Summary of findings 2. Antenatal pelvic floor muscle training compared to control for treatment of urinary and faecal incontinence.
| Antenatal pelvic floor muscle training compared to control for treatment of urinary and faecal incontinence | ||||||
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Patient or population: pregnant women who were incontinent when randomised Setting: health services or obstetric clinics in Brazil, Canada, the Netherlands and Turkey Intervention: antenatal PFMT Comparison: control (usual care) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with control | Risk with antenatal PFMT | |||||
| Urinary incontinence in late pregnancy | 776 per 1000 | 543 per 1000 (341 to 877) | RR 0.70 (0.44 to 1.13) | 345 (3 RCTs) | ⊕⊝⊝⊝ VERY LOW1,2,3 | |
| Urinary incontinence mid‐postnatal period (> 3‐6 months) | 528 per 1000 | 496 per 1000 (369 to 654) | RR 0.94 (0.70 to 1.24) | 187 (1 RCT) | ⊕⊕⊝⊝ LOW4,5 | |
| Urinary incontinence late postnatal period (> 6‐12 months) | 232 per 1000 | 116 per 1000 (30 to 448) | RR 0.50 (0.13 to 1.93) | 869 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW6,7,8 | |
| Faecal incontinence in late pregnancy | ‐ | ‐ | ‐ | (0 studies) | ‐ | Not reported. |
| Faecal incontinence mid‐postnatal period (> 3‐6 months) | ‐ | ‐ | ‐ | (0 studies) | ‐ | Not reported. |
| Faecal incontinence late postnatal period (> 6‐12 months) | ‐ | ‐ | ‐ | (0 studies) | ‐ | Not reported. |
| Urinary incontinence‐specific quality of life (ICIQ‐SF) Scale from: 0 to 10 (higher worse) | Mean 4.7, SD 5.6 | Mean 1.2, SD 2.5 | MD 3.5 lower (6.13 lower to 0.87 lower) | 41 (1 RCT) | ⊕⊕⊕⊝ MODERATE9 | Measured in late pregnancy. MD suggests clinically important effect but the upper limit of the CI is close to no effect. |
| Faecal incontinence‐specific quality of life | ‐ | ‐ | ‐ | (0 studies) | ‐ | Not reported. |
| Adverse events | ‐ | ‐ | ‐ | ‐ | ‐ | No events reported. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; ICIQ‐SF: International Consultation on Incontinence‐Short Form; MD: mean difference; PFMT: pelvic floor muscle training; RCT: randomised controlled trial; RR: risk ratio; SD: standard deviation. | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
1Downgraded one level due to serious risk of bias (one trial with heavy weighting in the pooled estimate at high risk).
2 Downgraded one level for inconsistency (substantial statistically significant heterogeneity; I² = 71%).
3 Downgraded one level for imprecision (fewer than 400 participants, wide confidence interval).
4Downgraded one level due to serious risk of bias.
5Downgraded one level for imprecision (single trial, fewer than 400 participants).
6Downgraded one level due to very serious risk of bias.
7Downgraded one level for inconsistency (considerable statistically significant heterogeneity; I² = 94%).
8Downgraded one level for imprecision (wide confidence interval).
9Downgraded one level due to serious imprecision (single trial, fewer than 400 participants, wide confidence interval).
The outcome measures relate to the presence of incontinence symptoms rather than absence. As this comparison addresses the effect of PFMT for treatment of existing continence symptoms, the data are "negative," that is continuing incontinence rather than cure. Symptoms of urinary and faecal incontinence were measured based on self‐report.