Is the electromagnetic chair all its hyped up to be?

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With increasing rates of women trying to avoid pelvic floor surgery, we have noticed a resurgence of the number of patients coming in to ask about the pelvic floor electromagnetic chair. We have also noticed a push in media advertising the benefits of the magical electromagnetic stimulation chair such as in last weekend’s Sunday paper. With this comes curiosity from patients wondering whether this should this be a part of their management as it appears to promise everything we have been looking for in incontinence and as it is stated on some websites is ‘ the answer ’ for incontinence. Could it be true? Lets take a closer look

How does it work and what does it cost?
You start by sitting fully clothed on the chair whilst it sends electromagnetic signals to the pelvic floor muscles (and everything in-between!) to create micro contractions of the muscles for the duration of the session, usually 28 - 30 mins. Fabulous, exercise you don’t really have to do, and you can read a magazine at the same time! Sign me up!

These sessions cost around $400 – 450 per session with most people requiring 6 sessions and then ongoing ‘top ups’ every 4 - 6 months. That’s a total of around $2500 for a course of treatment.
In the article the Emsella reports an average of 50% of improvement in UI symptoms, so $2500 for a 50% improvement in symptoms….

But does it actually work?
Currently the International Consultation on Incontinence( a group of 150 very smart experts from all over the world get together every four years to review all the research to produce treatment recommendations and much much more)

The ICI Current recommendations:

Is 'the chair' better than nothing?
No recommendations is possible based on current conflicting evidence

"For women with SUI, it might be more effective than sham in improving (not necessarily curing) symptoms (Level of Evidence: 2). Two small trials of magnetic stimulation (12 and 6 sessions) examining the effect on quality of life were conflicting (Level of Evidence: 2). For women with UUI, evidence from a small trial suggests that active magnetic stimulation might result in better quality of life than sham (Level of Evidence: 2), although there is some uncertainty surrounding this, as data was limited and no statistical test was completed" (ICI, 2017).

Is 'the chair' better than other treatments?
There are no trials comparing 'the chair' to other treatment (e.g. pelvic floor muscle training, vaginal pessary, vaginal electrical stimulation, topical oestrogen applications or lifestyle modifications) methods to treat incontinence

The big question......

Does the addition of 'the chair' to any other treatment add any benefit?
ONE study in women with stress urinary incontinence (Gilling et al, 2001) demonstrated that the addition of magnetic stimulation to pelvic floor muscle training DOES NOT appear to be beneficial.

Now as physiotherapists who are invested in improving the quality of women with incontinence for the long term, we are pleased to say we have high level evidence that our approach works:

  • An 8 week program of pelvic floor muscle training (PFMT) and biofeedback shows a 80% cure for SUI (Askac et al, 2003)

  • Supervised twice weekly PFMT demonstrated x 8 times the cure rate compared to control group (unsupervised PFMT) (Dumoulin et al, 2018)

  • A12 week physiotherapy program shows the greatest improvement for UI (Neumann et al, 2002)

  • 6 months of PFMT and biofeedback showed a 88.9% cure rate (Morkved et al, 2003)

  • PFMT can reduce pelvic organ prolapse severity, symptoms (Hagen et al, 2008) and progression (Handa & Jones, 2002)


Now, when we are choosing optimal management for the treatment of incontinence our recommendations are always guided by 'three pillars':

  1. The best available evidence based research, what treatment options have been proven to improve or cure urinary incontinence, what is currently recommended as 1st line management and what the research currently says. We understand research takes time to carry out and get published and can therefore be behind our clinical experiences. This is therefore why our clinical decision making always takes into consideration clinical expertise, common sense, patient experience and patient values.

  2. Clinician expertise: what we have found to work through our expertise and patient experience.

  3. Patient values: what you believe has worked for you in the past, treatment preferences, compliance and circumstances.

There are different types of urinary incontinence (stress, urge, functional, overflow) and different reasons behind them all. A pelvic floor muscle training program which is supervised and appropriately progressed by experienced physiotherapist is recommended by the experts at the International Consultation on Incontinence (ICI) to be first line management for urinary incontinence (ICI, 2017).

With all this said ladies their are women out their stating they have been cured from using the chair. So maybe it does work? Maybe this type of therapy might be beneficial in certain populations, and maybe the research to date has not been able to give us the high level evidence we need.
BUT, until further high quality research has been done we do not advise this as first line management for our patients with urinary or faecal incontinence.

Of course ladies, if you feel this therapy is something you would be keen to trial as you have exhausted all other conservative options, (and you have actually done your program!) then it's good to know that there have been no recorded adverse effects phew (other than a $3000 hole in your pocket!).

If we could choose for you we would much rather you spend your time and your $$ on building up the muscles the tried and tested way of actually exercising them rather than having a 28 min magazine catch up (all though it does sound lovely).

If you would like more information on Women’s health Physiotherapists approach to urinary incontinence give us a call on 99388 9093, check out the @continencefoundationofaustralia or view our Urinary Incontinence page information here.

 
Lyz Evans