International Urogynecology Journal

, Volume 29, Issue 10, pp 1429–1433 | Cite as

Classic papers on pelvic floor physiotherapy: the most frequently cited articles in three decades (1983–2013)

  • Alexandre Fornari
  • Cristiane Carboni
Review Article


Introduction and hypothesis

Pelvic floor physiotherapy has been utilized extensively over the past decades for the treatment of pelvic floor dysfunctions. The aim of this study was to identify and characterize the most frequently cited articles on pelvic floor physiotherapy published in the last 30 years.


A PubMed search of all articles published between 1983 and 2013 was performed. Articles with more than 100 citations were identified as “classic,” and were further analyzed based on author names, year of publication, journal of publication, subject, study design, country of research, and number of citations. In 2017, a new search for papers on pelvic floor physiotherapy was conducted using the same methods to compare them with the 2013 data.


Of 1,285 articles published between 1983 and 2013, only 20 articles were cited more than 100 times. Among them, we found 12 randomized clinical trials (RCTs) and only 4 reviews. The most common topics among the classic articles were behavior therapy, pelvic floor muscle training (PFMT), biofeedback-assisted PFMT, and neuromuscular electrical stimulation. In 2017, we found 1,745 papers containing the term “pelvic floor physiotherapy,” indicating an increase of around 35% in 4 years.


Although there is a fast-growing number of publications, we still have few classic papers on pelvic floor physiotherapy, concentrated in a few research centers. However, the large number of RCTs shows that these papers have a high scientific level, confirming that they can be classified as classic papers.


Classic article Pelvic floor Physiotherapy 


Compliance with ethical standards

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflicts of interest



  1. 1.
    Lamin E, Parrillo LM, Newman DK, Smith AL. Pelvic floor muscle training: underutilization in the USA. Curr Urol Rep. 2016;17(2):10. Scholar
  2. 2.
    Chan MC, Schulz JA, Flood CG, Rosychuk RJ. A retrospective review of patients seen in a multidisciplinary pelvic floor clinic. J Obstet Gynaecol Can. 2010;32(1):35–40.CrossRefGoogle Scholar
  3. 3.
    Dumoulin C, Hunter KF, Moore K, Bradley CS, Burgio KL, Hagen S, et al. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: summary of the 5th International Consultation on Incontinence. Neurourol Urodyn. 2016;35(1):15–20. Scholar
  4. 4.
    Martínez MA, Herrera M, López-Gijón J, Herrera-Viedma E. H-classics: characterizing the concept of citation classics through H-index. Scientometrics. 2014;98(3):1971–83.CrossRefGoogle Scholar
  5. 5.
    Gehanno JF, Takahashi K, Darmoni S, Weber J. Citation classics in occupational medicine journals. Scand J Work Environ Health. 2007;33(4):245–51.CrossRefGoogle Scholar
  6. 6. Accessed 30 August 2017.
  7. 7.
    Institute for Scientific Information. J Heredity. 1961;52(4):182.
  8. 8.
    Journal Citation Reports (2017) What’s new in journal citation reports? Accessed 30 August 2017.
  9. 9.
    Burgio KL, Locher JL, Goode PS, Hardin JM, McDowell BJ, Dombrowski M, et al. Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA. 1998;280(23):1995–2000.CrossRefGoogle Scholar
  10. 10.
    Bø K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999;318(7182):487–93.CrossRefGoogle Scholar
  11. 11.
    Fantl JA, Wyman JF, McClish DK, Harkins SW, Elswick RK, Taylor JR, et al. Efficacy of bladder training in older women with urinary incontinence. JAMA. 1991;265(5):609–13.CrossRefGoogle Scholar
  12. 12.
    Wald A, Tunuguntla AK. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. N Engl J Med. 1984;310(20):1282–7. Scholar
  13. 13.
    Lindström S, Fall M, Carlsson CA, Erlandson BE. The neurophysiological basis of bladder inhibition in response to intravaginal electrical stimulation. J Urol. 1983;129(2):405–10.CrossRefGoogle Scholar
  14. 14.
    Fall M, Lindström S. Electrical stimulation. A physiologic approach to the treatment of urinary incontinence. Urol Clin North Am. 1991;18(2):393–407.PubMedGoogle Scholar
  15. 15.
    Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology. 2003;125(5):1320–9.CrossRefGoogle Scholar
  16. 16.
    Bø K, Hagen RH, Kvarstein B, Jørgensen J, Larsen S, Burgio KL. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn. 1990;9(5):489–502.CrossRefGoogle Scholar
  17. 17.
    Sand PK, Richardson DA, Staskin DR, Swift SE, Appell RA, Whitmore KE, et al. Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: a multicenter, placebo-controlled trial. Am J Obstet Gynecol. 1995;173(1):72–9.CrossRefGoogle Scholar
  18. 18.
    Berghmans LC, Hendriks HJ, Bø K, Hay-Smith EJ, de Bie RA, Van Waalwijk van Doorn ES. Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials. Br J Urol. 1998;82(2):181–91.CrossRefGoogle Scholar
  19. 19.
    Bø K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85(3):269–82.PubMedGoogle Scholar
  20. 20.
    Sampselle CM, Miller JM, Mims BL, Delancey JO, Ashton-Miller JA, Antonakos CL. Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth. Obstet Gynecol. 1998;91(3):406–12.CrossRefGoogle Scholar
  21. 21.
    Miller JM, Ashton-Miller JA, DeLancey JO. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998;46(7):870–4.CrossRefGoogle Scholar
  22. 22.
    Burgio KL, Robinson JC, Engel BT. The role of biofeedback in Kegel exercise training for stress urinary incontinence. Am J Obstet Gynecol. 1986;154(1):58–64.CrossRefGoogle Scholar
  23. 23.
    Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130(3):657–64. Scholar
  24. 24.
    Van Kampen M, De Weerdt W, Van Poppel H, De Ridder D, Feys H, Baert L. Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. Lancet. 2000;355(9198):98–102. Scholar
  25. 25.
    Wyman JF, Fantl JA, McClish DK, Bump RC. Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence program for women research group. Am J Obstet Gynecol. 1998;179(4):999–1007.CrossRefGoogle Scholar
  26. 26.
    Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(2):76–84. Scholar
  27. 27.
    Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002;288(18):2293–9.CrossRefGoogle Scholar
  28. 28.
    Mørkved S, Bø K, Schei B, Salvesen KA. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstet Gynecol. 2003;101(2):313–9.PubMedGoogle Scholar
  29. 29.
    Coelho DH, Edelmayer LW, Fenton JE. A century of citation classics in otolaryngology-head and neck surgery journals revisited. Laryngoscope. 2014;124(6):1358–62. Scholar
  30. 30.
    Thomas K, Moore CM, Gerharz EW, O’Brien T, Emberton M. Classic papers in urology. Eur Urol. 2003;43(6):591–5.CrossRefGoogle Scholar
  31. 31.
    Kegel AH. Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol. 1948;56(2):238–48.CrossRefGoogle Scholar
  32. 32.
  33. 33.
    Heldwein FL, Rhoden EL, Morgentaler A. Classics of urology: a half century history of the most frequently cited articles (1955–2009). Urology. 2010;75(6):1261–8. Scholar
  34. 34.
    Bø K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, et al. 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. Int Urogynecol J. 2017;28(2):191–213. Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Alexandre Fornari
    • 1
  • Cristiane Carboni
    • 2
  1. 1.Santa Casa de Misericórdia de Porto AlegrePorto AlegreBrazil
  2. 2.Inspirar CollegePorto AlegreBrazil

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