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Entrenamiento muscular del suelo pélvico agregado a otro tratamiento activo versus el mismo tratamiento activo solo para la incontinencia urinaria en mujeres

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Referencias

References to studies included in this review

Bezerra 2009 {published data only}

Bezerra CA, Wroclawski ER, Rodrigues AO, Tristao R, Borrelli M. Randomized clinical trial do not show that PFMT plus vaginal electrical stimulation is better than electrical stimulation alone for SUI in women (Abstract number 1561). Journal of Urology 2009;181(4 Suppl):561. [sr‐incont62404]
Furst MC, de Mendonca RR, Rodrigues AO, de Matos LL, Pompeo AC, Bezerra CA. Long‐term results of a clinical trial comparing isolated vaginal stimulation with combined treatment for women with stress incontinence. Einstein 2014;12(2):168‐74. [sr‐incont62563]

Burgio 2010a {published data only}

Burgio KL, Goode PS, Richter HE, Markland AD, Johnson TM, Redden DT. Combined behavioral and individualized drug therapy versus individualized drug therapy alone for urge urinary incontinence in women. Journal of Urology 2010;184(2):598‐603.

Chen 2008 {published data only}

Chen S, Tsai C, Tong Y, Chen C. Does pelvic floor muscle exercises adding on effects on overactive bladder patients with unsatisfactory drug responses? (Abstract number 183). Proceedings of the 38th Annual Meeting of the International Continence Society (ICS), 2008 Oct 20‐24, Cairo, Egypt. 2008.

Ghoniem 2005 {published data only}

Eli Lilly, Company. Efficacy and safety of duloxetine compared with placebo, pelvic floor muscle training, and combined duloxetine/pelvic floor muscle training in subjects with moderate to severe stress urinary incontinence. CT Registry ID#2615. Study F1J‐MC‐SBAF. Eli Lilly Clinical Trial Registry 2008 (accessed 4 June 2008).
Freeman R. Initial management of stress urinary incontinence: pelvic floor muscle training and duloxetine. BJOG: an International Journal of Obstetrics & Gynaecology 2006;113:10‐6.
Ghoniem GM, Van Leeuwen JS, Elser DM, Freeman RM, Zhao YD, Yalcin I, et al. A randomized controlled trial of duloxetine alone, pelvic floor muscle training alone, combined treatment and no active treatment in women with stress urinary incontinence. Journal of Urology 2005;173(5):1647‐53.
Schagen van Leeuwen JH, Elser D, Freeman R, Ghoniem G, Zhao Y, Yalcin I, et al. Controlled trial of duloxetine alone, pelvic floor muscle training alone, combined treatment, and no treatment in women with stress urinary incontinence (SUI) (Abstract). European Urology Supplements 2004;3(2):52.

Hofbauer 1990 {published data only}

Hofbauer J, Preisinger F, Nurnberger N. The value of physical therapy in genuine female stress incontinence. [German]. Zeitschrift Fur Urologie Und Nephrologie 1990;83(5):249‐54.
Preisinger E, Hofbauer J, Nurnberger N, Sadil S, Schneider B. Possibilities of physiotherapy for urinary stress incontinence. Zeitschrift Physische Medizin, Balneologische Medizin Klimatologie 1990;19(2):75‐9.

Ishiko 2000 {published data only}

Ishiko O, Ushiroyama T, Saji F, Mitsuhashi Y, Tamura T, Yamamoto K, et al. Beta(2)‐adrenergic agonists and pelvic floor exercises for female stress incontinence. International Journal of Gynaecology & Obstetrics 2000;71(1):39‐44.

Jeyaseelan 2002 {published data only}

Jeyaseelan S, Haslam J, Oldham J. Can the effects of pelvic floor muscle exercises be enhanced with a new pattern of electrical stimulation in women with stress incontinence? Pilot data (Abstract number 135). Proceedings of the International Continence Society (ICS), 32nd Annual Meeting, 2002 Aug 28‐30, Heidelberg, Germany. 2002:66‐7.
Jeyaseelan S, Oldham JA. Can the effects of pelvic floor muscle exercises be enhanced with a new pattern of electrical stimulation in women with stress incontinence (Abstract). Proceedings of the World Confederation for Physical Therapy (WCPT), 14th International Congress, 2003 June 7‐12 , Barcelona. 2003.

Jin 2012 {published data only}

Jin Y, Song E, Lv L, Li D. The therapeutic effects of orally solifenacin combined with pelvic floor muscle exercises in treatment of female overactive bladder (Abstract number 67). Neurourology and Urodynamics 2012;31(6):813.

Kaya 2015 {published data only}

Kaya S, Akbayrak T, Gursen C, Beksac S. Pelvic floor muscle training added to bladder training versus bladder training alone for female urinary incontinence: A randomized controlled trial (Abstract number 401). Neurourology and Urodynamics 2014;33(6):864‐6. [sr‐incont64341]
Kaya S, Akbayrak T, Gursen C, Beksac S. Short‐term effect of adding pelvic floor muscle training to bladder training for female urinary incontinence: a randomized controlled trial. International Urogynecology Journal 2015;26(2):285‐93. [sr‐incont66433]

Kim 2011 {published data only}

Kim H, Yoshida H, Suzuki T. Effects of exercise treatment with or without heat and steam generating sheet on urine loss in community‐dwelling Japanese elderly women with urinary incontinence. Geriatrics & Gerontology International 2011;11(4):452‐9.

Richter 2010 {published data only}

Barber MD, Spino C, Janz NK, Brubaker L, Nygaard I, Nager CW, et al. The minimum important differences for the urinary scales of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. American Journal of Obstetrics & Gynecology 2009;200(5):580.e1‐7.
Bradley CS, Rahn DD, Nygaard IE, Barber MD, Nager CW, Kenton KS, et al. The questionnaire for urinary incontinence diagnosis (QUID): validity and responsiveness to change in women undergoing non‐surgical therapies for treatment of stress predominant urinary incontinence. Neurourology & Urodynamics 2010;29(5):727‐34.
Kenton K, Barber M, Wang L, Hsu Y, Rahn D, Whitcomb E, et al. Pelvic floor symptoms improve similarly after pessary and behavioral treatment for stress incontinence. Female Pelvic Medicine & Reconstructive Surgery 2012;18(2):118‐21.
Nager CW, Richter HE, Nygaard I, Paraiso MF, Wu JM, Kenton K, et al. Incontinence pessaries: size, POPQ measures, and successful fitting. International Urogynecology Journal 2009;20(9):1023‐8.
Richter HE. A randomized trial of pessary vs. behavioral therapy vs. combined therapy for treatment of stress urinary incontinence (Abstract number 195). Neurourology & Urodynamics 2009;28(7):816‐7.
Richter HE, Burgio KL, Brubaker L, Nygaard IE, Ye W, Weidner A, et al. Continence pessary compared with behavioral therapy or combined therapy for stress incontinence: a randomized controlled trial. Obstetrics & Gynecology 2010;115(3):609‐17.
Richter HE, Burgio KL, Goode PS, Borello‐France D, Bradley CS, Brubaker L, et al. Non‐surgical management of stress urinary incontinence: ambulatory treatments for leakage associated with stress (ATLAS) trial. Clinical Trials 2007;4:92‐101.
Schaffer J, Nager CW, Xiang F, Borello‐France D, Bradley CS, Wu JM, et al. Predictors of success and satisfaction of nonsurgical therapy for stress urinary incontinence. Obstetrics & Gynecology 2012;120(1):91‐7.

Wise 1993 {published data only}

Wise BG, Haken J, Cardozo LD, Plevnik S. A comparative study of vaginal cone therapy, cones + Kegel exercises, and maximal electrical stimulation in the treatment of female genuine stress incontinence (Abstract number 76). Neurourology & Urodynamics 1993;12(4):436‐7.

Wyman 1998 {published data only}

Barber MD, Visco AG, Wyman JF, Fantl JA, Bump RC, Continence Program for Women Research Group. Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstetrics & Gynecology 2002;99(2):281‐9.
Elser DM, Fantl JA, McClish DK. Comparison of "subjective" and "objective" measures of severity of urinary incontinence in women. Program for Women Research Group. Neurourology & Urodynamics 1995;14(4):311‐6.
Elser DM, Wyman JF, McClish DK, Robinson D, Fantl JA, Bump RC. The effect of bladder training, pelvic floor muscle training, or combination training on urodynamic parameters in women with urinary incontinence. Continence Program for Women Research Group. Neurourology & Urodynamics 1999;18(5):427‐36.
Sale PG, Wyman JF. Achievement of goals associated with bladder training by older incontinent women. Applied Nursing Research 1994;7(2):93‐6.
Theofrastous JP, Wyman JF, Bump RC, McClish DK, Elser DM, Bland DR, et al. Effects of pelvic floor muscle training on strength and predictors of response in the treatment of urinary incontinence. Neurourology & Urodynamics 2002;21(5):486‐90.
Wyman JF, Fantl JA, McClish DK, Bump RC. Comparative efficacy of behavioral interventions in the management of female urinary incontinence. American Journal of Obstetrics & Gynecology 1998;179(4):999‐1007.
Wyman JF, McClish DK, Sale P, Earle B, Camp J. Long‐term follow‐up of behavioral interventions in incontinent women (Abstract). International Urogynecology Journal and Pelvic Floor Dysfunction 1999;10(Suppl 1):S33.

References to studies excluded from this review

Alewijnse 2003 {published data only}

Alewijnse D, Metsemakers JF, Mesters IE, Van Den Borne B. Effectiveness of pelvic floor muscle exercise therapy supplemented with a health education program to promote long‐term adherence among women with urinary incontinence. Neurourology & Urodynamics 2003;22(4):284‐95.

Aslan 2008 {published data only}

Aslan E, Komurcu N, Beji NK, Yalcin O. Bladder training and Kegel exercises for women with urinary complaints living in a rest home. Gerontology 2008;54(4):224‐31.

Barber 2008 {published data only}

Barber M, Richter H, Menefee SA, Nager CW, Brubaker L, Visco A, et al. Operations and pelvic muscle training in the management of apical support loss: The OPTIMAL Trial. ControlledTrials.com (www.controlled‐trials.com) 2008 (accessed 22 May 2008).

Bawden 1992 {published data only}

Bawden ME, Kartha AS, Borrie MJ, Kerr PS, Durko NA, Haslam IF, et al. Treating women with stress incontinence in a multidisciplinary clinic: a randomized study (Abstract number 276). Proceedings of the International Continence Society (ICS), 22nd Annual Meeting, 1992 Sep 1‐4, Halifax, UK. 1992.

BE‐DRI 2008 {published data only}

Borello‐France D, Burgio KL, Goode PS, Markland AD, Kenton K, Balasubramanyam A, et al. Adherence to behavioral interventions for urge incontinence when combined with drug therapy: adherence rates, barriers, and predictors. Physical Therapy 2010;90(10):1493‐505.
Burgio KL, Kraus SR, Borello‐France D, Chai TC, Kenton K, Goode PS, et al. The effects of drug and behavior therapy on urgency and voiding frequency. International Urogynecology Journal 2010;21(6):711‐9.
Burgio KL, Kraus SR, Menefee S, Borello‐France D, Corton M, Johnson HW, et al. Behavioral therapy to enable women with urge incontinence to discontinue drug treatment: a randomized trial. Annals of Internal Medicine 2008;149(3):161‐9.
FitzGerald MP, Lemack G, Wheeler T, Litman HJ, for the Urinary Incontinence Treatment Network (UITN). Nocturia, nocturnal incontinence prevalence, and response to anticholinergic and behavioral therapy. International Urogynecology Journal 2008;19(11):1545‐50.
Goode PS, Burgio KL, Kraus SR, Kenton K, Litman HJ, Richter HE, et al. Correlates and predictors of patient satisfaction with drug therapy and combined drug therapy and behavioral training for urgency urinary incontinence in women. International Urogynecology Journal 2011;22(3):327‐34.
Kraus SR, for the Urinary Incontinence Treatment Network (UITN). Combining behavior and drug therapy to improve drug withdrawal in the treatment of urge incontinence: a randomized controlled trial (Abstract number 8 Oral). Journal of Pelvic Medicine & Surgery 2007;13(5):233‐4.
Steers WD, Urinary Incontinence Treatment Network (UITN). Behavior enhances drug reduction of incontinence (BE‐DRI). www.ClinicalTrials.gov2004.

