas y modelos lineales ajustados para explorar diferencias entre grupos. También se analizaron las correlaciones entre variables y se calcularon percentiles para aportar valores de referencia. Se calculó el tamaño muestral para garantizar la potencia estadística y la representatividad de los resultados. El análisis estadístico se realizó con IBM SPSS 28.0 y JASP, con un nivel de significación de 0,05 para todos los análisis.
Resultados: Los resultados mostraron una excelente fiabilidad intraobservador y una fiabilidad interobservador aceptable. La contracción breve generó desplazamientos y velocidades significativamente mayores que la mantenida. Se observó un dimorfismo sexual en los biomarcadores ecográficos, con valores superiores en hombres tanto en desplazamiento como en velocidad de contracción y relajación. En condiciones de hiperpresión intraabdominal, la aplicación del knack perineal redujo significativamente la magnitud y velocidad del desplazamiento caudal, sin diferencias entre sexos. Por grupos etarios, los mayores de 45 años mostraron valores más elevados en contracción breve y una relajación más rápida, mientras que los sujetos más jóvenes presentaron una respuesta más eficiente a las maniobras hiperpresivas.
Conclusión: La ecografía transabdominal en modo M es una técnica fiable para la evaluación funcional del suelo pélvico y útil para estudiar tanto la capacidad contráctil como el efecto protector de la maniobra de knack perineal ante hiperpresión abdominal, evidenciando diferencias significativas en la función dinámica de la MSP según sexo y grupos de edad.
Introduction: The pelvic floor musculature (PFM) plays a key role in maintaining continence and the position of the abdominopelvic organs. Transabdominal B-mode ultrasound has proven to be a valid tool to quantify the displacement of the PFM, with the advantage of being a non-invasive technique applicable to the whole population. However, the use of M-mode, widely used to assess the thoracoabdominal diaphragm, has not been previously explored in the study of the pelvic diaphragm. Objectives: To evaluate the intraobserver and interobserver reliability of ultrasound measurements obtained by M-mode ultrasound with a transabdominal approach for the dynamic study of the PSM, to describe the capacity of these variables to characterise its functional behaviour and to analyse differences by sex and age, both in voluntary contraction and in hyperpressive manoeuvres. Material and methods: Healthy adult volunteers of both sexes and different age groups participated in this study. A transabdominal M-mode ultrasound scan of the MSP was performed and demographic, health and lifestyle data were collected. The scan protocol included voluntary contractions of the MSP of different durations and two hyperpressive manoeuvres, concentric trunk flexion and forced cough, with and without early activation by perineal knack. The ultrasound variables analysed were direction, magnitude, and speed of displacement, and contraction time. Intra- and inter-observer reproducibility analysis of ultrasound measurements, a pilot study and a cross-sectional descriptive study with comparisons by sex and age groups were performed, using non-parametric tests and fitted linear models to explore differences between groups. Correlations between variables were also analysed and percentiles were calculated to provide reference values. Sample size was calculated to ensure statistical power and representativeness of the results. Statistical analysis was performed with IBM SPSS 28.0 and JASP, with a significance level of 0.05 for all analyses. Results: The results showed excellent intraobserver reliability and acceptable interobserver reliability. Short contraction generated significantly higher displacements and velocities than sustained contraction. Sexual dimorphism was observed in ultrasound biomarkers, with higher values in men for both displacement and contraction and relaxation velocities. Under conditions of intra-abdominal hyperpressure, the application of the perineal knack significantly reduced the magnitude and speed of caudal displacement, with no differences between sexes. By age group, those older than 45 years showed higher values for brief contraction and faster relaxation, while younger subjects showed a more efficient response to hyperpressive manoeuvres. Conclusion: Transabdominal M-mode ultrasound is a reliable technique for the functional assessment of the pelvic floor and useful for studying both the contractile capacity and the protective effect of the perineal knack manoeuvre against abdominal hyperpressure, showing significant differences in the dynamic function of the MSP according to sex and age groups.
Introduction: The pelvic floor musculature (PFM) plays a key role in maintaining continence and the position of the abdominopelvic organs. Transabdominal B-mode ultrasound has proven to be a valid tool to quantify the displacement of the PFM, with the advantage of being a non-invasive technique applicable to the whole population. However, the use of M-mode, widely used to assess the thoracoabdominal diaphragm, has not been previously explored in the study of the pelvic diaphragm. Objectives: To evaluate the intraobserver and interobserver reliability of ultrasound measurements obtained by M-mode ultrasound with a transabdominal approach for the dynamic study of the PSM, to describe the capacity of these variables to characterise its functional behaviour and to analyse differences by sex and age, both in voluntary contraction and in hyperpressive manoeuvres. Material and methods: Healthy adult volunteers of both sexes and different age groups participated in this study. A transabdominal M-mode ultrasound scan of the MSP was performed and demographic, health and lifestyle data were collected. The scan protocol included voluntary contractions of the MSP of different durations and two hyperpressive manoeuvres, concentric trunk flexion and forced cough, with and without early activation by perineal knack. The ultrasound variables analysed were direction, magnitude, and speed of displacement, and contraction time. Intra- and inter-observer reproducibility analysis of ultrasound measurements, a pilot study and a cross-sectional descriptive study with comparisons by sex and age groups were performed, using non-parametric tests and fitted linear models to explore differences between groups. Correlations between variables were also analysed and percentiles were calculated to provide reference values. Sample size was calculated to ensure statistical power and representativeness of the results. Statistical analysis was performed with IBM SPSS 28.0 and JASP, with a significance level of 0.05 for all analyses. Results: The results showed excellent intraobserver reliability and acceptable interobserver reliability. Short contraction generated significantly higher displacements and velocities than sustained contraction. Sexual dimorphism was observed in ultrasound biomarkers, with higher values in men for both displacement and contraction and relaxation velocities. Under conditions of intra-abdominal hyperpressure, the application of the perineal knack significantly reduced the magnitude and speed of caudal displacement, with no differences between sexes. By age group, those older than 45 years showed higher values for brief contraction and faster relaxation, while younger subjects showed a more efficient response to hyperpressive manoeuvres. Conclusion: Transabdominal M-mode ultrasound is a reliable technique for the functional assessment of the pelvic floor and useful for studying both the contractile capacity and the protective effect of the perineal knack manoeuvre against abdominal hyperpressure, showing significant differences in the dynamic function of the MSP according to sex and age groups.
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