Chapter 3 60 Protocol registry (http://www.clinicaltrials.gov) was screened for upcoming trials. The search strategy was developed by a health science librarian with experience in systematic review searching. Different relevant search terms (thesaurus terms and terms in title, abstract or both) concerning PFH and PFPT were used. The following medical subject headings and text words were used: hypertonicity of the pelvic floor, overactive pelvic floor, non-relaxing pelvic floor, micturition disorder, defecation disorder, sexual dysfunction, chronic pelvic pain, physical therapy, myofeedback and electrogalvanic stimulation. The reference lists of eligible studies and relevant systematic reviews were searched for additional articles that were not found in the main search. Search strings are listed in Appendix 1. Inclusion and exclusion criteria Randomized control trials (RCTs), cross-over studies, prospective and retrospective cohort studies and case studies involving PFPT in patients with PFH were included in the review. Inclusion criteria were men and/or women (>18 years) with pelvic floor problems and complaints suggestive of PFH; muscle tone diagnosed by palpation and/or s-EMG; adequate description of the intervention. Studies with the following outcome measures were eligible: pelvic floor muscle tone, pain, sexual function, quality of life, pelvic floor symptoms and patient’s perceived effect. Studies had to be original, available as full-text and written in English. Studies with patients with neurological diseases, low pelvic floor muscle tone, medication, surgery, sacral neuromodulation, and percutaneous tibial nerve stimulation were excluded. Data collection and analysis Two authors independently selected studies by screening titles and abstracts followed by full text screening. Any discrepancies were resolved by discussion until consensus. The following data were extracted: first author, year of publication, country, inclusion and exclusion criteria, sample size, participants characteristics (such as age, gender, sample size), study design, details of the pelvic floor interventions, outcomes measurements, and outcome. Level of bias was evaluated using the Cochrane Collaboration’s Risk of Bias criteria. For each of these risk domains, studies were categorized as at low, uncertain, or high risk of bias based on random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective outcome reporting and other bias.43
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