EPD501 - Video-Based Pelvic Floor Muscle Therapy for Patients with Pelvic Floor Disorders: A Prospective Single-Arm Pilot and Feasibility Study

Purpose/Background: Pelvic floor disorders including fecal incontinence, urinary incontinence, constipation, and pelvic organ prolapse are debilitating conditions that significantly impact quality of life. Although pelvic floor muscle therapy (PFMT) is first-line treatment, access and adherence to PFMT is limited by available therapists, scheduling constraints, travel logistics, and delays to specialty care. To address these barriers, we developed an eight-week video-based online PFMT program and evaluated program feasibility and acceptability compared to traditional in-person PFMT.

Methods/Interventions: We conducted a prospective single-arm pilot and feasibility study of English speaking, adult female patients with fecal incontinence, urinary incontinence, constipation, or pelvic organ prolapse. Figure 1 describes the study design with three major timepoints. The primary outcome measure of feasibility was defined as exercising at least three days each week during the eight-week program, with an overall goal of 80% adherence. Self-reported online weekly exercise logs were used to capture exercise frequency. A system usability survey (SUS) was used to measure acceptability of the online program. Secondary outcomes included efficacy, as measured by graded in-person PFMT evaluations with pelvic floor physical therapists, and life satisfaction, as measured by quality of life (QoL) and symptomatology surveys.

Results/Outcomes: A total of 13 participants are enrolled in the study, including two (15%) with fecal incontinence, two (15%) with constipation, eight (62%) with urinary incontinence, and one (8%) with pelvic organ prolapse. Six (38%) participants have fully completed the online PFMT program. Of those who have completed the study, four out six (67%) adhered to the weekly exercise goal. In terms of acceptability, the online PFMT program was rated on average 76% on the SUS (range 0-100). Efficacy of the graded pelvic floor exercises was the same or improved in 83% of participants. Symptomatology improved in 67% of participants. This is an ongoing study, and results are preliminary. We aim to recruit a total of 20 participants.

Conclusion/Discussion: PFMT is first-line therapy for pelvic floor disorders, yet adherence is limited by therapist availability and patient constraints. Preliminary data supports the feasibility and acceptability of a video-based PFMT option and confirmation of efficacy will require a larger randomized controlled trial.

Figure 1. Study design for a feasibility trial using video-based pelvic floor muscle therapy (PFMT) program for patients with pelvic floor disorders
At the initial clinic visit where patients are eligible for receiving PFMT, they will be offered to enroll in video-based PFMT. If they are consented, they will asked to complete the Short Form Health Survey (SF-12), and one of the four following symptom-specific surveys: 1) Cleveland Clinic Incontinence Score (CCIS), 2) Patient Assessment of Constipation Symptoms (PAC-SYM), 3) International Consensus on Incontinence Questionnaire Short Form (ICIQ-SF) or 4) Pelvic Organ Prolapse Symptom Score (POP-SS) which they will complete at the midpoint and after the 8 weeks of video-based PFPT. Participants will also complete the System Usability Survey (SUS) at the midpoint and at the end of the program to evaluate for ease of use of the web-based application. They will meet with a pelvic floor therapist prior to initiation of the video-based PFMT and again at the conclusion with an assessment of exercise competency preoperatively and postoperatively.