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How to report electrotherapy parameters and procedures for pelvic floor dysfunction

  • Clinical Opinion
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Abstract

Electrical stimulation is widely used for pelvic floor muscle dysfunctions (PFMDs), but studies are not always clear about the parameters used, jeopardizing their reproduction. As such, this study aimed to be a reference for researchers and clinicians when using electrical stimulation for PFMD. This report was designed by experts on electrophysical agents and PFMD who determined all basic parameters that should be described. The terms were selected from the Medical Subject Headings database of controlled vocabulary. An extensive process of systematic searching of databases was performed, after which experts met and discussed on the main findings, and a consensus was achieved. Electrical stimulation parameters were described, including the physiological meaning and clinical relevance of each parameter. Also, a description of patient and electrode positioning was added. A consensus-based guideline on how to report electrical stimulation parameters for PFMD treatment was developed to help both clinicians and researchers.

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References

  1. Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin N Am. 1998;25:723–46.

    Article  CAS  Google Scholar 

  2. Sung VW, Hampton BS. Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin N Am. 2009;36:421–43.

    Article  Google Scholar 

  3. Sharma A, Yuan L, Marshall RJ, et al. Systematic review of the prevalence of faecal incontinence. Br J Surg. 2016;103:1589–97. https://doi.org/10.1002/bjs.10298.

    Article  CAS  PubMed  Google Scholar 

  4. Dedicação ACA, Haddad M, Saldanha MMES, Driusso P. Comparison of quality of life for different types of female urinary incontinence. Brazilian J Phys Ther. 2009;13:116–22. https://doi.org/10.1590/S1413-35552009005000014.

    Article  Google Scholar 

  5. Richardson ML, Sokol ER. A cost-effectiveness analysis of conservative versus surgical management for the initial treatment of stress urinary incontinence. Am J Obstet Gynecol. 2014;211(5):565.e1–6. https://doi.org/10.1016/j.ajog.2014.07.006.

    Article  Google Scholar 

  6. Burge E, Monnin D, Berchtold A, Allet L. Cost-effectiveness of physical therapy only and of usual care for various health conditions: systematic review. Phys Ther. 2016;96:774–86. https://doi.org/10.2522/ptj.20140333.

    Article  PubMed  Google Scholar 

  7. Dumoulin C, Hay-Smith J, Habée-Séguin GM, Mercier J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn. 2015;34:300–8. https://doi.org/10.1002/nau.22700.

    Article  PubMed  Google Scholar 

  8. Paiva LL, Ferla L, Darski C, et al. Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis. Int Urogynecol J. 2017;28:351–9. https://doi.org/10.1007/s00192-016-3133-2.

    Article  PubMed  Google Scholar 

  9. Jarrett MED, Mowatt G, Glazener CMA, et al. Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg. 2004;91:1559–69. https://doi.org/10.1002/bjs.4796.

    Article  CAS  PubMed  Google Scholar 

  10. Horrocks EJ, Thin N, Thaha MA, et al. Systematic review of tibial nerve stimulation to treat faecal incontinence. Br J Surg. 2014;101:457–68.

    Article  CAS  Google Scholar 

  11. Booth J, Connelly L, Dickson S, et al. The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: a systematic review. Neurourol Urodyn. 2017. https://doi.org/10.1002/nau.23351.

    Article  Google Scholar 

  12. Rosenbaum TY, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction. J Sex Med. 2008;5:513–23. https://doi.org/10.1111/j.1743-6109.2007.00761.x.

    Article  PubMed  Google Scholar 

  13. Morin M, Carroll M-S, Bergeron S. Systematic review of the effectiveness of physical therapy modalities in women with provoked Vestibulodynia. Sex Med Rev. 2017;5:295–322. https://doi.org/10.1016/j.sxmr.2017.02.003.

    Article  PubMed  Google Scholar 

  14. Bonder JH, Chi M, Rispoli L. Myofascial pelvic pain and related disorders. Phys Med Rehabil Clin N Am. 2017;28:501–15. https://doi.org/10.1016/j.pmr.2017.03.005.

    Article  PubMed  Google Scholar 

  15. Sluka KA, Walsh D. Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. J Pain. 2003;4:109–21. https://doi.org/10.1054/jpai.2003.434.

