Scolaris Content Display Scolaris Content Display

PRISMA study flow diagram.
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Figure 1

PRISMA study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 PFMT versus no treatment, Outcome 1 number with increased frequency of prolapse symptoms.
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Analysis 1.1

Comparison 1 PFMT versus no treatment, Outcome 1 number with increased frequency of prolapse symptoms.

Comparison 1 PFMT versus no treatment, Outcome 2 number with increased bother of prolapse symptoms.
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Analysis 1.2

Comparison 1 PFMT versus no treatment, Outcome 2 number with increased bother of prolapse symptoms.

Comparison 1 PFMT versus no treatment, Outcome 3 number with pelvic heaviness.
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Analysis 1.3

Comparison 1 PFMT versus no treatment, Outcome 3 number with pelvic heaviness.

Comparison 1 PFMT versus no treatment, Outcome 4 prolapse symptom score: mean change from baseline.
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Analysis 1.4

Comparison 1 PFMT versus no treatment, Outcome 4 prolapse symptom score: mean change from baseline.

Comparison 1 PFMT versus no treatment, Outcome 5 self‐report of no improvement in prolapse.
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Analysis 1.5

Comparison 1 PFMT versus no treatment, Outcome 5 self‐report of no improvement in prolapse.

Comparison 1 PFMT versus no treatment, Outcome 6 prolapse QoL score.
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Analysis 1.6

Comparison 1 PFMT versus no treatment, Outcome 6 prolapse QoL score.

Comparison 1 PFMT versus no treatment, Outcome 7 Satisfaction with treatment (visual analogue scale 0‐10).
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Analysis 1.7

Comparison 1 PFMT versus no treatment, Outcome 7 Satisfaction with treatment (visual analogue scale 0‐10).

Comparison 1 PFMT versus no treatment, Outcome 8 number with POP‐Q stage not improved.
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Analysis 1.8

Comparison 1 PFMT versus no treatment, Outcome 8 number with POP‐Q stage not improved.

Comparison 1 PFMT versus no treatment, Outcome 9 POP‐Q measurements.
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Analysis 1.9

Comparison 1 PFMT versus no treatment, Outcome 9 POP‐Q measurements.

Comparison 1 PFMT versus no treatment, Outcome 10 mean pelvic floor muscle measures.
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Analysis 1.10

Comparison 1 PFMT versus no treatment, Outcome 10 mean pelvic floor muscle measures.

Comparison 1 PFMT versus no treatment, Outcome 11 number with worse bladder symptoms.
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Analysis 1.11

Comparison 1 PFMT versus no treatment, Outcome 11 number with worse bladder symptoms.

Comparison 1 PFMT versus no treatment, Outcome 12 change in ICIQ UI‐SF.
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Analysis 1.12

Comparison 1 PFMT versus no treatment, Outcome 12 change in ICIQ UI‐SF.

Comparison 1 PFMT versus no treatment, Outcome 13 mean bladder symptom score.
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Analysis 1.13

Comparison 1 PFMT versus no treatment, Outcome 13 mean bladder symptom score.

Comparison 1 PFMT versus no treatment, Outcome 14 urodynamics: post void residual (mL).
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Analysis 1.14

Comparison 1 PFMT versus no treatment, Outcome 14 urodynamics: post void residual (mL).

Comparison 1 PFMT versus no treatment, Outcome 15 urodynamics: flow rate (mL/s).
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Analysis 1.15

Comparison 1 PFMT versus no treatment, Outcome 15 urodynamics: flow rate (mL/s).

Comparison 1 PFMT versus no treatment, Outcome 16 urodynamics: closure pressure (cm H2O).
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Analysis 1.16

Comparison 1 PFMT versus no treatment, Outcome 16 urodynamics: closure pressure (cm H2O).

Comparison 1 PFMT versus no treatment, Outcome 17 number with dysuria.
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Analysis 1.17

Comparison 1 PFMT versus no treatment, Outcome 17 number with dysuria.

Comparison 1 PFMT versus no treatment, Outcome 18 number with stress incontinence.
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Analysis 1.18

Comparison 1 PFMT versus no treatment, Outcome 18 number with stress incontinence.

