Consensus-based recommendations on treatment dosage for biofeedback-assisted pelvic floor muscle training in women with stress urinary incontinence: a Delphi study

Background: 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. Methods: 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. Results: 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. Conclusion: 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.