Berghmans 2000 {published data only}

Berghmans LC, van Waalwijk van Doorn ES, Nieman FH, de Bie RA, van Kerrebroeck PE, van den Brandt P. Efficacy of physiotherapy in women with proven overactive bladder (Abstract number FDP34). International Urogynecology Journal 2000;11(Suppl 1):S45.

Berghmans 2000a {published data only}

Berghmans LCM, Nieman FHM, van Waalwijk van Doorn ESC, Smeets LWH, ten Haaf WMM, de Bie RA, et al. Effects of physiotherapy, using the adapted Dutch 1‐QOL in women with urge incontinence (Abstract). International Urogynecology Journal 2001;12(Suppl 3):S40.
Berghmans LCM, van Waalwijk van Doorn ESC, Nieman FHM, de Bie RA, Smeets LWH, ten Haaf H, et al. Efficacy of extramural physical therapy modalities in women with proven bladder overactivity: a randomized clinical trial (Abstract number 92). Neurourology & Urodynamics 2000;19(4):496‐7.

Berghmans 2001a {published data only}

Berghmans LCM, Nieman FHM, van Waalwijk van Doorn ESC, Smeets LWH, ten Haaf WMM, de Bie RA, et al. Effects of physiotherapy, using the adapted Dutch 1‐QOL in women with urge incontinence (Abstract). Neurourology & Urodynamics 2001;20(4):509‐10.

Berghmans 2002 {published data only}

Berghmans B, van Waalwijk van Doorn ES, Nieman F, de Bie R, van den Brandt P, Van Kerrebroeck P. Efficacy of physical therapeutic modalities in women with proven bladder overactivity. European Urology 2002;41(6):581‐7.

Beuttenmuller 2010 {published data only}

Beuttenmuller L, Cader SA, Macena RHM, Araujo NDS, Nunes EFC, Dantas EHM. Muscle contraction of the pelvic floor and quality of life of women with stress urinary incontinence who underwent kinesitherapy. Fizjoterapia 2010;18(1):35‐41.

Bidmead 2002 {published data only}

Bidmead J, Mantle J, Cardozo L, Hextall A, Boos K. Home electrical stimulation in addition to conventional pelvic floor exercises: A useful adjunct or expensive distraction? (Abstract number 68). Neurourology & Urodynamics 2002;21(4):372‐3.
Parsons M, Mantle J, Cardozo L, Hextall A, Boos K, Bidmead J. A single blind, randomised, controlled trial of pelvic floor muscle training with home electrical stimulation in the treatment of urodynamic stress incontinence [abstract number 296]. Proceedings of the Joint Meeting of the International Continence Society (ICS) (34th Annual Meeting) and the International UroGynecological Association (IUGA), 2004 Aug 23‐27, Paris, France. 2004.

Bo 2002 {published data only}

Bo K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women... reprinted with permission from BMJ Publishing Group. British Medical Journal. London: 1999; 318:487‐493. Copyright 1999, BMJ Publishing Group. Journal of the Section on Women's Health 2002;26(1):17‐23.

Bo 2012 {published data only}

Bo K. Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World Journal of Urology 2012;30(4):437‐43.

Burgio 1998 {published data only}

Burgio KL, Locher JL, Goode PS, Hardin JM, McDowell BJ, Candib D. Behavior vs drug therapy for urge incontinence in older women (Abstract 26). Proceedings of the American Urogynecology Society (AUGS), 15th Annual Meeting, 1994 Sep 21‐24, Toronto, Canada. 1994:48.
Burgio KL, Locher JL, Goode PS, Hardin JM, McDowell BJ, Dombrowski M, et al. Behavioral vs drug treatment for urge urinary incontinence in older women. JAMA 1998;280(23):1995‐2000.
Burgio KL, Locher JL, Roth DL, Goode PS. Psychological improvements associated with behavioral and drug treatment of urge incontinence in older women. Journals of Gerontology Series B‐Psychological Sciences & Social Sciences 2001;56(1):46‐51.

Burgio 2001a {published data only}

Burgio KL, Goode PS, Locher JL, Umlauf MG, Varner RE, Lloyd LK, et al. The role of biofeedback in the treatment of urge incontinence in older women (Abstract number 19). Proceedings of the American Urogynecology Society (AUGS), 22nd Annual Meeting, 2001 Oct 25‐27, Chicago (IL)2001.

Burgio 2007 {published data only}

Burgio K, Urinary Incontinence Treatment Network. Combining behavior and drug therapy to improve drug withdrawal in the treatment of urge incontinence: a randomized trial (Abstract number 21). Neurourology & Urodynamics 2007;26(5):616‐7.

Cammu 1996 {published data only}

Cammu H, van Nylen M. Pelvic floor exercises (PFE) versus vaginal cones (VC) in the treatment of genuine stress incontinence (abstract number 225). Proceedings of the International Continence Society (ICS), 26th Annual Meeting, 1996 Aug 27‐30, Athens, Greece. 1996:223.
Cammu H, van Nylen M. Pelvic floor exercises versus vaginal weight cones in genuine stress incontinence. European Journal of Obstetrics, Gynecology, & Reproductive Biology 1998;77(1):89‐93.

Capobianco 2012 {published data only}

Capobianco G, Donolo E, Borghero G, Dessole F, Cherchi PL, Dessole S. Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women. Archives of Gynecology & Obstetrics 2012;285(2):397‐403.

Chancellor 2008 {published data only}

Chancellor MB, Kianifard F, Beamer E, Mongay L, Ebinger U, Hicks G, et al. A comparison of the efficacy of darifenacin alone vs. darifenacin plus a Behavioural Modification Programme upon the symptoms of overactive bladder. International Journal of Clinical Practice 2008;62(4):606‐13.

Crothers 2003 {published data only}

Crothers E. A randomised controlled clinical trial of a cueing device to enhance patient compliance to a programme of pelvic floor exercises. National Research Register 2003, Issue 1.

de Jong 2006 {published data only}

de Jong JH, Van Kampen M, Biemans B. The effect of whole body vibration training on women with stress urinary incontinence (Abstract number 416). Proceedings of the International Continence Society (ICS), 36th Annual Meeting, 2006 Nov 27‐Dec 1, Christchurch, New Zealand. 2006.

Dowell 1997 {published data only}

Dowell CJ, Bryant CM, Moore KH, Prashar S. The efficacy and user friendliness of the urethral occlusive device (Abstract). Proceedings of the International Continence Society (ICS), 27th Annual Meeting, 1997 Sep 23‐26, Yokohama, Japan. 1997:295‐6.

Driusso 2008 {published data only}

Driusso P, Correia GN, Pereira VS, Aveiro MC. Physiotherapy for women with stress urinary incontinence: effects of kinesiotherapy, vaginal cones and electrical stimulation. www.anzctr.org 2008 (accessed 19 April 2011).

Dumoulin 2011 {published data only}

Dumoulin C, Sran M, Lieblich P, Wilson P. Physiotherapy significantly reduces leakage in postmenopausal women with osteoporosis and urinary incontinence: result of a parallel randomised controlled trial (Abstract number 130). Neurourology and Urodynamics 2011;30(6):985‐6.

Firra 2013 {published data only}

Firra J, Thompson M, Smith SS. Paradoxical Findings in the Treatment of Predominant Stress and Urge Incontinence: A Pilot Study With Exercise and Electrical Stimulation. Journal of Women's Health Physical Therapy 2013;37(3):113‐23. [sr‐incont61836]

Fonda 1995 {published data only}

Fonda D, Woodward M, D'Astoli M, Chin WF. Sustained improvement of subjective quality of life in older community‐dwelling people after treatment of urinary incontinence. Age and Ageing 1995;24(4):283‐6.
Fonda D, Woodward M, D'Astoli M, Chin WF. The continued success of conservative management for established urinary incontinence in older people. Australian Journal on Ageing 1994;13:12‐6.

Goode 2003 {published data only}

Goode PS, Burgio KL, Locher JL, Roth DL, Umlauf MG, Richter HE, et al. Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women: a randomized controlled trial. JAMA 2003;290(3):345‐52.

Goode 2011a {published data only}

Goode PS, Burgio KL, Johnson TM, Clay OJ, Roth DL, Markland AD, et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA 2011;305(2):151‐9.

Greer 2012 {published data only}

Greer JA, Smith AL, Arya LA. Pelvic floor muscle training for urgency urinary incontinence in women: a systematic review. International Urogynecology Journal 2012;23(6):687‐97.

Gronwald 2010 {published data only}

Gronwald C, Pantel M. Osteopathic treatment in women suffering from urinary incontinence. A controlled clinical trial. http://www.therapiebedarf.at/record/7283?ln=en2010. [sr‐incont49183]

Gunthorpe 1994 {published data only}

Gunthorpe W, Redman S, Millard R, Brown W. A randomised trial to assess the general practice‐based treatment of female incontinence (Abstract). Proceedings of the International Continence Society (ICS), 24th Annual Meeting, 1994 Aug 30‐Sep 2, Prague, Czech Republic. 1994:371‐2.

Ha 2008 {published data only}

Ha Y, Yun SJ, Kim Y, Lee S, Jung W, Kim W, et al. The development and effect of Ubiquitous program for female patients with overactive bladder: prospective, randomized 8‐weeks follow up with questionnaire and voiding diary based assessment (Abstract number 611). Proceedings of the 38th Annual Meeting of the International Continence Society (ICS), 2008 20‐24 Oct, Cairo, Egypt. 2008.

Hahn 1991 {published data only}

Hahn I, Sommar S, Fall M. A comparative study of pelvic floor training and electrical stimulation for the treatment of genuine female stress urinary incontinence. Neurourology & Urodynamics 1991;10(6):545‐54.

Haken 1991 {published data only}

Haken J, Benness C, Cardozo L, Cutner A. A randomised trial of vaginal cones and pelvic floor exercises in the management of genuine stress incontinence (Abstract). Neurourology & Urodynamics 1991;10(4):393‐4.

Henalla 1989 {published data only}

Henalla SM, Hutchins CJ, Robinson P, MacVicar J. Non‐operative methods in the treatment of female genuine stress incontinence of urine. Journal of Obstetrics and Gynaecology 1989;9(3):222‐5.

Herschorn 2004 {published data only}

Herschorn S, Becker D, Miller B, Thompson M, B, Forte L. The impact of a simple health education intervention in overactive bladder patients (Abstract). Proceedings of the International Continence Society (ICS), 33rd Annual Meeting, 2003 Oct 5‐9, Florence Italy. 2003:352‐3.
Herschorn S, Becker D, Miller E, Thompson M, Forte L. Impact of a health education intervention in overactive bladder patients. Canadian Journal of Urology 2004;11(6):2430‐7.

Huang 2006 {published data only}

Huang AJ, Thom DH, Kanaya AM, Wassel‐Fyr CL, Van den Eeden SK, Ragins AI, et al. Urinary incontinence and pelvic floor dysfunction in Asian‐American women. American Journal of Obstetrics & Gynecology 2006;195(5):1331‐7.

Huang 2012 {published data only}

Huang X, Xu T, Lv B, Xie L. Effects of medical interfered‐pelvic floor muscle training in behavioral therapy and/or tolterodine in female patients with primary overactive bladder syndrome: a single‐blind randomized study (Abstract number 351). Proceedings of the 42nd Annual Meeting of the International Continence (ICS), 2012 Oct 15‐19, Beijing, China. 2012.

Kafri 2007 {published data only}

Kafri R, Langer R, Dvir Z, Katz‐Leurer M. Rehabilitation vs drug therapy for urge urinary incontinence: short‐term outcome. International Urogynecology Journal and Pelvic Floor Dysfunction 2007;18(4):407‐11.

Kangchai 2002 {published data only}

Kangchai W, Srisuphun W, Kompayak J, Charoenyooth C, Jitapunkul S. Efficacy of self‐management promotion program for elderly women with urinary incontinence. Thai Journal of Nursing Research 2002;6(3):101‐14.

