Effects of Transcranial Direct Current Stimulation and Pelvic Floor Muscle Training in Women: protocol for a controlled, randomized, double-blind clinical trial
DOI:
https://doi.org/10.1590/1809-2950/e23006224ptKeywords:
Pelvic Floor, Transcranial Direct Current Stimulation (tDCS), Intravaginal Pressure, Sexual Function, Quality of LifeAbstract
Pelvic floor muscle weakness can lead to
urinary incontinence, pelvic organ prolapse, and sexual
dysfunction. Although it can be minimized by pelvic floor
muscle training (PFMT), its effects are not lasting. Therefore,
using combination therapy seems promising. This study
aims to evaluate the effect of transcranial direct current
stimulation (tDCS) combined with PFMT on intravaginal
pressure, pelvic floor muscle strength (PFMS), sexual
function (SF), and quality of life (QoL) in healthy women. A total of 32 women, aged from 18 to 45 years, will undergo
PFMT (with perineal contractions and relaxation) with the aid
of pressure biofeedback associated with active tDCS or sham
tDCS. Sessions will last 20 minutes, three times per week, for four
weeks, totaling 12 sessions. During the protocol, participants will be
instructed to also perform the home-based PFMT daily. The tDCS
anodal electrode will be positioned over the supplementary motor
area of the dominant cortical hemisphere, whereas the cathodal
will be over the contralateral supraorbital region, with a 2mA
intensity for 20 minutes. Intravaginal pressure (pressure gauge),
PFM strength (measured by digital palpation and the PERFECT
scheme), FSFI (Female Sexual Function Index), and QoL (SF-36
questionnaire) will be evaluated before and after the 12 sessions
and after a 30-day follow-up.
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References
Pereira LC, Botelho S, Marques J, Adami DB, Alves FK, et al.
Electromyographic pelvic floor activity: Is there impact during
the female life cycle? Neurourol Urodyn. 2016;35(2):230-4.
Aydin S, Arioğlu Aydin Ç, Batmaz G, Dansuk R. Effect of vaginal
electrical stimulation on female sexual functions: a randomized
study. J Sexual Med. 2015;12(2):463-9.
Kafri R, Kodesh A, Shames J, Golomb J, Melzer I. Depressive
symptoms and treatment of women with urgency urinary
incontinence. Int Urogynecol J Pelvic Floor Dysfunct.
;24(11):1953-9. doi: 10.1007/s00192-013-2116-9
Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, et al.
Pelvic floor muscle training for preventing and treating urinary
and faecal incontinence in antenatal and postnatal women.
Cochrane Database Syst Rev. 2020;5(5):CD007471.
doi: 10.1002/14651858.CD007471.pub4
Sartori DVB, Kawano PR, Yamamoto HA, Guerra R, Pajolli PR,
et al. Pelvic floor muscle strength is correlated with sexual
function. Investig Clin Urol. 2021;62(1):79-84.
Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OH. Pelvic floor
muscle parameters affect sexual function after 8 weeks of
transcutaneous electrical stimulation in women with stress
urinary incontinence. Sex Med. 2019;7(4):505-13.
Kegel AH. Progressive resistance exercise in the functional
restoration of the perineal muscles. Am J Obstet Gynecol.
;56(2):238-48.
Rivalta M, Sighinolfi MC, Micali S, Stefani S, Bianchi G. Sexual
function and quality of life in women with urinary incontinence
treated by a complete pelvic floor rehabilitation program
(Biofeedback, Functional Electrical Stimulation, Pelvic
Floor Muscles Exercises, and Vaginal Cones). J Sexual Med.
;7(3):1200-8.
Culligan PJ, Scherer J, Dyer K, Priestley JL, Guingon-White G,
et al. A randomized clinical trial comparing pelvic floor muscle
training to a Pilates exercise program for improving pelvic
muscle strength. Int Urogynecol J. 2010;21(4):401-8.
Purpura DP, Mcmurtry JG. Intracellular activities and evoked
potential changes during polarization of motor cortex’.
Neurophysiology. 1965;28:166-85.
Creutzfeldt OD, Fromm GH, Kapp H. Influence of transcortical
D-C currents on cortical neuronal activity. Experiment Neurol.
;5(6):436-52.
Costa-Ribeiro A, Maux A, Bosford T, Aoki Y, Castro R, et al.
Transcranial direct current stimulation associated with gait
training in Parkinson’s disease: a pilot randomized clinical trial.
