Effect of Rehabilitative Ultrasound Imaging (RUSI) Biofeedback on Improving Pelvic Floor Muscle Function in Individuals With Stress Urinary Incontinence: A Systematic Review

Background: Pelvic floor muscle training is a common intervention for the treatment of stress urinary incontinence (SUI). One method utilized to augment muscle training is biofeedback. Rehabilitative ultrasound imaging (RUSI) is a noninvasive biofeedback tool. Objectives: The purpose of this review was to determine the effect of RUSI on pelvic floor muscle function, quality of life, volume of urinary leakage, and severity of urinary leakage in females and males with urinary incontinence and, when possible, compare these results to those of other biofeedback interventions. Study Design: Systematic review. Methods: PubMed, CINAHL, Science Direct, Scopus, Web of Science, and MEDLINE were searched for titles from peer-reviewed journals and conference proceedings from January 2010 to May 2020. An updated search was performed in January 2021. Inclusion criteria included studies with participants 18 years or older with urinary incontinence. The primary experimental intervention was transabdominal or transperineal RUSI. Results: Nine studies were included in this review. The ability to correctly contract the pelvic floor was achieved by more than 95% of participants following RUSI biofeedback training. Although outcomes were not consistently reported, RUSI intervention resulted in a decrease in incontinence severity and number of incontinence episodes per week, as well as improved pelvic floor strength, self-rating of improvement, task-specific self-efficacy, and quality of life. Conclusion: The results of this review provide moderate evidence to support the use of RUSI biofeedback via a transabdominal or transperineal approach in males and females with SUI to improve motor performance of the pelvic floor.