Functional assessment of the pelvic floor muscles by electromyography: is there a normalization in data analysis? A systematic review

Aline Moreira Ribeiro,Thaís Daniel Da Silva,Elaine Cristine Lemes Mateus-Vasconcelos,Harley Francisco De Oliveira,Luiz Gustavo De Oliveira Brito

doi:10.1590/1809-2950/16559525012018

Abstract

ABSTRACT 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.

Highlights

The correlation between pelvic floor muscles (PFM) strength and dysfunctions in this region is still an open field of research, with few published data
Several functional PFM assessment methods are used in clinical practice and research, such as digital palpation, perineometry, surface electromyography, dynamometry, and imaging modalities, such as ultrasonography and magnetic resonance imaging[1,2]
Because PFMs lie deep to the skin surface and the superficial and deep layers of PFMs have distinct functions, to use surface electrodes adhered to the perineum is not ideal to study the deep layer of the PFMs, as unwanted activity would inevitably be recorded from the superficial PFMs and potentially from other nearby muscles including the anal sphincter, the gluteus, and the obturator hip musculature

Summary

Introduction

The correlation between pelvic floor muscles (PFM) strength and dysfunctions in this region is still an open field of research, with few published data. Several functional PFM assessment methods are used in clinical practice and research, such as digital palpation, perineometry, surface electromyography (sEMG), dynamometry, and imaging modalities, such as ultrasonography and magnetic resonance imaging[1,2]. Among these assessment methods, electromyography (EMG) outstands as an alternative method to monitor muscle tone at rest, muscle strength, and muscular endurance, and to obtain data on the normal and abnormal physical functions of the PFM. Considering that deep PFMs lie adjacent to the vaginal walls, electrodes positioned against the lateral vaginal walls are a convenient mean to record their EMG activity[6]

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Conclusion