Functional assessment of the pelvic floor muscles by electromyography: is there a normalization in data analysis? A systematic review
DOI:
https://doi.org/10.1590/1809-2950/16559525012018Keywords:
Pelvic Floor, Electromyography, ReviewAbstract
This study aims to evaluate the method of analysis of electromyographic data considering the functional assessment of pelvic floor muscles (PFM). We have included in our search strategy the following databases: Medline, PubMed, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, PEDro, and IBECS, considering articles published in the last ten years (2004-2014). The identified articles were independently examined by two evaluators, according to these inclusion criteria: (1) population: female adults; (2) PFM assessment by electromyography (EMG) with vaginal/anal probe; and (3) description of how electromyographic data analysis is performed. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias. We identified 508 articles, of which 23 were included in the review. The data showed differences between the collection protocols, and a significant number of studies did not normalize the electromyographic data. Physiotherapists are among the clinicians who most frequently use EMG to evaluate the function and dysfunction of the neuromuscular system. Although some previous studies have provided an overview to guide the evaluator in the assessment, few succeeding studies followed their recommendations.Downloads
References
Matheus-Vasconcelos ECL, Ribeiro AM. Força e função
muscular do assoalho pélvico: como avaliar? Fisioter Bras.
;14(6):465-9.
Bø K, Sherburn M. Evaluation of female pelvic-floor muscle
function and strength. Phys Ther. 2005;85(3):269-82. doi:
1093/ptj/85.3.269
Botelho S, Pereira LC, Marques J, Lanza AH, Amorim CF, Palma
P, et al. Is there correlation between electromyography and
digital palpation as means of measuring pelvic floor muscle
contractility in nulliparous, pregnant, and postpartum women?
Neurourol Urodyn. 2013;32(5):420-3. doi: 10.1002/nau.22321
Marques J, Botelho S, Pereira LC, Lanza AH, Amorim CF,
Palma P, et al. Pelvic floor muscle training program increases
muscular contractility during first pregnancy and postpartum:
electromyographic study. Neurourol Urodyn. 2012;32(7):998-
doi: 10.1002/nau.22346
Ocarino JM, Silva PLP, Vaz DV, Aquino CF, Brício RS, Fonseca
ST. Eletromiografia: interpretação e aplicações nas ciências
da reabilitação. Fisioter Bras. 2005;6(4):305-10.
Keshwani N, McLean L. State of the art review: intravaginal
probes for recording electromyography from the pelvic floor
muscles. Neurourol Urodyn. 2015;34(2):104-12. doi: 10.1002/
nau.22529
Turker KS. Electromyography: some methodological problems
and issues. Phys Ther. 1993;73(10):698-710.
de Luca CJ. The use of surface electromyography in
biomechanics. J Appl Biomech. 1997;13(2):135-63. doi: 10.1123/
jab.13.2.135
Burden A, Bartlett R. Normalisation of EMG amplitude: an
evaluation and comparison of old and new methods. Med Eng
Phys. 1999;21(4):247-57. doi: 10.1016/S1350-4533(99)00054-5
Stang A. Critical evaluation of the Newcastle-Ottawa scale
for the assessment of the quality of nonrandomized studies
in meta-analyses. Eur J Epidemiol. 2010;25(9):603-5. doi:
1007/s10654-010-9491-z
Auchincloss C, McLean L. The reliability of surface EMG
recorded from the pelvic floor muscles. J Neurosci Methods.
;182(1):85-96. doi: 10.1016/j.jneumeth.2009.05.027
Chen HL, Lin YC, Chien WJ, Huang WC, Lin HY, Chen PL. The
effect of ankle position on pelvic floor muscle contraction
activity in women. J Urol. 2009;181(3):1217-23. doi: 10.1016/j.
juro.2008.10.151
Devreese A, Staes F, Janssens L, Penninckx F, Vereecken R,
de Weerdt W. Incontinent women have altered pelvic floor
muscle contraction patterns. J Urol. 2007;178(2):558-62. doi:
1016/j.juro.2007.03.097
Frederice CP, Amaral E, Ferreira NO. Urinary symptoms and
pelvic floor muscle function during the third trimester of
pregnancy in nulliparous women. J Obstet Gynaecol Res.