    Article  PubMed  Google Scholar 

  16. Hatem SM, Saussez G, della Faille M, et al. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci. 2016;10:442. https://doi.org/10.3389/fnhum.2016.00442.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bo 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;318:487–93. https://doi.org/10.1136/bmj.318.7182.487.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Goode PS, Burgio KL, Locher JL, et al. Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women: a randomized controlled trial. JAMA. 2003;290:345–52. https://doi.org/10.1001/jama.290.3.345.

    Article  PubMed  Google Scholar 

  19. Thüroff JW, Abrams P, Andersson KE, et al. EAU guidelines on urinary incontinence. Eur Urol. 2011;59:387–400. https://doi.org/10.1016/j.eururo.2010.11.021.

    Article  PubMed  Google Scholar 

  20. Spruijt J, Vierhout M, Verstraeten R, et al. Vaginal electrical stimulation of the pelvic floor: a randomized feasibility study in urinary incontinent elderly women. Acta Obstet Gynecol Scand. 2003;82:1043–8.

    Article  Google Scholar 

  21. Schreiner L, dos Santos TG, Knorst MR, da Silva Filho IG. Randomized trial of transcutaneous tibial nerve stimulation to treat urge urinary incontinence in older women. Int Urogynecol J. 2010;21:1065–70. https://doi.org/10.1007/s00192-010-1165-6.

    Article  PubMed  Google Scholar 

  22. Schreiner L, dos Santos TG, de Souza ABA, et al. Electrical stimulation for urinary incontinence in women: a systematic review. Int Braz J Urol. 2013;39:454–64. https://doi.org/10.1590/S1677-5538.IBJU.2013.04.02.

    Article  PubMed  Google Scholar 

  23. Moroni R, Magnani P, Haddad J, et al. Conservative treatment of stress urinary incontinence: a systematic review with meta-analysis of randomized controlled trials. Rev Bras Ginecol Obstet/RBGO Gynecol Obstet. 2016;38:097–111. https://doi.org/10.1055/s-0035-1571252.

    Article  Google Scholar 

  24. Scaldazza CV, Morosetti C, Giampieretti R, et al. Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study. Int Braz J Urol. 2017;43:121–6. https://doi.org/10.1590/s1677-5538.ibju.2015.0719.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Jenkins PA, Carroll JD. How to report low-level laser therapy (LLLT)/photomedicine dose and beam parameters in clinical and laboratory studies. Photomed Laser Surg. 2011;29:785–7. https://doi.org/10.1089/pho.2011.9895.

    Article  PubMed  Google Scholar 

  26. Bo K, Frawley HC, Haylen BT, 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;28:191–213. https://doi.org/10.1007/s00192-016-3123-4.

    Article  PubMed  Google Scholar 

  27. Kitchen S. Electrotherapy: evidence-based practice. 11th ed. Toronto: Elsevier; 2001.

  28. Nelson RM, Hayes KW, Currier DP. Clinical Electrotherapy. Pearson; 1999.

  29. Bellew JW. Clinical electrical stimulation: application and techniques. In: Bellew JW, Michlovitz SL, Nolan TP, editors. Michlovitz’s modalities for therapeutic intervention, 6th ed. FA Davis Co.; 2016. p. 287–327.

  30. Cameron MH. Physical agents in rehabilitation: from research to practice. Elsevier Health; 2012.

  31. Kahn J. Principles and practice of electrotherapy, 4th ed. Churchill Livingstone; 1999.

  32. Robinson AJ, Snyder-Mackler L. Clinical electrophysiology: electrotherapy and Electrophysiologic testing. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 1995.

    Google Scholar 

  33. Low J, Reed A. Electrotherapy explained. Principles and practice. 3rd ed. Oxford: Butterworth-Heinemann; 2000.

    Google Scholar 

  34. Belanger A-Y. Therapeutic electrophysical agents: evidence behind practice. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2010.

    Google Scholar 

  35. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20. https://doi.org/10.1002/nau.20798.

    Article  PubMed  Google Scholar 

  36. Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the international continence society. Neurourol Urodyn. 2005;24:374–80. https://doi.org/10.1002/nau.20144.

    Article  PubMed  Google Scholar 

  37. Gormley EA, Lightner DJ, Faraday M, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193:1572–80. https://doi.org/10.1016/j.juro.2015.01.087.