Kaya 2011 {published data only}

Kaya S, Akbayrak T, Beksac S. Comparison of different treatment protocols in the treatment of idiopathic detrusor overactivity: a randomized controlled trial. Clinical Rehabilitation 2011;25(4):327‐38.

Kim 2001 {published data only}

Kim J. Continence efficacy intervention program for community residing women with stress urinary incontinence in Japan. Public Health Nursing 2001;18(1):64‐72.

Kim 2006 {published data only}

Kim JS, Yoon H, Chung WS, Shim BS. The long term effect of extracorporeal magnetic innervation therapy with pelvic floor muscle exercise for stress urinary incontinence. [Korean]. Korean Journal of Urology 2006;47(12):1334‐8.

Kim 2007 {published data only}

Kim H, Suzuki T, Yoshida Y, Yoshida H. Effectiveness of multidimensional exercises for the treatment of stress urinary incontinence in elderly community‐dwelling Japanese women: A randomized, controlled, crossover trial. Journal of the American Geriatrics Society 2007;55(12):1932‐9.

Kim 2009 {published data only}

Kim H, Yoshida H, Suzuki T. Exercises treatment to reduce the urine leakage in elderly community‐dwelling Japanese women with stress, urge, and mixed urinary incontinence (Abstract number 772). Proceedings of the 39th Annual Meeting of the International Continence Society (ICS), 2009 Sep 29‐Oct 3, San Francisco, CA. 2009.

Kincade 2007 {published data only}

Kincade JE, Dougherty MC, Carlson JR, Wells EC, Hunter GS, Busby‐Whitehead J. Factors related to urinary incontinence in community‐dwelling women. Urologic Nursing 2007;27(4):307‐17.

Kirschner‐Hermanns 1995 {published data only}

Kirschner‐Hermanns R, Niehaus S, Schafer W, Jakse G. Pelvic floor re‐education in female stress‐incontinence I. and II. follow‐up results (mean 43 months) (Abstract number 216). Proceedings of the International Continence Society (ICS), 25th Annual Meeting, 1995 Oct 17‐20, Sydney, Australia. 1995:230‐1.

Kobayashi 2009 {published data only}

Kobayashi H, Sawada N, Zakohji H, Yoshiyama M, Araki I, Takeda M. Researches on the improvement of QOL in both patients with overactive bladder syndrome and their caregivers. Comparison between pharmacotherapy alone and combination of pharmacotherapy, physio‐therapy, and education of both patients and caregiver (Abstract number 516). Proceedings of the 39th Annual Meeting of the International Continence Society (ICS), 2009 Sep 29‐Oct 3, San Francisco, CA. 2009.

Lagro‐Janssen 1991 {published data only}

Lagro‐Janssen TL, Debruyne FM, Smits AJ, van Weel C. Controlled trial of pelvic floor exercises in the treatment of urinary stress incontinence in general practice. British Journal of General Practice 1991;41(352):445‐9.

Laycock 1988 {published data only}

Laycock J. Interferential therapy in the treatment of genuine stress incontinence (Abstract). Neurourology & Urodynamics 1988;7(3):268‐9.

Laycock 1993 {published data only}

Laycock J, Jerwood D. Does pre‐modulated interferential therapy cure genuine stress incontinence?. Physiotherapy 1993;79(8):553‐60.

Laycock 1995 {published data only}

Laycock J, Knight S, Naylor D. Prospective, randomised, controlled clinical trial to compare acute and chronic electrical stimulation in combination therapy for GSI (Abstract). Neurourology & Urodynamics 1995;14(5):425‐6.

Laycock 2001 {published data only}

Laycock J, Brown J, Cusack C, Green S, Jerwood D, Mann K, et al. A multi‐centre, prospective, randomised, controlled, group comparative study of the efficacy of vaginal cones and PFX (Abstract number 47). Neurourology & Urodynamics 1999;18(4):301‐2.
Laycock J, Brown J, Cusack C, Green S, Jerwood D, Mann K, et al. A multi‐centre, prospective, randomised, controlled, group comparative study of the efficacy of vaginal cones and PFX (Abstract). International Urogynecology Journal and Pelvic Floor Dysfunction 1999;10(Suppl 1):S49.
Laycock J, Brown J, Cusack C, Green S, Jerwood D, Mann K, et al. Pelvic floor reeducation for stress incontinence: comparing three methods. British Journal of Community Nursing 2001;6(5):230‐44.

Lee 2005 {published data only}

Lee C, Johnson C, Chiarelli P. Women's waterworks: evaluating an early intervention for incontinence among adult women. Australian and New Zealand Continence Journal 2005;11(1):11‐6.

Madersbacher 2003 {published data only}

Madersbacher H, Pilloni S. Efficacy of extracorporeal magnetic innervation therapy (EXMI) in comparison to standard therapy for stress, urge and mixed incontinence: a randomised prospective trial (Abstract). Proceedings of the International Continence Society (ICS), 33rd Annual Meeting, 2003 Oct 5‐9, Florence Italy. 2003:296‐7.

Madersbacher 2004 {published data only}

Madersbacher H, Pilloni S. Efficacy of extracorporeal magnetic innervation therapy (ExMI) in comparison to standard therapy for stress, urge and mixed incontinence: A randomised prospective trial (Abstract number 185). European Urology Supplements 2004;3(2):49.

Maher 2009 {published data only}

Maher RM, Crowe L, Caulfield B. Comparison of two methods of electrical muscle stimulation training of pelvic floor musculature in the treatment of stress urinary incontinence. Journal of Women's Health Physical Therapy 2009;33(1):24.

McCormack 2004 {published data only}

McCormack PL, Keating GM. Duloxetine in stress urinary incontinence. Drugs 2004;64(22):2567‐73.

Millard 2003 {published data only}

Millard RJ. Clinical efficacy of tolterodine with or without a simplified pelvic floor exercise regimen (Abstract). Australian and New Zealand Continence Journal 2003;9(4):81.

Millard 2003a {published data only}

Millard RJ. A simplified pelvic floor exercise regimen adds no additional benefit to drug treatment alone (Abstract). Proceedings of the International Continence Society (ICS), 33rd Annual Meeting, 2003 Oct 5‐9, Florence Italy. 2003:215‐6.

Millard 2003b {published data only}

Millard RJ. Clinical efficacy of tolterodine with or without a simplified pelvic floor exercise regimen (Abstract). Australia and New Zealand Journal of Surgery 2003;73:A337.

Millard 2004 {published data only}

Millard RJ, Asia Pacific Tolterodine Study Group. Clinical efficacy of tolterodine with or without a simplified pelvic floor exercise regimen. Neurourology & Urodynamics 2004;23(1):48‐53.

Mørkved 2002 {published data only}

Mørkved S, Bø K, Fjortoft T. Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Obstetrics & Gynecology 2002;100(4):730‐9.

O'Brien 1996 {published data only}

O'Brien J. Evaluating primary care interventions for incontinence. Nursing Standard 1996;10(23):40‐3.
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References to other published versions of this review

Ayeleke 2013

Ayeleke RO, Hay‐Smith EJC, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women. Cochrane Database of Systematic Reviews 2013, Issue 11. [DOI: 10.1002/14651858.CD010551.pub2]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Bezerra 2009

Methods

2‐arm parallel RCT

Participants

48 women with SUI

Interventions

A. PFMT + electrical stimulation (ES) (N = 24)

PFMT was individually designed by physiotherapist. No other details were provided about PFMT, including duration of treatment. ES was delivered with vaginal electrodes, with 50 Hz of frequency, 1 ms pulse and fixed 20 mA

B. Electrical stimulation (ES) (N = 24)

ES was delivered with vaginal electrodes, with 50 Hz of frequency, 1 ms pulse and fixed 20 mA

Outcomes

1. Improvement in urinary symptoms

This outcome was assessed using voiding diary, no other details were reported

A. 5/15; B. 3/19

2. Satisfaction with treatment

No detail was reported on how this outcome was measured

Immediately after treatment

A. 8/15; B. 12/19

After 12 months

A. 7/15; B. 9/19

Notes

This study is a conference abstract with little detail reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Details not reported

Allocation concealment (selection bias)

Unclear risk

Details not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Impossible to blind participants and personnel to PFMT

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Details not reported

Incomplete outcome data (attrition bias)
All outcomes

High risk

proportions of withdrawals differ between the 2 treatment groups; reasons for withdrawals were not reported and it was not clear whether or not analysis was based on ITT

Selective reporting (reporting bias)

Unclear risk

Protocol not available

Ethical approval

Unclear risk

Details not reported

Source of funding or support

Low risk

It was stated that there was no source of funding

Conflict of interest

Unclear risk

Details not reported

Burgio 2010a

Methods

2‐arm randomised controlled trial, parallel design

Participants

64 women with urgency predominant incontinence

Interventions

A: Drug therapy alone group (N = 32). Individuals in this group received oxybutynin 5 mg daily with dose gradually increased during visits to the maximum level the individual could tolerate (dose range: 5 to 30 mg)

B: Behavioural therapy + drug therapy (N = 32): participants in this group received drug therapy as described above and behavioural therapy. Behavioural therapy included PFMT and urge suppression strategies. PFMT consisted of 3 sessions of 15 exercises daily (total of 45 exercises). During each session, participants were instructed to contract for 10 seconds and relax for another 10 seconds (maximum duration of 10 seconds was achieved on a gradual basis). They were also taught the skills on urge suppression strategies

Outcomes

1. Patient global perception of improvement: this was measured using the Global Perception of Improvement rating. Success was defined as the proportion of participants who felt 'much better' at the end of the treatment

At 8 weeks:

A: 28/31; B: 21/27 

2. Condition‐specific quality of life: assessed using the Incontinence Impact Questionnaire and Urogenital Distress Inventory (reported as mean score and SD; details of data not reported)

3. Patient satisfaction with treatment outcome: success was defined as the proportion of participants who were completely satisfied with the treatment outcome. It was assessed using the Patient Satisfaction Questionnaire

At 8 weeks:

A: 27/31; B: 21/27

4. Frequency of incontinence episodes per week: mean (SD) of incontinence episodes frequency was assessed at endpoint using the 7‐day bladder diary

At 8 weeks:

A: 2.0 (4.9), N = 30: B: 2.4 (6.2), N = 27

At 12 months:

A: 1.7 (3.9), N = 27; B: 4.5 (11.4), N = 22

5. Frequency of micturition per 24 hours (in mean and SD)

At 8 weeks:

A: 8.2 (1.9), N = 31; B: 8.4 (3.0), N = 27

6. Volumes of urine voided per 24 hours (in mean and SD)

At 8 weeks:

A: 256.7 (86.7), N = 31; B: 240.4 (129.1), N = 27

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Stated as "stratified block randomisation". Exact process not specified

Allocation concealment (selection bias)

Unclear risk

It was not stated whether or not the allocations were concealed

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of participants not possible

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Completed questionnaires were submitted in sealed envelopes and given to the nurses who administered the intervention. However, it is not specified whether the same or different nurses assessed the outcomes

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

5/64 dropped out of the trial: A 1/32; B 4/32. Reasons not specified

Selective reporting (reporting bias)

Unclear risk

Protocol not available

Ethical approval

Low risk

Approved by the institutional review board

Source of funding or support

Low risk

Stated (received grants from public institutions)

Conflict of interest

Unclear risk

Some of the authors had financial and other relationships with some pharmaceutical companies

Chen 2008

Methods

2‐arm randomised controlled trial, parallel design

Participants

29 women with over‐active bladder

Interventions

A: Drug alone (N = 14): details of drug including name and dose not stated

B: PFMT + drug (N = 15). PFMT was assisted by perineal surface electromyography and was taught inially. Participants were then instructed to perform 3 sets of PFMT per day, 15 contractions per set, continuously at home for 8 weeks. Drug regimen: as stated above

Outcomes

1. Urgency episodes per 24 hours: this was determined at baseline and endpoint using the 3‐day voiding diary and mean percentage change was calculated for the 2 groups (no useable data)

2. Daytime frequency per 24 hours: this was obtained before and after treatment using the 3‐day voiding diary and mean percentage change calculated (no useable data)

