title: Biofeedback for the treatment of female pelvic floor muscle dysfunction: a systematic review and meta-analysis.
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.
authors.affiliation: Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil. fanifitz@yahoo.com.br
authors.forename: Fátima Faní
authors.initials: FF
authors.lastname: Fitz
authors.forename: Ana Paula Magalhães
authors.initials: AP
authors.lastname: Resende
authors.forename: Liliana
authors.initials: L
authors.lastname: Stüpp
authors.forename: Marair Gracio Ferreira
authors.initials: MG
authors.lastname: Sartori
authors.forename: Manoel João Batista Castello
authors.initials: MJ
authors.lastname: Girão
authors.forename: Rodrigo Aquino
authors.initials: RA
authors.lastname: Castro
mesh_terms: D001676:Biofeedback, Psychology / Q000379:methods*; D005260:Female; D006801:Humans; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009135:Muscular Diseases / Q000503:physiopathology / Q000628:therapy*; D017773:Pelvic Floor / Q000503:physiopathology*; D016032:Randomized Controlled Trials as Topic; D053201:Urinary Bladder, Overactive / Q000628:therapy; D014549:Urinary Incontinence / Q000628:therapy