Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis

Abstract

Electromyographic biofeedback (EMG-BF) can be regarded as an adjuvant to pelvic floor muscle (PFM) training (PFMT) for the management of stress urinary incontinence (SUI). This meta-analysis aimed to compare the efficacy of PFMT with and without EMG-BF on the cure and improvement rate, PFM strength, urinary incontinence score, and quality of sexual life for the treatment of SUI or pelvic floor dysfunction (PFD). PubMed, EMBASE, the Cochrane Library, Web of Science, Wanfang, and CNKI were systematically searched for studies published up to January 2021. The outcomes were the cure and improvement rate, symptom-related score, pelvic floor muscle strength change, and sexual life quality. Twenty-one studies (comprising 1967 patients with EMG-BF + PFMT and 1898 with PFMT) were included. Compared with PFMT, EMG-BF + PFMT had benefits regarding the cure and improvement rate in SUI (OR 4.82, 95% CI 2.21-10.51, P < 0.001; I² = 85.3%, P_{heterogeneity} < 0.001) and in PFD (OR 2.81, 95% CI 2.04-3.86, P < 0.001; I² = 13.1%, P_{heterogeneity} = 0.331), and in quality of life using the I-QOL tool (SMD 1.47, 95% CI 0.69-2.26, P < 0.001; I² = 90.1%, P_{heterogeneity} < 0.001), quality of sexual life using the FSFI tool (SMD 2.86, 95% CI 0.47-5.25, P = 0.019; I² = 98.7%, P_{heterogeneity} < 0.001), urinary incontinence using the ICI-Q-SF tool (SMD - 0.62, 95% CI - 1.16, - 0.08, P = 0.024), PFM strength (SMD 1.72, 95% CI 1.08-2.35, P < 0.001; I² = 91.4%, P_{heterogeneity} < 0.001), and urodynamics using Qmax (SMD 0.84, 95% CI 0.57-1.10, P < 0.001; I² = 0%, P_{heterogeneity} = 0.420) and MUCP (SMD 1.54, 95% CI 0.66-2.43, P = 0.001; I² = 81.8%, P_{heterogeneity} = 0.019). There was limited evidence of publication bias. PFMT combined with EMG-BF achieves better outcomes than PFMT alone in SUI or PFD management.

Keywords: Electromyographic biofeedback; Meta-analysis; Pelvic floor dysfunction; Pelvic floor muscle training; Stress urinary incontinence.

Fig. 1

Flowchart of the search process and included studies

Fig. 2

Forest plots of the cure and improvement rate. A Stress urinary incontinence. B Pelvic floor dysfunction. C Subgroup analysis of stress urinary incontinence (> 3 months and ≤ 3 months)

Fig. 3

Forest plots of the quality of life score. A Urinary incontinence quality of life. B Quality of sexual life

Fig. 4

Forest plots of A the severity of urinary incontinence, B pelvic floor muscle strength, and C urodynamics