Of interest is that very few of the studies to date have incorporated functional retraining. This may be an important omission since there is little point in having strong muscles which are not activated in the right time and place. Costs have not been considered in this review, and need to be considered in future studies. If results are able to be achieved more quickly and at a lower cost with the same outcome, then this represents a superior outcome. Biofeedback is an example of where initial gains may be achieved more quickly and the overall number of treatments required may be less.
Further research is required to determine the cost effectiveness of conservative management options.
The women for whom conservative management appears to be most successful were not considered by the review. A vast array of exercise parameters was utilised in the studies reviewed and the effect of motivation and adherence to an exercise program were not considered. These factors should be considered when interpretating the findings of this review. This paper highlights the shortcomings in the research conducted to date and should encourage physiotherapists working in the area to answer the important questions of what exercise regimen is most effective, for whom and for how long. Randomised, observer-blind trial.