Electrical Muscle Stimulation for Conservative Management of Female Pelvic Floor Muscle Dysfunction: A Scoping Review

Abstract

Background Electrical muscle stimulation (EMS) is a conservative management tool for the treatment of pelvic floor dysfunctions (PFDs). This review aims to: (1) summarize available evidence on various types of EMS treatment and associated outcomes on PFDs in adult women; and (2) investigate the clinical utility of intra-vaginal EMS compared to extra-vaginal; high-intensity parameters compared to low-intensity; and differences in outcomes between EMS with, or without, a magnetic component. As a scoping review, this research aims to facilitate the generation of hypotheses for future investigation. Methods Arksey and O’Malley’s framework supplemented the Joanna Briggs Institute methodology for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews was used. Three databases were searched. Included studies were analyzed using Arksey and O'Malley’s content analysis and t-tests. Results A total of 40 included studies had low risk of bias (PEDro score = 6.38, SD = 1.47). Low-intensity and intra-vaginal protocols were found to require greater lengths of overall treatment time when compared to high-intensity protocols; however, only magnetic EMS treatments were found to result in significant improvement in symptoms (p < 0.01) when compared to non-magnetic EMS. Due to the heterogeneity of the outcome measures used among the included studies, effect sizes could not be evaluated. Conclusions EMS demonstrates positive effect for improving outcomes related PFDs in adult women. Included studies support the use of EMS for stress, urgency and mixed urinary incontinence. All versions of EMS studied were found to provide significant improvements in symptoms. However, high intensity, extra-vaginal approach and EMS with a magnetic component required less time to achieve significant therapeutic effect.