Adjunctive Autonomic Regulation Practices in Pelvic Floor Rehabilitation: A Retrospective Comparative Cohort Study

Background/Objectives: Pelvic floor physiotherapy (PFPT) and biofeedback are established conservative treatments for pelvic floor dysfunctions, but clinical response is heterogeneous. We explored whether exposure to a structured multicomponent set of non-device home practices, described here as adjunctive autonomic regulation practices, was associated with patient-reported improvement when used alongside standard PFPT/biofeedback. The study was exploratory and was not designed to establish an autonomic mechanism or causal treatment effect. Methods: This retrospective, observational, nonconcurrent comparative cohort study included adults treated in the same tertiary pelvic floor rehabilitation unit during two distinct periods. The adjunct-exposed cohort (Group A; September 2022–March 2023) received PFPT/biofeedback plus a structured multicomponent home program; the historical comparator (Group B; January–June 2019) received PFPT/biofeedback without the adjunct. Both programs included diaphragmatic breathing; in the standard program, no fixed breathing rate or duration was prescribed, whereas the adjunct included slow-paced breathing at approximately 6 breaths/min for 5 min three times daily. The primary outcome was the proportion of patients classified as responders according to improvement in the MYMOP2 Profile Score from baseline to approximately 2 months. The historical dataset operationalized clinically meaningful response as >1.0-point improvement. Between-group analyses were unadjusted. Results: A total of 111 patients were analyzed (Group A, n = 35; Group B, n = 76). MYMOP2 response occurred in 31/35 patients (88.6%) in Group A and 42/76 patients (55.3%) in Group B (Pearson chi-square: chi2(1) = 11.81, p < 0.001). The unadjusted risk ratio (RR) was 1.60 (95% CI 1.27–2.03), and the unadjusted absolute difference was 33.3 percentage points (95% CI 17.9–48.7). Using recently proposed physiotherapy-specific RR reference thresholds at a baseline risk near 0.5, the numerical RR lies in the upper medium range and close to the proposed large-effect threshold; this describes magnitude only and does not imply a causal treatment effect. Conclusions: Patients exposed to the adjunctive multicomponent program had a higher unadjusted MYMOP2 responder rate than patients in a nonconcurrent historical standard-rehabilitation cohort. Because the cohorts were separated in time, baseline characterization was incomplete, follow-up availability may have introduced selection bias, historical patient-level MYMOP2 scores are no longer accessible, and the intervention was multicomponent, the findings should be interpreted as exploratory and hypothesis-generating. Prospective studies with concurrent controls, standardized treatment delivery, objective pelvic floor outcomes, and prospectively measured adherence are required.