Table 11 Summary of interventions
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 | Â | 1 | 5s/10s, 10 reps, 3 sets/day. After 2 weeks, 10s/20s relax. Weekly individual sessions. | NR. Relaxation of abdominals, gluteals | Â | Â | 8 weeks | 8 |
Aksac 2003 PFMT+BF | Â | 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 | Â | Â | Â | Â | Â | NA | Â |
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 | Â | Â | 4 months | 3 |
Arvonon 2001 PFMT+VW | NA | 1 | a/a | Â | 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. | Â | 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 | Â | NR | 'Conventional 'PFE by experienced research physiotherapist. Home: details NR | NR | Â | Â | 14 weeks | NR |
Bidmead 2002 PFMT+ES | Â | NR | Â | Â | ES (no details reported) | Same PFE program with home ES | 14 weeks | NR |
Bidmead 2002 Control group | No treatment | Â | Â | Â | Â | Â | Â | Â |
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 | Â | Â | Â | Â | Â | Â | Â |
Bo 2000 PFMT | Â | NR | As for Bo 1999 | Â | Â | Â | 6 months | 24 group 6 individual |
Bo 2000 Control group | No contact Offered use of Continence Guard | Â | Â | Â | Â | Â | Â | Â |
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 | Â | 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 | Â | 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 | Â | Â | Â | Â | Â | 8 weeks | Â |
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 | Â | Â | 20 weeks | 4 + 3 phone calls |
Hay-Smith 2004 PFMT b | NA | NR | PFMT: strengthening plus motor relearning. Home: no details | Strength & motor learning | Â | Â | 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 | Â | 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 | Â | Â | 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. | Â | Â | 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 | Â | Â | 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 |