3. Treatment benefit: this was determined 4 weeks post‐treatment using the 'Benefit Questionnaire' and proportion of participants with perceived benefits calculated for each group

A: 4/14; B: 11/15

4. Symptom bothersome: scores were obtained before and after treatment and mean percentage change in bothersome scores was obtained for the 2 groups (no useable data)

5. Quality of life: total scores were calculated for different domains of the quality of life (such as sleeping, concern and coping) before and after treatment. Mean percentage increase was calculated for the 2 groups (no useable data)

Notes

Dropouts: not reported, only the number of participants who completed the trial was stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Process involved in randomisation was not reported

Allocation concealment (selection bias)

Unclear risk

Process involved in allocation concealment was not stated

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of participants not possible (assumed not done)

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not specified

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Not reported, only the number of participants who completed the trial was stated

Selective reporting (reporting bias)

Unclear risk

Protocol not available

Ethical approval

Low risk

Approved by the Ethics committee

Source of funding or support

Low risk

Stated "none" according to the authors

Conflict of interest

Unclear risk

Not declared

Ghoniem 2005

Methods

4‐arm randomised controlled trial, parallel design

Participants

201 women with predominant symptoms of stress urinary incontinence (SUI)

Interventions

A: No active treatment (N = 47). Received placebo plus imitation (sham) PFMT for 12 weeks. Imitation PFMT consisted of initial therapist‐supervised instructions on how to train the hip abductors. Participants were then given written instructions and a training log with the recommendation of 3 sets of 10 long and 2 sets of 10 rapid contractions 4 days weekly. However, no instructions were given to the participants to contract the pelvic floor muscles with physical activities associated with urine leakage (skill training)

B. PFMT only (N = 50). Received placebo plus PFMT for 12 weeks. PFMT comprised 30 minutes of initial therapist supervised instructions on how to contract the pelvic floor muscles. The correct type of contraction was confirmed by pelvic examination. Then participants received instructions to perform 3 sets of 10 long (6 to 8 seconds) and 2 sets of 10 rapid (1 to 2 seconds) contractions 4 days weekly (total of 200 contractions per week). At 4 and 8 weeks, participants received 15 minutes of re‐instruction and manual feedback and a training log was completed. Finally, skill training was giving by instructing participants to contract the pelvic floor muscles with physical events usually associated with urine loss

C: Duloxetine + sham PFMT (N = 52). This group received duloxetine and sham PFMT. Duloxetine was given at a dose of 40 mg twice daily for 12 weeks. Sham PFMT (as described above)

D: PFMT + duloxetine (N = 52). This is the combined group. Participants in this group received PFMT and duloxetine as described above

For this review comparison D versus C is relevant

Outcomes

1. Incontinence episode frequency (IEF) per week. This was computed from participant completed paper diaries at each visit. Mean (SD) weekly IEF at the endpoint was calculated for each treatment group

A: 18.50 (17.10), N = 44; B: 20.93 (16.26), N = 46; C: 10.96 (8.53), N = 46; D: 11.27 (10.06), N = 44

2. Improvement (IEF responder rate): this was defined as the proportion of participants who had a 50% or greater decrease in IEF with treatment as computed from the paper diaries

A: 11/44; B: 12/46; C: 26/46; D: 27/44

3. Number of continence pads used. Mean (SD) pads per week was calculated for each treatment group at endpoint

A: 10.22 (7.56), N = 44; B: 11.48 (8.36), N = 46; C: 7.23 (5.98), N = 46; D: 7.84 (7.41), N = 44

4. Condition‐specific quality of life: this was assessed at endpoint using the Incontinence Quality of Life (I‐QoL) score questionnaire and mean (SD) score was obtained for each group

A: 69.34 (20.69), N = 45; B: 68.76 (22.70), N = 49; C: 68.23 (20.87), N = 50; D: 74.07 (19.70), N = 51

5. Patient Global Impression of Improvement (PGI‐I): this was defined as the proportion of participants with a PGI‐I score in one of the following 3 categories: 1. 'very much better', 2. 'much better' or 3. 'a little better'. This was obtained using the validated PGI‐I questionnaire

A: 19/45; B: 32/49; C: 27/50; D: 36/51

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"...treatments were assigned using a centralised computer voice response"

Allocation concealment (selection bias)

Low risk

"...treatments were assigned using a centralised computer voice response"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Duloxetine and placebo were given in double‐blind fashion. However, it is not specified who exactly was blinded. Participants were blinded to PFMT or sham PFMT

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not stated whether or not outcome assessors were blinded

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Dropouts: all: 56/201; A: 10/47; B: 10/50; C: 19/52; D: 17/52

No differential loss to follow‐up between group C and D. However, there is excessive loss to follow‐up as 56/201 participants were dropped‐out.

Selective reporting (reporting bias)

Unclear risk

Trial protocol not available

Ethical approval

Low risk

Approved by the ethics committee

Source of funding or support

Low risk

Stated, supported by private organisations

Conflict of interest

Unclear risk

Stated but some of the authors had financial and other relationships with one of the organisations which supported the trial

Hofbauer 1990

Methods

4‐arm randomised controlled trial, parallel design

Participants

43 women with urodynamic evidence of stress urinary incontinence (SUI)

Interventions

A. PFMT + electrical stimulation (ES) (N = 11): participants in this group received both PFMT and ES. PFMT was part of an exercise programme which also included abdominal and hip exercise and was administered twice weekly for 20 minutes by a therapist in addition to a daily home exercise programme. Electrical stimulation consisted of vaginal and lumbar electrodes which were administered for 10 minutes, 3 times weekly for a total of 6 weeks. Output was increased until noticeable contraction was achieved and participant then added voluntary effort

B. PFMT alone (N = 11): as described above

C. Electrical stimulation (ES) alone (N = 11): as described above

D. Sham electrical stimulation (N = 10): as for ES above but current was so low that no effect (contraction) was possible

For this review comparison A versus C is relevant

Outcomes

1. Cure: this is the proportion of participants who became continent (free of symptoms of incontinence) at the end of the treatment as reported by the participants

At 10 to 12 weeks from the onset of treatment:

A: 3/11; B: 6/11; C: 1/11; D: 0/11

2. Improvement: proportion of participants who reported improvement in the symptoms of incontinence; success threshold not defined

At 10 to 12 weeks from the onset of treatment:

A: 4/11; B: 1/11; C: 2/11; D: 0/11

3. Success rate: this is the proportion of participants who reported cure of or significant improvement in the symptoms of incontinence

At 10 to 12 weeks from the onset of treatment:

A: 7/11; B:7/11; C: 3/11; D: 0/11

Notes

Dropouts: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Reported as "prospektiv randomisierten". No additional information provided.

Allocation concealment (selection bias)

Unclear risk

Reported as "prospektiv randomisierten". No additional information provided.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of participants undergoing PFMT not possible

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not specified

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Dropouts: not reported

Selective reporting (reporting bias)

Unclear risk

Not specified

Ethical approval

Unclear risk

Not specified

Source of funding or support

Unclear risk

Not specified

Conflict of interest

Unclear risk

Not specified

Ishiko 2000

Methods

3‐arm randomised controlled trial, parallel design

Participants

61 women with symptoms of stress, urinary incontinence

Interventions

A. Drug therapy (DT) group (N = 18). Participants in this group received clenbuterol tablets 20 µg twice daily

B. PFMT group (N = 20). Participants in this group received instructions on PFMT from gynaecologic specialists until they understood the technique. They were then instructed to perform the exercise for 10 minutes daily (other details not reported). Video tapes that demonstrated the proper method of performing PFMT were also given to the participants

C. PFMT + DT group (N = 23): participants in this group received both clenbuterol and PFMT as described above

For this review comparison C versus A is relevant

Outcomes

1. Cure: as reported by participants and is the proportion of participants who reported 100% reduction in symptoms of incontinence (i.e. no incontinence at all)

A: 10/13; B: 10/19; C: 17/19

2. Patient satisfaction with treatment outcome: defined as the proportion of participants who were completely satisfied with treatment outcome. Scale used for the assessment not stated

A: 11/13; B: 6/19; C: 13/19

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

The envelope method was used to randomise participants to treatment groups; not stated whether envelopes were sequentially numbered, opaque and sealed

Allocation concealment (selection bias)

Unclear risk

The envelope method was used to randomise participants to treatment groups; not stated whether envelopes were sequentially numbered, opaque and sealed

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of participants undergoing PFMT not possible

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Dropouts: all: 10/61; A: 5/18, B: 1/20; C: 4/23

Differential loss to follow‐up: not fully reported (2 and 3 participants withdrew from groups A and C respectively due to adverse drug effects; other reasons for withdrawal not reported)

Selective reporting (reporting bias)

Unclear risk

Trial protocol not available

Ethical approval

Low risk

Approved by the ethics committee

Source of funding or support

Unclear risk

Not stated

Conflict of interest

Unclear risk

Not stated

Jeyaseelan 2002

Methods

3‐arm randomised controlled trial, parallel design

Participants

16 women with stress incontinence

Interventions

A. Electrical stimulation (ES) group (N = 6): participants in this group used electrical stimulator for 1 hour a day every day (except when menstruating)

B. Pelvic floor muscle training (PFMT) alone (N = 7): PFMT consisted of individualised exercise regimen with instruction to the participants to carry out a minimum of 3 exercises per day with progression over the treatment period. Biofeedback was provided by means of a Periform probe. Other details not given

C. PFMT + ES (combined) (N = 6). Participants in this group received both PFMT and ES as described above

For this review comparison C versus A is relevant

Outcomes

1. Severity of incontinence assessed using 24‐hour pad test and 3‐day voiding diary

2. Condition‐specific quality of life assessed using Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI).

Notes

No useable data were reported in the trial (data reported in median and range)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not reported

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of participants not possible. Assumed not done

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Not explicitly reported

Selective reporting (reporting bias)

Unclear risk

Not reported

Ethical approval

Unclear risk

Not reported

Source of funding or support

Unclear risk

Not reported

Conflict of interest

Unclear risk

Not reported

Jin 2012

Methods

3‐arm randomised controlled trial, parallel design

Participants

242 women with urodynamic evidence of over‐active bladder

Interventions

A. Drug alone (N = 82). Participants in this group received oral solifenacin 5 mg once daily  

B. PFMT alone  (N = 80). Participants in this group performed PFMT once daily; other details were not given

C. PFMT + drug (N = 80). Participants in this group received both PFMT and drug as stated above

For this review comparison C versus A is relevant

Outcomes

1. Frequency of micturition per 24 hours (no useable data)

2. Number of episodes of over‐active bladder in 24 hours (no useable data)

3. Volume of urine voided per micturition in 24 hour (no useable data)

4. Adverse events: proportion (%) of participants who reported adverse events (mainly dry mouth) with solifenacin

A: 17/82; B: 0/80; C: 14/80

Notes

Dropouts: not reported

All participants randomised at baseline included in analysis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not reported

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of participants not possible for PFMT

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Not reported

Selective reporting (reporting bias)

Unclear risk

Trial protocol not available

Ethical approval

Low risk

"ethics not required" according to the authors

Trial was conducted in accordance with Helsinki declaration

Informed consent was obtained from participants

Source of funding or support

Low risk

No funding source according to the authors

Conflict of interest

Unclear risk

Not stated

Kaya 2015

Methods

2‐arm parallel RCT

Participants

132 women with SUI, UUI and MUI from 2 centres in Turkey

Interventions

A. PFMT + bladder training (N = 67):

Participants in this group completed a progressive home‐based exercise program consisting of strength and endurance training. They were taught both fast (2‐s) and slow voluntary PFM contractions (VPFMCs). One slow contraction took 15 s (5‐s contraction, 5‐s hold, 5‐s relaxation). One set of exercises involved ten fast and ten slow VPFMCs. During week 1, participants were instructed to perform five sets of exercises per day (5×10 fast and 10 slow = 50 fast and 50 slow VPFMCs daily), which was progressively increased by five sets/week: ten sets per day at week 2; 15 at week 3; 20 at week 4; 25 at week 5, and 30 at week 6 [600 VPFMCs daily (300 fast and 300 slow)].

