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

Background: Electrical muscle stimulation (EMS) is a conservative management tool for the treatment of pelvic floor dysfunctions (PFDs). The aim of this review was to scope, summarize and critically evaluate available research investigating the impact of various modes of EMS on PFDs in females. Methods: Joanna Briggs Institute methodology for scoping reviews was used with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Three databases were searched. Articles published in English that included female participants living with pelvic floor muscle dysfunction where EMS was used as a conservation care intervention were included in the review. Included studies were analyzed following Arksey and O'Malley's framework. The Cochrane Risk of Bias Tool for randomized trials was used to assess risk of bias for the randomized controlled trials (RCTs), and Hawker and Payne's quality appraisal criteria was used to appraise the data from the other included papers systematically. Results: A total of 37 studies, including 20 RCTs were included. A favorable impact, across various outcomes, was found across trials which investigated different types of EMS with varying protocols. The heterogenous nature of intervention protocols limited the ability to apply any statistical or meta-analyses. EMS demonstrates a positive effect for improving outcomes related to 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, which included them being used as a sole intervention or as an adjunct intervention. High intensity forms of EMS were consistently found to require shorter intervention times. Conclusions: EMS demonstrates improvement across outcomes for PFDs among adult women. In particular, the results of this review suggest that EMS may be particularly useful in women living with stress urinary incontinence (SUI) or who those are unable to perform voluntary muscle contractions when pelvic floor muscle training is attempted. Further research related to more novel versions of high intensity EMS approaches is needed.