Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
African journal of reproductive health
Effects of kegel training combined with acupoint application in preventing postpartum pelvic floor dysfunction: A randomized controlled trial
This study investigated the early preventive benefits of combining Kegel exercises with acupoint application at Qi Hai and Guan Yuan points for addressing postpartum pelvic floor dysfunction (PFD). A total of 110 first-time mothers were randomized into two groups: the prevention group, which received the combined intervention, and the control group, which practiced only Kegel exercises. The interventions followed a structured schedule during the postpartum period. At 42 days postpartum, the prevention group showed a notably lower rate of urinary leakage and improved outcomes in Type II pelvic floor muscle strength, ICI-Q-SF scores, and Hamilton Anxiety Scale results (all P<0.05). However, there were no significant differences between the groups in Type I muscle strength, vaginal dynamic pressure, PFDI-20 scores, or anatomical positioning of the bladder and cervix (P>0.05). The treatments were well-tolerated, with only two minor cases of redness and itching at application sites. We conclude that combining Kegel exercises with acupoint application at Qi Hai and Guan Yuan points may effectively reduce postpartum urinary incontinence, strengthen specific pelvic floor muscles, and improve emotional well-being. Cette étude a examiné les bénéfices préventifs précoces de la combinaison d'exercices de Kegel avec l'application d'acupression sur les points Qi Hai et Guan Yuan pour traiter la dysfonction du plancher pelvien (DPP) post-partum. Au total, 110 primipares ont été randomisées en deux groupes : le groupe prévention, recevant l'intervention combinée, et le groupe témoin, pratiquant uniquement les exercices de Kegel. Les interventions ont suivi un calendrier structuré pendant la période post-partum. À 42 jours post-partum, le groupe prévention a montré un taux de fuites urinaires nettement inférieur et de meilleurs résultats pour la force musculaire de type II du plancher pelvien, les scores ICI-Q-SF et les résultats à l'échelle d'anxiété de Hamilton (tous p<0,05). Cependant, aucune différence significative n'a été observée entre les groupes pour la force musculaire de type I, la pression dynamique vaginale, les scores PFDI-20 ou la position anatomique de la vessie et du col de l'utérus (p>0,05). Les traitements ont été bien tolérés, avec seulement deux cas mineurs de rougeurs et de démangeaisons aux sites d'application. En résumé, combiner les exercices de Kegel avec l'acupression sur les points Qi Hai et Guan Yuan pourrait réduire efficacement l'incontinence urinaire post-partum, renforcer des muscles spécifiques du plancher pelvien et améliorer le bien-être émotionnel.
31 May 2026
Read appraisal →The Cochrane database of systematic reviews
Surgery for women with anterior compartment prolapse
BACKGROUND: Anterior compartment prolapse is the most common pelvic organ prolapse. Clinicians have utilised various surgical techniques to minimise the rate of recurrent pelvic organ prolapse (POP). OBJECTIVES: To determine the benefits and harms of surgery for anterior compartment prolapse. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register on 29 April 2024. This includes records indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov and WHO ICTRP. We also handsearched journals, conference proceedings and the reference lists of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared surgical operations in women with anterior compartment prolapse. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed their risk of bias and extracted their data. MAIN RESULTS: We included 41 RCTs evaluating 4531 women. The certainty of evidence ranged from very low to moderate due to risk of bias and imprecision. Anterior native tissue repair versus biological graft at 1 to 2 years There is likely little to no difference between these two methods in terms of awareness of prolapse (RR 1.20, 95% CI 0.80 to 1.81; 5 RCTs, 515 women; moderate certainty). Native tissue repair likely increases the risk of recurrent anterior compartment prolapse (RR 1.53, 95% CI 1.19 to 1.97; 8 RCTs, 707 women; moderate certainty); the result suggests that if 21% of women had recurrent prolapse after biological graft, 24% to 40% would have recurrence after native tissue repair. There may be little to no difference between native tissue repair and biological graft repair groups for repeat surgery for prolapse (RR 