Patients were advised to exercise while in the supine, seated, and upright positions and to integrate these exercises into their daily activities, e.g., while watching television, waiting for something, travelling.

B. Bladder training (N = 65)

Based on the three frequency‐volume charts obtained at baseline, the longest voiding interval achieved several times was deemed the initial voiding interval. During week 1, participants were encouraged to hold urine for 30 min beyond the initial voiding interval. Then, the schedule was increased by 15 min per week depending on the patient’s tolerance to the schedule. Urgency suppression strategies, including distraction, relaxation, and PFM contraction, were explained to each participant. Techniques to control urgency were:

(1) Deep and slow breathing

(2) Contracting PFMs while relaxing other body parts

(3) Using mental imagery or self‐motivational statements, such as “I can wait” and “I can take control”

(4) Incorporating mental distractions, such as mathematical calculation

Outcomes

1. Global rating of improvement

A four‐point scale (worse, unchanged, improved, cured) was used to determine participants’ global perception of UI improvement at the end of the intervention period compared with baseline. Improvement was defined as the proportion of women 'cured' or 'improved

'At 6 weeks

A. 56/56; B. 43/52

2. Frequency and volume of incontinence (no usable data)

3. Symptom distress and quality of life (no usable data)

4. Incontinent episodes (No../day) (no usable data)

5. Micturition frequency (No./day) (no usable data)

Notes

6‐week treatment protocol was implemented for both groups by an experienced physical therapist over four visits (baseline and weeks 2, 4, and 6 of the program)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

“A stratified block randomization procedure was used to assign blocks of four participants to either treatment arm using opaque and sealed envelopes that contained a group allocation number from a computer generated random‐number table.”

Allocation concealment (selection bias)

Low risk

Allocation was concealed using sealed and opaque envelope

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Impossible to blind participants and personnel to PFMT

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

No details reported

Incomplete outcome data (attrition bias)
All outcomes

High risk

Proportions of withdrawals and reasons for withdrawals differ between the 2 groups and data analysis was not based on ITT

Selective reporting (reporting bias)

Unclear risk

Protocol not available

Ethical approval

Low risk

Ethics approval was said to be obtained

Source of funding or support

Low risk

Source of funding was declared

Conflict of interest

Low risk

It was reported that there was no known conflict of interest

Kim 2011

Methods

4‐arm randomised controlled trial

Participants

147 women with stress, urge or mixed UI from a single centre in Tokyo

Interventions

A. General education (GE) group (N = 36): general education classes were held (topics including cognitive function, osteoporosis and oral hygiene) once a month, a total of 3 times

B. Heat and steam generating sheet (HSGS) group (N = 37): participants in this group received HSGS, a thin, flexible, filmed sheet that generated heat and steam. When placed on the skin surface. It raises the temperature to 38 to 40°C by generating heat and steam continuously for up to 5 hours. Participants were asked to place the HSGS on their lower back once daily immediately after waking period, taking note of the time they started and ended

C. Exercise (Ex) group (N = 37): this group received stretching exercise, fitness exercise and PFM exercise. Participants were initially instructed to perform 10 fast contractions (3 seconds) with a 5‐second rest and 10 sustained contractions (8 to 10 seconds) with a 10‐second rest between the contractions

D. Ex + HSGS group (N = 37): participants in this group received both exercise and HSGS as described above

For this review comparison D versus B is relevant

Outcomes

Cure of urine loss episodes (assessed by interview, with cure defined as the proportion of participants with complete cessation of urine loss episodes)

At 3 months:

A: 1/34; B: 8/37; C: 12/35; D: 19/37

Notes

Changes in frequency of urine loss episodes: assessed based on changes on a 5‐point scale obtained in the interviews conducted at baseline (before treatment) and at 3 months after treatment. Data not available, only graphical presentation  

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Used "computer‐generated random numbers"

Allocation concealment (selection bias)

Unclear risk

Used "computer generated random numbers", however, no further information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of the participants not possible

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not stated

Incomplete outcome data (attrition bias)
All outcomes

Low risk

4/147 dropped out of the trial. However, there were no dropouts in the comparison of interest and there was no differential loss to follow‐up in the other group

Selective reporting (reporting bias)

Unclear risk

Protocol not available

Ethical approval

Unclear risk

Not stated

Source of funding or support

Unclear risk

Not stated

Conflict of interest

Low risk

Declared (no conflict of interest)

Richter 2010

Methods

3‐arm randomised controlled trial, parallel design

Participants

446 women with symptoms of stress urinary incontinence

Interventions

A. Continence pessary alone group (N = 149). Individuals in this group were fitted with a continence ring or dish either by a physician or a nurse. Most participants were fitted successfully in 1 clinic visit while up to 3 visits at 1 to 2‐week intervals were allowed for others to achieve optimal fitting. At the end of the 8‐week treatment period, participants were encouraged to continue to use the pessary

B. Behavioural therapy (PFMT + continence strategies) (N = 146). Intervention in this group consisted of pelvic floor muscle training (PFMT) and exercise and additional skills and strategies on the use of muscles to prevent urgency and stress incontinence. Treatment was administered by registered nurses, nurse practitioners and physical therapists and was implemented in 4 visits at 2‐week intervals. During each visit, participants received instructions on PFMT and exercise and also acquired additional skills and strategies on stress urge incontinence prevention. They were then given individualised prescriptions for daily PFM exercise and practice. At the end of the 8‐week treatment period, participants received an individualised home maintenance programme to enable them sustain their skills and muscle strength

C. Continence pessary + behavioural therapy (combined) (N = 150). Treatment regimen was as described for both pessary and behavioural therapy groups. In addition, participants in this group could continue in the trial with only 1 of the therapies at the end of the 8‐week treatment period

For this review comparison C versus A is relevant

Outcomes

1. The patient global impression of improvement (PGI‐I) was assessed for the 3 groups using a validated PGI‐I questionnaire with success defined as the proportion of participants with a response of 'much better' or 'very much better'

At 3 months:

A: 59/110; B: 72/124; C: 80/132

At 6 months:

A: 52/102; B: 59/116; C: 63/123

At 12 months:

A: 47/96; B: 48/99; C: 49/111

2. Condition‐specific quality of life (in form of the Pelvic Floor Distress inventory): this was assessed using the Urogenital Distress Inventory ‐ stress incontinence sub‐scale with success defined as the proportion of participants with absence of bothersome stress incontinence symptoms (indicated by an answer of 'no' to all 6 items on the sub‐scale or a response of 'yes' but with a bother of 'not at all' or 'somewhat'

At 3 months:

A: 49/110; B: 71/124; C: 66/132

At 6 months: data not reported

At 12 months:

A: 52/96; B: 59/99; C: 49/111

3. Frequency of incontinence episodes per week (self reported improvement) assessed by using the 7‐day diary with success defined as the proportion of women with 75% or more reduction in frequency of incontinence episodes

At 3 months:

A: 69/110; B: 68/124; C: 80/132

At 6 months: data not reported

At 12 months:

A: 51/96; B: 54/99; C: 52/111

4. Patient satisfaction with treatment: this was assessed using the validated Patient Satisfaction Questionnaire

At 3 months:

A: 94/110; B: 110/124; C: 118/132

At 6 months:

A: 87/102; B: 95/116; C: 104/123

At 12 months:

A: 75/96; B: 79/99; C: 81/111

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Permuted block randomisation schedule was used

Allocation concealment (selection bias)

Low risk

Allocation contained in sealed envelopes, opened by the interventionist only after the participants met all the inclusion/exclusion criteria

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of participants not possible especially for PFMT

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

All outcome assessors were blinded to the treatment group assignment

Incomplete outcome data (attrition bias)
All outcomes

High risk

Dropouts: at 3 months: all 79/445, C: 18/150, B: 22/146, A: 39/149; at 6 months: all 104/445, C: 27/150, B: 30/146, A: 47/149; at 12 months: all: 139/445; C: 39/150; B: 47/146; A: 53/149

"After randomization, dropout patterns differed among the three treatment groups (P = 0.015) with the pessary only group having the highest attrition rate ..."                                                        

Selective reporting (reporting bias)

Unclear risk

Trial protocol not available

Ethical approval

Low risk

Approved by the ethics committee

Source of funding or support

Low risk

Disclosed, funded by "Eunice Kennedy Shriver"

Conflict of interest

Unclear risk

Declared some of the authors were associated with a major pharmaceutical company

Wise 1993

Methods

3‐arm randomised controlled trial, parallel design

Participants

62 women with urodynamically proven genuine stress, urinary incontinence (GSI)

Interventions

A. Maximal electrical stimulation alone (N = 20). Participants in this group received a battery‐powered vaginal stimulator (impulse frequency: 20 Hz; duration: 0.75 ms; current intensity: 0 to 90 mA) at home daily for 20 minutes

B. Vaginal cones alone (N = 21). Participants in this group were instructed to use cones twice daily for 15 minutes and to increase the weight of the cones when successful on 2 occasions. They did not undergo vaginal examination. It was not reported whether participants were instructed to contract PFMs in order to hold the cones

C. Kegel exercise + vaginal cones (N = 21). Participants in this group received vaginal cones as stated above. In addition, they were taught by vaginal examination to voluntarily contract their pelvic floor muscles and carried out 10 sessions of 10 contractions daily. No further details were reported

For this review comparison C versus B is relevant

Outcomes

1. Improvement: threshold not defined, unclear whether self reported, detailed data not reported, only the level of significance was given for each treatment group

2. Reduction in urine leakage: this was assessed objectively (using pad testing); success threshold was not defined, details of data not reported, only P values were given

3. Decrease in pad weight: only the P values were reported, other details not given

4. Improvement on pad testing: objective assessment of improvement using pad testing; only proportions of participants were reported, success threshold was not defined

A: 12/16; B: 14/19; C: 14/15 

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not reported

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of participants not possible, especially for PFMT

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
All outcomes

High risk

Dropouts: all 12/62; C: 6/21, B: 2/21; A: 4/20

There is differential loss to follow‐up

Selective reporting (reporting bias)

Unclear risk

Trial protocol not available

Ethical approval

Unclear risk

Not stated

Source of funding or support

Unclear risk

Not disclosed

Conflict of interest

Unclear risk

Not disclosed

Wyman 1998

Methods

3‐arm randomised controlled trial, parallel design

Participants

204 women with urodynamic evidence of stress urinary incontinence (GSI), detrusor instability (DI) or both (mixed incontinence).

