3 Systematic review of treatment efficacy of PFPT 83 Discussion Three of 4 RCTs found positive effects of PFPT compared to controls on five of six outcome measurements (pelvic floor muscle resting tone and function, various features of pain, sexual function, pelvic floor symptoms, and patient’s perceived effect). QoL remained unchanged in 2 of 3 RCTs. The 5 prospective studies found significant improvements from pre- to post-treatment on all the outcome measures that they assessed (pelvic floor muscle resting tone and function in 3 studies; pain in all studies; sexual function in one study; pelvic floor symptoms in 4 studies, QoL in 4 studies and patients perceived effect in 1 study). Finally, the case study found positive effects on all outcome measures that were assessed (pain, sexual function, symptoms, QoL and patients perceived effect). Taken together, the findings of this systematic review suggest that PFPT can be beneficial in patients with PFH. However, it should be noted that the RCT52 with the largest sample size demonstrated an effect of PFPT in only 1 of 5 outcome measures, namely patient’s perceived effect. This was 1 of 2 RCTs51,52 that measured the least effect of PFPT in patients with IC/ PBS. It is not entirely clear why this particular RCT yielded negative results. Possibly, PFH in these patients is secondary to a visceral abnormality and therefore they may benefit less from PFPT than other PFH patient groups. The treatment modalities of PFPT used in this protocol may have been insufficient for this patient group, or perhaps the pain and urological complaints in this patient group was unrelated to PFH. This was also the study in which a substantial proportion of the participants (62%) reported at least one adverse event, the most common adverse event being pain in the bladder or pelvis. The high pain ratings may have negatively influenced the other outcome measurements. The other RCT51 had post treatment data of only 11 participants with IC/PBS and should therefore be considered less reliable. Treatment of PFPT proved to be most efficacious in improving muscle resting tone and function and pain. The 5 studies that measured muscle resting tone and function directly, all found significant improvements,44-46,48,50 and for pain 9 of 10 studies found pain to significantly decrease with PFPT. Interestingly, the 2 RCTs46,48 in women with dyspareunia found treatment effects in muscle function, a reduction in pain, as well as improvements in sexual function. Muscle function may be an important variable involved in sexual function. In an experimental study in women with PVD, Naess and Bø53 found maximal voluntary pelvic floor muscle contraction to reduce vaginal resting pressure and resting s-EMG activity. Their findings suggest that improving maximal voluntary pelvic floor muscle contractions are instrumental in treating PFH. In a study
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