The evidence of 7 RCT’s using electrical stimulation found inconsistent results, showing no cure or overall improvement of urinary incontinence in women, compared to sham stimulation or PFM training. Two of the studies found that electrical stimulation resulted in continence in about 20% of women (Bo et al., 1999; Smith, 1996). However despite the short term success of electrical stimulation in the above studies, a six month follow-up failed to show any statistically significant benefit from electrical stimulation compared to other physiotherapy management or medications. The remaining RCTs also did not display any significant benefits of electrical simulation when compared with the outcomes of Kegel exercises (Smith, 1996), biofeedback-assisted training (Pages et al., 2001), or placebo trials (Luber & Wolde-Tsadik, 1997: Fujishiro, 2000; Yamanishi et al, 1997; Yamanishi et al., 2000).
Evidence Specific to Interferential Treatment
Turkan et al., 2005, examined the short-term effects of physical therapy throughout the different intensities of urodynamic stress continence. Interferential current therapy and kegel exercises were both undertaken in the intervention, resulting in the conclusion that the combination treatment was more effective in mild and moderate cases rather than those with severe incontinence.
Dumoulin et al, 1995 found an increase in PFM strength and a subsequent decrease in quantity and frequency of incontinence; following the implementation of a combined physical therapy and interferential program, using suction cups.
A comparative study between interferential current and biofeedback found both modalities to be beneficial to those with USI. They noted an improvement in continence, pelvic muscle strength and quality of life. Finding no significant difference between biofeedback and interferential (Demirturk et al., 2008).
CONCLUSION
After looking at all the evidence for interferential therapy, we have come to the conclusion that it is quite a beneficial treatment for the pelvic floor, when combined with other interventions such as kegel exercises. It is considerably less invasive than other Estim techniques, and also does not produce as much skin irritation. When interferential current is used in isolation it seems to produce decent results concerning the restoration of PFM strength. The PFM play a vital role in one’s continence, and further investigation is required to determine whether the improvements gained from interferential therapy are maintained in the long term.
Adios Amigos
Mitch & Christie
Bø, K., Talseth, T., Holme, I. (1999). Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in manage- ment of genuine stress incontinence in women. BMJ. 318:487-93.
Demirturk, F., Akbayrak, T., Karakaya, I. C., Yuksel, I., Kirdi, N., Demirturk, F., Kaya, S., Ergen, A., Beksac, S. (2008). Interferential current versus biofeedback results in urinary stress incontinence. Swiss Medical Weekly, 317-321.
Dumoulin, C., Seaborne, D. E., Quirion-DeGirardi, C., Sullivan, S. J. (1995). Pelvic floor rehabilitation, Part 2: Pelvic-Floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women - A Cohort study. Physical Therapy, 75(12): 1075-1081.
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Sand, P. K., Richardson, D. A., Staskin, D. R., Swift, S. E., Appell, R. A., Whitmore, K. E., et al. (1995). Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: a multicenter, placebo-controlled trial. Am J Obstet Gynecol. 173:72-9.
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Turkan, A., Inci, Y., Fazli, D. (2005). The short- term effects of physical therapy in different intensities of urodynamic stress incontinence. Gynecol Obstet Invest, 59:43-48.
Yamanishi, T., Yasuda, K., Sakakibara, R., Hattori, T., Ito, H., Murakami, S. (1997). Pelvic floor electrical stimulation in the treatment of stress incontinence: an in-vestigational study and a placebo controlled double-blind trial. J Urol. 158: 2127-31.
Yamanishi, T., Yasuda, K., Sakakibara, R., Hattori, T., Suda, S. (2000). Randomized, double-blind study of electrical stimulation for urinary incontinence due to de-trusor overactivity. Urology. 55:353-7.
Thanks for this summary. As usual we can drill down to particular populations of sufferers with incontinence and find that no general treatment suits all of the people all of the time. But I'm glad your peers now recognize the validity of a trial of IFT adjuctively with the other elements of an active physio intervention e.g. education and exercises. The group with the most severe degree of problem, the bed-bound geriatric, also have additional contraindications and care factors regarding constantly damp skin. It's a huge area and one in which physios will continue to play a large part.
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