Interventions

A. Bladder training (BT) group (N = 68): involved a progressive voiding schedule that was altered every week for the first 6 weeks of the programme but remained unchanged for the last 6 weeks. The voiding interval was initially set at 30 or 60 minutes, depending on the baseline voiding diary and increased by 30 minutes each week if there was reduction in episodes of incontinence 

B. Pelvic floor muscle training (PFMT) alone (N = 69). PFMT was also structured and it consisted of an initial teaching session (which also included instructions on continence strategies) followed by a graded home exercise with audio cassette practice tapes and 4 office biofeedback sessions. In all, 10 fast (3‐second) contractions and 40 sustained (10‐second) contractions (a total of 50 contractions) with 10‐second rest periods between contractions were performed daily by the third week. Patients received 4 weekly 30‐minute sessions of visual and verbal biofeedback. Visual biofeedback was provided via a strip‐chart recorder demonstrating vaginal and abdominal pressures as measured by vaginal balloons

 C. PFMT + BT (combined) (N = 67). Treatment regimen was as described for the BT and PFMT groups. BT was implemented initially while PFMT was added during the third week, including instructions on continence strategies (urge inhibition and preventive contractions)

For this review comparison C versus A is relevant

Outcomes

1. Incontinence episodes per week (mean (SD)): this was assessed at endpoint using the records in a standardised diary

Immediately after treatment:

A: 10.6 (16.3), N = 68; B: 9.6 (10.8), N = 64; C: 6.8 (10.7), N = 61

3 months after treatment: data not reported

2. Cure rates: cure was defined as the proportion of participants who had 100% reduction in incontinence episodes, assessed using the standardised diary

Immediately after treatment:

A: 12/67; B: 8/62; C: 19/61

3 months after treatment:

A: 10/63; B: 13/65; C: 16/59

3. Improvement rates: improvement was defined as the proportion of participants who had 50% or greater reduction in incontinence episodes, assessed using the standardised diary

Immediately after treatment:

A: 35/67; B: 36/63; C: 43/61

3 months after treatment:

A: 28/61; B: 36/64; C: 35/59

4. Patient perceived improvement: instrument used in assessment not stated, success threshold was not defined but will be taken as the proportion of participants who were 'much better' or 'somewhat better' for the purpose of this review

Immediately after treatment:

A: 43/66; B: 48/63; C: 55/61

3 months after treatment:

A: 37/60; B: 45/64; C: 44/59

5. Patient satisfaction with treatment outcome: instrument used in assessment not stated, success threshold was not defined but will be taken as the proportion of participants who were 'very satisfied' or 'slightly satisfied' with treatment outcome for the purpose of this review

Immediately after treatment:

A: 48/66; B: 56/63; C: 57/61

3 months after treatment:

A: 47/60; B: 53/64; C: 51/58

6. Condition‐specific quality of life assessed at endpoint using:

   i. Urogenital Distress Inventory (UDI); reported as mean (SD):

Immediately after treatment:

A: 95.5 (54.4), N = 67; B: 90.8 (52.0), N = 63; C: 64.4 (48.6), N = 61

3 months after treatment:

A: 91.7 (55.0), N = 60; B: 85.0 (52.4), N = 64; C: 72.8 (50.4), N = 58

   ii. Incontinence Impact Questionnaire‐Revised (IIQ‐R); reported as mean (SD):

Immediately after treatment:

A: 72.1 (75.2), N = 66; B: 56.8 (61.4), N = 63; C: 46.6 (65.3), N = 61

3 months after treatment:

A: 65.7 (80.2), N = 60; B: 59.3 (67.7), N = 64; C: 59.8 (83.9), N = 58

7. Treatment adherence: this was defined as the proportion of participants adhering to the voiding schedule; assessed using treatment logs or standardised questionnaire (no useable data were: only percentages, without the actual proportions, were reported)

8. Number of women requiring further treatment (relapse): women were followed up for a mean time of 3.2 years and the overall number of women requiring additional treatment such as surgery, drug, etc. was determined for each treatment group

A: 19/48; B: 29/52: C: 18/48

Notes

Dropouts in each treatment group were not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not reported

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of participants not possible especially to PFMT

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Dropouts: immediately after treatment 9/204; 3 months after treatment 16/204

Differential loss to follow‐up: not reported

Selective reporting (reporting bias)

High risk

According to the authors, one pre‐specified outcome (pad weight) was eventually not reported due to large number of missing data

Ethical approval

Low risk

Approved by the ethics committee

Source of funding or support

Low risk

Disclosed (public institutions)

Conflict of interest

Unclear risk

Not stated

BT: bladder training
DT: drug therapy
ES: electrical stimulation
Ex: exercise
GE: general education
HSGS: heat and steam generating sheet
IEF: incontinence episode frequency
PFM: pelvic floor muscle
PFMT: pelvic floor muscle training
SD: standard deviation
UI: urinary incontinence

SUI˜: Stress Urinary Incontinence

UUI: Urgency Urinary Incontinence

MUI: Mixed Urinary Incontinence

Hz: Hertz

mA: milliampere

µg: microgram

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Alewijnse 2003

Intervention not relevant

Aslan 2008

Intervention not relevant

Barber 2008

Participants and intervention not relevant

Bawden 1992

Intervention not relevant

BE‐DRI 2008

Intervention not relevant

Berghmans 2000

Intervention not relevant

Berghmans 2000a

Intervention not relevant

Berghmans 2001a

Intervention not relevant

Berghmans 2002

Intervention not relevant

Beuttenmuller 2010

Intervention not relevant

Bidmead 2002

Intervention not relevant

Bo 2002

Intervention not relevant

Bo 2012

Systematic review

Burgio 1998

Intervention not relevant

Burgio 2001a

Intervention not relevant

Burgio 2007

Intervention not relevant

Cammu 1996

Intervention not relevant

Capobianco 2012

Participants not relevant

Chancellor 2008

Intervention not relevant

Crothers 2003

Intervention not relevant

de Jong 2006

Intervention not relevant

Dowell 1997

Design not relevant

Driusso 2008

Intervention not relevant

Dumoulin 2011

Intervention not relevant

Firra 2013

Intervention not relevant

Fonda 1995

Intervention not relevant

Goode 2003

Intervention not relevant

Goode 2011a

Post‐prostatectomy patients

Greer 2012

Systematic review

Gronwald 2010

Intervention not relevant

Gunthorpe 1994

Intervention not relevant

Ha 2008

Intervention not relevant

Hahn 1991

Intervention not relevant

Haken 1991

Intervention not relevant

Henalla 1989

Intervention not relevant

Herschorn 2004

Intervention not relevant

Huang 2006

Design not relevant

Huang 2012

Intervention not relevant

Kafri 2007

Intervention not relevant

Kangchai 2002

The study is about the efficacy of a self management promotion programme and the participants were not relevant

Kaya 2011

Intervention not relevant

Kim 2001

Intervention not relevant

Kim 2006

Design not relevant

Kim 2007

Intervention not relevant

Kim 2009

Intervention not relevant

Kincade 2007

Intervention not relevant

Kirschner‐Hermanns 1995

Intervention not relevant

Kobayashi 2009

Intervention not relevant

Lagro‐Janssen 1991

Intervention not relevant

Laycock 1988

Intervention not relevant

Laycock 1993

Intervention not relevant

Laycock 1995

Intervention not relevant

Laycock 2001

Intervention not relevant

Lee 2005

Intervention not relevant

Madersbacher 2003

Intervention not relevant

Madersbacher 2004

Intervention not relevant; recruited both men and women with no separate data for women

Maher 2009

Intervention not relevant

McCormack 2004

Design not relevant

Millard 2003

Participants were provided with a leaflet and were not under a structured PFMT programme and included both men and women (no separate data for women)

Millard 2003a

Participants were provided with a leaflet and were not under a structured PFMT programme and included both men and women (no separate data for women)

Millard 2003b

Participants were provided with a leaflet; were not under a structured PFMT programme; included both men and women (no separate data for women)

Millard 2004

Participants were provided with a leaflet and were not under a structured PFMT programme; included both men and women (no separate data for women)

Mørkved 2002

Intervention not relevant

O'Brien 1996

Intervention not relevant

Oldham 2010

Intervention not relevant

PRIDE 2004

Intervention not relevant

Rutledge 2012

Intervention not relevant

Sampselle 2003

Design not relevant

Sanchez 2008

Intervention not relevant

Savage 2005

Design not relevant

Scott 1979

Randomisation was not done for intervention (incontinence versus no incontinence)

Smith 1994

Intervention not relevant

Sran 2011

Intervention not relevant

Sultana 2014

Intervention not relevant

Suzuki 2003

Intervention not relevant

Tapp 1987

Intervention not relevant

Terry 1996

Intervention not relevant

Van Hespen 2006

Participants and intervention not relevant

Viereck 2011

Intervention not relevant

Voigt 1996

Intervention not relevant

von der Heide 2003

Intervention not relevant

Waterfield 2007

Participant and intervention not relevant

Wells 1999

Intervention not relevant

Wilson 1984

Intervention not relevant

Yamanishi 2006

Intervention not relevant

Yoon 1999

Intervention not relevant

Zhao 2000

Intervention not relevant

PFMT: pelvic floor muscle training

Data and analyses

Open in table viewer
Comparison 1. PFMT added to vaginal cones versus vaginal cones alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured or improved (objective assessment) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 1.1

Comparison 1 PFMT added to vaginal cones versus vaginal cones alone, Outcome 1 Number of women cured or improved (objective assessment).

Comparison 1 PFMT added to vaginal cones versus vaginal cones alone, Outcome 1 Number of women cured or improved (objective assessment).

Open in table viewer
Comparison 3. PFMT added to bladder training versus bladder training alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 3.1

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 1 Number of women cured.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 1 Number of women cured.

1.1 Immediately after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 3 months after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number of women cured or improved Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 3.2

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 2 Number of women cured or improved.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 2 Number of women cured or improved.

2.1 Immediately after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 3 months after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Condition‐specific quality of life on IIQ‐R Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 3.3

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 3 Condition‐specific quality of life on IIQ‐R.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 3 Condition‐specific quality of life on IIQ‐R.

3.1 Immediately after treatment

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 3 months after treatment

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Condition‐specific quality of life on UDI Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 3.4

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 4 Condition‐specific quality of life on UDI.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 4 Condition‐specific quality of life on UDI.

4.1 Immediately after treatment

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 3 months after treatment

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Number of women cured or improved using patient global impression of improvement Show forest plot

2

354

Risk Ratio (M‐H, Fixed, 95% CI)

1.27 [1.14, 1.41]

Analysis 3.5

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 5 Number of women cured or improved using patient global impression of improvement.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 5 Number of women cured or improved using patient global impression of improvement.

5.1 Immediately after treatment

2

235

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [1.15, 1.45]

5.2 3 months after treatment

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.94, 1.55]

6 Incontinence episode per week Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 3.6

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 6 Incontinence episode per week.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 6 Incontinence episode per week.

7 Patient satisfaction with treatment outcome Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 3.7

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 7 Patient satisfaction with treatment outcome.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 7 Patient satisfaction with treatment outcome.

7.1 Immediately after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 3 months after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Number of women requiring further treatment (relapse) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 3.8

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 8 Number of women requiring further treatment (relapse).

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 8 Number of women requiring further treatment (relapse).

Open in table viewer
Comparison 4. PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 4.1

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 1 Number of women cured.

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 1 Number of women cured.

2 Number of women cured or improved Show forest plot

2

56

Risk Ratio (M‐H, Fixed, 95% CI)

2.06 [0.79, 5.38]

Analysis 4.2

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 2 Number of women cured or improved.

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 2 Number of women cured or improved.

3 Patient satisfaction with treatment outcome Show forest plot

1

68

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.57, 1.43]

Analysis 4.3

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 3 Patient satisfaction with treatment outcome.

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 3 Patient satisfaction with treatment outcome.

3.1 Immediately after treatment

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.47, 1.52]

3.2 After 12 months

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.48, 2.02]

Open in table viewer
Comparison 6. PFMT added to continence pessary versus continence pessary alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured or improved Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 6.1

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 1 Number of women cured or improved.

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 1 Number of women cured or improved.

1.1 At 3 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 At 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Condition‐specific quality of life on UDI Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 6.2

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 2 Condition‐specific quality of life on UDI.

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 2 Condition‐specific quality of life on UDI.

2.1 At 3 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 At 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of women improved using patient global impression of improvement Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 6.3

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 3 Number of women improved using patient global impression of improvement.

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 3 Number of women improved using patient global impression of improvement.

3.1 At 3 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 At 6 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 At 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Patient satisfaction with treatment outcome Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 6.4

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 4 Patient satisfaction with treatment outcome.

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 4 Patient satisfaction with treatment outcome.

4.1 At 3 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 At 6 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 At 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 7. PFMT added to drug therapy versus drug therapy alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 7.1

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 1 Number of women cured.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 1 Number of women cured.

1.1 PFMT + clenbuterol vs clenbuterol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number of women cured or improved Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 7.2

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 2 Number of women cured or improved.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 2 Number of women cured or improved.

2.1 PFMT + duloxetine vs duloxetine

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Condition‐specific quality of life on I‐QoL questionnaire Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 7.3

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 3 Condition‐specific quality of life on I‐QoL questionnaire.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 3 Condition‐specific quality of life on I‐QoL questionnaire.

3.1 PFMT + duloxetine vs duloxetine

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of women improved on patient global impression of improvement in first 3 months Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 7.4

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 4 Number of women improved on patient global impression of improvement in first 3 months.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 4 Number of women improved on patient global impression of improvement in first 3 months.

4.1 PFMT + duloxetine vs duloxetine

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 PFMT + oxybutynin vs oxybutynin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Frequency of incontinence episodes per week in first 3 months Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 7.5

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 5 Frequency of incontinence episodes per week in first 3 months.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 5 Frequency of incontinence episodes per week in first 3 months.