Comparison 1 PFMT versus no treatment, Outcome 19 number with urgency.
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Analysis 1.19

Comparison 1 PFMT versus no treatment, Outcome 19 number with urgency.

Comparison 1 PFMT versus no treatment, Outcome 20 number with frequency.
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Analysis 1.20

Comparison 1 PFMT versus no treatment, Outcome 20 number with frequency.

Comparison 1 PFMT versus no treatment, Outcome 21 number with worse bowel symptoms.
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Analysis 1.21

Comparison 1 PFMT versus no treatment, Outcome 21 number with worse bowel symptoms.

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 1 Change in manometry measures (cm H2O).
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Analysis 14.1

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 1 Change in manometry measures (cm H2O).

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 2 Digital muscle test (modified Oxford).
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Analysis 14.2

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 2 Digital muscle test (modified Oxford).

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 3 Change in UDI total score (12 months post‐op ‐ baseline).
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Analysis 14.3

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 3 Change in UDI total score (12 months post‐op ‐ baseline).

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 4 Change in UDI irritative score (12 months post‐op ‐ baseline).
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Analysis 14.4

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 4 Change in UDI irritative score (12 months post‐op ‐ baseline).

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 5 Change in UDI stress score (12 months post‐op ‐ baseline).
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Analysis 14.5

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 5 Change in UDI stress score (12 months post‐op ‐ baseline).

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 6 Change in UDI obstructive score (12 months post‐op ‐ baseline).
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Analysis 14.6

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 6 Change in UDI obstructive score (12 months post‐op ‐ baseline).

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 7 Number with irritative bladder symptoms at 12 months (UDI‐19).
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Analysis 14.7

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 7 Number with irritative bladder symptoms at 12 months (UDI‐19).

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 8 Number with stress bladder symptoms at 12 months (UDI‐19).
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Analysis 14.8

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 8 Number with stress bladder symptoms at 12 months (UDI‐19).

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 9 Number with obstructive bladder symptoms at 12 months (UDI‐19).
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Analysis 14.9

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 9 Number with obstructive bladder symptoms at 12 months (UDI‐19).

Study

median change from baseline intervention

95% CI

median change from baseline control

95% CI

Heading 5

Frawley 2010

0.0

0, 14

10.0

5, 19

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Analysis 14.10

Comparison 14 PFMT and/or lifestyle plus surgery versus surgery, Outcome 10 IIQ‐7 at 12 months.

Comparison 1. PFMT versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 number with increased frequency of prolapse symptoms Show forest plot

1

69

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.21, 0.65]

2 number with increased bother of prolapse symptoms Show forest plot

1

69

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.33, 0.97]

3 number with pelvic heaviness Show forest plot

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.11, 0.61]

4 prolapse symptom score: mean change from baseline Show forest plot

1

37

Mean Difference (IV, Fixed, 95% CI)

‐3.37 [‐6.23, ‐0.51]

5 self‐report of no improvement in prolapse Show forest plot

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.26, 0.91]

6 prolapse QoL score Show forest plot

2

87

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.51 [‐0.94, ‐0.07]

6.1 mean score for prolapse interference with everyday life

1

40

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.67, 0.57]

6.2 Ditrovie quality of life score

1

47

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.95 [‐1.57, ‐0.34]

7 Satisfaction with treatment (visual analogue scale 0‐10) Show forest plot

1

47

Mean Difference (IV, Fixed, 95% CI)

‐3.22 [‐3.79, ‐2.65]

8 number with POP‐Q stage not improved Show forest plot

2

128

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.71, 0.96]

9 POP‐Q measurements Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

9.1 mean post ‐ pre POP‐Q Ba measurement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.2 mean post ‐ pre POP‐Q Aa measurement

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 mean pelvic floor muscle measures Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 manometry strength improvement (cm H2O)

1

109

Mean Difference (IV, Fixed, 95% CI)

‐12.00 [‐14.90, ‐9.10]

10.2 manometry endurance improvement (cm H2O sec)

1

109

Mean Difference (IV, Fixed, 95% CI)

‐99.0 [‐131.47, ‐66.53]

10.3 other strength measure

1

47

Mean Difference (IV, Fixed, 95% CI)

1.12 [0.66, 1.58]

