3 Systematic review of treatment efficacy of PFPT 59 stress-system and should thus be regarded as a physical manifestation of emotional dysregulation. Clinically, PFH is diagnosed by digital palpation of the pelvic floor. This includes assessment of muscle tone (resistance provided by a muscle when a pressure or a stretch is applied to it) and muscle function (voluntary contractility, strength, endurance, repeatability, co-contraction, and relaxation ability).8,13,24,25 There is no single accepted or standardized way of measuring muscle tone and there are no normative values.13 Digital palpation can be combined with the use of surface electromyography (s-EMG) and dynamometry.8,26 To access pain and MTrPs, patientreported outcome measures can be used and include numerical rating scales, visual analog scales (VAS) 27,28 and simple verbal pain rating scales.13 Pelvic floor physical therapy (PFPT) is considered to be an important part of treatment of PFH and includes strategies to optimize lumbopelvic, spinal and pelvic floor muscle function and to improve urinary, defecatory and sexual function.29-31 The aim of PFPT for PFH is to increase awareness and proprioception, to improve muscle relaxation and elasticity of the pelvic floor and to reduce pain. Interventions consist of education about the pelvic floor and related symptoms, behavioural modifications, exercises aimed at pelvic floor awareness and relaxation combined with soft-tissue manipulation and myofascial release.30,32-35 Another frequently used treatment modality is s-EMG to register pelvic floor muscle activation with intravaginal or-anal electrode probes.36,37 Electrogalvanic stimulation is used to improve muscle proprioception and relaxation of the pelvic floor muscles and is used as form of neuromodulation for pain relief.38-41 To date, efficacy of this range of treatments is not yet well established. Investigation by systematically reviewing the effectiveness of PFPT for PFH as a stand-alone entity has not yet been performed. The goal of this review was to systematically appraise the current literature on the effectiveness of PFPT for the treatment of PFH. Material and Methods Search strategy This systematic review adhered to guidelines detailed in the Preferred reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.42 A comprehensive literature search was conducted using the following electronic databases: MEDLINE, Embase, Emcare, and the Cochrane Central Register of Controlled Trials (Wiley Interface, current issue) from inception until February 2020.
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