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Biofeedback for the treatment of female pelvic floor muscle dysfunction: a systematic review and meta-analysis

  • Review Article
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Abstract

Biofeedback (BF) has been widely used in the treatment of pelvic floor dysfunctions, mainly by promoting patient learning about muscle contraction with no side effects. However, its effectiveness remains poorly understood with some studies suggesting that BF offers no advantage over the isolated pelvic floor muscle training (PFMT). The main objective of this study was to systematically review available randomized controlled trials assessing the effectiveness of BF in female pelvic floor dysfunction treatment. Trials were electronically searched and rated for quality by use of the PEDro scale (values of 0–10). Randomized controlled trials assessing the training of pelvic floor muscle (PFM) using BF in women with PFM dysfunction were selected. Outcomes were converted to a scale ranging from 0 to 100. Trials were pooled with software used to prepare and update Cochrane reviews. Results are presented as weighted mean differences with 95 % confidence intervals (CI). Twenty-two trials with 1,469 patients that analyzed BF in the treatment of urinary, anorectal, and/or sexual dysfunctions were included. PFMT alone led to a superior but not significant difference in the function of PFM when compared to PFMT with BF, by using vaginal measurement in the short and intermediate term: 9.89 (95 % CI −5.05 to 24.83) and 15.03 (95 % CI −9.71 to 39.78), respectively. We found a few and nonhomogeneous studies addressing anorectal and sexual function, which do not provide the cure rate calculations. Limitations of this review are the low quality and heterogeneity of the studies, involving the usage of distinct protocols of interventions, and various and different outcome measures. The results of this systematic review suggest that PFMT with BF is not more effective than other conservative treatments for female PFM dysfunction.

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Abbreviations

BF:

Biofeedback

PFMT:

Pelvic floor muscle training

PFM:

Pelvic floor muscle

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Acknowledgments

This study was funded by the National Council for Scientific and Technological Development (CNPq) research foundation, grant nº 153287/2010-1.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil

    Fátima Faní Fitz, Ana Paula Magalhães Resende, Liliana Stüpp, Marair Gracio Ferreira Sartori, Manoel João Batista Castello Girão & Rodrigo Aquino Castro

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  1. Fátima Faní Fitz
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  2. Ana Paula Magalhães Resende
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  3. Liliana Stüpp
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Correspondence to Fátima Faní Fitz.

Appendices

Appendix

Search strategies

PEDro

Therapy: no selection

Problem: incontinence

Body part: perineum or genitourinary system

Subdiscipline: continence and women’s health

Method: clinical trial

Match all search terms (AND)

Therapy: no selection

Problem: motor incoordination

Body part: perineum or genitourinary system

Subdiscipline: continence and women’s health

Method: clinical trial

Match all search terms (AND)

Therapy: no selection

Problem: muscle weakness

Body part: perineum or genitourinary system

Subdiscipline: no selection

Method: clinical trial

Match all search terms (AND)

MEDLINE/LILACS

1. ((biofeedback and (muscle and pelvic and floor))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

2. ((biofeedback and (urinary and incontinence))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

3. ((biofeedback and (urinary and incontinence and muscle and pelvic and floor))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

4. ((biofeedback and (stress and urinary and incontinence))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

5. (biofeedback and (overactive and bladder))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

6. ((biofeedback and pelvic and floor and exercises)) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

7. ((biofeedback and neuromuscular and electrical and stimulation)) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

8. ((biofeedback and (fecal and incontinence))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

9. ((biofeedback and (anal and incontinence))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

10. ((biofeedback and (anal and incontinence and muscle and pelvic and floor))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

11. ((biofeedback and (fecal and incontinence and muscle and pelvic and floor))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

12. ((biofeedback and (intestinal and constipation))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

13. ((biofeedback and (constipation))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

14. ((biofeedback and (dyspareunia))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

15. ((biofeedback and (sexual and dysfunction))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

16. ((biofeedback and (sexual))) AND ([CT] humano or humanos) AND ([CT] FEMININO) AND ([PT] ENSAIO CLINICO CONTROLADO OR ENSAIO CONTROLADO ALEATORIO) [Palavras]

17. biofeedback and (vaginismus) AND Espécie = Humanos AND Gênero = Feminino AND Tipo de publicação = Ensaio clínico controlado