    Article  PubMed  Google Scholar 

  38. Glinski R, Siegel S. Refractory overactive bladder: beyond oral anticholinergic therapy. Indian J Urol. 2007;23:166. https://doi.org/10.4103/0970-1591.32069.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Kuhn A, Keller T, Lawrence M, Morari M. The influence of electrode size on selectivity and comfort in transcutaneous electrical stimulation of the forearm. IEEE Trans Neural Syst Rehabil Eng. 2010;18:255–62. https://doi.org/10.1109/TNSRE.2009.2039807.

    Article  PubMed  Google Scholar 

  40. Gracanin F, Trnkoczy A. Optimal stimulus parameters for minimum pain in the chronic stimulation of innervated muscle. Arch Phys Med Rehabil. 1975;56:243–9.

    CAS  PubMed  Google Scholar 

  41. Alon G. High voltage stimulation. Effects of electrode size on basic excitatory responses. Phys Ther. 1985;65:890–5.

    Article  CAS  Google Scholar 

  42. Keller T, Kuhn A. Electrodes for transcutaneous (surface) electrical stimulation. J Autom Control. 2008;18:35–45. https://doi.org/10.2298/JAC0802035K.

    Article  Google Scholar 

  43. Gorgey AS, Dudley GA. The role of pulse duration and stimulation duration in maximizing the normalized torque during neuromuscular electrical stimulation. J Orthop Sports Phys Ther. 2008;38:508–16. https://doi.org/10.2519/jospt.2008.2734.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Gorgey AS, Mahoney E, Kendall T, Dudley GA. Effects of neuromuscular electrical stimulation parameters on specific tension. Eur J Appl Physiol. 2006;97:737–44. https://doi.org/10.1007/s00421-006-0232-7.

    Article  PubMed  Google Scholar 

  45. Delitto A, Rose SJ. Comparative comfort of three waveforms used in electrically eliciting quadriceps femoris muscle contractions. Phys Ther. 1986;66:1704–7. https://doi.org/10.1093/ptj/66.11.1704.

    Article  CAS  PubMed  Google Scholar 

  46. Downey RJ, Bellman MJ, Kawai H, et al. Comparing the induced muscle fatigue between asynchronous and synchronous electrical stimulation in able-bodied and spinal cord injured populations. IEEE Trans Neural Syst Rehabil Eng. 2015;23:964–72. https://doi.org/10.1109/TNSRE.2014.2364735.

    Article  PubMed  Google Scholar 

  47. Fuentes CJ, Armijo-Olivo S, Magee DJ, Gross D. Does amplitude-modulated frequency have a role in the hypoalgesic response of interferential current on pressure pain sensitivity in healthy subjects? A randomised crossover study. Physiotherapy. 2010;96:22–9. https://doi.org/10.1016/j.physio.2009.06.009.

    Article  Google Scholar 

  48. Ward AR. Electrical stimulation using kilohertz-frequency alternating current. Phys Ther. 2009;89:181–90. https://doi.org/10.2522/ptj.20080060.

    Article  PubMed  Google Scholar 

  49. Liebano RE, Waszczuk S, Corrêa JB. The effect of burst-duty-cycle parameters of medium-frequency alternating current on maximum electrically induced torque of the quadriceps Femoris, discomfort, and tolerated current amplitude in professional soccer players. J Orthop Sports Phys Ther. 2013;43:920–6. https://doi.org/10.2519/jospt.2013.4656.

    Article  PubMed  Google Scholar 

  50. Laycock J, Jerwood D. Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy. 2001;87:631–42. https://doi.org/10.1016/S0031-9406(05)61108-X.

    Article  Google Scholar 

  51. Brink CA, Sampselle CM, Wells TJ, et al. A digital test for pelvic muscle strength in older women with urinary incontinence. Nurs Res. 38:196–9.

    Article  CAS  Google Scholar 

  52. Ortiz OC, Nuñez FC. Dynamic assessment of pelvic floor function in women using the intravaginal device test. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7:317–20. https://doi.org/10.1007/BF01901106.

    Article  Google Scholar 

  53. Houghton PE, Nussbaum EL, Hoens AM. ELECTROPHYSICAL AGENTS - contraindications and precautions: an evidence-based approach to clinical decision making in physical therapy. Physiother Can. 2010;62:1–80. https://doi.org/10.3138/ptc.62.5.

