Home Biofeedback Versus Physical Therapy for Stress Urinary Incontinence: A Randomized Trial

Telehealth is effective for pelvic health physical therapy

BACKGROUND

Telehealth utilization, largely spurred by the COVID-19 pandemic, has become popular due to convenience and access. We assessed the effectiveness of telehealth for delivering pelvic health physical therapy (PHPT) in patients with pelvic floor disorders (PFD).

METHODS

In this IRB approved, cross-sectional study, 812 patients who underwent PHPT treatment by telehealth or in combination with in-person visits were surveyed. Post intervention effectiveness was analyzed using Patient Global Impression of Change (PGIC) and short form Pelvic Floor Impact Questionnaire (PFIQ-7).

RESULTS

One hundred and forty-one patients, 80% female, mean (SD) age of 52 (17) completed the study. The mean number of encounters was 4.55 (4.25) with 2.81 (2.08) telehealth visits. A total of 42 (30%) patients reported no change/worse, 27 (19%) minimal, and 72 (51%) moderate/much improvement of symptoms consistent with a lower PFIQ-7 scores. Patients who reported improvement were significantly younger (p < 0.002). Age was the only independent factor that could predict response to PHPT. Patients <50 years old reported significantly more symptom improvement (p < 0.02), symptom resolution (p < 0.002), meeting personal goals (p < 0.0001), improved muscle strength, coordination, and relaxation (p < 0.05), greater satisfaction with bowel movements, and less negative impact of bowel on quality of life (p < 0.005) than older patients. Regardless of age, 89 (64%) patients preferred hybrid telehealth visits.

CONCLUSION & INFERENCES

Utilizing telehealth alone or in a hybrid format combined with in-person visits for PHPT appears to be preferred by patients and associated with subjective report of improvement of symptoms. However, efficacy of telehealth interventions in older adults warrants further studies.

Geographic Access to Urogynecology Care in the United States

IMPORTANCE

Although access to urogynecologic care is known to influence patient outcomes, less is known regarding geographic access to care and how it may vary by population characteristics.

OBJECTIVE

The primary objective of this study was to estimate geographic accessibility of urogynecologic services in terms of drive time and by population demographics.

STUDY DESIGN

We performed a descriptive study using practice location data by zip code for all board-certified urogynecologists who are American Urogynecologic Society members (n = 497) and pelvic floor physical therapists (n = 985). Drive times from each zip code to the nearest health care professional zip code were calculated. These data were then overlaid onto a map of the continental United States. Race/ethnicity, age, education, poverty status, disability status, health insurance coverage, and rurality were compared across travel times.

RESULTS

Of the 31,754 zip codes of the continental United States, 389 (1.23%) had at least 1 urogynecologist, and 785 (2.47%) had at least 1 pelvic floor physical therapist; 92.29 million women older than 35 years were represented in the demographic analyses. Seventy-nine percent of the studied population live within 1 hour of a urogynecologist, and 85% live within 1 hour of a pelvic floor physical therapist. Seven percent and 3% live >2 hours from urogynecologic services, respectively. Values for drive times to all health care professionals indicate that American Indian/Alaska Native individuals have a much greater travel burden than other racial/ethnic groups.

CONCLUSIONS

There are population groups with limited geographic access to urogynecologic services. Pelvic floor physical therapists are more geographically accessible to the population studied than urogynecologists.

Health Qigong Mawangdui Guidance can improve pelvic floor muscle function and quality of life in females with stress urinary incontinence: A randomized controlled trial pilot study

BACKGROUND

Urinary incontinence (UI) is a great problem of public health, especially for women's quality of life. UI afflicts at least 21.6% of the global population, and more than half of the UI is related to female stress urinary incontinence (SUI). Mawangdui Guidance plays an important role in preventing diseases and maintaining health.

METHODS

Sixty female patients with SUI were randomly divided into a control group (n = 30) and an experimental group (n = 30). Patients in both groups were treated with basic rehabilitation therapy under the guidance of rehabilitation therapists who were trained in Mawangdui Guidance, based on the former, the experimental group was taught to exercise Mawangdui Guidance(including selected movements: "Qishi," "Longdeng," "Chishi," and "Yinyao"), while the control group performed Kegel exercise with a procedure of 20 min, six times per week for 6 weeks. The function was mainly evaluated by the 1 h pad-test, incontinence quality of life questionnaire (I-QOL), and international consultation on incontinence questionnaire urinary incontinence short form (ICI-Q-SF). In addition, evaluation of pelvic floor muscle function was also included in our assessment.

RESULTS

The leakage of urine in the 1 h pad-test was significantly decreased in both two groups after treatment (P < .05), and the urine leakage in the experimental group was significantly less than that in the control group (P < .05). The muscle strength of type I and II muscle fibers of the pelvic floor, intravaginal pressure, and I-QOL score in both two groups were increased after treatment; moreover, the experimental group was more significant than the control group (P <.05). The fatigue degree of type I and type II muscle fibers of the pelvic floor, and the ICI-Q-SF score in both groups were significantly improved after treatment (P < .05); however, there were no differences between these two groups. The total effective rate of the experimental group was 90.00%, and 76.67% in the control group (P <.05).

