3 research outputs found
Retroalimentaci贸n (feedback) o biorretroalimentaci贸n (biofeedback) para aumentar el entrenamiento muscular del piso pelviano en la incontinencia urinaria de la mujer
Antecedentes: El entrenamiento muscular del piso pelviano (EMPP) es un tratamiento efectivo para la incontinencia urinaria de esfuerzo en la mujer. Aunque en su mayor铆a los ensayos de EMPP se han realizado en mujeres con incontinencia urinaria de esfuerzo, tambi茅n hay algunas pruebas de ensayos de que el EMPP es efectivo en la incontinencia urinaria de urgencia y la incontinencia urinaria mixta. La retroalimentaci贸n o biorretroalimentaci贸n son complementos habituales utilizados juntos con el EMPP para ayudar a ense帽ar a contraer el m煤sculo del piso pelviano de forma voluntaria o mejorar la realizaci贸n del entrenamiento.
Objetivos: Determinar si la retroalimentaci贸n o biorretroalimentaci贸n a帽ade un beneficio adicional al EMPP en las mujeres con incontinencia urinaria. Comparar la efectividad de diferentes formas de retroalimentaci贸n o biorretroalimentaci贸n.
Estrategia de b煤squeda: Se realizaron b煤squedas en el Registro Especializado de Ensayos del Grupo Cochrane de Incontinencia (Cochrane Incontinence Group) (b煤squeda 13 de mayo de 2010) y en las listas de referencias de los art铆culos pertinentes.
Criterios de selecci贸n: Ensayos aleatorios o cuasialeatorios en mujeres con incontinencia urinaria de esfuerzo, de urgencia o mixta (seg煤n los s铆ntomas, los signos o la urodinamia). Al menos dos brazos de los ensayos incluyeron EMPP. Adem谩s, al menos un brazo incluy贸 retroalimentaci贸n verbal o biorretroalimentaci贸n mediada por un dispositivo.
Obtenci贸n y an谩lisis de los datos: La elegibilidad y el riesgo de sesgo de los ensayos se evaluaron de forma independiente. Dos revisores extrajeron los datos y los verificaron de forma cruzada. Los desacuerdos se resolvieron mediante discusi贸n o la opini贸n de un tercer revisor. El an谩lisis de los datos se realiz贸 seg煤n el Manual Cochrane para Revisiones Sistem谩ticas de Intervenci贸n (Cochrane Handbook for Systematic Reviews of Interventions) (versi贸n 5.1.0). El an谩lisis dentro de los subgrupos se bas贸 en la existencia de una diferencia en el EMPP entre los dos brazos que se hab铆an comparado.
Resultados principales: Veinticuatro ensayos que inclu铆an a 1583 mujeres cumpl铆an los criterios de inclusi贸n; 17 ensayos contribuyeron con datos para el an谩lisis de uno de los resultados primarios. Todos los ensayos contribuyeron con datos para uno o m谩s de los resultados secundarios. Las mujeres que recibieron biorretroalimentaci贸n tuvieron significativamente m谩s probabilidades de informar que su incontinencia urinaria se hab铆a resuelto o hab铆a mejorado en comparaci贸n con las que recibieron EMPP solo (cociente de riesgos 0,75; intervalo de confianza del 95%: 0,66 a 0,86). Sin embargo, fue frecuente que las mujeres de los brazos de biorretroalimentaci贸n tuvieran m谩s contacto con el profesional sanitario que las de los brazos de ninguna biorretroalimentaci贸n. Muchos ensayos presentaron un riesgo de sesgo de moderado a alto, seg煤n los informes de los ensayos. Hubo mucha variedad en los reg铆menes propuestos para agregar retroalimentaci贸n o biorretroalimentaci贸n al EMPP solo, y a menudo no estuvo claro lo que incluy贸 la intervenci贸n real o cu谩l fue el objetivo de la intervenci贸n.
