The Use of Mobile Health Technology to Support Post-Partum Pelvic Health: A Randomized Mixed Methods Pilot Study

Dufour S1, Fedorkow D1, Fang Q1

Research Type

Clinical

Abstract Category

Conservative Management

Abstract 25
E-Technologies and Innovative Treatment
Scientific Podium Short Oral Session 3
Wednesday 29th August 2018
09:20 - 09:27
Hall C
Conservative Treatment Pelvic Floor Rehabilitation
1. McMaster University
Presenter
S

Sinead Dufour

Links

Abstract

Hypothesis / aims of study
Pelvic floor muscle exercises commened in the post-partum period have clearly established efficacy(1-2).   The popularity of mobile health (mHealth) devices affirms their perceived utility among the public.  Claims of mHealth technologies supporting pelvic floor health and fitness have not routinely been substantiated with systematic inquiry (3). The specific aims of this study were three fold: 
1.)	Is the mHealth techology a feasible intervention to support pelvic floor health in the post-partum period? 
2.)	Is the mHealth technology  an acceptable intervention to support pelvic floor health in the post-partum period?
3.)	Is the mHealth technology effective in supporting pelvic floor health in the post-partum period?
Study design, materials and methods
A blinded, randomized, mixed methods study was conducted to evaluate a 16-week intervention.  Quantitative measurements included the Incontinence Impact Questionnaire (IIQ-7) scores, Urogenital Distress Inventory (UDI-6) and PERFECT pelvic exam. Interpretive description methodology, using one-to-one interviews determined factors influencing acceptability and feasibility.
Results
A total 23 women with a mean age of 32.2 years were randomized to the mHealth device (n=13) or control (n-10) groups.  Both groups improved on quantitative measures but only the UDI-6 showed statistical significance in both groups.  There were no statistical differences between groups in any quantitative measure.  Most participants (72.7%) indicated value in the concept of the mHealth device, technical difficulties (72.7%), a cumbersome process to set up the software (63.6%) and discomfort of the device (63.6%) impeded the device’s acceptability.  The assessment and instruction received at the onset of the study was identified as more useful than the mHealth device (72.7%).   This utility was affirmed by all control subjects.
Interpretation of results
The mHealth solution studied did demonstrate improvement in outcomes when compared to standard care in the population of post-partum women in this study.  Notably, standard care consistent of a standardized pelvic floor exam inclusive of instruction of correct basic pelvic floor exercises.  Considering the collective results (quantitative and qualitative) pointing to the value of this standard care.  Although the concept of the mHealth solution was perceived as valuable the issues related to the operationalization of the mHealth device studied, did not translate to overall acceptability or feasibility.
Concluding message
The mHealth solution studied was not found to be acceptable, feasible or superior to a standard care protocol for post-partum women.
Figure 1
References
  1. Dumoulin C, Hay-Smith EJC, Habée-Séguin GM. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2014; Issue 5. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654.pub3.
  2. Dumoulin C, Hay-Smith J, Habée-Séguin GM, Mercier J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn. 2015;34:300–308.
  3. Melnyk BM. The role of technology in enhancing evidence-based practice, education, healthcare quality, and patient outcomes: a call for randomized controlled trials and comparative effectiveness research. Worldv Evid-Based Nu. 2012;9.2:63-65. DOI: 10.1111/j.1741-6787.2012.00245.x.
Disclosures
<span class="text-strong">Funding</span> None <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics Committee</span> Hamilton Integrated Ethics Board <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes