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Table 11 Summary of interventions

From: Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review

Studies/arms of studies Control group protocol PFM action taught 1 = digital vaginal 2 = other PFMT protocol (s/s) = Contraction time in seconds/relaxation time in seconds Intensity of contract-ions or type of PFM T Adjunct-ive therapy Adjunctive therapy protocol Duration of inter-vention N of treat-ments (individual unless other-wise stated)
Aksac 2003 PFMT   1 5s/10s, 10 reps, 3 sets/day. After 2 weeks, 10s/20s relax. Weekly individual sessions. NR. Relaxation of abdominals, gluteals    8 weeks 8
Aksac 2003 PFMT+BF   2 10s/20s, 40 reps, 3 sets/week. Weekly individual sessions. NR EMG vaginal BF to learn action only No home training with BF. 8 weeks 8
Aksac 2003 Control group No PFMT       NA  
Arvonon 2001 PFMT NA 1 5s/5s, 10 reps (max), seated/standing, 2 sets/day. 3s/3s, 15 reps, (submax) 1 set/day 2 min. sustained (submax) 1 rep, 1 set/day. 3 clinic visits Maximal, submaximal    4 months 3
Arvonon 2001 PFMT+VW NA 1 a/a   VW VW (50 g, 65 g, 80, 100 g) 20s/20s, (max) 10 reps, standing, 2 sets/day. 15 mins. VW with daily activities, gymnastics. 4 months 3
Balmforth 2004 PFMT+BF NA 2 Perineal ultrasound Intensive + individualised PFMT + 'behavioural modification' program Home program: NR NR Perineal ultrasound to teach correct contraction. Pre-treatment only.   14 weeks NR
Berghmans 1996 PFMT NA 1 3–30s contractions, 10–30 reps, supine/standing/all fours. PFE with coughing, stairs, lifting, jumping. Home: 3x/day. NR    4 weeks 12
Berghmans 1996 PFMT+BF NA 1 a/a NR EMG vaginal BF Clinic only. Individual program for 12 sessions. 4 weeks 12
Bidmead 2002 PFMT   NR 'Conventional 'PFE by experienced research physiotherapist. Home: details NR NR    14 weeks NR
Bidmead 2002 PFMT+ES   NR    ES (no details reported) Same PFE program with home ES 14 weeks NR
Bidmead 2002 Control group No treatment        
Bo 1999 PFMT   1 6–8s/6 s, 8–12 reps, 3–4 fast contractions at end of 'hold', 3 sets/day. Weekly group sessions with ex in different positions and for abdominals, back, thighs. Monthly PFM assessment. High intensity    6 months 24 group 6 individual
Bo 1999 Control group No contact. Offered Continence Guard        
Bo 2000 PFMT   NR As for Bo 1999     6 months 24 group 6 individual
Bo 2000 Control group No contact Offered use of Continence Guard        
Cammu & van Nylen 1998 PFMT+BF NA 1 'Brief' + 10s contractions, 10 reps, as many sets as possible 'within patients capacity'. Home: Increasing number of sets Maximal BF vag EMG + 'abdominal' EMG to reduce Valsalva efforts Individual: Weekly, 30 min BF session 12 weeks 6
Chen 1999 PFMT+ES NA 1 No details. 15 mins 2 sets/day, 3 months Then 15 mins/day, 1 set/day, 21 months   ES intravaginal, home stimulator Increasing tx times: 20,40, 60 min, 2/week, 3 months. Biphasic square wave, 25 Hz. 3 months (ES) 24 months (PFE) 24 + 6
Dumoulin 2004 PFMT+ES+BF   NR Standardised reeducation program. Home: 5 days/week: no details. Weekly individual sessions Strength & motor learning 1. ES vag
2. BF vag EMG. Clinic only
1. ES:15 mins 6s on/18s off, weeks 1–4, 8s on/24s off, weeks 5–8. 50 Hz, 250 msec.
2. BF 25 min
8 weeks 8
Dumoulin 2004 PFMT+ES+BF+ abdominal exercises   NR a/a Additional weekly 30 min session with deep abdominal muscle training a/a a/a a/a 8 weeks 8 + 8 group sessions for abdominal muscle training
Dumoulin 2004 Control group weekly massage with PT       8 weeks  
Dumoulin 1995 PFMT+BF+ES NA 1 5s/10 s, 10 reps, 2 sets Home: 4 sets/day Individual session with ES/BF 3x/week. Maximal 1. ES Interferential current 4 suction electrodes
2. BF vag pressure Clinic only
1. ES 15 mins 10–50 Hz, 15 mins 50 Hz.
2. BF 15 mins
3 weeks 9
Finkenhagen 1998 PFMT NA 1 6–8 s/6 s, 8–12 reps, 3–4 fast contractions at end of 'hold'. Home: 8–12 reps, 3 sets/day. Weekly exercise class (protocol as for Bo 1999) Strength    6 months 1 individual + 24 group training
Glavind 1996 PFMT NA 1 'standard procedure' – no details given. Individual sessions 2–3 times NR    4 weeks 2–3
Glavind 1996 PFMT+BF NA NR 5–10s contractions, 10 reps in supine, sitting, standing, Individual instruction NR BF vag EMG + rectal pressure BF to avoid IAP rise 4 weekly sessions. Clinic only. 4 weeks 6–7
Hay-Smith 2004 PFMT a NA NR PFMT :motor relearning alone Home: no details Motor learning    20 weeks 4 + 3 phone calls
Hay-Smith 2004 PFMT b NA NR PFMT: strengthening plus motor relearning. Home: no details Strength & motor learning    20 weeks 4 + 3 phone calls
Johnson 2001 PFMT (SVC) +BF NA 2. Vaginal perineo meter 10 s/10s, 15 minutes, submaximal (60% of MVC). 3 sets/day Submaximal VoluntayContractions BF vag pressure. Rectus EMG BF for first instruct ion BF home training 6 weeks 2
Johnson 2001 PFMT (NMVC) +BF NA 2. Vaginal perineo meter 10s/10s, 10 minutes, near-maximal (90% of MVC). 3 sets/day Near-maximal Voluntary Contract ions BF vaginal pressure Home trainer   6 weeks 2
Knight 1998 PFMT+BF NA 1 Up to 10s/4s (individualised), fast (up to 10), up to 10 reps, 6 sets a day. 6–18 months:1 set/day Maximal BF vaginal pressure. Home trainer + clinic. Home trainer: 1 set PFX per day. Clinic: weekly for 1 month, then bi-weekly. 6–18 months: BF 1/week 6 months 14
Knight 1998 PFMT+BF+ES (home) NA 1 a/a Maximal As for PFMT+BF plus ES (home) Vaginal, overnight, 10 Hz, 200 ms. 5 on/5 off. Low intensity. 6–18 months: BF 1/week 6 months 14
Knight 1998 PFMT+BF+ES (clinic) NA 1 a/a Maximal As for PFMT+BF plus ES (clinic) Vaginal, 16 × 30 min., 35 Hz, 250 ms. 5 on/5 off. High intensity, contraction with stimulator. 6–18 months: BF 1/week 6 months 14 PFMT+BF 16 ES
Miller 1998 PFMT NA 1 Taught to contract and cough. Home practice. Motor learning    1 week 2
Morkved 2002 PFMT NA 1 6–8s/6 s, 8–12 reps (high intensity). 3–4 fast contractions at end of 'hold. Home: 3 sets/day. Individual sessions High intensity    6 months 16
Morkved 2002 PFMT+BF NA 1 a/a with home BF. Individual sessions High intensity BF vaginal pressure home trainer 6–8s/6 s, 8–12 reps (high intensity). 3–4 fast contractions at end of 'hold', 3 sets daily 6 months 16
Pages 2001 PFMT NA 1 Group 5/week. Home: 100 reps/day during daily activities. Supine 10 mins, 2 sets/day. Group: different positions 'Isolated' contractions, intensity NR.    4 weeks group then 2 months home PFMT 3 individual + 20 group
Pages 2001 PFMT+BF NA 1 1 group session, individual BF training 15 mins, 5/week/4 weeks. Home: 10 reps, 4 sets, 5 times/week NR BF vaginal pressure. Clinic only 15 min sessions Supine 10 reps/4 sets 4 weeks individual then 2 months home PFMT 23 individual
Parkkinen 2004 PFMT+ES+BF+VW NA 1 Short, low-intensity, 8–10 reps. High intensity: 5s/10s, 5 reps, low intensity: 20–30s/40–60s, 5 reps, supine & standing. Contract & cough. Home: 2 sets/day, 5 days/week High intensity 1. BF vag EMG
2. ES interferential 5–10 mins 50 Hz, 5–10 mins 10–50 Hz Clinic only. 3. VW
1. BF
2. ES 10 mins
3. VW (20–80 g), 30 min/day, 5 days/week, during daily activities
Weekly to one year. Duration individual-ised: 'until desired outcome achieved' 9 (3–29)
Parkkinen 2004 PFMT+VW NA 1 a/a a/a VW VW (20–80 g), 30 min/day, 5 days/week, during daily activities 12 months. 3
Pieber 1995 PFMT+BF NA 1,2 Perineal ultrasound Contract-relax times NR. 100 PFX per day. Encouraged to do the 'knack'. Individualised home program Intensity NR. Relaxation of abdominals, gluteals, thighs BF: Perineal ultra-sound (3 times). Clinic only BF: Visualised PF on screen (3 sessions) 3 months 2–4 weekly intervals, 3 (asses ment)
Pieber 1995 PFMT+BF+VW NA 1 a/a a/a 1. BF: Perineal ultra-sound. Clinic only
2. VW
1. Visualised PF on screen (3 sessions)
2. VW (20–70 g) 15 mins during daily activities
3 months a/a
Sung 2000 PFMT Explanation, no treatment NR PFM exercises 'as developed by Bo', details NR. Exercises in clinic with video. Home: same exercises, details NR Intensive    6 weeks 6
Turkan 2005 PFMT+ES NA 2 (not clearly reported) 5s contractions, 10 reps, 5 sets/day, 5 sets added in each week. Home: also with activities of daily living, provocation Maximum intensity ES -Interferential, 4 vacuum electrodes Clinic only 10 mins each 0–10 Hz, 0–100 Hz. Voluntary contractions with ES 5 weeks 15
Wong 2001 PFMT+BF NA NR Home: NR Fast: maximal Slow: as long as possible. BF vag EMG 5 sets: 'fast'/10s rest: 3 reps, 'slow'/1 min rest: 2 reps. with BF. Clinic only 4 weeks 4
Wong 2001 PFMT+BF+ abdominal EMG BF NA NR a/a a/a BF vag EMG & EMG BF-rectus abdominis Clinic only a/a with abdominal EMG BF to minimise rectus activity 4 weeks 4
  1. PFMT = pelvic floor muscle training, PFX = pelvic floor exercises, BF = biofeedback, ES = electrical stimulation, VW = vaginal weights EMG = electromyography, vag = vaginal, reps= repetitions, NA = not applicable, NR = not reported, a/a = as above