(141) MULTIMODAL PHYSIOTHERAPY FOR CHRONIC PELVIC PAIN IN WOMEN – A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Starzec-Proserpio M , Frawley H , Bo K , Morin M 
Published: December 2024

Abstract

Introduction
Chronic pelvic pain (CPP) significantly burdens both women and society, often leading to adverse cognitive, behavioral, and emotional consequences. Additionally, over 80% of women with CPP may experience sexual dysfunction. Multimodal physiotherapy is well-suited to address these challenges as it incorporates various therapies and modalities that enable the integration of biopsychosocial interventions. However, there is currently a limited understanding of the effectiveness of this approach for CPP, and a comprehensive review of the existing literature is needed.

Objective
This study aimed to assess the effectiveness of multimodal physiotherapy approaches in women with CPP.

Methods
Eight electronic databases were systematically searched for randomized-controlled trials targeting women with CPP without a defined pathology, disease, or event (e.g., cancer, infection). Trials comparing multimodal physiotherapy (i.e., comprehensive approaches within the scope of physiotherapy, involving several different interventions, such as education, pelvic floor muscle exercises, massage, self-management strategies) to inert (e.g., placebo, waitlist, usual care) or non-conservative treatment (e.g., surgical, pharmacological) were included. All study data were aggregated, and effects on pain intensity, sexual measures (e.g., sexual function, sexual distress), and psychological function (e.g., anxiety, depression) were analyzed for the purpose of this abstract. Meta-analyses (using a random effects model) were conducted whenever possible (≥ 5 studies), considering post-treatment value scores. The obtained standardized mean difference values were converted to a mean difference (MD) on a 0-10 pain scale. The value of 1.1 points was interpreted as a minimal, clinically meaningful threshold for between-group differences. The quality of the evidence was assessed with the PEDro scale, and the certainty of the evidence with Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria.

Results
Seven trials investigating multimodal physiotherapy approaches were included and most of them (n = 5) had moderate-to-high methodological quality. Meta-analyses revealed that multimodal physiotherapy resulted in significantly lower pain intensity compared to inert or non-conservative treatment at both the post-treatment (MD −2.87 [95% CI −4.32, −1.45]; high certainty of evidence as assessed with the GRADE) and 12-36 weeks follow-up (MD −3.09 [95% CI −5.32, −0.88]; moderate certainty of evidence). Meaningful effects (MD ≥ 1.1) for between-group differences favoring multimodal physiotherapy were observed regardless of the comparator (inert or non-conservative treatment). Sexual measures were investigated in 4 trials, but only three used validated outcomes assessing sexual function and/or sexual distress. These demonstrated the superiority of multimodal physiotherapy over control treatment. Similarly, four trials investigated the effects on psychological function. Of the three that provided between-group comparisons, multimodal physiotherapy showed superior results over the control group for at least one psychological outcome measured.

Conclusions
The findings suggest that multimodal physiotherapy approaches are effective for women with CPP, with a high certainty of evidence for significant and clinically meaningful lower pain intensity at post-treatment compared to inert or non-conservative treatment. Therefore, this approach should be offered as a first-line, non-pharmacological, conservative treatment option.

Disclosure
No.