Physical Therapist Practice Patterns Utilizing Transcutaneous Tibial Nerve Stimulation for the Treatment of Overactive Bladder

Background: Pelvic health physical therapists (PTs) use a variety of treatment approaches to treat overactive bladder (OAB). Transcutaneous tibial nerve stimulation (TTNS) uses peripheral neuromodulation to deliver electrical current to the tibial nerve for the treatment of OAB. The purpose of this survey was to identify current practice patterns and barriers to implementation of TTNS. Methods: One hundred and seventy-eight surveys were electronically submitted by PT members of American Physical Therapy Association (APTA) Academy of Pelvic Health Physical Therapy (APHPT). Results: The use of TTNS by pelvic health PTs in the United States (US) varies widely. Only 30.6% of therapists noted using TTNS as first line therapy along with behavioral and lifestyle modifications. The most common reasons therapists do not use TTNS include precautions or contraindications and patient choice. Some therapists reported unfamiliarity with the research as a reason for not using TTNS. A significant association was found between a PT not being familiar with the research and how often TTNS was used ( P = .0111). The majority of therapists in this survey position electrodes on a single limb and used a pulse width of 200 or 250 microseconds (µsec), and a pulse frequency of 10 to 12 hertz (Hz) for 30 minutes. This aligns with current evidence. Discussion: TTNS should be considered in a pelvic PT treatment algorithm for OAB. Evidence suggests that providers increase their knowledge of TTNS and educators include instruction about TTNS in evidenced-based training in order to apply the modality effectively.