0.99, 95% CI 0.45 to 2.17; 6 RCTs, 524 women; low certainty). Surgery for stress urinary incontinence was not reported. There is likely little to no difference between groups in dyspareunia (RR 0.87, 95% CI 0.39 to 1.93; 2 RCTs, 151 women; moderate certainty). De novo dyspareunia was not reported. Anterior native tissue repair versus transvaginal anterior permanent mesh at 1 to 2 years Native anterior tissue repair likely results in more awareness of prolapse than anterior mesh repair (RR 1.77, 95% CI 1.37 to 2.27; 10 RCTs, 1203 women; moderate certainty); the result suggests that if 13% of women were aware of prolapse after mesh repair, 17% to 29% would be aware after native tissue repair. Native tissue repair may result in slightly increased recurrent anterior compartment prolapse (RR 3.21, 95% CI 2.27 to 4.55; 20 RCTs, 2483 women; low certainty). There was moderate heterogeneity (I2 = 73%). The result suggests that if 13% of women had recurrent prolapse after mesh repair, 29% to 58% would have recurrence after native tissue repair. Repeat surgery for prolapse is probably more likely after native tissue repair (RR 2.17, 95% CI 1.31 to 3.58; 14 RCTs, 1799 women; moderate certainty); the result suggests that if 2% of women required repeat surgery after mesh repair, 3% to 8% would do so after native tissue repair. There is likely little or no difference between groups in surgery for stress urinary incontinence (RR 1.32, 95% CI 0.73 to 2.40; 6 RCTs, 967 women; moderate certainty). There is likely little or no difference between groups for dyspareunia (RR 1.06, 0.59 to 1.90; 8 RCTs, 1096 women; moderate certainty). There is likely little or no difference between groups for de novo dyspareunia (RR 0.64, 95% CI 0.36 to 1.12; 11 RCTs, 797 women; moderate certainty); the result suggests that if 7% of women reported dyspareunia after mesh repair, 2% to 8% would do so after native tissue repair. Permanent anterior vaginal mesh versus abdominal sacrocolpopexy at 1 year There may be little to no difference between permanent anterior vaginal mesh and abdominal sacrocolpopexy groups in awareness of prolapse (RR 0.93, 95% CI 0.45 to 1.94; 3 RCTs, 441 women; low certainty). There was some heterogeneity (I2 = 37%). There is likely little or no difference between groups in recurrent anterior compartment prolapse (RR 0.95, 95% CI 0.46 to 1.97; 4 RCTs, 306 women; moderate certainty). There was some heterogeneity (I2 = 69%). The result suggests that if recurrent prolapse occurred in 26% of women after sacrocolpopexy, 12% to 51% would have recurrence after transvaginal mesh repair. There may be little or no difference between groups in repeat surgery for prolapse (RR 1.68, 95% CI 0.56 to 5.04; 3 RCTs, 455 women; low certainty). There may be little or no difference between groups in repeat surgery for mesh complications (RR 2.61, 95% CI 0.62 to 10.99; 2 RCTs, 373 women; low certainty); the result suggests that if 1% of women needed repeat surgery for mesh exposure after sacrocolpopexy, 0.5% to 12% would do so after transvaginal mesh repair. There may be little or no difference between groups in surgery for stress urinary incontinence (RR 0.78, 95% CI 0.20 to 3.12; 2 RCTs, 299 women; low certainty). There was some heterogeneity (I2 = 60%). Dyspareunia was not reported. De novo dyspareunia is probably more likely to be reported with permanent anterior vaginal mesh than after abdominal sacrocolpopexy (RR 2.15, 95% CI 1.17 to 3.98; 2 RCTs, 248 women; moderate certainty); the result suggests that if 10% of women reported dyspareunia after abdominal sacrocolpopexy, 12% to 40% would do so with permanent anterior vaginal mesh. AUTHORS' CONCLUSIONS: Recurrence is probably more likely after native tissue repair than with biological graft or absorbable synthetic mesh at one to two years. We found no data for surgery for stress urinary incontinence. Anterior native tissue repair likely increases awareness of prolapse, recurrence and surgery for prolapse compared with transvaginal anterior permanent mesh repair. It is likely that fewer women report dyspareunia after abdominal sacrocolpopexy than with permanent mesh repair. For other outcomes, there was little or no difference between the groups being compared. Many of the transvaginal permanent meshes evaluated have been removed from the market because of reported complications. Five studies tested mesh kits that are currently available. We suggest that clinicians and women use caution when utilising these products as their long-term safety and efficacy have not yet been established.
