Does non-implanted electrical stimulation reduce post-stroke urinary or fecal incontinence? A systematic review with meta-analysis

Abstract

Background

Urinary and fecal incontinence are disabling impairments after stroke that can be clinically managed with electrical stimulation.

Aim

The purpose of this systematic review was to determine the effectiveness of non-implanted electrical stimulation to reduce the severity of post-stroke incontinence.

Summary of review

Clinical trials of non-implanted electrical stimulation applied for the purposes of treating post-stroke incontinence were searched in MEDLINE, EMBASE, CINAHL, PEDro, and CENTRAL. From a total of 5043 manuscripts, 10 trials met the eligibility criteria (n = 894 subjects). Nine trials reported urinary incontinence severity outcomes enabling meta-analysis of transcutaneous electrical nerve stimulation (TENS; five trials) and electroacupuncture (four trials). Studies provide good-to-fair quality evidence that TENS commenced <3 months post-stroke has a large effect on urinary continence (SMD = −3.40, 95% CI −4.46 to −2.34) and a medium effect when commenced >3 months after stroke (SMD = −0.67, 95% CI −1.09 to −0.26). Electroacupuncture has a large effect when administered >5 times a week (SMD = −2.32, 95% CI −2.96 to −1.68) and a small effect when administered five times a week (SMD = −0.44, 95% CI −0.69 to −0.18). Only one trial reported the effect of non-implanted electrical stimulation on post-stroke fecal incontinence.

Conclusions

Published trials evaluating the effect of non-implanted electrical stimulation on post-stroke incontinence are few and heterogenous. Synthesized trials suggest that early and frequent treatment using electrical stimulation is probably more effective than sham or no treatment. Further trials measuring incontinence in an objective manner are required.

Keywords

Electric stimulation incontinence stroke transcutaneous electric nerve stimulation electroacupuncture neuroscience rehabilitation

Get full access to this article

View all access options for this article.

References

Patel

Coshall

Rudd

Wolfe

. Natural history and effects on 2-year outcomes of urinary incontinence after stroke. Stroke 2001; 32: 122–127.

Harari

Coshall

Rudd

Wolfe

. New-onset fecal incontinence after stroke: prevalence, natural history, risk factors, and impact. Stroke 2003; 34: 144–150.

Fowler

Griffiths

de Groat

. The neural control of micturition. Nat Rev Neurosci 2008; 9: 453–66.

Tillisch

Mayer

Labus

. Quantitative meta-analysis identifies brain regions activated during rectal distension in irritable bowel syndrome. Gastroenterology 2011; 140: 91–100.

Edwards

Hahn

Dromerick

. Post-stroke urinary loss, incontinence and life satisfaction: when does post-stroke urinary loss become incontinence?. Neurourol Urodyn 2006; 25: 39–45.

Dromerick

Hahn

Kleine

Edwards

. Urinary incontinence predicts quality of life and activity participation after stroke. Stroke 2003; 34: 313.

Thomas

Coupe

Cross

Tan

Watkins

. Interventions for treating urinary incontinence after stroke in adults. Cochr Datab Syst Rev 2019; 2: CD004462.

Coggrave

Norton

Cody

. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochr Datab Syst Rev 2014; 1: CD002115.

Martellucci

Weil

EHJ

Matzel

. Electrical stimulation for pelvic floor disorders, Cham, Switzerland: Springer, 2015.

10.

Berghmans

Hendriks

Bernards

de Bie

Omar

. Electrical stimulation with non-implanted electrodes for urinary incontinence in men. Cochr Datab Syst Rev 2013; 6: CD001202.

11.

Cumpston

Chandler

Chapter II: planning a cochrane review. In: Higgins

Thomas

Chandler

, et al.(eds). Cochrane handbook for systematic reviews of interventions, Version 60. London, UK: Cochrane Collaboration, 2019.

12.

Hoffmann

Glasziou

Boutron

, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Br Med J 2014; 348: 1–12.

13.

Foley

Teasell

Bhogal

Speechley

. Stroke rehabilitation evidence-based review: methodology. Top Stroke Rehabil 2003; 10: 1–7.

14.

Cohen

. Statistical power analysis for the behavioral sciences, 2nd ed. Hoboken, NJ: Taylor and Francis, 1988.

15.

Bernhardt

Hayward

Kwakkel

, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: the Stroke Recovery and Rehabilitation Roundtable Taskforce. Int J Stroke 2017; 12: 444–450.

16.

Higgins

JPT

Thomas

Chandler

, et al. Cochrane handbook for systematic reviews of interventions, 2nd ed. London, UK: The Cochrane Collaboration, 2019.

17.

Booth

Connelly

Dickson

, et al. Transcutaneous tibial nerve stimulation for rehabilitation and treatment of urinary incontinence (TREAT-UI) after stroke: a feasibility study with Pilot Randomised Controlled Trial. Int J Stroke 2016; 11(4 Suppl 1): 13.

