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Meta-Analysis
. 2023 Jul;34(7):1339-1349.
doi: 10.1007/s00192-023-05489-2. Epub 2023 Feb 22.

Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence - a systematic review and meta-analysis

Ghazal Kharaji  1 , Shabnam ShahAli  2 , Ismail Ebrahimi-Takamjani  1 , Javad Sarrafzadeh  1 , Fateme Sanaei  3 , Sanaz Shanbehzadeh  1
Affiliations
Meta-Analysis

Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence - a systematic review and meta-analysis

Ghazal Kharaji et al. Int Urogynecol J. 2023 Jul.

Abstract

Introduction and hypothesis: This study synthesized the effects of supervised and unsupervised pelvic floor muscle training (PFMT) programs on outcomes relevant to women's urinary incontinence (UI).

Methods: Five databases were searched from inception to December 2021, and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity of UI, and patient satisfaction outcomes were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference.

Results: Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias", and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFM function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised and unsupervised PFMT with thorough education and regular reassessment showed better results than those for unsupervised PFMT without educating patients about correct PFM contractions.

Conclusions: Supervised and unsupervised PFMT programs can both be effective in treating women's UI if training sessions and regular reassessments are provided.

Keywords: Exercise; Home exercise; Outpatient exercise; Pelvic floor muscle; Training; Urinary incontinence.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow diagram mapping the review
Fig. 2
Fig. 2
Risk of bias summary about each risk of bias domain for each included randomised controlled trial (RCT) separately
Fig. 3
Fig. 3
Risk of bias summary for the included non-randomised controlled trial
Fig. 4
Fig. 4
Forest plot of supervised PFMT versus unsupervised: QoL outcome, pooled data from five RCTs (n = 235)
Fig. 5
Fig. 5
Forest plot of supervised PFMT versus unsupervised: urinary symptom outcome, pooled data from two RCTs and one NRCT (n = 166)
Fig. 6
Fig. 6
Forest plot of supervised PFMT versus unsupervised: PFM function/ strength outcome, pooled data from three RCTs (n = 117)
See this image and copyright information in PMC

References

    1. Tettamanti G, Altman D, Iliadou AN, Bellocco R, Pedersen NL. Depression, neuroticism, and urinary incontinence in premenopausal women: a nationwide twin study. Twin Res Hum Genet. 2013;16(5):977–984. doi: 10.1017/thg.2013.60. - DOI - PubMed
    1. Farage MA, Miller KW, Berardesca E, Maibach HI. Psychosocial and societal burden of incontinence in the aged population: a review. Arch Gynecol Obstet. 2008;277(4):285–290. doi: 10.1007/s00404-007-0505-3. - DOI - PubMed
    1. Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nat Rev Dis Primers. 2017;3:17042. doi: 10.1038/nrdp.2017.42. - DOI - PMC - PubMed
    1. Russo E, Caretto M, Giannini A, Bitzer J, Cano A, Ceausu I, et al. Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas. 2021;143:223–230. doi: 10.1016/j.maturitas.2020.09.005. - DOI - PubMed
    1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. doi: 10.1002/nau.20798. - DOI - PubMed