This meta-analysis aims to compare biofeedback-assisted pelvic muscle floor training (PFMT) and low-frequency pelvic electrical stimulation (ES) as an intervention group, with PFMT or bladder training (BT) as the control group, in women with an overactive bladder (OAB). The major goal of this study is to examine the role and efficacy of interventions in terms of improving QoL and reducing symptoms following therapy.

PubMed, Cochrane, CINAHL, EMBASE, and Scopus were systematically searched for randomized controlled trials (RCTs) published up to November 2021. The RCTs were screened for our eligibility criteria and quality was evaluated using the Cochrane Risk Index of Bias tools. The outcomes were changes in quality of life (QoL), episodes of incontinence, and the number of participants cured/improved.

Eight studies involving 562 patients (comprising of 204 patients with biofeedback-assisted PFMT, 108 patients with pelvic ES, and 250 patients who received PFMT alone or BT and lifestyle recommendations only, as the control group) were included. The ES group showed significant differences in terms of changes in QoL (MD 7.41, 95% CI 7.90 to 12.92, p = 0.008), episodes of incontinence (MD -1.33, 95% CI -2.50 to -0.17, p = 0.02), and the number of participants cured or improved (RR 1.46, 95% CI 1.14 to 1.87, p = 0.003), while the biofeedback group resulted in non-significant changes in QoL (MD 0.13, 95% CI -7.87 to 8.12, p = 0.98), episodes of incontinence (MD 0.01, 95% CI -0.89 to 0.90, p = 0.99), and the number of participants cured or improved (RR 1.15, 95% CI 0.99 to 1.33, p = 0.08), both compared to the control group respectively.

The main purpose of treatment is to reduce OAB symptoms and thus improve the patients’ QoL. Significant results in term of change in QoL, incontinence episodes, and cure/improvement rate are shown in patients undergoing low-frequency electrical stimulation as an adjuvant therapy when compared to PFMT alone or BT with lifestyle recommendations. These data suggest that pelvic ES may help with OAB treatment, as seen by a decrease in incontinence episodes and a higher improvement in QoL. Evidence of which parameters in the training protocol for ES are the most effective remains open for future investigation. In contrast, the biofeedback-assisted PFMT group revealed a non-statistically significant difference in those outcomes. These results show the benefits of biofeedback-assisted PFMT appear to be minimal for women with OAB.

This meta-analysis shows that low-frequency pelvic ES appears to be sufficient and effective as an additional intervention for women with OAB in clinical practice according to improvements in the subjects’ QoL and reduction of symptoms. Meanwhile, biofeedback-assisted PFMT does not appear to be a significant adjuvant for conservative OAB therapy.

Continence 2S2 (2022) 100361
DOI: 10.1016/j.cont.2022.100361