{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:04:16Z","timestamp":1791644656217,"version":"4.3.4"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T00:00:00Z","timestamp":1652832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>It is estimated that over 400 million people worldwide experience some form of urinary incontinence (UI). Pelvic floor muscle training (PFMT) is commonly used in cases of urine loss. Game therapy (GT) has been suggested as a new conservative modality for UI treatments. GT represents a form of virtual reality (VR) that allows users to interact with elements of a simulated scenario. The purpose of this review was to assess the potential of using VR-based PFMT in the treatment of UI with a particular focus on the impact of this form of therapy on the patients\u2019 muscle function, symptoms of UI and quality of life (QoL). The following electronic databases were searched: PubMed, Embase, Cochrane Library, Scopus and Web of Science. Systematic review methods were based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Electronic medical databases were searched from inception to 28 January 2021. From a total of 38 articles, 26 were analyzed after removing duplicates, then 22 records were excluded according to inclusion criteria and 4 were assessed as full texts. Finally, 2 randomized controlled trials (RCT) with 79 patients were included. For the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the meta-analysis showed a significant difference in favor of the control condition (MD = 2.22; 95% CI 0.42, 4.01; I2 = 0%). Despite the popularity of the use of VR in rehabilitation, we found a scarcity of literature evaluating the application of VR in the field of UI therapy. Only one study matched all of the criteria established. The effects of VR training improved PFM function and QoL; however, these changes were comparable to those of traditional PFMT. It is not possible to reach final conclusions from one study; thus, further development of VR interventions in the field of UI treatments are needed.<\/jats:p>","DOI":"10.3390\/ijerph19106155","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T11:59:37Z","timestamp":1652875177000},"page":"6155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Use of Virtual Reality-Based Therapy in Patients with Urinary Incontinence: A Systematic Review with Meta-Analysis"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2456-8499","authenticated-orcid":false,"given":"Anna","family":"Rutkowska","sequence":"first","affiliation":[{"name":"Department of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8838-0399","authenticated-orcid":false,"given":"Silvia","family":"Salvalaggio","sequence":"additional","affiliation":[{"name":"Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, 30126 Venice, Italy"},{"name":"Padova Neuroscience Center, Universit\u00e0 degli Studi di Padova, Via Orus 2\/B, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8504-0129","authenticated-orcid":false,"given":"Sebastian","family":"Rutkowski","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1609-8060","authenticated-orcid":false,"given":"Andrea","family":"Turolla","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences\u2013DIBINEM, Alma Mater Studiorum Universit\u00e0 di Bologna, Via Massarenti 9, 40138 Bologna, Italy"},{"name":"Operative Unit Occupational Medicine, IRCCS Policlinico Sant\u2019Orsola-Malpighi, Via Pelagio Palagi 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1002\/nau.23551","article-title":"6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and Treatment of Urinary Incontinence, Pelvic Organ Prolapse and Faecal Incontinence","volume":"37","author":"Abrams","year":"2018","journal-title":"Neurourol. Urodyn."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1111\/j.1464-410X.2011.10498.x","article-title":"Worldwide Prevalence Estimates of Lower Urinary Tract Symptoms, Overactive Bladder, Urinary Incontinence, and Bladder Outlet Obstruction","volume":"108","author":"Griebling","year":"2011","journal-title":"Bju Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.urology.2009.12.043","article-title":"Prevalence of Urinary Incontinence in Men, Women, and Children-Current Evidence: Findings of the Fourth International Consultation on Incontinence REPLY","volume":"76","author":"Buckley","year":"2010","journal-title":"Urology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/nau.20798","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction","volume":"29","author":"Haylen","year":"2010","journal-title":"Neurourol. Urodyn."},{"key":"ref_5","first-page":"CD005654","article-title":"Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women","volume":"10","author":"Dumoulin","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","unstructured":"Tran, L.T., and Puckett, Y. (2020). Urinary Incontinence, StatPearls Publishing."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/j.juro.2013.10.050","article-title":"Urinary Incontinence Incidence: Quantitative Meta-Analysis of Factors that Explain Variation","volume":"191","author":"Stewart","year":"2014","journal-title":"J. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1097\/AOG.0b013e3181c2ce96","article-title":"Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050","volume":"114","author":"Wu","year":"2009","journal-title":"Obs. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s00192-013-2276-7","article-title":"Perceptions about female urinary incontinence: A systematic review","volume":"25","author":"Siddiqui","year":"2014","journal-title":"Int. Urogynecol. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"957","DOI":"10.2147\/CIA.S160057","article-title":"The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: A systematic literature review","volume":"13","author":"Radziminska","year":"2018","journal-title":"Clin. Interv. Aging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"721","DOI":"10.20344\/amp.12012","article-title":"Stress Urinary Incontinence and Female Sexual Dysfunction: The Role of Pelvic Floor Rehabilitation","volume":"32","author":"Preda","year":"2019","journal-title":"Acta Med. Port."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"84","DOI":"10.12968\/bjon.2016.25.2.84","article-title":"Assessment, diagnosis and treatment of urinary incontinence in women","volume":"25","author":"Ostle","year":"2016","journal-title":"Br. J. Nurs."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/0002-9378(48)90266-X","article-title":"Progressive resistance exercise in the functional restoration of the perineal muscles","volume":"56","author":"Kegel","year":"1948","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s00192-016-3123-4","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction","volume":"28","author":"Bo","year":"2017","journal-title":"Int. Urogynecol. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1002\/nau.1004","article-title":"Pelvic muscle activity in nulliparous volunteers","volume":"20","author":"Peschers","year":"2001","journal-title":"Neurourol. Urodyn."},{"key":"ref_16","unstructured":"Hayes, W. (2008). Evidence-Based Physical Therapy for the Pelvic Floor-Bridging Science and Clinical Practice, Cambridge Press."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Garcia-Sanchez, E., Avila-Gandia, V., Lopez-Roman, J., Martinez-Rodriguez, A., and Rubio-Arias, J.A. (2019). What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence? A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16224358"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1007\/s11255-019-02107-3","article-title":"Uroflow stop test with electromyography: A novel index of urinary continence recovery after RARP","volume":"51","author":"Boni","year":"2019","journal-title":"Int. Urol. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Milios, J.E., Ackland, T.R., and Green, D.J. (2019). Pelvic floor muscle training in radical prostatectomy: A randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence. BMC Urol., 19.","DOI":"10.1186\/s12894-019-0546-5"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"27","DOI":"10.5604\/01.3001.0014.4120","article-title":"The use of total immersion in the rehabilitation process","volume":"24","author":"Rutkowska","year":"2020","journal-title":"Med. Rehabil."},{"key":"ref_21","unstructured":"Swadley, R. (1993). Welcome to the virtual world. On the Cutting Edge of Technology, Sams Publishing."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1186\/s13063-019-3660-5","article-title":"Efficacy of intergrating vestibular rehabilitation and cognitive behaviour therapy in persons with persistent dizziness in primary care- a study protocol for a randomised controlled trial","volume":"20","author":"Kristiansen","year":"2019","journal-title":"Trials"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"jrm00121","DOI":"10.2340\/16501977-2755","article-title":"Use of virtual reality-based training in different fields of rehabilitation: A systematic review and meta-analysis","volume":"52","author":"Rutkowski","year":"2020","journal-title":"J. Rehabil. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"149","DOI":"10.2478\/hukin-2019-0022","article-title":"Effect of Virtual Reality-Based Rehabilitation on Physical Fitness in Patients with Chronic Obstructive Pulmonary Disease","volume":"69","author":"Rutkowski","year":"2019","journal-title":"J. Hum. Kinet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/MRR.0000000000000190","article-title":"The use of commercial video games in rehabilitation: A systematic review","volume":"39","author":"Bonnechere","year":"2016","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"79","DOI":"10.2478\/hukin-2018-0044","article-title":"Pulmonary Rehabilitation with a Stabilometric Platform after Thoracic Surgery: A Preliminary Report","volume":"65","author":"Jastrzebski","year":"2018","journal-title":"J. Hum. Kinet."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1002\/nau.22553","article-title":"Virtual Reality Rehabilitation as a Treatment Approach for Older Women With Mixed Urinary Incontinence: A Feasibility Study","volume":"34","author":"Elliott","year":"2015","journal-title":"Neurourol. Urodyn."