Part 4: IFT Vs. Biofeedback = Demirturk et al.

Of all the literature reviewed, one study stood out as the most valid for determining the effectiveness of Interferential Therapy (IFT) in the treatment of Urinary Stress Incontinence (USI); a study published in 2008 by Demirturk and colleagues. It directly compared IFT versus Biofeedback and Kegel exercises. 40 USI patients were randomly designated to 2 groups, one undergoing IFT and the other Biofeedback with Kegel exercises. The patients were all female with a mean age of 52 years and an average number of deliveries of 3. This represents a significant clinical population but fails to address all at risk populations of USI. Each group was prescribed 15 sessions of each protocol for 15-minutes each, over a 5-week period.

The results were found using a 1-hour pad test to detect any leakage, pelvic floor muscle (PFM) strength testing and quality of life (QoL) questionnaire. Both methods were found to be similarly effective in all the parameters tested. The figures below show the relatively similar effects of both treatments when taking into account the pre-intervention and post-intervention values.

Since no adverse effects were observed, the study concluded that the two approaches could be applied effectively in the treatment of USI. The clinical significance of these results applies to the way in which practitioners can treat their USI patients. Therapists can decide whether to use IFT or Biofeedback based on their personal preference, clinical experience and patient preferences with the confidence that both methods are effective. The advantages of IFT are its ease of usage and external application. The Biofeedback treatment may be avoided due to the relative invasiveness of the vaginal probe required.

At the end of the study, participants were recommended to perform an at-home program of Kegel exercises, to be followed up on at a later date. The results of this follow-up survey are yet to come, but would provide an interesting prognosis of the condition after each mode of treatment.

The advantages of this study were that it involved a relatively large sample size and significant intervention time. The disadvantage was that all participants were female.

The following points summarize the findings of the literature on Interferential Therapy for Urinary Stress Incontinence. Electrode placement for IFT is more effective when the anterior electrode is above the pubic bone, as per the Dumoulin method ^[2]. IFT was found to be effective in increasing PFM strength and Quality of Life and also reduced the frequency of incontinence, volume of urine loss ^[3][4]. Additionally, IFT was shown to be better suited to mild and moderate than severe USI ^[5].

Dosages, Precautions & Contraindications

To summarize the blog, the following information can be used to safely apply IFT in a clinical setting:

In order to treat the PFM the following dosage parameters are recommended: a Phase Duration of 125ms, a current of 80 mA or to patient comfort and a frequency of 2–4000 Hz with an interference current of 50 Hz.

An important precaution specific to IFT is the presence of skin conditions as the suction cups may cause irritation or further damage. Such conditions include thin, frail skin, open wounds or lesions. Also if the patient is taking anticoagulant medication or is prone to bruising, this may lead to visible marks where the suction cups had been.

A contraindication specific to IFT for the PFM is pregnancy due to the inherent electrode positioning of the treatment.

We hope you have enjoyed this blog and found it relevant to your practice.

References

1.     Demirturk, F., Akbayrak, T., Karakaya, I. C., Yuksel, I., Kirdi, N., Demirturk, F., Kaya, S., Ergen, A., Beksac, S. (2008). Interferential current versus biofeedback results in urinary stress incontinence. Swiss Medical Weekly, 138(21-22), 317-321.

2.     Dumoulin, C., Seaborne, D. E., Quirion-DeGirardi, C. & Sullivan S. J. (1995). Pelvic-floor rehabilitation, part 1: comparison of two surface electrode placements during stimulation of the pelvic-floor musculature in women who are continent using bipolar interferential currents. Journal of the American Physical Therapy Association, 75(12), 35-42.

3.     Dumoulin, C., Seaborne, D. E., Quirion-DeGirardi, C. & Sullivan S. J. (1995). Pelvic-floor rehabilitation, part 2: pelvic-floor reeducation with interferential currents and exercise in the treament of genuine stress incontinence in postpartum women – a cohort study. Journal of the American Physical Therapy Association, 75(12), 44-49.

4.     Oh-oka, H. (2008). Efficacy of interferential low frequency therapy for elderly wet overactive bladder patients. Department of Urology Kobe Medical Center Japan, 24(2), 178-181.

5.     Turkan, A., Inci, Y. & Demirturk, F. (2005). The short-term effects of physical therapy in different intensities of urodynamic stress incontinence. Gynecologic and Obstetric Investigation, 59(1), 43-48.