Feasibility and acceptability of transcutaneous tibial nerve stimulation for the treatment of bladder storage symptoms among people with multiple sclerosis

 Background: Neurogenic lower urinary tract dysfunction is an abnormality in the presence of underlying neurologic  disease. A recent systematic review and meta-analysis demonstrated that storage phase symptoms are the predomi?nant symptoms among people with multiple sclerosis (PwMS). Transcutaneous tibial nerve stimulation (TTNS) is a  non-invasive treatment for bladder storage symptoms; however, the potential efcacy of stimulation among PwMS is  based on a small number of studies with the absence of high-quality evidence. The aim of this study was to evaluate  the feasibility, acceptability, and safety of TTNS in PwMS using an afordable transcutaneous electrical nerve stimula?tion (TENS) unit. Methods: A total of 23 participants with MS enrolled in the study. The primary outcomes included recruitment/ retention rate, completion of the outcomes and the intervention, adherence to the protocol, adverse events, and  acceptability of the intervention. The primary outcomes were assessed using diaries and a satisfaction questionnaire.  The secondary outcomes included changes in urinary symptoms and quality of life assessed using a set of validated  outcome measures including a 3-day bladder diary, PPIUS, ICIQ-OAB, and KHQ at baseline and post-intervention. Results: Twenty participants completed the study. Three participants (13.04%) withdrew. All 20 participants com?pleted the 6-week intervention and all the outcome measures (100%), with no reported adverse events. Participants  were satisfed and found the unit acceptable. Three-day bladder diary showed changes in urinary frequency from  a daily median of 10 times to 8 times and daily median urgency changed from 6 times at baseline to 2 times post?intervention. PPIUS showed changes in daily median sever urgency from 3 points (IQR=4) to 1 point (IQR=1) post?intervention. ICIQ-OAB total scores changed from 8 points (IQR=2.25) to 4 points (IQR=2.5) post-intervention. Median  and mean scores of KHQ showed a clinical meaningful change of QoL in part-two and part-three of the questionnaire. Conclusions: TTNS is feasible, safe, and acceptable for PwMS. Changes of urinary symptoms scores and QoL post?intervention suggested improvements. Future implications need to consider the treatment protocol including fre?quency of treatment sessions, duration of treatment, and the electrical stimulation parameters as well as the outcome  measures followed in the current study for the implementation of the future pilot RCT.