Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis

Xiaoli Wu, Xiu Zheng, Xiaohong Yi, Ping Lai, Yuping Lan, Xiaoli Wu, Xiu Zheng, Xiaohong Yi, Ping Lai, Yuping Lan

Abstract

Electromyographic biofeedback (EMG-BF) can be regarded as an adjuvant to pelvic floor muscle (PFM) training (PFMT) for the management of stress urinary incontinence (SUI). This meta-analysis aimed to compare the efficacy of PFMT with and without EMG-BF on the cure and improvement rate, PFM strength, urinary incontinence score, and quality of sexual life for the treatment of SUI or pelvic floor dysfunction (PFD). PubMed, EMBASE, the Cochrane Library, Web of Science, Wanfang, and CNKI were systematically searched for studies published up to January 2021. The outcomes were the cure and improvement rate, symptom-related score, pelvic floor muscle strength change, and sexual life quality. Twenty-one studies (comprising 1967 patients with EMG-BF + PFMT and 1898 with PFMT) were included. Compared with PFMT, EMG-BF + PFMT had benefits regarding the cure and improvement rate in SUI (OR 4.82, 95% CI 2.21-10.51, P < 0.001; I2 = 85.3%, Pheterogeneity < 0.001) and in PFD (OR 2.81, 95% CI 2.04-3.86, P < 0.001; I2 = 13.1%, Pheterogeneity = 0.331), and in quality of life using the I-QOL tool (SMD 1.47, 95% CI 0.69-2.26, P < 0.001; I2 = 90.1%, Pheterogeneity < 0.001), quality of sexual life using the FSFI tool (SMD 2.86, 95% CI 0.47-5.25, P = 0.019; I2 = 98.7%, Pheterogeneity < 0.001), urinary incontinence using the ICI-Q-SF tool (SMD - 0.62, 95% CI - 1.16, - 0.08, P = 0.024), PFM strength (SMD 1.72, 95% CI 1.08-2.35, P < 0.001; I2 = 91.4%, Pheterogeneity < 0.001), and urodynamics using Qmax (SMD 0.84, 95% CI 0.57-1.10, P < 0.001; I2 = 0%, Pheterogeneity = 0.420) and MUCP (SMD 1.54, 95% CI 0.66-2.43, P = 0.001; I2 = 81.8%, Pheterogeneity = 0.019). There was limited evidence of publication bias. PFMT combined with EMG-BF achieves better outcomes than PFMT alone in SUI or PFD management.

Keywords: Electromyographic biofeedback; Meta-analysis; Pelvic floor dysfunction; Pelvic floor muscle training; Stress urinary incontinence.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of the search process and included studies
Fig. 2
Fig. 2
Forest plots of the cure and improvement rate. A Stress urinary incontinence. B Pelvic floor dysfunction. C Subgroup analysis of stress urinary incontinence (> 3 months and ≤ 3 months)
Fig. 3
Fig. 3
Forest plots of the quality of life score. A Urinary incontinence quality of life. B Quality of sexual life
Fig. 4
Fig. 4
Forest plots of A the severity of urinary incontinence, B pelvic floor muscle strength, and C urodynamics

References

    1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167–178. doi: 10.1002/nau.10052.
    1. Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123:141–148. doi: 10.1097/AOG.0000000000000057.
    1. Reynolds WS, Dmochowski RR, Penson DF. Epidemiology of stress urinary incontinence in women. Curr Urol Rep. 2011;12:370–376. doi: 10.1007/s11934-011-0206-0.
    1. Qaseem A, Dallas P, Forciea MA, et al. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161:429–440. doi: 10.7326/M13-2410.
    1. Committee on Practice Bulletins—Gynecology and the American Urogynecologic Society ACOG Practice Bulletin No. 155: urinary incontinence in women. Obstet Gynecol. 2015;126:e66–e81. doi: 10.1097/AOG.0000000000001148.
    1. Cardozo L, Chapple CR, Dmochowski R, et al. Urinary urgency—translating the evidence base into daily clinical practice. Int J Clin Pract. 2009;63:1675–1682. doi: 10.1111/j.1742-1241.2009.02205.x.
    1. Osman NI, Li Marzi V, Cornu JN, Drake MJ. Evaluation and classification of stress urinary incontinence: current concepts and future directions. Eur Urol Focus. 2016;2:238–244. doi: 10.1016/j.euf.2016.05.006.
    1. Oelke M, De Wachter S, Drake MJ, et al. A practical approach to the management of nocturia. Int J Clin Pract. 2017;71(11):e13027. doi: 10.1111/ijcp.13027.
    1. Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299:1446–1456. doi: 10.1001/jama.299.12.1446.
    1. Fatton B, de Tayrac R, Costa P. Stress urinary incontinence and LUTS in women–effects on sexual function. Nat Rev Urol. 2014;11:565–578. doi: 10.1038/nrurol.2014.205.
    1. Lifford KL, Townsend MK, Curhan GC, Resnick NM, Grodstein F. The epidemiology of urinary incontinence in older women: incidence, progression, and remission. J Am Geriatr Soc. 2008;56:1191–1198. doi: 10.1111/j.1532-5415.2008.01747.x.
    1. Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5:CD007471.
    1. Fritel X, de Tayrac R, Bader G, et al. Preventing urinary incontinence with supervised prenatal pelvic floor exercises: a randomized controlled trial. Obstet Gynecol. 2015;126:370–377. doi: 10.1097/AOG.0000000000000972.
    1. Burkhard FC, Bosch JLHR, Cruz F, et al. EAU guidelines on urinary incontinence in adults. Arnhem: European Association of Urology; 2020.
    1. Hagen S, Elders A, Stratton S, et al. Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial. BMJ. 2020;371:m3719. doi: 10.1136/bmj.m3719.
    1. Herderschee R, Hay-Smith EJ, Herbison GP, Roovers JP, Heineman MJ. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2011 doi: 10.1002/14651858.CD009252.
    1. Selcuk AA. A guide for systematic reviews: PRISMA. Turk Arch Otorhinolaryngol. 2019;57:57–58. doi: 10.5152/tao.2019.4058.
    1. Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions version 6.1. London: Cochrane Collaboration; 2020.
    1. Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. doi: 10.1136/bmj.i4919.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560. doi: 10.1136/bmj.327.7414.557.
    1. Yao Q, Xu X, Liu Y, Zeng B, Liao B. The function of biofeedback-electrical stimulation-pelvic floor muscle exercise on the quality of sexual life in postpartum women. Health Med Res Pract. 2015;12:31–35.
    1. Xiao G. Effect of functional electrical stimulation combined with biofeedback pelvic floor muscle exercise in the treatment of female stress urinary incontinence. Inner Mongolia J Tradit Chin Med. 2018;37:80–81.
    1. Fang K. Feasibility study of biofeedback and electrical stimulation therapy for female stress urinary incontinence. China Modern Med. 2016;23:98–100.
    1. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:CD005654.
    1. Ding X, Wang L, Chen X. Effects of pelvic floor electromyography biofeedback therapy on postpartum pelvic floor muscle strength and sexual function in primiparas. China Modern Doctor. 2020;58:55–58.
    1. Lan Q. Analyze the effect of biofeedback electrical stimulation treatment on the improvement and recovery of pelvic floor function after delivery. Women’s Health Res. 2020;14–5.
    1. Li Y, Dong L, Zhu Q. Effect of electrical stimulation biofeedback therapy on functional rehabilitation of postpartum women’s pelvic floor muscles. China Foreign Med Treat. 2020;39:40–43.
    1. Liu J, Zhou W, Li L, Zhang L, Li Q, Wang E. The fate of inverted limbus in children with developmental dysplasia of the hip: clinical observation. J Orthop Res. 2020 doi: 10.1002/jor.24864.
    1. Zeng X. Effect of electrostimulation biofeedback therapy combined with pelvic floor muscle exercise in the treatment of female pelvic floor dysfunction. Jilin Med J. 2020;41:1941–1942.
    1. Ge J, Ye H, Pu W, et al. Effect of rehabilitation training combined with biofeedback and electrical stimulation on postpartum stress urinary incontinence. Chin J Clin Obstet Gynecol. 2019;20:59–60.
    1. Bertotto A, Schvartzman R, Uchôa S, Wender MCO. Effect of electromyographic biofeedback as an add-on to pelvic floor muscle exercises on neuromuscular outcomes and quality of life in postmenopausal women with stress urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2017;36:2142–2147. doi: 10.1002/nau.23258.
    1. Özlü A, Yıldız N, Öztekin Ö. Comparison of the efficacy of perineal and intravaginal biofeedback assisted pelvic floor muscle exercises in women with urodynamic stress urinary incontinence. Neurourol Urodyn. 2017;36:2132–2141. doi: 10.1002/nau.23257.
    1. Jing J. Clinical study of female stress urinary incontinence treated by biofeedback electrical stimulation of pelvic floor muscle: 80 cases. Chin Remedies Clin. 2013;13:499–501.
    1. Ding C, Ma L, Sun Y. A comparative study of the effect of biofeedback electrical stimulation combined with pelvic floor muscle exercises and simple pelvic floor muscle exercises on female stress urinary incontinence. Acta Acad Med Weifang. 2012;34:417–9.
    1. Chmielewska D, Stania M, Kucab-Klich K, et al. Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises. PLoS ONE. 2019;14:e0225647. doi: 10.1371/journal.pone.0225647.
    1. Shen F. Clinical effect of electrostimulation biofeedback combined with pelvic floor muscle exercise in 500 cases of female pelvic floor dysfunction. Med Front. 2017;7:201–202.
    1. Yang H. Efficacy of electrostimulation biofeedback therapy combined with pelvic floor muscle exercise in female patients with pelvic floor dysfunction. J Med Theory Pract. 2017;30:3535–3537.
    1. Cai Y, Zhao X, Wang Y, Zheng L, Liu J. Observation on the curative effect of biofeedback combined with electrical stimulation in treatment of female stress urinary incontinence. Maternal Child Health Care China. 2014;29:4661–4664.
    1. Yang J, Pang J, Gong M. Curative effect of treating postpartum stress urinary incontinence with electrogymnastics and biofeedback. Modern Med J. 2014;42:1034–1036.
    1. Xuan J, Lou C, Qiu Y. Efficacy of biofeedback combined with electrical stimulation in the treatment of stress urinary incontinence in middle-aged women. Zhejiang J Traumatic Surg. 2019;24:35–36.
    1. Ma X, Liu Y, Lv Y, Shang L, Zhang L. Efficacy of electrostimulation biofeedback therapy combined with pelvic floor muscle exercise in the treatment of female pelvic floor dysfunction and the effect on POP-Q. Maternal Child Health Care China. 2018;33:3378–3380.
    1. Ji J. Clinical study of female stress urinary incontinence treated by biofeedback electrical stimulation of pelvic floor muscle: 80 cases. Chin Remedies Clin. 2013;13:499–501.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir