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Non-surgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness

Slide: 32 of 50

Continence and Improvement From Nonpharmacological Interventions for Stress UI

Nonpharmacological interventions promote continence and improve symptom severity for patients with stress UI, as described below.

Evaluation of 10 studies of 959 participants that examined PFMT for ability to achieve continence found that the rates of continence for groups using PFMT were 3.7-fold that of control groups. 299 reports of continence per 1,000 treated patients can be attributed to the intervention (statistically valid range from 188 to 410 reports). The strength of evidence for this finding is high. In 6 studies of 510 participants, reports of clinically important improvement in incontinence were 5.44-fold more likely with PFMT (statistically valid range from 1.57- to 18.83-fold) than for the control group, with 412 events per 1,100 treated (statistically valid range from 174 to 649 reports) attributable to the intervention. The strength of evidence for this finding is moderate.

Evaluation of 2 studies of 185 participants that evaluated PFMT plus biofeedback found that the rate of continence with PFMT plus biofeedback was 11-fold that of control groups, with a statistically valid range from 2.21- to 56.44-fold. 490 reports of continence per 1,000 treated patients can be attributed to the intervention. However, the analysis for events per 1,000 did not achieve conventional levels of statistical significance. The strength of evidence for this finding is low. In 4 studies of 383 participants, reports of clinically important improvement in incontinence were 3.93-fold more likely with PFMT plus biofeedback (statistically valid range from 1.00- to 15.49-fold) than for the control group, with 390 events per 1,000 treated patients (statistically valid range from 170 to 610 reports) attributable to the intervention. The strength of evidence for this finding is high.

Evaluation of seven studies of 420 participants that evaluated electrical stimulation for ability to achieve continence found that the rates of continence for groups using electrical stimulation were 2.86-fold that of control groups, with a statistically valid range for the result from 1.57- to 5.23-fold. 162 reports of continence per 1,000 treated patients can be attributed to the intervention, with a statistically valid range for the outcome from 64 to 259 reports. The strength of evidence for this finding is high. In 8 studies of 582 participants, reports of clinically important improvement in incontinence were 2.01-fold more likely with electrical stimulation (statistically valid range from 1.28- to 3.15-fold) than for the control group, with 156 events per 1,000 treated patients (statistically valid range from 84 to 228 reports) attributable to the intervention. The strength of evidence for this finding is high.

Evaluation of 3 studies of 171 participants that examined magnetic stimulation for ability to achieve continence found no statistically significant difference in continence rates between intervention and control groups. The strength of evidence for this finding is moderate. In 3 studies of 153 participants, reports of clinically important improvement in incontinence were 2.3-fold more likely with magnetic stimulation (statistically valid range from 1.43- to 3.71-fold) than for the control group, with 265 events per 1,000 treated patients (statistically valid range from 112 to 417 reports) attributable to the intervention. The strength of evidence for this finding is moderate.