Biofeedback for pelvic floor muscle training in women with stress urinary incontinence: a systematic review with meta-analysis

Physiotherapy. 2019 Mar;105(1):10-23. doi: 10.1016/ Epub 2018 Sep 24.


Background: Several clinical effects have been attributed to the use of biofeedback (BF) as an adjuvant in the treatment of women with stress urinary incontinence (SUI).

Objectives: To determine whether BF is more effective than other interventions for women with SUI in terms of quantification of urine leakage, episodes of urinary loss, quality of life and muscle strength.

Data sources: Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL and LILACS from January 2000 to February 2017.

Study selection: Randomised controlled trials (RCTs) addressing the effects of pelvic muscle floor training (PFMT) with BF for the conservative treatment of women with SUI.

Data extraction and data synthesis: Two independent assessors extracted data from articles. The risk of bias for individual studies was assessed using the Jadad scale and Physiotherapy Evidence Database (PEDro) scale. Mean differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses.

Results: In total, 1194 studies were retrieved and 11 were included in this review. Only two RCTs demonstrated a low risk of bias according to the PEDro scale. The results demonstrated that PFMT with BF was no better than alternative interventions in terms of muscle strength measured using a perineometer.

Limitations: Low methodological quality of studies, heterogeneity of outcomes, and differences in implementation of intervention protocols and BF modalities.

Conclusions: PFMT with BF does not offer therapeutic benefits over alternative interventions (no training, PFMT alone and vaginal electrical stimulation) for the treatment of female SUI.

Systematic review registration number prospero: CRD42017060780.

Keywords: Biofeedback; Meta-analysis; Pelvic floor muscle; Systematic review; Urinary incontinence.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Biofeedback, Psychology / methods*
  • Combined Modality Therapy
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Muscle Contraction / physiology
  • Muscle Strength / physiology
  • Pelvic Floor / physiology*
  • Physical Therapy Modalities
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Urinary Incontinence, Stress / therapy*