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Transabdominal ultrasonography-guided biofeedback training for pelvic floor muscles integrated with stabilization exercise improved pregnancy-related pelvic girdle pain and disability: a randomized controlled trial [with consumer summary]
Kuo Y-L, Lin K-Y, Wu M-H, Wu C-H, Tsai Y-J
Physiotherapy 2024 Sep;124:106-115
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: Investigate effects of integrated training for pelvic floor muscles (PFM) with and without transabdominal ultrasonography (TAUS) imaging-guided biofeedback in postpartum women with pregnancy-related pelvic girdle pain (PPGP). DESIGN: Three-arm, single-blinded randomized controlled trial SETTING: University laboratory PARTICIPANTS: Fifty-three postpartum women with PPGP randomized into stabilization exercise with TAUS-guided biofeedback (BIO plus EXE), exercise (EXE), and control (CON) groups. INTERVENTIONS: The BIO plus EXE and EXE groups underwent an 8-week exercise program, with the BIO plus EXE group receiving additional TAUS-guided biofeedback for PFM training during the first 4 weeks. The CON group only received a pelvic educational session. MAIN OUTCOME MEASURES: Primary outcomes included self-reported pain (numeric rating scale) and disability (pelvic girdle questionnaire). Secondary outcomes included functional tests (active straight leg raising (ASLR) fatigue, timed up-and-go, and 6-meter walking tests) and muscle contractibility indicated by muscle thickness changes for abdominal muscles and bladder base displacement for PFM (ultrasonographic measures). RESULTS: The BIO plus EXE group had lower pain (1.8 (1.5) versus 4.4 (1.5), mean difference -2.6, 95% confidence interval (CI) -3.9 to -1.2) and disability (14% (10) versus 28% (21), mean difference -14, 95% CI -25 to -2) and faster walking speed (3.1 seconds (1) versus 3.3 seconds (1), mean difference -0.2, 95% CI -1.0 to -0.2) than the CON group. The EXE group only had lower pain intensity compared to the CON group (2.7 (2.0) versus 4.4 (1.5), mean difference -1.7, 95% CI -3.1 to -0.4). No significant differences were observed among groups in timed up-and-go, ASLR fatigue, or muscle contractibility. CONCLUSIONS: Integrated training for PFM and stabilization with TAUS-guided biofeedback seems to be beneficial for reducing pain and disability in postpartum women with PPGP.

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