Pelvic floor muscle exercises plus biofeedback versus pelvic floor muscle exercises for patients with stress urinary incontinence: A systematic review and meta-analysis of randomized controlled trials

Background: Stress urinary incontinence (SUI) is a widespread illness that mostly affects women, particularly those who have recently given birth or gone through menopause. The purpose of this meta-analysis is to compare the effectiveness of pelvic floor muscle exercises (PFME) plus biofeedback to PFME alone in treating SUI in female patients. Methods: We systemically searched six electronic databases (PubMed, Scopus, and Web of Science) from inception until February 7, 2022. We included randomized controlled trials (RTCs) comparing patients who had undergone PFME plus biofeedback to PFME alone. For risk of bias-2 (RoB2) assessment, we used cochrane risk of bias assessment tool. Continuous data were pooled as standardized mean difference (SMD), and dichotomous data were pooled as odds ratio with the corresponding 95% confidence intervals (CI). Results: 15 RCTs were included, with a total of 788 patients with SUI. The overall effect estimate between PFME+BF and PFME alone groups favored the PFME+BF group in improving PFME strength (SMD=0.33, 95% CI [0.14 to 0.52], p=.0009) and did not favor either of the two groups for quality of life (SMD=-0.22, 95% CI [-0.44 to 0.00], p=0.05), leakage (SMD=-0.10, 95% CI [-0.37 to 0.17], p=0.47), pad weight test (SMD=-0.22, 95% CI [-0.44 to 0.00], p=0.05), cure rate (odd ratio [OR]=2.44, 95% CI [0.52 to 11.42, p=0.26), and social activity (SMD=0.66, 95% CI [-0.04 to 1.36], p=0.07). Conclusion: BF addition to PRME improves cure rate and PFME strength without affecting leakage or quality of life. Healthcare providers must consider patient safety and comfort while choosing BF devices with PFME. SUI management strategies should include BF to improve results.