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the evidence gained from this systematic review is very limited. The use of cones may be helpful for urinary incontinence after childbirth, but further research is needed.

Citation: Oblasser, C., Christie, J. & McCourt, C. (2015). Vaginal cones or balls to improve pelvic floor muscle performance and urinary continence in women postpartum: a quantitative systematic review and meta-analysis protocol. This is the accepted version of the paper. This version of the publication may differ from the final published version. Permanent repository link: http://openaccess.city.ac.uk/4817/ Link to published version: http://dx. Abstract Aim: To identify, critically appraise and synthesise the best current evidence on the use of vaginal cones or balls to improve pelvic floor muscle performance and urinary continence in women post partum. Background: The vaginal use of cones or balls is a pelvic floor muscle training method that aims to enhance muscle performance and thereby prevent or treat urinary incontinence. Nonetheless to date, no systematic review has focused on the effectiveness of these devices specifically during the postpartum period. Design: Quantitative systematic review with potential meta-analysis Methods: The review will be undertaken by searching 14 scientific databases (including PubMed and CINAHL, without date restriction) and the worldwide web; experts will also be contacted for published and unpublished data. Included studies must be randomised or quasi-randomised trials and have female participants until one year after childbirth. The intervention will be compared to no treatment, placebo, sham treatment or active controls. Outcome measures will relate to pelvic floor muscle performance or urinary incontinence. Studies will be selected, "risk of bias" assessed, and data extracted by two reviewers independently. Following inter-reviewer agreement of included studies, data will be checked after entry into systematic review processing software. If appropriate, data will be synthesised by meta-analysis; if this is not possible, a narrative review only will be undertaken. Discussion: The information gained from this systematic review will help midwives, nurses, other health professionals and women after childbirth decide how to promote female pelvic floor health and in defining further areas of study. Why this systematic review is needed  As childbearing challenges pelvic floor integrity, postpartum pelvic floor health is an important issue in maternity health care  The vaginal use of cones or balls by women post partum raises the question of their effectiveness and evidence about it  This is the first systematic review to focus specifically on the use of vaginal cones for pelvic floor muscle training in the postpartum period 2