The main aim of this literature review is to examine whether the BTL Emsella chair or the eCoin
provide better outcomes in terms of cost-effectiveness, symptoms reduction, and quality of life of women with
urinary incontinence. To accomplish this, the following objectives were set to tackle and evaluate the
effectiveness of each of the treatment.
1. To evaluate the effectiveness of the BTL Emsella chair as a non-invasive therapy for managing urinary
incontinence in women
Forest Plot 1. Effectiveness of the BTL Emsella
The forest plot presents a meta-analysis comparing the efficacy of BTL Emsella versus a control group
across multiple studies. Each study provides a standardized mean difference (SMD) with a 95% confidence
interval (CI), indicating the effect size. The reported SMD values range from 0.02 to 0.22, with most confidence
intervals crossing zero, suggesting that the individual studies do not show a statistically significant difference
between the two groups. The overall pooled effect size is 0.09 [-0.03, 0.21], which suggests a small positive
effect in favor of BTL Emsella, though the confidence interval includes zero, indicating that the effect is not
statistically significant. Regarding heterogeneity, the results show Tau² = 0, χ² = 1.50, df = 8 (P = 0.99), and I² =
0%, which indicates no observed heterogeneity among the included studies. This suggests that the results across
studies are consistent, and any variation in effect sizes is likely due to random chance rather than true
differences between studies. Additionally, the test for the overall effect yields Z = 1.54 (P = 0.02), which,
although statistically significant at the 0.05 level, indicates only a marginal effect.
2. To assess the effectiveness of eCoin nickel ankle implant in reducing urinary incontinence symptoms in
women
Forest Plot 2. Effectiveness of eCoin nickel
The forest plot presents a meta-analysis evaluating the efficacy of eCoin therapy compared to a control
group across multiple studies. Each study provides a standardized mean difference (SMD) with 95% confidence
intervals (CIs) to assess the effect size. The reported SMD values range from 0.04 to 0.06, with all confidence
intervals crossing zero, suggesting that no individual study found a statistically significant effect. The overall
pooled effect size is 0.05 [-0.06, 0.17], indicating a very small benefit of eCoin therapy, but the confidence
interval includes zero, making the effect statistically non-significant. Regarding heterogeneity, the results show
Tau² = 0, χ² = 0.01, df = 8 (P = 1.00), and I² = 0%, indicating no observed heterogeneity across the included
studies. This suggests that the effect sizes are consistent across studies and any variation is likely due to random
chance rather than substantial differences in study outcomes. The test for the overall effect reports Z = 0.87 (P =
0.008), which, despite being statistically significant, indicates a minimal clinical effect.
3. To compare the outcomes of invasive (eCoin implant) and non-invasive (BTL Emsella chair) treatments
in terms of symptom reduction, quality of life and cost-effectiveness
Forest Plot 3. Comparison of invasive (eCoin implant) and non-invasive (BTL Emsella chair)
With a test for overall effect producing Z = 1.87 (P = 0.04), the result is now statistically significant at
the 0.05 level, indicating that the observed effect is unlikely to be the result of random chance. The
heterogeneity statistics are Tau² = 0, χ² = 0.03, df = 8 (P = 1.00), and I² = 0%, which indicates no heterogeneity
between the included studies, i.e., the results are extremely consistent between different trials. This implies that
the intervention—presumably BTL Emsella—has a statistically significant but very small effect in comparison
to the control. But whereas significance is obtained, the clinical practical relevance must still be taken into
account within the context of the effect size and confidence interval.
