BACKGROUND: Real time ultrasound (RTUS) is being used by physiotherapists as a tool for enhancing biofeedback. AIM: The aim of this systematic review was to summarise and evaluate the available literature on the effectiveness of RTUS as a biofeedback tool for muscle retraining. METHOD: A systematic review of the literature was performed to identify primary research examining the effect of RTUS muscle retraining. Studies were ranked according to the National Health and Medical Research Council hierarchy of evidence. The methodological quality of the randomised controlled trials was systematically assessed using the PEDro rating scale while a modified tool for case series studies was used. RESULTS: Three RCTs, one case series and one case study were included. The methodological quality of the five studies was average to good, ranging from 55 to 82%. The studies used abdominal, multifidus and pelvic floor muscles to demonstrate the effects of RTUS biofeedback. The results varied depending on the purpose of the tool and the muscles re-trained. The effectiveness of RTUS as a teaching tool is moderate for multifidus, modest for abdominal muscles and weak for pelvic floor muscles. There was a paucity of available literature on the long term retention of muscle control following use of RTUS as a biofeedback tool. CONCLUSION: While research in this field is limited in quantity at the current time, the results warrant further investigation. However, future researchers must make an effort to ensure that their study design is of the highest quality and also demonstrate the long term effects of using RTUS to enhance muscle retraining.

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