;39(1):188-94. doi: 10.1111/j.1447-0756.2012.01962.x
Grape HH, Dedering A, Jonasson AF. Retest reliability of
surface electromyography on the pelvic floor muscles.
Neurourol Urodyn. 2009;28(5):395-9. doi: 10.1002/nau.20648
Halski T, Słupska L, Dymarek R, Bartnicki J, Halska U, Król
A, et al. Evaluation of bioelectrical activity of pelvic floor
muscles and synergistic muscles depending on orientation of
pelvis in menopausal women with symptoms of stress urinary
incontinence: a preliminary observational study. Biomed Res
Int. 2014;2014:[8 p.]. doi: 10.1155/2014/274938
Halski T, Ptaszkowski K, Słupska L, Dymarek R. The evaluation
of bioelectrical activity of pelvic floor muscles depending on
probe location: a pilot study. Biomed Res Int. 2013;2013:[7 p.].
doi: 10.1155/2013/238312
Junginger B, Baessler K, Sapsford R, Hodges PW. Effect of
abdominal and pelvic floor tasks on muscle activity, abdominal
pressure and bladder neck. Int Urogynecol J. 2010;21(1):69-77.
doi: 10.1007/s00192-009-0981-z
Lauper M, Kuhn A, Gerber R, Luginbühl H, Radlinger L. Pelvic
floor stimulation: what are the good vibrations? Neurourol
Urodyn. 2009;28(5):405-10. doi: 10.1002/nau.20669
Luginbuehl H, Lehmann C, Gerber R, Kuhn A, Hilfiker R,
Baeyens JP, et al. Continuous versus intermittent stochastic
resonancewhole body vibration and its effect on pelvic floor
muscle activity. Neurourol Urodyn. 2012;31(5):683-7. doi:
1002/nau.21251
Pereira LC, Botelho S, Marques J, Amorim CF, Lanza AH, Palma
P, et al. Are transversus abdominis/oblique internal and pelvic
floor muscles coactivated during pregnancy and postpartum?
Neurourol Urodyn. 2013;32(5):416-9. doi: 10.1002/nau.22315
Petricelli CD, Resende AP, Elito Júnior J, Araujo Júnior E,
Alexandre SM, Zanetti MR, et al. Distensibility and strength
of the pelvic floor muscles of women in the third trimester
of pregnancy. Biomed Res Int. 2014;2014:[6 p.]. doi:
1155/2014/437867
Resende AP, Petricelli CD, Bernardes BT, Alexandre SM,
Nakamura MU, Zanetti MR. Electromyographic evaluation
of pelvic floor muscles in pregnant and nonpregnant
women. Int Urogynecol J. 2012;23(8):1041-5. doi: 10.1007/
s00192-012-1702-6
Resende AP, Zanetti MR, Petricelli CD, Castro RA, Alexandre
SM, Nakamura MU. Effects of the Paula method in
electromyographic activation of the pelvic floor: a comparative
study. Int Urogynecol J. 2011;22(6):677-80. doi: 10.1007/
s00192-010-1331-x
Sapsford RR, Richardson CA, Maher CF, Hodges PW.
Pelvic floor muscle activity in different sitting postures in
continent and incontinent women. Arch Phys Med Rehabil.
;89(9):1741-7. doi: 10.1016/j.apmr.2008.01.029
Smith MD, Coppieters MW, Hodges PW. Is balance different
in women with and without stress urinary incontinence?
