Comparative efficacy of electrical stimulation for post-stroke urinary incontinence: a protocol for a systematic review and network meta-analysis
- 1Department of Rehabilitation Medicine, The Fourth People’s Hospital of Nantong, Nantong, Jiangsu, China
- 2Department of Rehabilitation Medicine, Weihai Municipal Hospital, Weihai, Shandong, China
- 3Department of Rehabilitation Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
Abstract
Introduction: Post-stroke urinary incontinence (PSUI) is a debilitating complication that affects approximately 38% of stroke survivors. It is characterised by urinary frequency, urgency and incontinence, with detrusor overactivity or detrusor-sphincter dyssynergia acting as the primary underlying urodynamic abnormalities. This condition elevates the risk of urinary tract infections, pressure ulcers, and renal impairment, as well as contributing to patients’ psychological distress and thereby impairing their quality of life and increasing caregiver burden. Although electrical stimulation has emerged as a promising non-invasive alternative to neuromodulation, there is, as yet, no consensus concerning which modality is most effective for this purpose. This study thus aims to systematically compare the efficacy of different electrical stimulation types in cases of PSUI by conducting a systematic review and network meta-analysis.
Method and analysis: The proposed research will be based on a systematic search of several major electronic databases from their inception to 15 October 2026; these main sources are PubMed, Web of Science, Embase and the Cochrane Library. Additional Chinese databases will also be searched, namely China National Knowledge Infrastructure (CNKI), Wanfang databases (Wanfang), VIP Database (VIP) and the China Biomedical Literature Database (CBM). Relevant clinical trial registries, including ClinicalTrials.gov, the Chinese Clinical Trial Registry (ChiCTR) and the WHO International Clinical Trials Registry Platform (ICTRP), will also be searched, and grey literature sources and forward and backward citation searching will be added to ensure full coverage. The search will, however, be restricted to studies published in English or Chinese. The primary outcome assessed will be the number of urinary incontinence episodes over 24 hours, with secondary outcomes based on the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) scores and adverse events. Pairwise meta-analyses will be performed using Stata V.17.0. The network meta-analysis will involve Bayesian analysis using R V.4.3.1 with the gemtc package V.1.1-2 and JAGS V.4.3.2 as a Markov chain Monte Carlo (MCMC) engine to use MCMC methods to compare the relative efficacy of the different electrical stimulation modalities. A random-effects consistency model will be used throughout. Study screening, data extraction, risk of bias assessment and evidence quality evaluation will all be conducted independently by the investigators. The risk of bias will be assessed by means of the Cochrane Risk of Bias tool (ROB 2), while the validity of the evidence for direct comparisons will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Confidence in the network estimates will similarly be evaluated using the Confidence in Network Meta-Analysis framework.
Ethics and dissemination: This study is a systematic review of previously published literature, so no new ethical approval is required. The findings of this research will be submitted for publication in a peer-reviewed journal and/or presented at relevant academic conferences.
PROSPERO registration number: CRD420261425736.
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BibTeX
@article{zhang2026comparative,
title = {{Comparative efficacy of electrical stimulation for post-stroke urinary incontinence: a protocol for a systematic review and network meta-analysis}},
author = {Linlin Zhang and Qian Li and Linlin Li},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-124412},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-124412},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Comparative efficacy of electrical stimulation for post-stroke urinary incontinence: a protocol for a systematic review and network meta-analysis
AU - Linlin Zhang
AU - Qian Li
AU - Linlin Li
PY - 2026
DA - 2026/10/26
JO - BMJ Open
DO - 10.1136/bmjopen-2026-124412
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-124412
AB - Introduction: Post-stroke urinary incontinence (PSUI) is a debilitating complication that affects approximately 38% of stroke survivors. It is characterised by urinary frequency, urgency and incontinence, with detrusor overactivity or detrusor-sphincter dyssynergia acting as the primary underlying urodynamic abnormalities. This condition elevates the risk of urinary tract infections, pressure ulcers, and renal impairment, as well as contributing to patients’ psychological distress and thereby impairing their quality of life and increasing caregiver burden. Although electrical stimulation has emerged as a promising non-invasive alternative to neuromodulation, there is, as yet, no consensus concerning which modality is most effective for this purpose. This study thus aims to systematically compare the efficacy of different electrical stimulation types in cases of PSUI by conducting a systematic review and network meta-analysis. Method and analysis: The proposed research will be based on a systematic search of several major electronic databases from their inception to 15 October 2026; these main sources are PubMed, Web of Science, Embase and the Cochrane Library. Additional Chinese databases will also be searched, namely China National Knowledge Infrastructure (CNKI), Wanfang databases (Wanfang), VIP Database (VIP) and the China Biomedical Literature Database (CBM). Relevant clinical trial registries, including ClinicalTrials.gov, the Chinese Clinical Trial Registry (ChiCTR) and the WHO International Clinical Trials Registry Platform (ICTRP), will also be searched, and grey literature sources and forward and backward citation searching will be added to ensure full coverage. The search will, however, be restricted to studies published in English or Chinese. The primary outcome assessed will be the number of urinary incontinence episodes over 24 hours, with secondary outcomes based on the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) scores and adverse events. Pairwise meta-analyses will be performed using Stata V.17.0. The network meta-analysis will involve Bayesian analysis using R V.4.3.1 with the gemtc package V.1.1-2 and JAGS V.4.3.2 as a Markov chain Monte Carlo (MCMC) engine to use MCMC methods to compare the relative efficacy of the different electrical stimulation modalities. A random-effects consistency model will be used throughout. Study screening, data extraction, risk of bias assessment and evidence quality evaluation will all be conducted independently by the investigators. The risk of bias will be assessed by means of the Cochrane Risk of Bias tool (ROB 2), while the validity of the evidence for direct comparisons will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Confidence in the network estimates will similarly be evaluated using the Confidence in Network Meta-Analysis framework. Ethics and dissemination: This study is a systematic review of previously published literature, so no new ethical approval is required. The findings of this research will be submitted for publication in a peer-reviewed journal and/or presented at relevant academic conferences. PROSPERO registration number: CRD420261425736.
SN - 2044-6055
SN - 2044-6055
ER -