Intervention
The intervention entailed 12 sessions with a duration of 45-60 minutes for each visit. The exercise period lasted on average 3.7 (range 2.6-6.7) months. The participants met weekly with a physiotherapist. If they cancelled, a new appointment was given in order to accomplish 12 sessions.
The NeuroTrack Simplex® biofeedback device with electromyographic vaginal sensors (Quintet, Norway) was used to facilitate the PFMT. Treatment was customized to each woman´s capacity within a protocol encouraging 10 close to maximum contractions and 5 second holding periods with a 10 second rest between each contraction. During the first two appointments women were coached to do two exercise sets during every visit with a rest in between and thereafter 3 x 10 contractions if possible. The participants used the biofeedback device to aid progress and to help with relaxation between each contraction. During visits 8-9, the women were asked to add three fast contractions at the end of each contraction and do so in the remaining sessions.20
Women in the TG were asked to do home exercises of 10 close-to-maximum PFM contractions, three sets/day and use the „knack“ (pre-contracting the PFM before coughing and sneezing).21 They were encouraged to adhere to the home training program and to register daily exercises in a training diary. During each visit they were encouraged to adhere to the home exercises.
The short-term evaluation was done within a week after the last training session. Long-term assessment was one year after childbirth. At both time-points women answered the APFQ. During the long-term appointment participants also answered a questionnaire about PFMT adherence. The CG women had no further follow-up after recruitment, which included general instructions and assessment of PFM contractions, but they were not discouraged from doing PFM exercises. The main assessor was blinded to group allocation throughout the study.