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Respuestas clínicas Cochrane

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PRISMA study flow diagram.
Figuras y tablas -
Figure 1

PRISMA study flow diagram.

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'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.

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'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.

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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).

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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).

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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