Chapter 3 84 in patients with PVD45 pain and muscle resting tone improved but unfortunately, sexual function was not investigated. Three studies45,46,48 showed that PFPT decreased vulvar pain and pain during intercourse. These findings suggest that PFH is a maintaining factor in vulvar pain syndromes. Sexual function was also improved in patients who did not present with sexual problems as their primary complaint.35,49 QoL improved significantly in 6 of 8 studies,35,44,45,48-50 but no improvement was seen in the 2 RCTs that measured QoL.51,52 These were the RCTs in patients with IC/ PBS, the majority of whom had high pain ratings during treatment. Possibly other contributing factors may be involved that affect their QoL, such as depression and anxiety as a consequence of chronic pain.54 An outcome measure related to QoL, self-reported global perceived effect, improved significantly in all four studies that assessed this variable.35,49,51,52 Surprisingly, the RCT52 with the largest sample of IC/ PBS patients did report greater global perceived effect than the controls. Even though their symptoms did not improve significantly, patients apparently did feel that the treatment was worthwhile. The authors of the study neither noted nor discussed this discrepancy. Other than a possible placebo effect, we have no explanation for this finding. Several limitations of the studies in this systematic review impede the interpretation of the findings, such as the heterogeneity of patient groups and outcome measures, the small number of RCTs that met our inclusion criteria and the wide range of treatment modalities. In addition, an RCT is a prerequisite for preventing selection bias, performance bias and detection bias which was a common limitation in most of the studies reviewed. Treatment programmes varied considerably in their content and duration and some data were incompletely reported. Most studies did not present follow-up data of adequate duration. In addition, none of the 10 studies were of high quality. Although muscle resting tone improved in most studies that measured this, these findings should be interpreted with caution. Muscle resting tone was mostly quantified by digital palpation using various scales. These scales require a subjective interpretation on the part of the assessor and in some studies, the physical therapist providing the treatment was also the one assessing improvement. This may have biased the findings towards a positive outcome. In three studies muscle resting tone and function was established using more objective measures such as s-EMG,44,45,48 but caution is warranted in clinical use and interpretation of this measure as well. Many factors influence amplitude, skin conductance and artefacts. Other common problems
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