Dev Neurorehabil. 2017;20(3):121-8.
Vitor-Costa M, Pereira LA, Montenegro RA, Okano AH, Altimari
LR. A Estimulação transcraniana por corrente contínua como
recurso ergogênico: uma nova perspectiva no meio esportivo.
Rev Educ Fis UEM. 2012;23(2):167-74.
Shafi MM, Westover MB, Fox MD, Pascual-Leone A.
Exploration and modulation of brain network interactions
with noninvasive brain stimulation in combination
with neuroimaging. Eur J Neurosci. 2012;35(6):805-25.
doi: 10.1111/j.1460-9568.2012.08035.x
Kim YJ, Ku J, Cho S, Kim HJ, Cho YK, et al. Facilitation of
corticospinal excitability by virtual reality exercise following
anodal transcranial direct current stimulation in healthy
volunteers and subacute stroke subjects. J Neuroeng Rehabil.
;11(1):124. doi: 10.1186/1743-0003-11-124
Kuhtz-Buschbeck JP, van der Horst C, Wolff S, Filippow N,
Nabavi A, et al. Activation of the supplementary motor area
(SMA) during voluntary pelvic floor muscle contractions-An
fMRI study. Neuroimage. 2007;35(2):449-57. doi: 10.1016/j.
neuroimage.2006.12.032
Zhang H, Reitz A, Kollias S, Summers P, Curt A, et al. An fMRI study
of the role of suprapontine brain structures in the voluntary
voiding control induced by pelvic floor contraction. Neuroimage.
;24(1):174-80. doi: 10.1016/j.neuroimage.2004.08.027
Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O miniexame do estado mental em uma população geral impacto
da escolaridade. Arq Neuropsiquiatr. 1994;52(1):1-7.
Persu C, Chapple C, Cauni V, Gutue S, Geavlete P. Pelvic Organ
Prolapse Quantification System (POP-Q) - a new era in pelvic
prolapse staging. J Med Life. 2011;4(1):75-81.
Talasz H, Kalchschmid E, Kofler M, Lechleitner M. Effects of
multidimensional pelvic floor muscle training in healthy young
women. Arch Gynecol Obstet. 2012;285(3):709-15. doi: 10.1007/
s00404-011-2039-y
Barbosa PB, Franco MM, Souza FO, Antônio FI, Montezuma
T, et al. Comparison between measurements obtained with
three different perineometers. Clinics. 2009;64(6):527-33.
Laycock J, Jerwood D. Pelvic floor muscle assessment: the
perfect scheme. Physiotherapy. 2001;87(12):631-42.
Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin
J, et al. Evidence-based guidelines on the therapeutic
use of transcranial direct current stimulation (tDCS).
Clinical Neurophysiology. 2017;128(1):56-92. doi: 10.1016/j.
clinph.2016.10.087
Angelo PH, Varella LRD, Oliveira MCE, Matias MGL, Azevedo
MAR, et al. A manometry classification to assess pelvic floor
muscle function in women. PLoS One. 2017;12(10):e0187045.
doi: 10.1371/journal.pone.0187045
Ferreira CHJ, Barbosa PB, Souza FO, Antônio FI, Franco
MM, et al. Inter-rater reliability study of the modified Oxford
Grading Scale and the Peritron manometer. Physiotherapy.
;97(2):132-8. doi: 10.1016/j.physio.2010.06.007
Frawley HC, Galea MP, Phillips BA, Sherburn M, Boø K. Reliability
of pelvic floor muscle strength assessment using different test
positions and tools. Neurourol Urodyn. 2006;25(3):236-42.
Carvalho-Pacagnella R, Zangiacomi-Martinez E, Meloni-Vieira E.
Validade de construto de uma versão em português do female
sexual function index. Cad Saude Publica. 2009;25(11):2333-44.
doi: 10.1590/S0102-311X2009001100004
Ciconelli RM. Tradução para o português e validação do
questionário medical outcomes study 36-item short-form
health survey (SF-36). São Paulo: Universidade Federal
de São Paulo; 1997.
Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Silva Miozzo
IC, et al. Validation of the Brazilian Portuguese version of the
Pittsburgh sleep quality Index. Sleep Med. 2011;12(1):70-5.
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Copyright (c) 2024 Fernanda Ishida Corrêa, Ângela Cristina Ledur, João Carlos Ferrari Corrêa, Felipe Fregni
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