Four RCTs (n=3,295) were included.
Three RCTs reported adequate allocation concealment, blinded assessment of the primary outcome, use of intention-to-treat analysis and calculation of power. Loss to follow-up was variable (6, 11, 29 and 36%). There was marked heterogeneity in the type and intensity of interventions in both groups, and also in outcome measures. Only two studies used validated measurement tools.
One RCT (n=676) reported a statistically significant reduction in severe incontinence in the intervention group at 3 months (response rate, RR 0.60, 95% confidence interval, CI: 0.40, 0.89), but no statistically significant effect at 12 months. A second RCT (n=747), in which all participants had incontinence, reported a statistically significant reduction in both incontinence and severe incontinence in the intervention group at 12 months (RR 0.87, 95% CI: 0.76, 0.99 and RR 0.62, 95% CI: 0.46, 0.84, respectively), but no significant difference between the groups at 6 years. Three quarters of women incontinent at baseline remained so at 6 years. The third RCT found a statistically significant reduction in severity of incontinence in the intervention group at 6 weeks, as measured by the urinary continence symptom score (mean difference -0.38. 95% CI: -0.72, -0.04), but no significant ongoing difference over the 12-month follow-up. The fourth RCT reported no statistically significant difference between the groups.
No statistically significant increase in pelvic muscle strength was reported over 6 months' follow-up (one RCT, n=72).
No statistically significant difference between the intervention and control groups was found for depression or general well-being. Hospital Anxiety and Depression Scale anxiety scores were lower in the intervention group at 12 months in one RCT (statistical significance not stated, n=747) and depression was reported significantly less frequently (p<0.05) in the intervention group in another RCT (n=1,800).
Three RCTs (n=1,495) reported that intervention group members were more likely to continue exercise than control group members at initial follow-up (58 to 100% and 42 to 66%, respectively). The numbers exercising declined over time and the RCT with the 6-year follow-up reported that equal numbers in each group (50%) were doing pelvic floor exercises at that stage.