Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, unclear blinding, and incomplete outcome data in most of the trials) and by inconsistency (unexplained variability in results) .
Biofeedback in addition to pelvic floor muscle training is recommended to women with urinary incontinence and a difficulty to identify pelvic floor muscles.
The recommendation is strong because pelvic floor muscle training is an effective, cheap and harmless treatment for urinary incontinence. The recommendation attaches a low value for potential poor availability of the intervention.
A Cochrane review [Abstract] 1 included 24 studies with a total of 1583 subjects. Women who received biofeedback (BF) were significantly more likely to report that their urinary incontinence was cured or improved compared to those who received pelvic floor muscle training (PFMT) alone (RR 0.75 , 95% CI 0.66 to 0.86; 7 trials, n=520). However, women in the biofeedback arms had more contact with the health professional than those in the non-biofeedback arms. There were no statistically significant difference in leakage episodes in 24 hours (MD 0.12, 95% CI -0.22 to -0.01; 8 trials, n=532); this difference comprised around one fewer leakage episodes every eight days. For quality of life, the effect estimates in separate did not show a statistically significant difference, although the possibility of a summary statistic favouring BF or no BF could not be excluded.
A meta-analysis 3 comparing PFMT with and without electromyographic biofeedback (EMG-BF) for stress urinary incontinence (SUI) included 21 trials with the total of 3865 participants. Compared with PFMT, EMG-BF + PFMT had better rates for cure and improvement in SUI (OR 4.82, 95% CI 2.21 to 10.51, I² = 85.3%), and better quality of life and quality of sexual life.
A multicentre randomised controlled trial 2 assessed the effectiveness of PFMT plus EMG-BF or PFMT alone for newly presenting stress or mixed urinary incontinence in women (n=600). Self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form = ICIQ-UI SF, range 0 to 21) did not differ between the groups (ICIQ-UI SF score 8.2 in biofeedback PFMT vs 8.5 in PFMT). Comment: Women unable to contract their muscles were excluded, as biofeedback is recommended especially for these women.
Date of latest search: 2021-09-20
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