Conclusiones de los autores: La retroalimentaci贸n o biorretroalimentaci贸n puede proporcionar efectos beneficiosos adem谩s del entrenamiento muscular del piso pelviano a las mujeres con incontinencia urinaria. Sin embargo, se necesitan estudios de investigaci贸n adicionales para diferenciar si es la retroalimentaci贸n o biorretroalimentaci贸n la que causa el efecto beneficioso o alguna otra diferencia entre los brazos del ensayo (como el mayor contacto con los profesionales sanitarios)
Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women: shortened version of a Cochrane systematic review
Feedback and biofeedback (BF) are common adjuncts to pelvic floor muscle training (PFMT) for women with stress, urgency, and mixed urinary incontinence (UI). An up to date systematic review of adjunctive feedback or BF was needed to guide practice and further research. To determine whether feedback or BF add benefit to PFMT for women with UI. The Cochrane Incontinence Group Specialised Trials Register was searched (May 2010) for randomised or quasi-randomized trials in women with stress, urgency or mixed UI regardless of cause, which compared PFMT versus PFMT augmented with feedback or BF. Two reviewers independently undertook eligibility screening, risk of bias assessment and data extraction. Analysis was in accordance with the Cochrane Handbook for Systematic Reviews of Intervention (version 5.0.2). Twenty-four trials were included, and many were at moderate to high risk of bias. Women who received BF were less likely to report they were not improved (RR 0.75, 95% CI: 0.66-0.86), although there was no statistically significant difference for cure (RR 0.92, 95% CI: 0.81-1.05) and marginal statistical significance for leakage episodes (mean difference: -0.12 leaks/day, 95% CI: -0.22 to -0.01). It is possible the results are confounded because women in the BF group commonly had more contact with the health professional than those in the PFMT only arm. BF may add benefit to PFMT but the observed effect could well be related to another variable, such as the amount of health professional contact rather than the BF per s
Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women
Pelvic floor muscle training (PFMT) is an effective treatment for stress urinary incontinence in women. Whilst most of the PFMT trials have been done in women with stress urinary incontinence, there is also some trial evidence that PFMT is effective for urgency urinary incontinence and mixed urinary incontinence. Feedback or biofeedback are common adjuncts used along with PFMT to help teach a voluntary pelvic floor muscle contraction or to improve training performance. To determine whether feedback or biofeedback adds further benefit to PFMT for women with urinary incontinence.To compare the effectiveness of different forms of feedback or biofeedback. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 13 May 2010) and the reference lists of relevant articles. Randomised or quasi-randomised trials in women with stress, urgency or mixed urinary incontinence (based on symptoms, signs or urodynamics). At least two arms of the trials included PFMT. In addition, at least one arm included verbal feedback or device-mediated biofeedback. Trials were independently assessed for eligibility and risk of bias. Data were extracted by two reviewers and cross-checked. Disagreements were resolved by discussion or the opinion of a third reviewer. Data analysis was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Intervention (version 5.1.0). Analysis within subgroups was based on whether there was a difference in PFMT between the two arms that had been compared. Twenty four trials involving 1583 women met the inclusion criteria; 17 trials contributed data to analysis for one of the primary outcomes. All trials contributed data to one or more of the secondary outcomes. Women who received biofeedback were significantly more likely to report that their urinary incontinence was cured or improved compared to those who received PFMT alone (risk ratio 0.75 , 95% confidence interval 0.66 to 0.86). However, it was common for women in the biofeedback arms to have more contact with the health professional than those in the non-biofeedback arms. Many trials were at moderate to high risk of bias, based on trial reports. There was much variety in the regimens proposed for adding feedback or biofeedback to PFMT alone, and it was often not clear what the actual intervention comprised or what the purpose of the intervention was. Feedback or biofeedback may provide benefit in addition to pelvic floor muscle training in women with urinary incontinence. However, further research is needed to differentiate whether it is the feedback or biofeedback that causes the beneficial effect or some other difference between the trial arms (such as more contact with health professionals