The Impact of Female Chronic Pelvic Pain Questionnaire (IF-CPPQ): A Validation Study

Practical Application of Value-Based Medicine in Chronic Pelvic Pain: A Qualitative Study

RATIONALE

Chronic pelvic pain syndrome (CPPS) is prevalent and a complex multifactorial condition. The incidence is rising. CPPS patients may benefit from multidisciplinary care in a structured care pathway.

AIM AND OBJECTIVES

The aim of this explorative study is to give an overview of patient and healthcare provider perspectives on the current patient journey to implement these perspectives in a CPPS care pathway.

METHODS

A Qualitative study was performed using nominal group technique. The participants were nine female patients CPPS and fourteen healthcare providers involved in CPPS care. The perspectives of the stakeholder groups on the individual components of the CPPS patient journey were collected.

RESULTS

Five overarching key topics were identified: structured start of the patient journey, execution of the patient journey, follow-up after the patient journey, administration during the patient journey, and communication and education. The following recommendations were formulated based on the prioritised points: implementation of a multidisciplinary approach from the start of the journey, adding a case manager and expanding the multidisciplinary team, providing a collaborative triage, updating the questionnaires, improving communication, developing a rehabilitation programme, and reducing waiting times.

CONCLUSION

Stakeholder focus groups using the nominal group technique was a pivotal step in the development of our CPPS care pathway. This step led to fundamental recommendations, of which a personalised treatment plan at an earlier stage in the patient journey might be the most impactful. This is now implemented, and we monitor the effects on outcomes, quality of life and patient's satisfaction.

A Multisite Randomized Feasibility Trial of a Remotely Delivered Pelvic Yoga Program for Women with Chronic Pelvic Pain Syndrome

Objective: Yoga has been recommended as a complementary management strategy for women with chronic pelvic pain (CPP), but many women lack access to specialized yoga instruction for this indication, and few data are available to evaluate changes in CPP with yoga. This feasibility trial evaluated the acceptability and tolerability of a remotely delivered yoga program for CPP in women and examined data quality and interpretability for measures of pelvic pain intensity and impact with yoga instruction. Methods: Ambulatory women with CPP were recruited from northern California in 2020-2022 and randomly assigned to a 2-month program involving twice weekly group classes delivered by videoconference supplemented by individual practice of pelvic yoga techniques versus a control program involving equivalent-time instruction and practice of nonspecific skeletal muscle stretching-strengthening exercises. Diaries, questionnaires, and in-class observations assessed intervention adherence and self-efficacy as well as CPP intensity and impact. Results: Among the 36 participants randomized (aged 27-77 years), the average (±standard deviation) baseline pelvic pain intensity was 4.2 (±2.0) (0-10 scale). Thirty-one (86%) completed the 2-month intervention programs, and 27 (75%) attended more than 85% of intervention classes. Among participants completing the yoga program (N = 16), 14 (87%) reported being at least moderately confident about performing all yoga postures after 2 months. Thirty (83%) provided pain intensity data at 2 months. Average pelvic pain intensity "at its worst" and "on average" were 1.9 (±1.6) and 1.1 (±1.4) points lower, respectively, after 2 months in this yoga group. Yoga participants also reported improvements in scores in the emotional, occupational, and psychological domains of the Impact of Female Chronic Pelvic Pain Questionnaire. Conclusions: Findings demonstrate the feasibility and acceptability of a videoconference-based yoga program and collection of pain-related data among women with CPP, paving the way for future research to rigorously evaluate its specific efficacy in representative samples of women. Clinicaltrials.gov identifier: NCT04615247.