This study aimed to explore physiotherapists’ reasons for using biofeedback in female PFM rehabilitation.
177 physiotherapists participated. Most were women (n= 175, 99%), living in the global north (n=132, 75%). Participants were aged between 24 and 83 years old, with 1 to 36 years of PFM rehabilitation experience. The analysis made it possible to understand physiotherapists' clinical reasoning for using biofeedback is mainly the PFM function, pelvic floor dysfunctions (PFD) and in their professional experience. PFM biofeedback is delivered using ultrasound, electromyography and manometry with either vaginal, anorectal or perineal sensors. All described options were potentially ‘invasive’ (e.g. intravaginal, intra-anal) or ‘intimate’ (e.g. perineal electrode or perinal ultrasound probe). Choosing which one to use was centered on the patient's PFM function and type of pelvic floor dysfunction. Common patterns were:
(1) for PFM weakness or timing-deficient contractions, biofeedback via ultrasound or vaginal or anorectal electromyography with voluntary PFM contractions (isolated or “functional”) and a “strengthening” protocol. Electrical nerve stimulation was sometimes added during biofeedback.
(2) for difficulties with PFM relaxation or increased PFM tonus, biofeedback via vaginal electromyography with relaxation-focused PFM contractions and a “downtraining” protocol.
(3) for pelvic pain, dyspareunia, proprioceptive or body consciousness deficit, biofeedback via perineal electromyography, and isolated voluntary PFM contractions.
(4) for abdominopelvic dyssynergia, “defecation training” is performed with anorectal manometry.
Based on the reasons participants gave for these choices, the dominant source of evidence is ‘clinical expertise’ (i.e. past experiences). Patient experience, and preferences or involvement in shared decision-making were rarely mentioned. While the equipment and protocols used by participants are found in scientific literature, they overstated the evidence for the use of biofeedback which is equivocal for PFM weakness, and very limited for “downtraining” and “defecation training”.
Clinical experience may dominate decision-making about when, how, and for what reasons to use biofeedback in PFM rehabilitation. Physiotherapists may give less attention to women’s values, preferences, and circumstances or evidence of effectiveness.
Shared decision-making process can be improved in PFM rehabilitation.
pelvic floor
women's health