18.

Chu

J-M

Bao

Y-H

Zou

Zhao

H-L

Gong

Wang

C-M

. Randomized controlled clinical trials for electroacupuncture treatment of urinary incontinence in stroke patients. Zhen Ci Yan Jiu [Acupuncture Res] 2011; 36: 428–432.

19.

Guo

Liu

. Transcutaneous electrical nerve stimulation in the treatment of patients with poststroke urinary incontinence. Clin Interv Aging 2014; 9: 851–856.

20.

Guo

Kang

. Effectiveness of neuromuscular electrical stimulation therapy in patients with urinary incontinence after stroke: a Randomized sham controlled trial. Medicine (Baltimore) 2018; 97(52 e13702): 1–5.

21.

Jiaofeng

Shufang

Juanjuan

. Electro-acupuncture combined with needle warming therapy of urinary incontinence after stroke in clinical research. Asia Pacific Tradit Med 2019; 15: 132–134.

22.

Liu

Wang

. Electroacupuncture at points Baliao and Huiyang (BL35) for post-stroke detrusor overactivity. Neural Regen Res 2013; 8: 1663–1672.

23.

Liu

Luo

Teng

. Effects of transcutaneous electrical nerve stimulation at two frequencies on urinary incontinence in poststroke patients. Am J Phys Med Rehabil 2016; 95: 183–193.

24.

Monteiro

De Carvalho

LBC

Fukujima

Lora

Do Prado

. Electrical stimulation of the posterior tibialis nerve improves symptoms of poststroke neurogenic overactive bladder in men: a randomized controlled trial. Urology 2014; 84: 509–514.

25.

Song

Jiang

Zheng

, et al. Electroacupuncture for post-stroke urinary incontinence: a multi-center randomized controlled study. Zhongguo Zhen Jiu (Chin Acupunct Moxibustion) 2013; 33: 769–773.

26.

Zhao

Hong

. Clinical observation of electro-acupuncture combined with pelvic floor muscle training in treatment of patients with urinary incontinence after cerebral infarction. China J Tradit Chinese Med Pharm 2016; 31: 3377–3380.

27.

Avery

Donovan

Peters

Shaw

Gotoh

Abrams

. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 2004; 23: 322–330.

28.

Jimenez‐Cidre

Lopez‐Fando

Esteban‐Fuertes

, et al. The 3‐day bladder diary is a feasible, reliable and valid tool to evaluate the lower urinary tract symptoms in women. Neurourol Urodyn 2015; 34: 128–132.

29.

Elmer

Murphy

Elliott

Book

. Twenty-four hour voiding diaries versus 3-day voiding diaries: a clinical comparison. Female Pelvic Med Reconstr Surg 2017; 23: 429–432.

30.

Crooks

Schnelle

Ouslander

McNees

. Use of the minimum data set to rate incontinence severity. J Am Geriatr Soc 1995; 43: 1363–1369.

31.

Collin

Wade

Davies

Horne

. The Barthel ADL index: a reliability study. Int Disabil Stud 1988; 10: 61–63.

32.

Stewart

Berghmans

Bø

Glazener

. Electrical stimulation with non-implanted devices for stress urinary incontinence in women. Cochr Datab Syst Rev 2017; 10: CD012390.

33.

National Institute for Health and Care Excellence (NICE). Percutaneous posterior tibial nerve stimulation for overactive bladder syndrome. In: Interventional procedures guidance, 2010, pp.1–6, www.nice.org.uk/guidance/ipg362 (accessed 27 February 2021).

34.

National Institute for Health and Care Excellence (NICE). Percutaneous tibial nerve stimulation for patients with faecal incontinence. In: Interventional procedures guidance, 2011, pp.1–5, www.nice.org.uk/guidance/ipg395 (accessed 27 February 2021).

35.

Schulz

Chalmers

Hayes

Altman

. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273: 408–412.

36.

Gill

Pizarro-Berdichevsky

Bhattacharyya

, et al. Real-time changes in brain activity during sacral neuromodulation for overactive bladder. J Urol 2017; 198: 1379–1385.

37.

Chipchase

Schabrun

Hodges

. Peripheral electrical stimulation to induce cortical plasticity: a systematic review of stimulus parameters. Clin Neurophysiol 2011; 122: 456–463.

38.

Sheldon

Kiff

Clarke

Harris

Hamdy

. Sacral nerve stimulation reduces corticoanal excitability in patients with faecal incontinence. Br J Surg 2005; 92: 1423–1431.

39.

Meesen

Cuypers

Rothwell

Swinnen

Levin

. The effect of long-term TENS on persistent neuroplastic changes in the human cerebral cortex. Hum Brain Mapp 2011; 32: 872–882.

40.

Krakauer

Carmichael

Corbett

Wittenberg

. Getting neurorehabilitation right: what can be learned from animal models?. Neurorehabil Neural Repair 2012; 26: 923–931.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB