Avaliação funcional dos músculos do assoalho pélvico pela eletromiografia: existe a normalização na análise de dados? Uma revisão sistemática
DOI:
https://doi.org/10.1590/1809-2950/16559525012018Palavras-chave:
Diafragma da Pelve, Eletromiografia, RevisãoResumo
Este estudo objetiva analisar o método de análise dos dados eletromiográficos na avaliação funcional dos músculos do assoalho pélvico (MAP). As bases de dados consultadas foram: Medline, PubMed, Cochrane Central Register of Controlled Trials e Cochrane Database of Systematic Reviews, PEDro e IBECS, considerando-se artigos publicados nos últimos dez anos (2004-2014). Os artigos identificados foram avaliados independentemente por dois avaliadores, de acordo com os critérios de inclusão: (1) população: mulheres adultas; (2) avaliação dos MAP utilizando a eletromiografia (EMG) com sonda vaginal ou anal; (3) descrição de como é feita a análise dos dados eletromiográficos. O instrumento Newcastle-Ottawa Scale (NOS) foi usado para avaliação da qualidade metodológica dos estudos. Foram identificados 508 artigos, dos quais 23 foram incluídos na revisão. Os dados mostraram diferenças entre os protocolos de coleta, e um número significativo de estudos não utilizaram a normalização na análise dos dados eletromiográficos. Os fisioterapeutas estão entre os profissionais que mais utilizam a EMG para avaliar a função e disfunção do sistema neuromuscular. Apesar de alguns estudos anteriores fornecerem uma visão geral para orientar o avaliador no uso deste instrumento, poucos estudos subsequentes seguiram suas recomendações.Downloads
Referências
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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