PubMed

1. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("pelvic floor"[MeSH Terms] OR ("pelvic"[All Fields] AND "floor"[All Fields]) OR "pelvic floor"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

2. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("muscles"[MeSH Terms] OR "muscles"[All Fields] OR "muscle"[All Fields]) AND ("pelvic floor"[MeSH Terms] OR ("pelvic"[All Fields] AND "floor"[All Fields]) OR "pelvic floor"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

3. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("urinary incontinence"[MeSH Terms] OR ("urinary"[All Fields] AND "incontinence"[All Fields]) OR "urinary incontinence"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

4. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("urinary incontinence, stress"[MeSH Terms] OR ("urinary"[All Fields] AND "incontinence"[All Fields] AND "stress"[All Fields]) OR "stress urinary incontinence"[All Fields] OR ("stress"[All Fields] AND "urinary"[All Fields] AND "incontinence"[All Fields]))) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

5. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("urinary bladder, overactive"[MeSH Terms] OR ("urinary"[All Fields] AND "bladder"[All Fields] AND "overactive"[All Fields]) OR "overactive urinary bladder"[All Fields] OR ("overactive"[All Fields] AND "bladder"[All Fields]) OR "overactive bladder"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

6. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("exercise"[MeSH Terms] OR "exercise"[All Fields]) AND ("pelvic floor"[MeSH Terms] OR ("pelvic"[All Fields] AND "floor"[All Fields]) OR "pelvic floor"[All Fields]) AND ("muscles"[MeSH Terms] OR "muscles"[All Fields] OR "muscle"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

7. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND neuromuscular[All Fields] AND ("electric stimulation"[MeSH Terms] OR ("electric"[All Fields] AND "stimulation"[All Fields]) OR "electric stimulation"[All Fields] OR ("electrical"[All Fields] AND "stimulation"[All Fields]) OR "electrical stimulation"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

8. (#6) AND #4 AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

9. (#6) AND #3 AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

10. (#7) AND #3 AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

11. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("faecal incontinence"[All Fields] OR "fecal incontinence"[MeSH Terms] OR ("fecal"[All Fields] AND "incontinence"[All Fields]) OR "fecal incontinence"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

12. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND anal[All Fields] AND ("urinary incontinence"[MeSH Terms] OR ("urinary"[All Fields] AND "incontinence"[All Fields]) OR "urinary incontinence"[All Fields] OR "incontinence"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized

13. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("sexual behavior"[MeSH Terms] OR ("sexual"[All Fields] AND "behavior"[All Fields]) OR "sexual behavior"[All Fields] OR "sexual"[All Fields]) AND ("physiopathology"[Subheading] OR "physiopathology"[All Fields] OR "dysfunction"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

14. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("dyspareunia"[MeSH Terms] OR "dyspareunia"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

15. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("constipation"[MeSH Terms] OR "constipation"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

16. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("intestines"[MeSH Terms] OR "intestines"[All Fields] OR "intestinal"[All Fields]) AND ("constipation"[MeSH Terms] OR "constipation"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

17. (("biofeedback, psychology"[MeSH Terms] OR ("biofeedback"[All Fields] AND "psychology"[All Fields]) OR "psychology biofeedback"[All Fields] OR "biofeedback"[All Fields]) AND ("pelvic floor"[MeSH Terms] OR ("pelvic"[All Fields] AND "floor"[All Fields]) OR "pelvic floor"[All Fields]) AND ("muscles"[MeSH Terms] OR "muscles"[All Fields] OR "muscle"[All Fields]) AND ("physiopathology"[Subheading] OR "physiopathology"[All Fields] OR "dysfunction"[All Fields])) AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

18. (#14) AND #6 AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

19. (#15) AND #6 AND ("humans"[MeSH Terms] AND "female"[MeSH Terms] AND Randomized Controlled Trial[ptyp])

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Fitz, F.F., Resende, A.P.M., Stüpp, L. et al. Biofeedback for the treatment of female pelvic floor muscle dysfunction: a systematic review and meta-analysis. Int Urogynecol J 23, 1495–1516 (2012). https://doi.org/10.1007/s00192-012-1707-1

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  • DOI: https://doi.org/10.1007/s00192-012-1707-1

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