Introduction
Materials and methods
Design and registration
Search strategy
Eligibility criteria
Data extraction
Quality assessment
Data synthesis
Results
Study selection
Study characteristics
Study reference | Duration | Supervision frequency | Session number | Session duration | Expertise | Home exercises | Home exercises frequency | Support | How group intervention was defined | How adherence was recorded |
---|---|---|---|---|---|---|---|---|---|---|
Bussara Sangsawang 2016 | 6 weeks | Biweekly | 3 | 45 min | Midwife | Yes | Twice per day, at least 5 days | 1. Make an appointment to remind about time and date 1 day before each session 2. A specially designed 25-page PFME handbook was provided | Four–five participants in a group | Did not state clearly in the study |
S Morkved 2003 | 12 weeks from 20 to 32 pregnancy weeks | Weekly | 12 | 60 min | Physiotherapist | Yes | Twice a day | Not provided | 10–15 participants in a group | A training diary at home and group session adherence |
Linda Mason 2010 | 4 months from 20 to 36 pregnancy weeks | Monthly | 4 | 45 min | Physiotherapist | Yes | Twice a day | 1. A reminder of the time and date of the class was sent to women a week before each session2. Class was held early evening | Participants attended a group session | Did not state clearly in the study |
Gunvor Hilde 2013 | 16 weeks from 6 weeks after delivery | Weekly | 16 | Not provided | Physical therapist | Yes | Not provided | 1. Customary leaflet2. Initial instruction on how to contract correctly | Group training session | A training diary at home and group session adherence |
Study characteristics | Participant characteristics | Intervention description | Comparator | Outcome measures | Results | Strength and limitation |
---|---|---|---|---|---|---|
Sangsawang 2016; RCT; control group: n = 35 Intervention group: n = 35 Thailand; prevention study | Primigravid women without UI; gestational ages of 20–30 weeks; age range: 18–43 years old | before intervention: the participants must be ascertained to exercise the correct muscle by using stop-test; PFMT protocol: 20 sets of PFME exercises twice a day; at least 5 days per week during the whole 6 weeks, in different positions; each set of PFME includes one slow contraction (strong contraction for 10 s), followed by one fast contraction (briefly contracting and relax the muscle rapidly) | Regular prenatal care | Primary outcome: self-reported SUI; secondary outcome: severity of SUI (frequency, amount of urine leakage and visual analogue scale) | Significantly fewer women reported SUI in the intervention group at 38 weeks’ gestational age | Limitation: no objective indicators were assessed |
Linda Mason 2010; RCT Control group: n = 145 Intervention group: n = 141; UK; prevention study | Nulliparous pregnant women; no symptoms of SUI; around 20th gestational week; age range: 17–41 years old | Before intervention: confirm women could do correct PFMT by digital assessment; PFMT protocol: near maximal muscle contraction held for 6 to 8 s, followed by three or four fast contractions in different positions; home exercises: 8–12 maximal contractions repeated twice a day; used Bo’s protocol, which was employed by three studies included in this review | Usual care and instruction in PFME; the ‘usual’ instruction ranged from occasional one-to-one exercising with an instructor, through a leaflet, through a brief reminder to nothing at all [43] | Bristol Female Lower Urinary Tract Symptoms Questionnaire (BFLUTS); Leicester Impact Scale (LIS); 3-day diary | The intervention group was significantly more likely to exercise their PFM; fewer episodes of incontinence and a lower score on the LIS in the intervention group, but not significant. The intervention group had lower total and average number of incontinence episodes (total: 57, mean: 1.06 ± 2.32) compared to the control group (total: 85, mean 0.77 ± 1.52); LIS score: control group (1.89 ± 3.08), intervention group (3.97 ± 3.80) (P > 0.05) | Limitation: low attendance of training sessions (the percentage of attendance was not provided in the study); the sample size only reached 70%, which is lower than the anticipated 80% power |
Siv Morkved 2003; RCT Control group: n = 153 Intervention group: n = 148; Norway; prevention study | Nulliparous women; 18 gestational weeks; mean age: 28 years old in the intervention group; 26.9 years old in the control group | Before intervention: a correct contraction in both groups was confirmed by vaginal palpation and observation of inward movement of perineum; PFMT protocol: near maximal muscle contractions which were held for 6 to 8 s, followed by three to four fast contractions in different positions; home exercises: 8–12 equally intensive pelvic floor muscle contractions twice per day; used Bo’s protocol which was employed by three studies included in this review | Customary information was given by their midwife or general practitioner; not discouraged from doing pelvic floor muscle exercise on their own | Primary outcome: self-report of UI; secondary outcome: episodes of urine leakage and whether the urinary leakage had changed in the home diary; pelvic floor muscle strength | Significantly fewer women reported UI and significantly higher pelvic floor muscle strength in the intervention group. The number of leakage episodes was significantly lower in the training group (25 of 148 versus 44 of 144, P = 0.014) at 36 weeks’ pregnancy, at 3 months postpartum 20 of 148 versus 34 of 144 were found, P = 0.049 | Strength: high adherence to the training (81% women in the intervention group followed the training protocol) |
Po-Chun Ko 2010; RCT Control group: n = 150 Intervention group: n = 150; China; mixed prevention and treatment study | Nulliparous women; 16–24 gestational weeks; mean age: 32 years old in the intervention group; 31 years old in the control group | Before intervention: confirm women could do correct PFMT by observation of inward movement of perineum during contraction; PFMT protocol: eight contractions each held for 6 s, 2 min rest between three repetitions; home exercises: twice daily followed the PFMT protocol; used Reilly’s protocol, which was developed based on Bo’s protocol | Women received regular prenatal care and customary written postpartum instructions which did not include PFMT from the hospital, but they were not discouraged from performing PFMT on their own | Urogenotal Distress Inventory-6 (UDI-6); Incontinence Impact Questionnaire-7 (IIQ-7) and question of self-reported UI | Significantly lower total UDI-6 and IIQ-7 scores in the intervention group during late pregnancy and the postpartum period; self-reported UI was significantly lower in the intervention group; women who experienced vaginal delivery were more likely to develop UI than women who delivered by cesarean section at 3 days after delivery (38% versus 15%, P < 0.01) and 6 weeks after delivery (31% versus 13%, P = 0.01) | Limitation: no objective assessments and lack of data from long-term follow-up; strength: monitoring the adherence to the training program between sessions |
Methodology quality of included studies
Different protocols used in studies
The effectiveness of group-based PFMT delivered during pregnancy
Effectiveness of group-based PFMT after childbirth
Study characteristics | Participant characteristics | Intervention description | Comparator | Outcome measures | Results | Strength and limitation |
---|---|---|---|---|---|---|
Hilde 2013 RCT Control group: n = 87 Intervention group: n = 88 Norway Mixed prevention and treatment study | Singleton primiparous women who delivered vaginally after > 32 weeks gestation; mean age: 29.8 years old | Before intervention: a correct contraction was confirmed by observation and palpation PFMT protocol: 8–12 close to maximum contractions with each held for 6 to 8 s; followed by three or four fast contractions in different positions Home exercises: three sets of 8 to 12 contractions close to maximum Used Bo’s protocol, which was employed by three studies included in this review | No further intervention | Primary outcome: ICIQ-SF Secondary outcome: pad test; vaginal resting pressure; pelvic floor muscle strength; pelvic floor muscle endurance | No significant difference was found in self-reported UI between the two groups. 30 of 87 (34.5%) in the intervention group versus 34 of 88 (38.6%) in the control group reported UI at 6 months after delivery (P = 0.57); 23 of 87 (21.8%) in the intervention group versus 23 of 88 (26.1%) in the control group had positive pad test at 6 months after delivery (P = 0.69); mean differences at the intervention test were 1.3 cmH2O for vaginal resting pressure (P = 0.257), 3.3 cmH2O for floor muscle strength (P = 0.172) and 29.8 cmH2O for endurance (P = 0.148) | Limitation: drop out imbalance between two groups (12 women in the intervention group dropped out by only three women dropped out from the control group). |