Group-Based Pelvic Floor Telerehabilitation to Treat Urinary Incontinence in Older Women: A Feasibility Study

Abstract

Less than half of women with urinary incontinence (UI) receive treatment, despite the high prevalence and negative impact of UI and the evidence supporting the efficacy of pelvic floor muscle training (PFMT). A non-inferiority randomized controlled trial aiming to support healthcare systems in delivering continence care showed that group-based PFMT was non-inferior and more cost-effective than individual PFMT to treat UI in older women. Recently, the COVID-19 pandemic highlighted the importance of providing online treatment options. Therefore, this pilot study aimed to assess the feasibility of an online group-based PFMT program for UI in older women. Thirty-four older women took part in the program. Feasibility was assessed from both participant and clinician perspectives. One woman dropped out. Participants attended 95.2% of all scheduled sessions, and the majority (32/33, 97.0%) completed their home exercises 4 to 5 times per week. Most women (71.9%) were completely satisfied with the program’s effects on their UI symptoms after completion. Only 3 women (9.1%) reported that they would like to receive additional treatment. Physiotherapists reported high acceptability. The fidelity to the original program guidelines was also good. An online group-based PFMT program appears feasible for the treatment of UI in older women, from both participant and clinician perspectives.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

“…There are studies on the use of telerehabilitation in metabolic syndrome, 105 burns 106 and urinary incontinence 107 which show some positive effects or feasibility of telerehabilitation.…”

“…It is recommended that PRM physicians prescribe telerehabilitation for patients with health conditions for which there is already some evidence of efficacy or at least clinical positive experiences. These include neurological disorders in general [SoE: I-IV; 38 - 40 SoR: A] specifically including stroke 42 , 43 [SoE: I; 44 - 49 SoR:A], traumatic brain injury [SoE: I 51 (particularly for cognitive rehabilitation); SoR: A], Parkinson’s disease [SoE: I; 52 - 54 SoR: A], multiple Sclerosis 55 - 59 [SoE: I (low level); 55 SoR: A] and spinal cord injury [SoE: II-IV; 60 - 65 SoR: A ] and respiratory conditions 70 [SoE: I; 71 - 76 SoR: A], cardiovascular conditions [SoE: I; 77 - 84 SoR: A], musculoskeletal conditions 73 , 74 such as knee osteoarthritis [SoE: I; 87 - 89 SoR: A] and orthopedic conditions such as joint replacement surgery [SoE: I; 90 - 92 SoR: A], low back pain [SoE: I; 94 SoR: A], fibromyalgia [SoE: II; 95 SoR: A], shoulder pain [SoE: I (very low); 96 SoR: A], COVID-19 including post COVID-19 condition [SoE: I; 99 - 103 SoR:A], low vision [SoE: II (very low); 104 SoR: A] and others such as metabolic syndrome [SoE: IV; 105 SoR: A] burns [SoE: II; 106 SoR: A] and urinary incontinence [SoE: IV; 107 SoR: A] as well as rehabilitation fields such as cancer rehabilitation [SoE: (insufficient); 108 , 109 SoR: A], geriatric rehabilitation in general [SoE: I; 110 - 113 SoR: A] and specifically for those with cognitive impairment [SoE: I; 66 SoR: A] and pediatric rehabilitation [SoE: I; 114 , 115 SoR: A] (may not be limited to those as evidence emerges).…”