Transabdominal ultrasonography-guided biofeedback training for pelvic floor muscles integrated with stabilization exercise improved pregnancy-related pelvic girdle pain and disability: a randomized controlled trial

Abstract

ObjectivesInvestigate effects of integrated training for pelvic floor muscles (PFM) with and without transabdominal ultrasonography (TAUS) imaging-guided biofeedback in postpartum women with pregnancy-related pelvic girdle pain (PPGP). DesignThree-arm, single-blinded randomized controlled trial SettingUniversity laboratory ParticipantsFifty-three postpartum women with PPGP randomized into stabilization exercise with TAUS-guided biofeedback (BIO+EXE), exercise (EXE), and control (CON) groups. InterventionsThe BIO+EXE and EXE groups underwent an 8-week exercise program, with the BIO+EXE group receiving additional TAUS-guided biofeedback for PFM training during the first 4 weeks. The CON group only received a pelvic educational session. Main outcome measuresPrimary outcomes included self-reported pain (numeric rating scale) and disability (pelvic girdle questionnaire). Secondary outcomes included functional tests (active straight leg raising [ASLR] fatigue, timed up-and-go, and 6-meter walking tests) and muscle contractibility indicated by muscle thickness changes for abdominal muscles and bladder base displacement for PFM (ultrasonographic measures). ResultsThe BIO+EXE group had lower pain [1.8 (1.5) vs. 4.4 (1.5), mean difference −2.6, 95% confidence interval (CI) −3.9 to −1.2] and disability [14% (10) vs. 28% (21), mean difference −14, 95% CI −25 to −2] and faster walking speed [3.1 seconds (1) vs. 3.3 seconds (1), mean difference −0.2, 95% CI −1.0 to −0.2] than the CON group. The EXE group only had lower pain intensity compared to the CON group [2.7 (2.0) vs. 4.4 (1.5), mean difference −1.7, 95% CI −3.1 to −0.4]. No significant differences were observed among groups in timed up-and-go, ASLR fatigue, or muscle contractibility. ConclusionsIntegrated training for PFM and stabilization with TAUS-guided biofeedback seems to be beneficial for reducing pain and disability in postpartum women with PPGP. Contribution of the paper•8-week integrated training for PFM and stabilization with TAUS imaging-guided biofeedback reduced pain and disability, although there was no change in abdominal muscle thickness and PFM function•Correct PFM contraction through visual biofeedback was effective and may be beneficial in the treatment of postpartum women with PPGP