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.

Investigate 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). Design: Three-arm, single-blinded randomized controlled trial Setting: University laboratory Participants: Fifty-three postpartum women with PPGP randomized into stabilization exercise with TAUS-guided biofeedback (BIO+EXE), exercise (EXE), and control (CON) groups. Interventions: The 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 measures: Primary 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). Results: The 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. Conclusions: Integrated 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 © 2024 Chartered Society of Physiotherapy