The Effect of Home Biofeedback Training on Stress Incontinence

This study was conducted to investigate the efficacy of biofeedback in pelvic floor training for treatment of stress urinary incontinence. Thirty-five consecutive patients who had previously untreated urodynamic stress urinary incontinence were randomized to receive instruction in pelvic floor training (PFT) with adjunctive biofeedback or PFT alone.All participants underwent 12 weeks of intensive physiological training. Each visited the same physiotherapist at 0, 1, 4, 8, and 12 weeks. After 1 year, study subjects returned for a follow-up visit. They reported previous surgery or other treatment for stress urinary incontinence. A leakage index described by Bo, which evaluates urinary leakage involved with 13 different kinds of physical activity, was used to measure subjective outcomes at 12 weeks and 12 months.Biofeedback patients were instructed in the use of a personal, electromyography-assisted, home biofeedback device (FemiScan; MegaElectronics, Kuopio, Finland). At each visit, 3 3-second contractions with 10-second intervals were measured in the supine and standing positions. Patients kept records of training sessions with and without the device. The data from the devices were downloaded. At the end of the 12-week period, the devices were returned and patients were instructed to continue training at home.Women randomized to PFT alone received verbal and written instructions in both long- and short-duration exercises designed to strengthen both type I and type II muscle fibers. Practice sessions of 20 minutes' duration 5 days a week were recommended as well as practice during times of rest throughout the week. Patients were asked to keep a training diary and continue their exercises.There were 16 women in the home biofeedback group and 19 in the PFT alone group. Biofeedback patients had a mean 68 home training sessions (range, 10-131) recorded by the biofeedback device. In addition, they reported an average of 46 (range, 6-76) practice sessions without the device. Two patients discontinued the use of the home biofeedback device and practiced PFT alone. Women in the PFT-alone group recorded a mean of 61 training days (range, 21-87). One woman did not return her training diary.At the 1-year follow-up period, 2 participants could not be contacted and 2 could only be evaluated by telephone. Of the remaining 31 patients, 5 women in the biofeedback group (31%) and 9 in the PFT group (47%) had undergone or were awaiting incontinence surgery. The 10 women from the biofeedback group who did not undergo surgery had demonstrated a significant increase in pelvic floor muscle activity (P = 0.005 in the supine and standing positions) and decrease in leakage index (P = 0.05) during intensive the 12-week intensive biofeedback training period. This was the only group, including those with and without operation and with and without biofeedback, who had a statistically significant improvement at the end of the intensive 12-week period. None of the groups demonstrated any improvement in urinary incontinence measures from 12 weeks to 1 year.