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1590\/bjpt-rbf.2014.0148","article-title":"The effects of training by virtual reality or gym ball on pelvic floor muscle strength in postmenopausal women: A randomized controlled trial","volume":"20","author":"Martinho","year":"2016","journal-title":"Braz. J. Phys."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ Br. Med. J."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Methley, A.M., Campbell, S., Chew-Graham, C., McNally, R., and Cheraghi-Sohi, S. (2014). PICO, PICOS and SPIDER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv. Res., 14.","DOI":"10.1186\/s12913-014-0579-0"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.urology.2004.01.005","article-title":"International consultation on incontinence questionnaire short form: Comparison of physician versus patient completion and immediate and delayed self-administration","volume":"63","author":"Hajebrahimi","year":"2004","journal-title":"Urology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1046\/j.1464-410X.1996.93013.x","article-title":"The ICS-\u2018BPH\u2019 study: The psychometric validity and reliability of the ICSmale questionnaire","volume":"77","author":"Donovan","year":"1996","journal-title":"BJU"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res. Synth. Methods"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1089\/g4h.2019.0207","article-title":"Impact of Pelvic Floor Muscle Training Isolated and Associated with Game Therapy on Mixed Urinary Incontinence: A Randomized Controlled Trial","volume":"10","author":"Bezerra","year":"2021","journal-title":"Games Health J."},{"key":"ref_37","unstructured":"Martinho, N. (2021, June 10). O Treinamento Por Meio De Realidade Virtual Melhora A Funcionalidade Dos M\u00fasculos Do Assoalho P\u00e9lvico De Mulheres Na P\u00f3s-Menopausa?. Available online: https:\/\/bdtd.unifal-mg.edu.br:8443\/bitstream\/tede\/588\/5\/Disserta%C3%A7%C3%A3o%20de%20Natalia%20Miguel%20Martinho.pdf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1007\/s00192-015-2698-5","article-title":"Virtual reality: A proposal for pelvic floor muscle training","volume":"26","author":"Botelho","year":"2015","journal-title":"Int. Urogynecol. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1002\/nau.24350","article-title":"Game therapy a new approach to treat women facing mixed urinary incontinence: A study protocol","volume":"39","author":"Oliveira","year":"2020","journal-title":"Neurourol. Urodyn."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1590\/1806-9282.63.07.642","article-title":"Pelvic floor muscle training protocol for stress urinary incontinence in women: A systematic review","volume":"63","author":"Oliveira","year":"2017","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/S0090-4295(02)02125-8","article-title":"Increase in pelvic floor muscle activity after 12 weeks\u2019 training: A randomized prospective pilot study","volume":"60","author":"Aukee","year":"2002","journal-title":"Urology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/BF01901111","article-title":"Biofeedback and physiotherapy versus physiotherapy alone in the treatment of genuine stress urinary incontinence","volume":"7","author":"Glavind","year":"1996","journal-title":"Int. Urogynecol. J. Pelvic Floor Dysfunct."},{"key":"ref_43","unstructured":"(2019). Urinary Incontinence and Pelvic Organ Prolapse in Women: Management, NICE."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.bjpt.2021.01.001","article-title":"Mobile health technologies for the management of urinary incontinence: A systematic review of online stores in Brazil","volume":"25","author":"Dantas","year":"2021","journal-title":"Braz. J. Phys."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e12587","DOI":"10.2196\/12587","article-title":"Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study","volume":"7","author":"Dufour","year":"2019","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1097\/SPV.0000000000000670","article-title":"The Adherence of Home Pelvic Floor Muscles Training Using a Mobile Device Application for Women with Urinary Incontinence: A Randomized Controlled Trial","volume":"26","author":"Araujo","year":"2020","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.urology.2015.06.022","article-title":"Using the Vibrance Kegel Device With Pelvic Floor Muscle Exercise for Stress Urinary Incontinence: A Randomized Controlled Pilot Study","volume":"86","author":"Ong","year":"2015","journal-title":"Urology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"109","DOI":"10.3233\/NRE-203209","article-title":"What can virtual reality offer to stroke patients? A narrative review of the literature","volume":"47","author":"Cieslik","year":"2020","journal-title":"NeuroRehabilitation"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/10\/6155\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:14:23Z","timestamp":1760138063000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/10\/6155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,18]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["ijerph19106155"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19106155","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,18]]}}}