We will refer to these as ‘alternative exercises’. Alternative

exercises include training of the deep abdominal muscles, contraction of the ring muscles of the mouth and eyes (the Paula method), Pilates exercise, yoga, Tai Chi, breathing exercises, posture correction, and general fitness training. The effectiveness of some alternative exercise regimens was also explored by Hay-Smith et al (2011), but these exercises were not the focus of that Cochrane review. A framework for this review is provided by our paper on how new therapies become incorporated into clinical practice (Bø and Herbert 2009). In selleck chemicals that paper we presented a three-phase protocol for the introduction of new therapies into clinical practice (Box 1). The central idea is that the development phase for new therapies involves clinical observation, laboratory studies, clinical exploration, and pilot clinical trials. Once there are sufficient data from such studies to believe that the therapy could be effective, its effectiveness is tested with a randomised

controlled trial. We argued, SB431542 manufacturer as have many before us (eg, Chalmers 1977), that new therapies should not be considered to have been shown to be effective, or be introduced into routine clinical practice, until they have been shown to have clinically important effects in properly conducted randomised controlled trials. Thus the testing phase involves the conduct of randomised trials. Lastly, once an intervention has been shown to be effective, usually with Dichloromethane dehalogenase more than one randomised trial ( Ferreira et al 2012), further trials may be conducted to examine how best to administer the therapy and to whom the therapy is best

administered. This is the refinement and dissemination phase. It is only at this last phase that clinicians should be actively encouraged to adopt the new therapy. However, not all therapies thought to be effective in the first phase will be shown to be effective in clinical trials. We will classify alternative interventions for treatment of stress urinary incontinence or mixed urinary incontinence according to whether they are currently in the Development Phase, the Testing Phase, or the Refinement and Dissemination Phase. Stage 1: Clinical observation or laboratory studies Development Phase Stage 2: Clinical Stage 3: Pilot studies Stage 4: Randomised clinical trials Testing Phase Stage 5: Refinement Refinement and Dissemination Phase Stage 6: Active dissemination Full-size table Table options View in workspace Download as CSV We conducted a systematic review to examine evidence of the effectiveness of these alternative exercise regimens.