Chapter 3 62 external manipulation of the pelvic floor and surrounding muscles;35,45,46,48-52 insertion techniques using dilatators,45 muscle exercises focused on awareness and relaxation;35,44,46,48,49,51,52 infrared thermotherapy,48 home exercises35,45-49,51,52 and bladder training.47 Four studies used s-EMG44,45,47,48 and 2 studies used electrogalvanic stimulation.45,46 Treatment in the control-arm of the 4 RCTs consisted of no-treatment,46 western massage of lower back muscles,51,52 heat applied to lower back and myofascial release of the abdominal diaphragm, piriformis and iliopsoas muscles.48 Results Search results In total, 570 studies were identified through electronic searches of which 237 duplicates were removed. Of the remaining 333 studies, 298 were excluded based on title and abstract screening. Thirty-five references were read in full, after which 25 references were excluded (see Figure 1 for exclusion reasons). A total of 10 studies met the inclusion criteria. Four studies were RCTs,46,48,51,52 there was one case study35 and 5 prospective cohort studies.44,45,47,49,50 No ongoing studies were found. Studies represented a total of 581 participants, samples sizes in the studies varied from 19 to 138 patients. Patients with sexual problems were investigated in 2 RCTs46,48 and in one prospective cohort study.45 These studies involved patients with dyspareunia and provoked vestibulodynia (PVD). Patients with interstitial cystitis and painful bladder syndrome (IC/PBS) were investigated in 2 RCTs51,52 and 1 prospective study.50 Patients with chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) were studied in one RCT,51 3 prospective studies44,47,49 and in the case study.35 Given the marked heterogeneity of the studies, with different indications, outcome measurements and interventions, all studies were narratively reviewed. Study quality assessment A summary of study design, patient characteristics, sample size, interventions, outcome assessments and findings are listed in Table 2. The quality assessment (see Figure 2) related to selection bias indicated a high risk of bias for six studies due to the absence of randomization or a comparison group. Blinding of participants and personnel for treatment received was feasible in none of the studies. Blinding of outcome assessment was at high risk in eight studies.35,44-48,50,51
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