5.1 PFMT + duloxetine vs duloxetine

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 PFMT + oxybutynin vs oxybutynin

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Frequency of incontinence episodes per week at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 7.6

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 6 Frequency of incontinence episodes per week at 12 months.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 6 Frequency of incontinence episodes per week at 12 months.

6.1 PFMT + oxybutynin vs oxybutynin

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Frequency of micturitions per 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 7.7

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 7 Frequency of micturitions per 24 hours.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 7 Frequency of micturitions per 24 hours.

7.1 PFMT + oxybutynin vs oxybutynin

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Volumes of urine per micturition Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 7.8

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 8 Volumes of urine per micturition.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 8 Volumes of urine per micturition.

8.1 PFMT + oxybutynin vs oxybutynin

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Number of continence pads used per week Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 7.9

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 9 Number of continence pads used per week.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 9 Number of continence pads used per week.

9.1 PFMT + duloxetine vs duloxetine

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Treatment adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 7.10

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 10 Treatment adverse events.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 10 Treatment adverse events.

10.1 PFMT + solifenacin vs solifenacin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Patient satisfaction with treatment outcome in first 3 months Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 7.11

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 11 Patient satisfaction with treatment outcome in first 3 months.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 11 Patient satisfaction with treatment outcome in first 3 months.

11.1 PFMT + oxybutynin vs oxybutynin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 PFMT + clenbuterol vs clenbuterol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Treatment benefit Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 7.12

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 12 Treatment benefit.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 12 Treatment benefit.

12.1 PFMT + ?drug vs ?drug (drug name not reported)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 9. PFMT added to other treatment versus other treatment alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 9.1

Comparison 9 PFMT added to other treatment versus other treatment alone, Outcome 1 Number of women cured.

Comparison 9 PFMT added to other treatment versus other treatment alone, Outcome 1 Number of women cured.

1.1 PFMT + heat and steam generating sheet versus heat and steam generating sheet alone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

PRISMA study flow diagram.
Figuras y tablas -
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.
Figuras y tablas -
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 domain for each included study.
Figuras y tablas -
Figure 3

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

Comparison 1 PFMT added to vaginal cones versus vaginal cones alone, Outcome 1 Number of women cured or improved (objective assessment).
Figuras y tablas -
Analysis 1.1

Comparison 1 PFMT added to vaginal cones versus vaginal cones alone, Outcome 1 Number of women cured or improved (objective assessment).

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 1 Number of women cured.
Figuras y tablas -
Analysis 3.1

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 1 Number of women cured.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 2 Number of women cured or improved.
Figuras y tablas -
Analysis 3.2

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 2 Number of women cured or improved.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 3 Condition‐specific quality of life on IIQ‐R.
Figuras y tablas -
Analysis 3.3

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 3 Condition‐specific quality of life on IIQ‐R.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 4 Condition‐specific quality of life on UDI.
Figuras y tablas -
Analysis 3.4

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 4 Condition‐specific quality of life on UDI.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 5 Number of women cured or improved using patient global impression of improvement.
Figuras y tablas -
Analysis 3.5

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 5 Number of women cured or improved using patient global impression of improvement.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 6 Incontinence episode per week.
Figuras y tablas -
Analysis 3.6

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 6 Incontinence episode per week.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 7 Patient satisfaction with treatment outcome.
Figuras y tablas -
Analysis 3.7

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 7 Patient satisfaction with treatment outcome.

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 8 Number of women requiring further treatment (relapse).
Figuras y tablas -
Analysis 3.8

Comparison 3 PFMT added to bladder training versus bladder training alone, Outcome 8 Number of women requiring further treatment (relapse).

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 1 Number of women cured.
Figuras y tablas -
Analysis 4.1

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 1 Number of women cured.

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 2 Number of women cured or improved.
Figuras y tablas -
Analysis 4.2

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 2 Number of women cured or improved.

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 3 Patient satisfaction with treatment outcome.
Figuras y tablas -
Analysis 4.3

Comparison 4 PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes), Outcome 3 Patient satisfaction with treatment outcome.

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 1 Number of women cured or improved.
Figuras y tablas -
Analysis 6.1

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 1 Number of women cured or improved.

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 2 Condition‐specific quality of life on UDI.
Figuras y tablas -
Analysis 6.2

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 2 Condition‐specific quality of life on UDI.

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 3 Number of women improved using patient global impression of improvement.
Figuras y tablas -
Analysis 6.3

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 3 Number of women improved using patient global impression of improvement.

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 4 Patient satisfaction with treatment outcome.
Figuras y tablas -
Analysis 6.4

Comparison 6 PFMT added to continence pessary versus continence pessary alone, Outcome 4 Patient satisfaction with treatment outcome.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 1 Number of women cured.
Figuras y tablas -
Analysis 7.1

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 1 Number of women cured.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 2 Number of women cured or improved.
Figuras y tablas -
Analysis 7.2

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 2 Number of women cured or improved.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 3 Condition‐specific quality of life on I‐QoL questionnaire.
Figuras y tablas -
Analysis 7.3

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 3 Condition‐specific quality of life on I‐QoL questionnaire.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 4 Number of women improved on patient global impression of improvement in first 3 months.
Figuras y tablas -
Analysis 7.4

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 4 Number of women improved on patient global impression of improvement in first 3 months.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 5 Frequency of incontinence episodes per week in first 3 months.
Figuras y tablas -
Analysis 7.5

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 5 Frequency of incontinence episodes per week in first 3 months.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 6 Frequency of incontinence episodes per week at 12 months.
Figuras y tablas -
Analysis 7.6

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 6 Frequency of incontinence episodes per week at 12 months.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 7 Frequency of micturitions per 24 hours.
Figuras y tablas -
Analysis 7.7

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 7 Frequency of micturitions per 24 hours.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 8 Volumes of urine per micturition.
Figuras y tablas -
Analysis 7.8

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 8 Volumes of urine per micturition.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 9 Number of continence pads used per week.
Figuras y tablas -
Analysis 7.9

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 9 Number of continence pads used per week.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 10 Treatment adverse events.
Figuras y tablas -
Analysis 7.10

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 10 Treatment adverse events.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 11 Patient satisfaction with treatment outcome in first 3 months.
Figuras y tablas -
Analysis 7.11

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 11 Patient satisfaction with treatment outcome in first 3 months.

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 12 Treatment benefit.
Figuras y tablas -
Analysis 7.12

Comparison 7 PFMT added to drug therapy versus drug therapy alone, Outcome 12 Treatment benefit.

Comparison 9 PFMT added to other treatment versus other treatment alone, Outcome 1 Number of women cured.
Figuras y tablas -
Analysis 9.1

Comparison 9 PFMT added to other treatment versus other treatment alone, Outcome 1 Number of women cured.

Summary of findings for the main comparison. PFMT added to vaginal cones versus vaginal cones alone for urinary incontinence in women

PFMT added to vaginal cones versus vaginal cones alone for urinary incontinence in women

Patient or population: women with urinary incontinence
Settings: Secondary care
Intervention: PFMT added to vaginal cones versus vaginal cones alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

PFMT added to vaginal cones versus vaginal cones alone

Number of women cured or improved (subjective) ‐ not reported

Not estimable

Not reported

Number of women reporting incontinence at 1 year or more after treatment (subjective) ‐ not reported

Not estimable

Not reported

Objective measure of urine leakage (pad test)

Study population

RR 1.27
(0.94 to 1.71)

34
(1 study)

⊕⊝⊝⊝
very low1,2

737 per 1000

936 per 1000
(693 to 1000)

Number of women experiencing pain ‐ not reported

Not estimable

Not reported

Condition‐specific quality of life assessed by patient questionnaire such as Incontinence Impact Questionnaire (IIQ), King's Health Questionnaire (KHQ) ‐ not reported

Not estimable

Not reported

General health status evaluation e.g. Short Form (SF)‐36 ‐ not reported

Not estimable

Not reported

Number of women requiring further treatment such as surgery, drugs, mechanical devices (relapse) ‐ not reported

Not estimable

Not reported

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PFMT: pelvic floor muscle training; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Random sequence generation and allocation concealment unclear.
2Confidence interval is very wide (0.94 to 1.71).

Figuras y tablas -
Summary of findings for the main comparison. PFMT added to vaginal cones versus vaginal cones alone for urinary incontinence in women
Summary of findings 2. PFMT added to lifestyle intervention versus lifestyle intervention alone for urinary incontinence in women

PFMT added to lifestyle intervention versus lifestyle intervention alone for urinary incontinence in women

Patient or population: women with urinary incontinence
Settings: Secondary care
Intervention: PFMT added to lifestyle intervention versus lifestyle intervention alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

PFMT added to lifestyle intervention versus lifestyle intervention alone

Number of women cured or improved (subjective) ‐ not reported

Not estimable

Not reported

Number of women reporting incontinence at 1 year or more after treatment (subjective) ‐ not reported

Not estimable

Not reported

Objective measure of urine leakage (e.g. pad test) ‐ not reported

Not estimable

Not reported

Number of women reporting adverse events ‐ not reported

Not estimable

Not reported

Condition‐specific quality of life ‐ not reported

Not estimable

Not reported

General health status evaluation e.g. Short Form (SF)‐36 ‐ not reported

Not estimable

Not reported

Number of women requiring further treatment such as surgery, drugs, mechanical devices (relapse) ‐ not reported

Not estimable

Not reported

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PFMT: pelvic floor muscle training

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figuras y tablas -
Summary of findings 2. PFMT added to lifestyle intervention versus lifestyle intervention alone for urinary incontinence in women
Summary of findings 3. PFMT added to bladder training versus bladder training alone for urinary incontinence in women

PFMT added to bladder training versus bladder training alone for urinary incontinence in women

Patient or population: women with urinary incontinence
Settings: Secondary care
Intervention: PFMT added to bladder training versus bladder training alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

PFMT added to bladder training versus bladder training alone

Number of women cured ‐ 3 months after treatment

Study population

RR 1.71
(0.84 to 3.46)

122
(1 study)

⊕⊝⊝⊝
very low1,2

159 per 1000

271 per 1000
(133 to 549)

Number of women reporting incontinence at 1 year or more after treatment (subjective) ‐ not reported

Not estimable

Not reported

Objective measure of urine leakage (e.g. pad test) ‐ not reported

Not estimable

Not reported

Number of women experiencing pain ‐ not reported

Not estimable

Not reported

Condition‐specific quality of life ‐ 3 months after treatment
Incontinence Impact Questionnaire‐ Revised (IIQ‐R)

The mean condition‐specific quality of life ‐ 3 months after treatment in the intervention groups was 5.9 lower (35.53 lower to 23.73 higher)

118
(1 study)

⊕⊝⊝⊝
very low1,3

lower scores imply lower impact of incontinence on quality of life

General health status evaluation e.g. Short Form (SF)‐36 ‐ not reported

Not estimable

Not reported

Number of women requiring further treatment such as surgery, drugs, mechanical devices (relapse)

396 per 1000

376 per 1000
(226 to 621)

RR 0.95
(0.57 to 1.57)

96
(1 study)

⊕⊝⊝⊝
very low1,4

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PFMT: pelvic floor muscle training; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Random sequence generation and allocation concealment is unclear.
2Confidence interval is very wide (0.84 to 3.46).
3Confidence interval is very wide (‐35.53 to 23.73).
4Confidence interval is very wide (0.57 to 1.57).

Figuras y tablas -
Summary of findings 3. PFMT added to bladder training versus bladder training alone for urinary incontinence in women
Summary of findings 4. PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes) for urinary incontinence in women

PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes) for urinary incontinence in women

Patient or population: women with urinary incontinence
Settings: Secondary care
Intervention: PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes)

Number of women cured

Study population

RR 2.06
(0.79 to 5.38)

56
(2 study)

⊕⊝⊝⊝
very low1,2

167 per 1000

343 per 1000
(132 to 897)

Number of women reporting incontinence at 1 year or more after treatment (subjective) ‐ not reported

Not estimable

Not reported

Objective measure of urine leakage (e.g. pad test) ‐ not reported

Not estimable

Not reported

Number of women experiencing pain ‐ not reported

Not estimable

Not reported

Condition‐specific quality of life assessed by patient questionnaire such as Incontinence Impact Questionnaire (IIQ), King's Health Questionnaire (KHQ) ‐ not reported

Not estimable

Not reported

General health status evaluation e.g. Short Form (SF)‐36 ‐ not reported

Not estimable

Not reported

Number of women requiring further treatment such as surgery, drugs, mechanical devices (relapse) ‐ not reported

Not estimable

Not reported

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PFMT: pelvic floor muscle training; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Random sequence generation and allocation concealment unclear.
2Confidence interval very wide (0.79 to 5.38).