11 number with worse bladder symptoms Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 SUI: number with increased frequency

1

66

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.20, 0.66]

11.2 SUI: number with increased bother

1

66

Risk Ratio (M‐H, Fixed, 95% CI)

0.44 [0.26, 0.74]

11.3 UUI: number with increased frequency

1

39

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.33, 1.12]

11.4 UUI: number with increased bother

1

39

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.35, 1.01]

12 change in ICIQ UI‐SF Show forest plot

1

39

Mean Difference (IV, Fixed, 95% CI)

‐1.79 [‐3.68, 0.10]

13 mean bladder symptom score Show forest plot

1

47

Mean Difference (IV, Fixed, 95% CI)

‐9.22 [‐10.68, ‐7.76]

14 urodynamics: post void residual (mL) Show forest plot

1

47

Mean Difference (IV, Fixed, 95% CI)

‐21.28 [‐32.75, ‐9.81]

15 urodynamics: flow rate (mL/s) Show forest plot

1

47

Mean Difference (IV, Fixed, 95% CI)

‐3.23 [‐5.16, ‐1.30]

16 urodynamics: closure pressure (cm H2O) Show forest plot

1

47

Mean Difference (IV, Fixed, 95% CI)

‐4.86 [‐12.06, 2.34]

17 number with dysuria Show forest plot

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

0.31 [0.13, 0.74]

18 number with stress incontinence Show forest plot

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

0.16 [0.04, 0.68]

19 number with urgency Show forest plot

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 0.79]

20 number with frequency Show forest plot

1

47

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.10, 0.72]

21 number with worse bowel symptoms Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

21.1 Emptying difficulty: number with increased frequency

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.35, 1.26]

21.2 Emptying difficulty: number with increased bother

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.47, 1.90]

21.3 Flatus leakage: number with increased frequency

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.40, 0.91]

21.4 Flatus leakage: number with increased bother

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.46, 0.99]

21.5 Loose FI: number with increased frequency

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.39, 0.92]

21.6 Loose FI: number with increased bother

1

24

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.20, 0.76]

21.7 Solid FI: number with increased frequency

1

5

Risk Ratio (M‐H, Fixed, 95% CI)

2.25 [0.13, 38.09]

21.8 Solid FI: number with increased bother

1

5

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.08, 5.54]

Figures and Tables -
Comparison 1. PFMT versus no treatment
Comparison 14. PFMT and/or lifestyle plus surgery versus surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Change in manometry measures (cm H2O) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 vaginal resting pressure

1

31

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐3.67, 3.27]

1.2 vaginal squeeze pressure: peak maximum

1

41

Mean Difference (IV, Fixed, 95% CI)

2.9 [‐2.06, 7.86]

1.3 vaginal squeeze pressure: area maximum

1

41

Mean Difference (IV, Fixed, 95% CI)

8.2 [‐5.79, 22.19]

2 Digital muscle test (modified Oxford) Show forest plot

1

50

Mean Difference (IV, Fixed, 95% CI)

0.48 [0.12, 0.84]

3 Change in UDI total score (12 months post‐op ‐ baseline) Show forest plot

1

49

Mean Difference (IV, Fixed, 95% CI)

‐9.90 [‐24.46, 4.66]

4 Change in UDI irritative score (12 months post‐op ‐ baseline) Show forest plot

1

49

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐5.53, 4.73]

5 Change in UDI stress score (12 months post‐op ‐ baseline) Show forest plot

1

49

Mean Difference (IV, Fixed, 95% CI)

‐5.5 [‐15.76, 4.76]

6 Change in UDI obstructive score (12 months post‐op ‐ baseline) Show forest plot

1

49

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐4.07, 2.87]

7 Number with irritative bladder symptoms at 12 months (UDI‐19) Show forest plot

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

1.36 [0.48, 3.86]

8 Number with stress bladder symptoms at 12 months (UDI‐19) Show forest plot

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.54, 2.36]

9 Number with obstructive bladder symptoms at 12 months (UDI‐19) Show forest plot

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

5.63 [0.28, 111.43]

10 IIQ‐7 at 12 months Show forest plot

Other data

No numeric data

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Comparison 14. PFMT and/or lifestyle plus surgery versus surgery