Stress urinary incontinence (SUI) is a prevalent condition among women. Biofeedback (BF)-assisted pelvic floor muscle training (PFMT) is a widely used conservative treatment, but there is no consensus on the dosage of its application. This study aimed to establish a consensus among a group of experts on the dosage of BF-assisted PFMT in women with SUI.
A Delphi survey was conducted online from May to November 2024 using SurveyPluto. Recruited by purposive and snowball sampling, the participants included healthcare professionals or academics with at least two years of experience in treating women with SUI. In round one, experts provided demographic data and opinions on the BF-assisted PFMT dosage, and these were then converted into statements for round two. Rounds two and three involved ranking these statements on a 5-point Likert scale, with consensus defined as ≥70% agreement.
The expert panel consisted of 15 experts from eight countries. Response rates of 100%, 87%, and 93% were recorded across the three rounds. Initially, 11 treatment dosage principles were proposed in round one. These suggestions were converted into 17 statements for round two, with 11 items reaching consensus. There were two additional statements proposed by the expert panel in round two. Therefore, eight statements were carried forward to round three. All eight evaluated statements achieved consensus in round three. Combining the consensus statements from rounds two and three, a total of 19 recommendations were developed.
This Delphi study established a recommended BF-assisted PFMT dosage for women with SUI, which may provide exercise guidelines as a decision-support tool for managing SUI.
Stress urinary incontinence is common in women and refers to urine leakage during activities such as coughing, sneezing, exercise, or other physical effort. Pelvic floor muscle training is recommended as a first-line treatment, and biofeedback is often added to help women identify and correctly contract their pelvic floor muscles. However, there is currently no clear agreement on the recommended dosage of biofeedback-assisted pelvic floor muscle training.This study used a Delphi survey to develop expert consensus recommendations on treatment dosage for biofeedback-assisted pelvic floor muscle training in women with stress urinary incontinence. Fifteen experts, including physiotherapists, gynecologists, urologists, and rehabilitation physicians, from eight countries participated in the survey. Across three survey rounds, the panel reached consensus on 19 recommendations.The agreed recommendations suggest that training should include both fast and sustained pelvic floor muscle contractions, be performed regularly each week, and be continued over several months. The experts also recommended an initial supervised phase, followed by a home-based training phase, with ongoing use of biofeedback and regular clinical support to help women perform the exercises correctly and maintain training adherence.These recommendations may provide practical guidance for clinicians and researchers and help improve the consistency of biofeedback-assisted pelvic floor muscle training programs for women with stress urinary incontinence.
Current medical research and opinion. 2026 May 27 [Epub ahead of print]
Shirley Zhaoxue Liu, Stanley John Winser, Yingchun Zhang, Roger Dmochowski, Gladys L Y Cheing, Priya Kannan
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong., Department of Biomedical Engineering, Desai Sethi Urology Institute, and Miami Project to Cure Paralysis, University of Miami, Florida, USA., Department of Urology, Vanderbilt University Medical Center, Nashville, USA., Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.