Efficacy of interferential low frequency therapy for elderly wet overactive bladder patients

Interferential electrical stimulation for improved bladder management following spinal cord injury

Patients with spinal cord injury (SCI) with neurogenic bladder (NB) represent a major medical problem, which initiated the search for a non-invasive and effective treatment that is easy to apply and without side effects. A study was performed using interferential medium frequency current electrical stimulation (IMFC ES) on 332 patients shortly after SCI diagnosed with NB dysfunction. All subjects received standard care and patients of the experimental group additionally received IMFC ES. Urinary management results included volitional control of voiding, intermittent catheterization, post-voidance residuum (PVR) quantity and quantity of urine lost (LOSS). Results were assessed based on the American spinal cord injury association impairment scale (AIS). The IMFC ES included two channels of medium frequency stimulation that were marginally different. Within the body, a low frequency field was generated through the interaction of the medium frequencies, which stimulated the urinary structures. In the IMFC ES group, interference stimulation was applied for 10 min with frequencies cycling from 0-100 Hz and back in 10 sec intervals. The strength of the low frequency stimulation, achieved by the interference of the two medium-frequency fields, was adjusted to the patients' vibration sensation. The intensities triggering vibration sensation were between 20-80 mA for patients with AIS levels B, C and D. For patients with AIS level A intensities <20 mA were used for therapeutic effects without causing skin injuries. Safety of IMFC ES was based on occurrence of adverse events of which none were recorded in the experimental group. IMFC ES was effective in patients with AIS levels B and C, significantly decreasing PVR and LOSS compared with patients receiving standard care No significant improvements in urinary management were observed following IMFC ES treatment of patients with AIS level A. Patients with SCI and NB classed as AIS levels B and C that exhibit preserved sensitivity were the best beneficiaries of IMFC ES therapy.

Neuromodulation via Interferential Electrical Stimulation as a Novel Therapy in Gastrointestinal Motility Disorders

The concept of therapeutic percutaneous neuromodulation has, until recently, been limited by the ability to penetrate deeply enough to stimulate internal organs. By utilizing 2 medium frequency, slightly out of phase electrical currents passing diagonally through the abdomen, a third, low frequency current is created at the point of bisection. This interferential current appears to stimulate nerve fibers in the target organs and may have a therapeutic action. The aim of the study is to review the use of transcutaneous interferential electrical stimulation with a focus on its application in gastroenterology, particularly in motility disorders. Studies involving use of interferential current therapy were searched from Medline, PubMed, and Scopus databases, and articles pertaining to history, its application and all those treating abdominal and gastrointestinal disorders were retrieved. Seventeen studies were identified, 13 involved children only. Eleven of these were randomised controlled trials (3 in adults). Four trials were from the one center, where each paper reported on different outcomes such as soiling, defecation frequency, quality of life, and colon transit studies from the one pool of children. All studies found statistically significant improvement in symptom reduction. However, weaknesses in study design were apparent in some. In particular, finding an adequate placebo to interferential current therapy has been difficult. Interferential current therapy shows potential as a novel, non-pharmacological and economical means of treating gastrointestinal dysfunction such as constipation. More studies are needed particularly in the adult population. However, the design of a suitable placebo is challenging.

Impact of ao-dake-humi, Japanese traditional bamboo foot stimulator, on lower urinary tract symptoms, constipation and hypersensitivity to cold: a single-arm prospective pilot study

Background

Ao-dake-humi is a traditional Japanese bamboo foot stimulator consisting of a half-pipe-shaped step made of bamboo used to stimulate the foot by stepping on it, and is commonly used to promote general health among the elderly in Japan. However, its efficacy has not been reported in the scientific literature. This study was performed to investigate the role of ao-dake-humi focusing on lower urinary tract symptoms (LUTS), constipation, and hypersensitivity to cold (HC).

Methods

Participants with LUTS, constipation, or HC were enrolled in this study. Ao-dake-humi was used twice a day for 28 days. Before and 28 days after starting ao-dake-humi use, international prostate symptom score (IPSS), quality-of-life (QoL) score, and overactive bladder symptom score (OABSS) were measured to evaluate the efficacy of ao-dake-humi on LUTS. To evaluate the objective efficacy of ao-dake-humi on LUTS, a frequency-volume chart (FVC) was plotted in LUTS patients for 3 days. A visual analogue scale (VAS) was used to evaluate the efficacy of ao-dake-humi on constipation (VAS-constipation) and HC (VAS-HC) in the participants with constipation or HC.

Results

A total of 24 participants were enrolled in this study. Twenty-one participants had LUTS, 11 had constipation, and 17 participants had HC. IPSS, especially storage-subscore, QoL score and OABSS, decreased significantly after use of ao-dake-humi. The use of ao-dake-humi increased maximal bladder capacity, resulting in a significant decrease in urinary frequency as determined from the FVC. In accordance with the results of VAS-constipation and VAS-HC, both constipation and HC were significantly relieved after ao-dake-humi use.

Conclusion

The results of this prospective pilot study indicated that ao-dake-humi is safe and has therapeutic efficacy in cases of LUTS, constipation and HC. The possibility of using ao-dake-humi as physical neuromodulation therapy was shown in the management of LUTS, constipation and HC.

Trial registration

UMIN000019333 (UMIN-CTR, Registered October-15-2015) retrospectively registered.

Transabdominal electrical stimulation (TES) for the treatment of slow-transit constipation (STC)

Slow-transit constipation (STC) is a newly described subtype of intractable constipation in children which we originally identified with deficiency of substance P in axons supplying the proximal colonic muscle. When nuclear transit studies became available, the patients were found to have slow proximal colonic transit, and responded to antegrade enemas. Using the appendicostomy, we found that there was reduced frequency in propagating sequences throughout the colon. We began testing whether transcutaneous electrical stimulation (TES) could improve motility and symptoms, and over several trials have now shown that TES is remarkably effective in treating children with STC, with long-lasting effects. TES holds promise for treating STC, as well as a range of gastrointestinal motility disorders.

Comparison of different treatment protocols in the treatment of idiopathic detrusor overactivity: a randomized controlled trial

Objective: To investigate and compare the effectiveness of various treatment protocols for the treatment of women with idiopathic detrusor overactivity.

Design: Prospective, randomized controlled trial.

Setting: Departments of Physiotherapy and Rehabilitation and Obstetrics and Gynaecology, Hacettepe University.

Subjects: Forty-six subjects were randomized to three groups.

Interventions: The first group received only pharmacotherapy, the second group received only physiotherapy and in the third group pharmacotherapy was combined with physiotherapy (combined therapy group).

Main measures: All patients were evaluated at the beginning and at the end of treatment. Assessment parameters were maximum cystometric capacity, electromyographic activity of pelvic floor muscles, voiding diary parameters, the amount of urine leakage and the quality of life score.

Results: The maximum cystometric capacity and the electromyographic activity of pelvic floor muscles increased significantly and the number of voids/day and incontinence episodes/day, and the amount of urine leakage reduced significantly ( P < 0.05) in both physiotherapy and combined therapy groups while there was no significant difference in the pharmacotherapy group. After treatment, the number of voids/day increased by 0.3 ± 3.4 in the pharmacotherapy group ( P > 0.05) and decreased by 5.1 ± 5.5 and 4.7 ± 5.6 in the physiotherapy and combined therapy groups, respectively ( P < 0.05). Statistically significant improvements were observed in all groups according to the number of voids/night and the quality of life scores at the end of the treatment.

Conclusion: The physiotherapy protocol we introduced in the present study with or without anticholinergic therapy has a substantial positive impact on the treatment of female patients with idiopathic detrusor overactivity.