    Article  Google Scholar 

  54. Dunn PA, Rogers D, Halford K. Transcutaneous electrical nerve stimulation at acupuncture points in the induction of uterine contractions. Obstet Gynecol. 1989;73:286–90.

    CAS  PubMed  Google Scholar 

  55. Keskin EA, Onur O, Keskin HL, et al. Transcutaneous electrical nerve stimulation improves low back pain during pregnancy. Gynecol Obstet Investig. 2012;74:76–83. https://doi.org/10.1159/000337720.

    Article  CAS  Google Scholar 

  56. Crothers E, Coldron Y, Cook T, et al. Safe use of transcutaneous electrical nerve stimulation for musculoskeletal pain during pregnancy. J Assoc Chart Physiother Women’s Heal; 2012.

  57. Dowswell T, Bedwell C, Lavender T, Neilson JP. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database Syst Rev. 2009. https://doi.org/10.1002/14651858.CD007214.pub2.

  58. Dowswell T, Bedwell C, Lavender T, Neilson James P. Transcutaneous electrical nerve stimulation (TENS) for pain management in labour. Cochrane Database Syst Rev. 2009. https://doi.org/10.1002/14651858.CD007214.pub2.

  59. Chao A-S, Chao A, Wang T-Z, et al. Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: a randomized double-blind placebo-controlled trial. Pain. 2007. https://doi.org/10.1016/j.pain.2006.08.016.

    Article  Google Scholar 

  60. Tsen LC, Thomas J, Segal S, et al. Transcutaneous electrical nerve stimulation does not augment epidural labor analgesia. J Clin Anesth. 2001. https://doi.org/10.1016/S0952-8180(01)00332-4.

    Article  CAS  Google Scholar 

  61. Kayman-Kose S, Arioz DT, Toktas H, et al. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section. J Matern Fetal Neonatal Med. 2014;27:1572–5. https://doi.org/10.3109/14767058.2013.870549.

    Article  CAS  PubMed  Google Scholar 

  62. Dionisi B, Senatori R. Effect of transcutaneous electrical nerve stimulation on the postpartum dyspareunia treatment. J Obstet Gynaecol Res. 2011;37:750–3. https://doi.org/10.1111/j.1447-0756.2010.01425.x.

    Article  PubMed  Google Scholar 

  63. Machado AFP, Santana EF, Tacani PM, Liebano RE. The effects of transcutaneous electrical nerve stimulation on tissue repair: a literature review. Can J Plast Surg. 2012;20:237–40.

    Article  Google Scholar 

  64. Maffiuletti NA. Physiological and methodological considerations for the use of neuromuscular electrical stimulation. Eur J Appl Physiol. 2010;110:223–34. https://doi.org/10.1007/s00421-010-1502-y.

    Article  PubMed  Google Scholar 

  65. Castillo-Lozano R. Effectiveness of neuromuscular electrical stimulation in the functional knee rehabilitation in soldiers. Sanid Mil. 2015;71:239–46.

    Article  Google Scholar 

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Authors and Affiliations

  1. School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, São Paulo State University (UNESP), Av. Hygino Muzzi Filho, 737, Bairro: Mirante, Marília, SP, CEP:17.525-900, Brazil

    Angélica Mércia Pascon Barbosa & Cristiane Rodrigues Pedroni

  2. Post-Graduate Program of Biotechnology on Regenerative Medicine and Medical Chemistry, University of Araraquara, (UNIARA), Araraquara, SP, Brazil

    Nivaldo Antonio Parizotto

  3. Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil

    Nivaldo Antonio Parizotto, Mariana Arias Avila, Richard Eloin Liebano & Patricia Driusso

  4. Research Nucleus on Electrophysical Agents (Núcleo de Pesquisa em Agentes Eletrofísicos – NUPE), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil

    Mariana Arias Avila, Richard Eloin Liebano & Patricia Driusso

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  1. Angélica Mércia Pascon Barbosa
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  2. Nivaldo Antonio Parizotto
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  3. Cristiane Rodrigues Pedroni
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  4. Mariana Arias Avila
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Correspondence to Angélica Mércia Pascon Barbosa.

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Barbosa, A.M.P., Parizotto, N.A., Pedroni, C.R. et al. How to report electrotherapy parameters and procedures for pelvic floor dysfunction. Int Urogynecol J 29, 1747–1755 (2018). https://doi.org/10.1007/s00192-018-3743-y

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