Biofeedback enhanced pelvic floor muscle training in treatment of urinary incontinence
Level of evidence: D
The evidence on Pelvic Floor Muscle Training (PFMT) with EMG Biofeedback (EMG-BF) is very uncertain.
A systematic review and meta-analysis of including biofeedback in pelvic muscle training to treat stress urinary incontinence found uncertain impact on urinary incontinence symptoms (ICIQ-UI SF) «Wu X, Zheng X, Yi X, et al. Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis. Adv Ther 2021;38(8):4163-4177 »1.
Cure and improvement of incontinence due to stress Urinary Incontinence (SUI) were analyzed in 11 RCTs. EMG-BF+PFMT increased the rate of cure or improvement compared to PFMT alone (OR 4.82, 95% CI 2.21–10.51). However, the evidence was very uncertain. Only one study was conducted outside of China. The trial was the largest and high quality including 600 patients and found no difference between the intervention and control groups (OR 0.93, 95% CI 0.63 to 1.37).
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| MA=meta-analysis | |||||
| «Wu X, Zheng X, Yi X, et al. Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis. Adv Ther 2021;38(8):4163-4177 »1 | MA | Women with Stress Urinary Incontinence (SUI) | PFMT+ EMG_BF vs PFMT alone. | Cure or improvement of Incontinence | High |
| Reference | Comments |
|---|---|
| «Wu X, Zheng X, Yi X, et al. Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis. Adv Ther 2021;38(8):4163-4177 »1 | The used outcome measures varied. No blinding. Substantial loss to follow up. 17/21 trials were conducted in China. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (SD) I | Mean (SD) C | Standardized mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: very low Quality of evidence was downgraded due to high risk of bias and imprecision. I=intervention; C=comparison; CI=confidence interval | |||||
| «Wu X, Zheng X, Yi X, et al. Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis. Adv Ther 2021;38(8):4163-4177 »1 | 4 trials (484/478) | 1 – 24 months | Not reported | Not reported | -0.52 (-2.17 to 1.12) |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (SD) I | Mean (SD) C | Odds Ratio (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: very low The quality of evidence was downgraded due to high risk of bias, indirectness and imprecision I=intervention; C=comparison; CI=confidence interval | |||||
| «Wu X, Zheng X, Yi X, et al. Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis. Adv Ther 2021;38(8):4163-4177 »1 | 10 trials | 1–24 months | Not reported | Not reported, | 4.82, 95% (2.21–10.51) |
References
- Wu X, Zheng X, Yi X, et al. Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis. Adv Ther 2021;38(8):4163-4177 «PMID: 34176082»PubMed