CONCLUSION

Mawangdui Guidance can effectively improve the function of pelvic floor muscle, improve the ability of urine storage and control, and alleviate the symptoms of female patients with SUI. However, the international research on Mawangdui Guidance is very limited, and more in-depth research is needed.

Implementing telemedicine in urogynecology: A feasibility study

INTRODUCTION AND HYPOTHESIS

Telemedicine has been recommended for the management of urogynecological conditions during the coronavirus (COVID 19) pandemic. This study aimed to evaluate the feasibility of telemedicine for urogynecology at a Brazilian public hospital.

METHODS

A descriptive observational study was performed at a urogynecology outpatient clinic. The primary outcome was the desire to continue with telemedicine. Secondary outcomes were appointment resolvability, technical aspects of the appointment, and patient satisfaction. The participants had in-person appointments that were canceled because of the COVID-19 pandemic. We collected data on sociodemographic characteristics and clinical and technical aspects of the appointments. The participants responded to satisfaction questionnaires 7-15 days post-procedure. The categorical variables were evaluated based on absolute and relative frequency. The continuous variables were described as the mean and standard deviation. A chi-square test was performed to determine the association between variables.

RESULTS

In total, 225 patients had appointments canceled due to the COVID-19 pandemic, of which 171 were eligible for the study. Telemedicine appointments were agreed upon by 48% of the participants and 85.5% responded to the satisfaction survey. We found that 57.7% of the participants desired to continue with telemedicine. The appointment resolvability rate was 76.1%, 63.4% of the appointments met the technical criteria, and the satisfaction rate was 93%. The only variable associated with the desire to continue telemedicine was overall patient satisfaction (p=0.02).

CONCLUSIONS

Telemedicine in urogynecology is feasible and can be implemented in the studied population. However, actions are essential to adequately support patient preference and improve the acceptance of telemedicine.

A digital health program for treatment of urinary incontinence: retrospective review of real-world user data

INTRODUCTION AND HYPOTHESIS

To determine the effectiveness of a prescription digital therapeutic (pDTx) in reducing urinary incontinence (UI) symptoms in real-world users.

METHODS

This is a retrospective cohort study of real-world data from users of a pDTx designed to guide pelvic floor muscle training(PFMT) between July 1, 2020-December 31, 2021. The primary outcome was UI symptom change as reported via in-app Urogenital Distress Inventory (UDI-6). Included subjects were female, ≥ 18 years with a diagnosis of stress, urgency, or mixed UI who completed the UDI-6 at baseline and 8 weeks. Demographic, symptom, and adherence data were summarized. Paired t-test and Wilcoxon signed rank test were used to analyze change in outcomes from baseline to 8 weeks across adherence and UI diagnosis groups.

RESULTS

Of 532 women with UI, 265 (50%) met criteria and were included in the analysis. Mean age was 51.2 ± 11.5 years (range 22-84, N = 265). Mean body mass index (BMI) was 27.3 ± 6.2 kg/m² (range 15.2-46.9, N = 147). Most participants had stress UI (59%) followed by mixed UI (22%), urgency UI/OAB (11%), and unspecified UI (8%). UDI-6 scores improved by 13.90 ± 15.53 (p ≤ 0.001); 62% met or exceeded MCID. Device-reported PFMT adherence was 72% at 4 weeks and 66% at 8 weeks (100% = 14 uses/week). Participants in each diagnosis category reported significant improvement on UDI-6 score from baseline to 8 weeks. No association between UDI-6 score improvement and adherence category, age, BMI, or UI subtype was identified.

CONCLUSIONS

This study demonstrates effectiveness of a pDTx in reducing UI symptoms in a real-world setting. Users achieved statistically and clinically significant symptom improvement over an 8-week period.

Evidence for the Appropriate Use of Telemedicine in Female Pelvic Medicine and Reconstructive Surgery

Purpose of Review

To summarize the available literature regarding telehealth interventions in the management of pelvic floor disorders.

Recent Findings

Most Female Pelvic Medicine and Reconstructive Surgery (FPMRS) patients own and feel comfortable operating the technology required to participate in telehealth interventions and would be willing to interact remotely with their providers. Telehealth may be an appropriate and effective tool for patient education about bladder and pelvic physiology and pathophysiology, remote pelvic floor muscle strengthening when in-person physical therapy is not accessible, overactive bladder follow-up and medication management, and for postoperative care following uncomplicated incontinence and prolapse surgery.

Summary

There is a growing body of literature specific to FPMRS supporting various telehealth interventions that could reasonably be expected to improve access to sub-specialty care while maintaining or improving healthcare quality and reducing costs to the patient and the healthcare system.