28 Apr 2026
Read appraisal →Medicine
Clinical study on the efficacy of electroacupuncture combined with pelvic floor muscle training for female stress urinary incontinence
BACKGROUND: To evaluate the clinical efficacy and synergistic effects of electroacupuncture (EA) combined with pelvic floor muscle training (PFMT) in the treatment of mild-to-moderate stress urinary incontinence (SUI) in women. METHODS: A single-blind (assessor-blinded), 2 × 2 factorial, randomized controlled trial was conducted. A total of 128 SUI patients were allocated to 4 groups: the EA group (sessions every other day, targeting acupoints including Guanyuan [RN4] and Shenshu [BL23]), PFMT group (3 daily sessions), combination group (EA + PFMT), and waitlist group. The intervention lasted for 4 weeks. The primary outcome was the change in 1-hour pad test leakage volume. Secondary outcomes included 72-hour urinary incontinence episodes and International Consultation on Incontinence Questionnaire-Short Form scores. Data were analyzed using intention-to-treat and factorial analysis of variance. RESULTS: The combination group showed the greatest reduction in leakage volume (6.17 g, 95% confidence interval [CI] = 5.89-6.44), significantly outperforming the EA group (4.53 g, 95% CI = 4.26-4.81), PFMT group (2.13 g, 95% CI = 1.85-2.41), and waitlist group (0.38 g, 95% CI = 0.11-0.66; all P < .001). Factorial analysis confirmed significant main effects for EA (mean difference = 5.35 g, 95% CI = 5.15-5.54) and PFMT (mean difference = 4.15 g, 95% CI = 3.95-4.34; both P < .001), but no interaction effect (P = .686). Secondary outcomes showed consistent improvements in incontinence episodes and International Consultation on Incontinence Questionnaire-Short Form scores. CONCLUSION: Combined EA and PFMT significantly alleviated SUI symptoms. Although no synergy was observed, the additive therapeutic effect provided clinical benefits, offering a promising nonsurgical alternative for SUI management.
20 Apr 2026
Read appraisal →European journal of pediatrics
Efficacy of physiotherapeutic interventions in the management of functional constipation in pediatric and adolescent populations: a systematic review and meta-analysis
UNLABELLED: To evaluate the efficacy of physiotherapeutic interventions in the management of functional constipation (FC) in pediatric and adolescent populations, and to analyze the methodological quality of the available evidence. A systematic review of randomized controlled trials (RCTs) published in PubMed, Cochrane Library, Embase, and Web of Science was conducted (February-March 2025). Studies including participants aged 18 years diagnosed with FC, treated with pelvic floor physiotherapy versus conventional medical treatment, were included. Methodological quality was assessed using the PEDro scale (Physiotherapy Evidence Database). Seven clinical trials were included in the meta-analysis with sample sizes ranging from 45 to 400 participants (total n = 775). The interventions covered pelvic floor exercises, biofeedback, telerehabilitation, visceral mobilization, and electrostimulation. The majority showed improvements in painful defecation, fecal consistency, and quality of life, with less consistent results in defecatory frequency (MD = 1.00; 95% CI: 0.35 to 1.65). However, the marked heterogeneity in protocols (type, intensity, duration), variability in assessment instruments, and frequent co-intervention with polyethylene glycol (PEG) hinder comparison between studies and limit external validity. Follow-ups shorter than 12 months and the absence of blinding of participants and therapists constitute additional risks of bias. CONCLUSIONS: Pelvic floor physiotherapy appears to be a promising adjuvant intervention in the treatment of pediatric FC, with positive effects on symptoms and quality of life. Nevertheless, multicenter trials with standardized protocols, large samples, and prolonged follow-up are required to confirm its efficacy and long-term sustainability. WHAT IS KNOWN: •Despite the clinical use of physiotherapy, there was no quantitative synthesis integrating its efficacy against standard medical treatment, nor had its specific effect size on defecatory pain and quality of life been established in the pediatric population. WHAT IS NEW: •This meta-analysis confi rms that pelvic fl oor physiotherapy is an eff ective adjuvant with a large effect size, demonstrating consistent improvements in reducing painful defecation and enhancing the biopsychosocial dimensions of quality of life.
12 Apr 2026
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