Neurourol Urodyn. 2008;27(1):71-8. doi: 10.1002/nau.20476
Smith MD, Coppieters MW, Hodges PW. Postural response of
the pelvic floor and abdominal muscles in women with and
without incontinence. Neurourol Urodyn. 2007;26(3):377-85.
doi: 10.1002/nau.20336
Soljanik I, Janssen U, May F, Fritsch H, Stief CG, Weissenbacher
ER, et al. Functional interactions between the fossa ischioanalis,
levatorani and gluteus maximus muscles of the female pelvic
floor: a prospective study in nulliparous women. Arch Gynecol
Obstet. 2012;286(4):931-8. doi: 10.1007/s00404-012-2377-4
Stüpp L, Resende AP, Petricelli CD, Nakamura MU, Alexandre
SM, Zanetti MR. Pelvic floor muscle and transversus abdominis
activation in abdominal hypopressive technique through 1. Matheus-Vasconcelos ECL, Ribeiro AM. Força e função
muscular do assoalho pélvico: como avaliar? Fisioter Bras.
;14(6):465-9.
Bø K, Sherburn M. Evaluation of female pelvic-floor muscle
function and strength. Phys Ther. 2005;85(3):269-82. doi:
1093/ptj/85.3.269
Botelho S, Pereira LC, Marques J, Lanza AH, Amorim CF, Palma
P, et al. Is there correlation between electromyography and
digital palpation as means of measuring pelvic floor muscle
contractility in nulliparous, pregnant, and postpartum women?
Neurourol Urodyn. 2013;32(5):420-3. doi: 10.1002/nau.22321
Marques J, Botelho S, Pereira LC, Lanza AH, Amorim CF,
Palma P, et al. Pelvic floor muscle training program increases
muscular contractility during first pregnancy and postpartum:
electromyographic study. Neurourol Urodyn. 2012;32(7):998-
doi: 10.1002/nau.22346
Ocarino JM, Silva PLP, Vaz DV, Aquino CF, Brício RS, Fonseca
ST. Eletromiografia: interpretação e aplicações nas ciências
da reabilitação. Fisioter Bras. 2005;6(4):305-10.
Keshwani N, McLean L. State of the art review: intravaginal
probes for recording electromyography from the pelvic floor
muscles. Neurourol Urodyn. 2015;34(2):104-12. doi: 10.1002/
nau.22529
Turker KS. Electromyography: some methodological problems
and issues. Phys Ther. 1993;73(10):698-710.
de Luca CJ. The use of surface electromyography in
biomechanics. J Appl Biomech. 1997;13(2):135-63. doi: 10.1123/
jab.13.2.135
Burden A, Bartlett R. Normalisation of EMG amplitude: an
evaluation and comparison of old and new methods. Med Eng
Phys. 1999;21(4):247-57. doi: 10.1016/S1350-4533(99)00054-5
Stang A. Critical evaluation of the Newcastle-Ottawa scale
for the assessment of the quality of nonrandomized studies
in meta-analyses. Eur J Epidemiol. 2010;25(9):603-5. doi:
1007/s10654-010-9491-z
Auchincloss C, McLean L. The reliability of surface EMG
recorded from the pelvic floor muscles. J Neurosci Methods.
;182(1):85-96. doi: 10.1016/j.jneumeth.2009.05.027
Chen HL, Lin YC, Chien WJ, Huang WC, Lin HY, Chen PL. The
effect of ankle position on pelvic floor muscle contraction
activity in women. J Urol. 2009;181(3):1217-23. doi: 10.1016/j.
juro.2008.10.151
Devreese A, Staes F, Janssens L, Penninckx F, Vereecken R,
de Weerdt W. Incontinent women have altered pelvic floor
muscle contraction patterns. J Urol. 2007;178(2):558-62. doi:
1016/j.juro.2007.03.097
Frederice CP, Amaral E, Ferreira NO. Urinary symptoms and
pelvic floor muscle function during the third trimester of
pregnancy in nulliparous women. J Obstet Gynaecol Res.
;39(1):188-94. doi: 10.1111/j.1447-0756.2012.01962.x
Grape HH, Dedering A, Jonasson AF. Retest reliability of
surface electromyography on the pelvic floor muscles.
Neurourol Urodyn. 2009;28(5):395-9. doi: 10.1002/nau.20648
Halski T, Słupska L, Dymarek R, Bartnicki J, Halska U, Król
A, et al. Evaluation of bioelectrical activity of pelvic floor
muscles and synergistic muscles depending on orientation of
pelvis in menopausal women with symptoms of stress urinary
incontinence: a preliminary observational study. Biomed Res
Int. 2014;2014:[8 p.]. doi: 10.1155/2014/274938
Halski T, Ptaszkowski K, Słupska L, Dymarek R. The evaluation
of bioelectrical activity of pelvic floor muscles depending on
probe location: a pilot study. Biomed Res Int. 2013;2013:[7 p.].
doi: 10.1155/2013/238312
Junginger B, Baessler K, Sapsford R, Hodges PW. Effect of
abdominal and pelvic floor tasks on muscle activity, abdominal
pressure and bladder neck. Int Urogynecol J. 2010;21(1):69-77.
doi: 10.1007/s00192-009-0981-z
Lauper M, Kuhn A, Gerber R, Luginbühl H, Radlinger L. Pelvic
floor stimulation: what are the good vibrations? Neurourol
Urodyn. 2009;28(5):405-10. doi: 10.1002/nau.20669
Luginbuehl H, Lehmann C, Gerber R, Kuhn A, Hilfiker R,
Baeyens JP, et al. Continuous versus intermittent stochastic
resonancewhole body vibration and its effect on pelvic floor
muscle activity. Neurourol Urodyn. 2012;31(5):683-7. doi:
1002/nau.21251
Pereira LC, Botelho S, Marques J, Amorim CF, Lanza AH, Palma
P, et al. Are transversus abdominis/oblique internal and pelvic
floor muscles coactivated during pregnancy and postpartum?
Neurourol Urodyn. 2013;32(5):416-9. doi: 10.1002/nau.22315
Petricelli CD, Resende AP, Elito Júnior J, Araujo Júnior E,
Alexandre SM, Zanetti MR, et al. Distensibility and strength
of the pelvic floor muscles of women in the third trimester
of pregnancy. Biomed Res Int. 2014;2014:[6 p.]. doi:
1155/2014/437867
Resende AP, Petricelli CD, Bernardes BT, Alexandre SM,
Nakamura MU, Zanetti MR. Electromyographic evaluation
of pelvic floor muscles in pregnant and nonpregnant
women. Int Urogynecol J. 2012;23(8):1041-5. doi: 10.1007/
s00192-012-1702-6
Resende AP, Zanetti MR, Petricelli CD, Castro RA, Alexandre
SM, Nakamura MU. Effects of the Paula method in
electromyographic activation of the pelvic floor: a comparative
study. Int Urogynecol J. 2011;22(6):677-80. doi: 10.1007/
s00192-010-1331-x
Sapsford RR, Richardson CA, Maher CF, Hodges PW.
Pelvic floor muscle activity in different sitting postures in
continent and incontinent women. Arch Phys Med Rehabil.
;89(9):1741-7. doi: 10.1016/j.apmr.2008.01.029
Smith MD, Coppieters MW, Hodges PW. Is balance different
in women with and without stress urinary incontinence?
Neurourol Urodyn. 2008;27(1):71-8. doi: 10.1002/nau.20476
Smith MD, Coppieters MW, Hodges PW. Postural response of
the pelvic floor and abdominal muscles in women with and
without incontinence. Neurourol Urodyn. 2007;26(3):377-85.
doi: 10.1002/nau.20336
Soljanik I, Janssen U, May F, Fritsch H, Stief CG, Weissenbacher
ER, et al. Functional interactions between the fossa ischioanalis,
levatorani and gluteus maximus muscles of the female pelvic
floor: a prospective study in nulliparous women. Arch Gynecol
Obstet. 2012;286(4):931-8. doi: 10.1007/s00404-012-2377-4
Stüpp L, Resende AP, Petricelli CD, Nakamura MU, Alexandre
SM, Zanetti MR. Pelvic floor muscle and transversus abdominis
activation in abdominal hypopressive technique through
Downloads
Published
Issue
Section
License
Copyright (c) 2018 Fisioterapia e Pesquisa
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
