Why carry out this study?
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Electromyographic biofeedback (EMG-BF) can be regarded as an adjuvant to pelvic floor muscle training (PFMT) for the management of stress urinary incontinence. |
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 PFD. |
What was learned from the study?
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PFMT combined with EMG-BF achieves better outcomes than PFMT alone in SUI or PFD management. Still, randomized controlled trials in different countries are still necessary to confirm the results. |
Digital Features
Introduction
Methods
Literature Search
Eligibility Criteria
Data Extraction and Quality Assessment
Statistical Analysis
Results
Study Selection and Characteristics
Author, year | Region | Study design | Age (years, mean, or range) I/C | Simple size I/C | Diagnosis SUI/PFD | Intervention I/C | Stimulation instrument | Follow-up (months) | Definition of cure and improvement | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Ding, 2020 [25] | China | RCT | 26.3 ± 3.6/26.8 ± 4.3 | 50/50 | PFM strength screening | eBF + Kegel | Kegel | AM 3000 | 6 | – | |
Hagen, 2020 [15] | UK | RCT | 48.2 ± 11.6/47.3 ± 11.4 | 300/300 | Clinically diagnosed | – | eBF + PFMT | PFMT | – | 6, 12, 24 | Cure (never or no responses to ICIQ-UI SF frequency or quantity items) and improvement in urinary incontinence (reduction in ICIQ-UI SF score of ≥ 3 points) |
Lan, 2020 [26] | China | RCT | 28.65 ± 2.73/28.7 ± 2.68 | 150/150 | – | – | eBF + Kegel | Kegel | – | 6 | PFM strength score > 4 or 3–4 |
Li, 2020 [27] | China | RCT | 28.41 ± 2.33/28.46 ± 2.47 | 145/145 | – | eBF + PFMT | PFMT | – | 2 | Significant effect: grade > 4, > 80 points; effective grade 2–3, 60–80 points | |
Liu, 2020 [28] | China | RCT | 31.82 ± 4.67/32.38 ± 5.14 | 40/40 | Diagnostic criteria | – | eBF + PFMT | PFMT | PHENIX USB4 | 2 | Cured (urinary incontinence completely disappeared, no leakage of urine during coughing, laughing and exercise) Effective (the perceived frequency and quantity of urine leakage were improved) |
Zeng, 2020 [29] | China | RCT | 34.4 ± 2.9/34.5 ± 2.8 | 36/36 | – | – | eBF + PFMT | PFMT | SOKO 900 III | 2 | Significant effect: clinical symptoms disappeared and indicators returned to normal; effective: symptoms improved and indicators improved |
Ge, 2019 [30] | China | RCT | 29.65 ± 3.26/30.21 ± 3.52 | 90/90 | Diagnostic criteria | – | eBF + Kegel | Kegel | Laborie | 1 | – |
Bertotto, 2017 [31] | Brazil | RCT | 58.4 ± 6.8/59.3 ± 4.9 | 16/15 | International Consultation on Incontinence Questionnaire | eBF + PFMT | PFMT | Miotool 400 system | 1 | – | |
Özlü, 2017 [32] | Turkey | RCT | 42.22 ± 8.88/42.82 ± 6.30 | 35/18 | Urodynamically confirmed diagnoses of SUI | – | eBF + PFMT | PFMT | Enraf Nonius Myomed 932 device | 1, 2 | 1-h pad test, 2 g and under of it is considered as a cure The improvement was assessed in terms of 50% and more reduction in wet weight compared to baseline measurements in the 1-h pad test |
Fang, 2016 [23] | China | RCT | 59.09 ± 15.86/59.17 ± 15.62 | 40/40 | 72 h urination record, routine urine examination, urine dynamic examination, PFM strength test | – | eBF + Vaginal dumbbell | Vaginal dumbbell | PHENIX USB4 | – | Significant effect, PFM strength reached level 5. No urinary incontinence occurred; effective, PFM strength reached grade 4 or increased by 50%, and urinary incontinence was reduced |
Yao, 2015 [21] | China | RCT | 28.84 ± 3.36/29.13 ± 3.39 | 45/43 | – | eBF + PFMT | PFMT | PHENIX USB8 | 3 | – | |
Ji, 2013 [33] | China | RCT | – | 80/80 | Gynecological examination, nervous system examination, stress test, finger pressure test, cotton swab test, and urodynamic examination | – | eBF + PFMT | PFMT | PHENIX | – | Cure: symptoms disappeared, urinary incontinence disappeared, urination normal, no leakage of urine; Significant effect: symptom relief |
Ding, 2012 [34] | China | RCT | 50.1 ± 7.63/52.1 ± 6.96 | 48/48 | Clinically diagnosed | – | eBF + Kegel | Kegel | AM 1000B | 10 | Cure (urinary incontinence symptoms disappeared) Improvement (reduce the number of urine leakage by > 50%) |
Chmielewska, 2019 [35] | Poland | PCS | 52.9 ± 4/51.5 ± 5.2 | 18/13 | Clinically diagnosed | – | eBF + PFMT | Pilates exercises | – | 2, 6 | – |
Shen, 2017 [36] | China | PCS | 38.6 ± 7.2/38.8 ± 7.2 | 500/500 | – | PFM strength screening | eBF + Vaginal dumbbell | Vaginal dumbbell | – | 6 | Increase the muscle strength of type I and II muscle fibers by 2 grades or more |
Yang, 2017 [37] | China | PCS | 36.55 ± 1.24/36.25 ± 1.34 | 45/45 | – | Clinically diagnose | eBF + PFMT | PFMT | SOKO 900 III | 2 | Significant effect: the clinical symptoms and various indicators are obviously restored or normal; effective: the clinical symptoms and various indicators are somewhat restored |
Cai, 2014 [38] | China | PCS | – | 32/24 | 72 h urination record, routine urine examination, urine dynamic examination, PFM strength test | – | eBF + Kegel | Kegel | UROSTYM | 4.8 | 1-h pad test, 2 g and under of it is considered as a cure The improvement was assessed in terms of 50% and more reduction in wet weight compared to baseline measurements in the 1-h pad test |
Yang, 2014 [39] | China | PCS | – | 90/78 | Medical history and urological examination | – | eBF + Kegel | Kegel | PHENIX | 2 | Cure (urinary incontinence symptoms disappeared) Improvement (reduce the number of urine leakage by > 50%) |
Xuan, 2019 [40] | China | RCS | 46.3 ± 7.7/45.3 ± 8.2 | 72/48 | Clinically diagnosed | eBF + Kegel | Kegel | – | – | 1-h pad test, 2 g and under of it is considered as a cure The improvement was assessed in terms of 50% and more reduction in wet weight compared to baseline measurements in the 1-h pad test | |
Ma, 2018 [41] | China | RCS | 28.5 ± 2.8/29.4 ± 3.7 | 110/110 | – | PFM strength | eBF + vaginal dumbbell | Vaginal dumbbell | Medtronics-Synetics | – | Significant effect: pelvic floor muscle contraction is complete, and can be maintained for more than 5 s, and the body is in good condition; effective: after treatment, the pelvic floor muscles contracted completely and slightly against each other. The number of times was 2–4 and the time was 2-4 s. The physical state was stable |
Xiao, 2018 [22] | China | RCS | 47.29 ± 10.36/47.25 ± 10.24 | 25/25 | Clinically diagnosed | eBF + PFMT | PFMT | UROSTIM | – | Cure (urinary incontinence symptoms disappeared) Improvement (reduced the number of urine leakage by > 50%) |
RCT study | Random sequence generation | Allocation concealment | Blinding of participants and personnel | Blinding of outcome assessment | Incomplete outcome data | Selective reporting | Other bias |
---|---|---|---|---|---|---|---|
Ding, 2020 [25] | High | Unclear | Unclear | Unclear | Low | Low | Unclear |
Hagen, 2020 [15] | Low | Low | Low | Low | Low | Low | Unclear |
Lan, 2020 [26] | High | Unclear | Unclear | Unclear | Low | Low | Unclear |
Li, 2020 [27] | Low | Unclear | Unclear | Unclear | Low | Unclear | Unclear |
Liu, 2020 [28] | Low | Unclear | Unclear | Unclear | Low | Unclear | Unclear |
Zeng, 2020 [29] | High | Unclear | Unclear | Unclear | Low | Low | Unclear |
Ge, 2019 [30] | Low | Unclear | Unclear | Unclear | Low | Low | Unclear |
Bertotto, 2017 [31] | Low | Low | Low | Unclear | Low | Low | Unclear |
Özlü, 2017 [32] | Low | Low | Low | Low | Low | Low | Unclear |
Fang, 2016 [23] | Low | Unclear | Unclear | Unclear | Low | Low | Unclear |
Yao, 2015 [21] | High | Unclear | Unclear | Unclear | Low | Low | Unclear |
Ji, 2013 [42] | High | Unclear | Unclear | Unclear | Low | Low | Unclear |
Ding, 2012 [34] | High | Unclear | Unclear | Unclear | Low | Low | Unclear |
nRCT study | Bias due to confounding | Bias in selection of participants | Bias in classification of interventions | Bias due to deviations from intended interventions | Bias due to missing data | Bias in measurement of outcomes | Bias in selection of the reported result | Overall bias |
---|---|---|---|---|---|---|---|---|
Chmielewska, 2019 [35] | Low | Low | Moderate | Low | Low | Moderate | Moderate | Low |
Shen, 2017 [36] | Moderate | Low | Moderate | Moderate | Moderate | Low | Low | Moderate |
Yang, 2017 [37] | Low | Low | Moderate | Low | Low | Moderate | Low | Low |
Cai, 2014 [38] | Low | Moderate | Moderate | Moderate | Low | Low | Moderate | Moderate |
Yang, 2014 [39] | Low | Low | Moderate | Moderate | Low | Low | Low | Low |
Xuan, 2019 [40] | Moderate | Moderate | Moderate | Moderate | Low | Low | Moderate | Moderate |
Ma, 2018 [41] | Moderate | Low | Moderate | Low | Low | Low | Moderate | Low |
Xiao, 2018 [22] | Moderate | Low | Moderate | Low | Low | Low | Moderate | Low |