Evaluación funcional de los músculos del suelo pélvico por la electromiografía: ¿la normalización existe en el análisis de datos? Una revisión sistemática
DOI:
https://doi.org/10.1590/1809-2950/16559525012018Palabras clave:
Diafragma de la Pelvis, Electromiografía, RevisiónResumen
Se evaluó, en este estudio, el método de análisis de los datos electromiográficos en la evaluación funcional de los músculos del suelo pélvico. Las bases de datos consultadas fueron: Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PEDro y IBECS. La investigación fue refinada considerándose artículos publicados en los últimos diez años (2004 a 2014). Se evaluaron de forma independiente los artículos identificados por dos evaluadores, según los siguientes criterios de inclusión: (1) población: mujeres adultas; (2) evaluación de los músculos del suelo pélvico utilizándose la electromiografía (EMG) con sonda vaginal o anal; (3) descripción de cómo es el análisis de los datos electromiográficos. Se utilizó el instrumento Newcastle-Ottawa Scale (NOS) para evaluar la calidad metodológica de los estudios. Se identificaron 508 artículos y 23 de estos fueron incluidos en la revisión. Los datos mostraron diferencias entre los protocolos de recolección y un número significativo de estudios no utilizaron la normalización en el análisis de los datos electromiográficos. Los fisioterapeutas están entre los profesionales que más utilizan la EMG para evaluar la función y disfunción del sistema neuromuscular. Aunque algunos estudios anteriores proporcionen una visión general para orientar el evaluador en el uso de este instrumento, pocos estudios posteriores han seguido sus recomendaciones.Descargas
Referencias
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
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