Prioritisation of outpatient appointments and elective surgery in gynaecology

Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review

BACKGROUND

Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women.

OBJECTIVE

We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core "capability, opportunity, and motivation" (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care.

METHODS

We conducted a scoping review of the literature. Published quantitative literature that compared the use of a PFMT mobile app to a control group was included to address the objectives of the study. The electronic bibliographic databases searched included MEDLINE, CINAHL, Scopus, Web of Science, and PEDro, along with CENTRAL. Studies were also identified from reference searching of systematic reviews. Original articles written in English from 2006 onward were included. Nonexperimental quantitative studies, qualitative studies, studies that use male participants, case studies, web-based interventions, and interventions that use vaginal probes were excluded. Narrative synthesis was conducted on eligible articles based on the aims of the study.

RESULTS

Of the 114 records retrieved from the search, a total of 6 articles met the eligibility and inclusion criteria. The total number of participants in the studies was 471. All PFMT mobile apps used the BCT "prompts and cues." Opportunity was the core COM behavior targeted by the PFMT mobile apps. Higher levels of adherence to PFMT were observed among women using PFMT mobile apps.

CONCLUSIONS

Digital "prompts and cues" are a BCT commonly used in PFMT mobile apps, and further research is required to practically assess whether a future randomized controlled trial that investigates the effectiveness of digital "prompts and cues" on PFMT adherence in women can be conducted.

The ongoing impact of the Covid-19 pandemic on endometriosis patients: A survey of 1,089 UK patients

Background: The impact of Covid-19 on endometriosis patients is under-researched. Endometriosis has significant psychosocial effects on patients. Moreover, the mainstay of diagnosis and treatment of endometriosis is elective surgery, impacted as a result of healthcare strain. Objective: To better understand the effect of the Covid-19 pandemic on endometriosis patients Materials and Methods: An online survey sent to adult UK endometriosis patients between 27th August and 15th September 2021. The study received HRA and HCRW research ethic committee approval. Main outcome measures: Effects of the Covid-19 pandemic on endometriosis symptoms and surgery Results: We received 1,089 survey responses. Respondents had a median age of 34, and 82.0% of respondents were white British. 18.8% of respondents reported a previous positive Covid-19 PCR test. 84.6% of patients had been double vaccinated at time of response. 20 patients reported Covid-related hospital admission, with 1 requiring intubation. Large numbers of patients (31.4-55.2%) reported worsening of endometriosis symptoms during the pandemic. 69.2% of respondents reported worsening of associated mental health symptoms. Whilst 44% of respondents had elective endometriosis surgery planned, the majority of operations were disrupted, and 18.7% of total respondents did not have a new surgery date. Conclusions: More research and support are needed for endometriosis patients as they wait longer for surgery. A holistic approach, encompassing mental health needs, may be particularly beneficial for patients. What is new? This is the first survey examining the effects of Covid-19 on endometriosis patients including data beyond January 2021.

Covid-19, pelvic health, and women's voices: A descriptive study

Objective

To examine how the pandemic affected women with pelvic dysfunction.

Methods

A Survey Monkey™ online questionnaire on how the pandemic and Covid-19 infection affected women's pelvic problems, exercise, and weight. A free text box captured their comments.

Results

Six hundred and forty-seven women took part. Bladder control 265 (41%), prolapse 240 (37%), pelvic pain 40 (6%), sexual dysfunction 27 (4%), faecal incontinence 19 (3%) and other symptoms 56 (9%) were women's main pelvic problems. Symptoms were unchanged for 331 (51%), worse for 243 (38%), and improved for 60 (10%). Weight was gained by 290 (45%), unchanged by 243 (38%), and lost by 114 (17%). Exercise levels were unchanged, worse, or better in 33% each. Access to medical appointments and date for surgery were difficult for 235 (36.5%) and 38 (6%) women respectively. Sixty-six (10.3%) women reported Covid-19 infection: the distribution of pelvic problems and changes through the pandemic, weight and exercise patterns, and difficulty accessing a date for surgery or healthcare were similar to those not contracting infection. Sexual dysfunction was the main new or worsening problem, featuring 13 women (18%). Seventy women - 16 postnatal, and 54 with a pre-existing pelvic problem commented. Five core themes were identified. Difficulty accessing healthcare review, mental health impact and physiotherapy services especially affected delivered women: lifestyle alterations and conservative treatment tools were prominent in women with a pre-existing problem.

Conclusions

Pelvic floor dysfunction adversely affected women's mental health in the pandemic through limiting their ability to exercise. Furthermore, the pandemic exposed the fact that female pelvic health services are not readily available to those in need: many women particularly postnatally received no care. Sexual dysfunction was a feature of recovery from Covid infection in this study.