Figuras y tablas -
Summary of findings 4. PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes) for urinary incontinence in women
Summary of findings 5. PFMT added to magnetic stimulation versus magnetic stimulation alone for urinary incontinence in women

PFMT added to magnetic stimulation versus magnetic stimulation alone for urinary incontinence in women

Patient or population: women with urinary incontinence
Settings: Secondary care
Intervention: PFMT added to magnetic stimulation versus magnetic stimulation alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

PFMT added to magnetic stimulation versus magnetic stimulation alone

Number of women cured or improved (subjective) ‐ not reported

Not estimable

Not reported

Number of women reporting incontinence at 1 year or more after treatment (subjective) ‐ not reported

Not estimable

Not reported

Objective measure of urine leakage (e.g. pad test) ‐ not reported

Not estimable

Not reported

Number of women reporting adverse events ‐ not reported

Not estimable

Not reported

Condition‐specific quality of life assessed by patient questionnaire such as Incontinence Impact Questionnaire (IIQ), King's Health Questionnaire (KHQ) ‐ not reported

Not estimable

Not reported

General health status evaluation e.g. Short Form (SF)‐36 ‐ not reported

Not estimable

Not reported

Number of women requiring further treatment such as surgery, drugs, mechanical devices (relapse) ‐ not reported

Not estimable

Not reported

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PFMT: pelvic floor muscle training

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figuras y tablas -
Summary of findings 5. PFMT added to magnetic stimulation versus magnetic stimulation alone for urinary incontinence in women
Summary of findings 6. PFMT added to continence pessary versus continence pessary alone for urinary incontinence in women

PFMT added to continence pessary versus continence pessary alone for urinary incontinence in women

Patient or population: women with urinary incontinence
Settings: Secondary care
Intervention: PFMT added to continence pessary versus continence pessary alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

PFMT added to continence pessary versus continence pessary alone

Number of women cured or improved (subjective) at 12 months

Study population

RR 0.88
(0.67 to 1.16)

207
(1 study)

⊕⊕⊕⊝
moderate1

531 per 1000

468 per 1000
(356 to 616)

Number of women reporting incontinence at 1 year or more after treatment (subjective) ‐ not reported

Not estimable

Not reported

Objective measure of urine leakage (e.g. pad test) ‐ not reported

Not estimable

Not reported

Number of women reporting adverse events ‐ not reported

Not estimable

Not reported

Condition‐specific quality of life at 12 months
Urogenital Distress Inventory (UDI)

Study population

RR 0.81
(0.62 to 1.08)

207
(1 study)

⊕⊕⊕⊝
moderate2

542 per 1000

439 per 1000
(336 to 585)

General health status evaluation e.g. Short Form (SF)‐36 ‐ not reported

Not estimable

Not reported

Number of women requiring further treatment such as surgery, drugs, mechanical devices (relapse) ‐ not reported

Not estimable

Not reported

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PFMT: pelvic floor muscle training; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Wide confidence interval (0.67 to 1.16).
2Confidence interval is wide (0.62 to 1.08).

Figuras y tablas -
Summary of findings 6. PFMT added to continence pessary versus continence pessary alone for urinary incontinence in women
Summary of findings 7. PFMT added to drug therapy versus drug therapy alone for urinary incontinence in women

PFMT added to drug therapy versus drug therapy alone for urinary incontinence in women

Patient or population: women with urinary incontinence
Settings: Secondary care
Intervention: PFMT added to drug therapy versus drug therapy alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

PFMT added to drug therapy versus drug therapy alone

Number of women cured ‐ PFMT + clenbuterol versus clenbuterol

Study population

RR 1.16
(0.83 to 1.63)

32
(1 study)

⊕⊝⊝⊝
very low1,2

769 per 1000

892 per 1000
(638 to 1000)

Number of women reporting incontinence at 1 year or more after treatment (subjective) ‐ not reported

Not estimable

Not reported

Objective measure of urine leakage (e.g. pad test) ‐ not reported

Not estimable

Not reported

Number of women reporting adverse events

207 per 1000

174 per 1000
(1000 to 332)

RR 0.84
(45 to 1.60)

162
(1 study)

⊕⊝⊝⊝
very low1,3

Condition‐specific quality of life on I‐QoL Questionnaire ‐ PFMT + duloxetine versus duloxetine
Incontinence Quality of Life questionnaire

The mean condition‐specific quality of life on I‐QoL questionnaire ‐ PFMT + duloxetine versus duloxetine in the intervention groups was 5.84 higher
(2.08 lower to 13.76 higher)

101
(1 study)

⊕⊕⊝⊝
low4

Higher scores mean less symptom impact on the quality of life (better)

General health status evaluation e.g. Short Form (SF)‐36 ‐ not reported

Not estimable

Not reported

Number of women requiring further treatment such as surgery, drugs, mechanical devices (relapse) ‐ not reported

Not estimable

Not reported

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PFMT: pelvic floor muscle training; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Random sequence generation and allocation concealment is unclear.
2Confidence interval is very wide (0.83 to 1.63).
3Confidence interval is very wide (0.45 to 1.50).
4Confidence interval is very wide (‐2.08 to 13.76).

Figuras y tablas -
Summary of findings 7. PFMT added to drug therapy versus drug therapy alone for urinary incontinence in women
Summary of findings 8. PFMT prior to surgical intervention versus surgical intervention alone for urinary incontinence in women

PFMT prior to surgical intervention versus surgical intervention alone for urinary incontinence in women

Patient or population: women with urinary incontinence
Settings: Secondary care
Intervention: PFMT prior to surgical intervention versus surgical intervention alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

PFMT prior to surgical intervention versus surgical intervention alone

Number of women cured or improved (subjective) ‐ not reported

Not estimable

Not reported

Number of women reporting incontinence at 1 year or more after treatment (subjective) ‐ not reported

Not estimable

Not reported

Objective measure of urine leakage (e.g. pad test) ‐ not reported

Not estimable

Not reported

Number of women reporting adverse events ‐ not reported

Not estimable

Not reported

Condition‐specific quality of life assessed by patient questionnaire such as Incontinence Impact Questionnaire (IIQ), King's Health Questionnaire (KHQ) ‐ not reported

Not estimable

Not reported

General health status evaluation e.g. Short Form (SF)‐36 ‐ not reported

Not estimable

Not reported

Number of women requiring further treatment such as surgery, drugs, mechanical devices (relapse) ‐ not reported

Not estimable

Not reported

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PFMT: pelvic floor muscle training

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Figuras y tablas -
Summary of findings 8. PFMT prior to surgical intervention versus surgical intervention alone for urinary incontinence in women
Summary of findings 9. PFMT added to HSGS versus HSGS alone for urinary incontinence in women

PFMT added to HSGS versus HSGS alone for urinary incontinence in women

Patient or population: women with urinary incontinence
Settings: Secondary care
Intervention: PFMT added to other versus other treatment alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

PFMT added to other versus other treatment alone

Number of women cured

Study population

RR 2.38
(1.19 to 4.73)

74
(1 study)

⊕⊕⊕⊝
moderate1

216 per 1000

515 per 1000
(257 to 1000)

Number of women reporting incontinence at 1 year or more after treatment (subjective) ‐ not reported

Not estimable

Not reported

Objective measure of urine leakage (e.g. pad test) ‐ not reported

Not estimable

Not reported

Number of women experiencing pain ‐ not reported

Not estimable

Not reported

Condition‐specific quality of life assessed by patient questionnaire such as Incontinence Impact Questionnaire (IIQ), King's Health Questionnaire (KHQ) ‐ not reported

Not estimable

Not reported

General health status evaluation e.g. Short Form (SF)‐36 ‐ not reported

Not estimable

Not reported

Number of women requiring further treatment such as surgery, drugs, mechanical devices (relapse) ‐ not reported

Not estimable

Not reported

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; HSGS: heat and steam generating sheet; PFMT: pelvic floor muscle training; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Allocation concealment unclear.

Figuras y tablas -
Summary of findings 9. PFMT added to HSGS versus HSGS alone for urinary incontinence in women
Comparison 1. PFMT added to vaginal cones versus vaginal cones alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured or improved (objective assessment) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 1. PFMT added to vaginal cones versus vaginal cones alone
Comparison 3. PFMT added to bladder training versus bladder training alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Immediately after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 3 months after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number of women cured or improved Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Immediately after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 3 months after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Condition‐specific quality of life on IIQ‐R Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Immediately after treatment

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 3 months after treatment

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Condition‐specific quality of life on UDI Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 Immediately after treatment

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 3 months after treatment

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Number of women cured or improved using patient global impression of improvement Show forest plot

2

354

Risk Ratio (M‐H, Fixed, 95% CI)

1.27 [1.14, 1.41]

5.1 Immediately after treatment

2

235

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [1.15, 1.45]

5.2 3 months after treatment

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.94, 1.55]

6 Incontinence episode per week Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7 Patient satisfaction with treatment outcome Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

7.1 Immediately after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 3 months after treatment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Number of women requiring further treatment (relapse) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 3. PFMT added to bladder training versus bladder training alone
Comparison 4. PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Number of women cured or improved Show forest plot

2

56

Risk Ratio (M‐H, Fixed, 95% CI)

2.06 [0.79, 5.38]

3 Patient satisfaction with treatment outcome Show forest plot

1

68

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.57, 1.43]

3.1 Immediately after treatment

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.47, 1.52]

3.2 After 12 months

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.48, 2.02]

Figuras y tablas -
Comparison 4. PFMT added to electrical stimulation versus electrical stimulation alone (excluding implanted electrodes)
Comparison 6. PFMT added to continence pessary versus continence pessary alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured or improved Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 At 3 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 At 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Condition‐specific quality of life on UDI Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 At 3 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 At 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of women improved using patient global impression of improvement Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 At 3 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 At 6 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 At 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Patient satisfaction with treatment outcome Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 At 3 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 At 6 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 At 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 6. PFMT added to continence pessary versus continence pessary alone
Comparison 7. PFMT added to drug therapy versus drug therapy alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 PFMT + clenbuterol vs clenbuterol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number of women cured or improved Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 PFMT + duloxetine vs duloxetine

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Condition‐specific quality of life on I‐QoL questionnaire Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 PFMT + duloxetine vs duloxetine

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of women improved on patient global impression of improvement in first 3 months Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 PFMT + duloxetine vs duloxetine

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 PFMT + oxybutynin vs oxybutynin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Frequency of incontinence episodes per week in first 3 months Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 PFMT + duloxetine vs duloxetine

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 PFMT + oxybutynin vs oxybutynin

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Frequency of incontinence episodes per week at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6.1 PFMT + oxybutynin vs oxybutynin

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Frequency of micturitions per 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7.1 PFMT + oxybutynin vs oxybutynin

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Volumes of urine per micturition Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

8.1 PFMT + oxybutynin vs oxybutynin

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Number of continence pads used per week Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

9.1 PFMT + duloxetine vs duloxetine

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Treatment adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

10.1 PFMT + solifenacin vs solifenacin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Patient satisfaction with treatment outcome in first 3 months Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

11.1 PFMT + oxybutynin vs oxybutynin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 PFMT + clenbuterol vs clenbuterol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Treatment benefit Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

12.1 PFMT + ?drug vs ?drug (drug name not reported)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 7. PFMT added to drug therapy versus drug therapy alone
Comparison 9. PFMT added to other treatment versus other treatment alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of women cured Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 PFMT + heat and steam generating sheet versus heat and steam generating sheet alone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 9. PFMT added to other treatment versus other treatment alone