This is the first study to identify the temporal and content related structure of whole-body vibration (WBV) training for treatment of postpartum pelvic floor muscle (PFM) dysfunction. Additionally, necessary prerequisites are determined.

However, due to a lack of evidence, it has not yet been determined whether WBV is an appropriate method for the specific requirements involved in the target group of women postpartum with PFM dysfunction. Therefore, a systematic literature review (MEDLINE, Cochrane Library) was conducted from November 2022 to May 2023, supplemented by an exploratory literature search. In total 49 studies have been found and were analysed according to PRISMA. Only one prospective study [1] as well as one RCT [2] fulfilled the predetermined inclusion criteria set by PICOS model. To evaluate the quality of these two studies SIGN assessments were used. Subsequently, a qualitative study design with individual interviews was chosen. Over six months, different international urogynecological organizations were approached for a theoretical sampling. Concurrently, extensive expert search was conducted through the internet, social networks and the snowball method. A final sample of seven medical professionals regarding their practical experiences with WBV for postpartum pelvic floor muscle training (PFMT) was recruited (years of expertise: M = 23; SD = 6,5; min. = 10; max. = 32). To achieve gold standard, transcription was carried out using the automatic AI transcription tool “AmberScript” and the analysis process followed the structuring content analysis approach developed by Kuckartz and Rädiker [3]. The category system was developed deductively-inductively and elaborated using computer-assisted software “MAXQDA”.

As study results, a workflow for medical professionals implementing WBV training as one possible conservative therapeutic method for treatment of postpartum PFM dysfunction was created (Fig. 1). The periodization and progression of WBV training for PFM postpartum follows principles of classical training theories (Fig. 2). However, there is no consensus among experts regarding the specific design of training parameters and exercises. As a secondary result all experts emphasised to reflect on the individual bio-psycho-social dimension of each woman postpartum when implementing WBV training.

It is a well-known fact, that 20-30% of women suffer from persistent PFM dysfunction after childbirth, e.g. including symptoms of postpartum urinary/faecal incontinence and/or pelvic organ prolapse (POP). International guidelines recommend active training of the PFM as part of the treatment for these complaints. Additionally, positive effects have been reported through reactive PFMT, which represents a progressive level of resistance training and can be integrated into rehabilitation and training through WBV. These vibrations reflexively stimulate the muscle spindles of the PFM, potentially reducing symptoms of postpartum urinary/faecal incontinence and/or POP [1, 2]. According to the literature review, there is a lack of evidence whether WBV training is appropriate for the specific requirements involved in the target group of women postpartum with PFM dysfunction. The experiences of the interviewed experts demonstrate, that WBV training can be used as a specific resistance training method to enhance the reactive strength capacity of the PFM during a late phase postpartum. Consequently, symptoms of postpartum urinary/faecal incontinence and/or POP can be reduced [1, 2]. Prior to practical implementation, there is a consensus among the experts, that certain prerequisites need to be met and several challenges must be overcome at first (Fig. 1). Once these prerequisites are fulfilled, WBV training on the one hand follows classical principles of periodization and progression of resistance training (temporal dimension). On the other hand, there is no consensus regarding the specific design of training parameters and exercises because of the different available WBV devices and their setting options, the women’s individual PFM symptoms, the individual training philosophy, creativity and knowhow of a medical professional user (content dimension). As a secondary result all experts emphasised to reflect on the individual bio-psycho-social dimension of each woman postpartum when implementing WBV training, e.g. to consider the new family setting with a baby, participation and possible aims for a return to sport, individual desires and new body and mind set as well as a new sexuality after childbirth.

In Conclusion, the experts' consensus suggests that WBV training can be one potentially conservative therapeutic method for treating postpartum PFM dysfunction. The created workflow can serve as a first guideline based on professional experiences of an international, high-level expert group and provides a first evidence-based standard for further empirical studies. Besides, medical professionals have to be aware of possible limitations of WBV and in cases of non-responders, they should sensitize these patients for further therapeutic options (conservative as well as surgical).

Lauper, M., Kuhn, A., Gerber, R., Luginbuehl, H. & Radlinger, L. (2009). Pelvic Floor Stimulation: What Are The Good Vibrations?. Neurourology and Urodynamics, 28(5), 405-410.
Luginbuehl, H., Lehmann, C., Gerber, R., Kuhn, A., Hilfiker, R., Baeyens, J.P. & Radlinger, L. (2012). Continous Versus Intermittent Stochastic Resonance Whole Body Vibration and Its Effect on Pelvic Floor Muscle Activity. Neurourology and Urodynamics, 31(5), 683-687.
Kuckartz, U. & Rädiker, S. (2022). Qualitative Inhaltsanalyse. Methoden, Praxis, Computerunterstützung (5. Aufl.). Weinheim: Beltz Juventa.