Telerehabilitation for Treating Pelvic Floor Dysfunction: A Case Series of 3 Patients' Experiences

Abstract

Background: Pelvic fl oor dysfunctions (PFD) affect women, men, and children globally. While physical therapy (PT) has been shown to improve PFDs, overall access to PT is limited because of provider shortage and expertise. We hypothesize telerehabilitation (TR) is a novel approach to address access and expertise care for PFD. Study Design: Case series. Case Descriptions: Three pelvic health patients (1 male and 2 females) volunteered to receive initial and follow-up care via TR. The male patient was treated for premature ejaculation, and the female patients were seen for postpartum recovery, stress urinary incontinence, and diastasis recti. A total of 9 visits were completed. Outcomes: Using a HIPAA-compliant, cloud-based, synchronous mobile app, a 14-question survey, and the Premature Ejaculation Diagnostic Tool (for the male health participant), participants rated their experience with TR. INTRODUCTION Pelvic fl oor dysfunctions (PFDs) affect women, men, and children globally. Urinary incontinence alone affects 200 million people worldwide. 1 Almost 25% of women in the United States have at least one kind of PFD, including urinary incontinence, fecal incontinence, and pelvic organ prolapse. 2 Evidence indicates that the growth of PFD will signifi cantly outpace the growth of the American population. 3 According to the US National Health and Nutrition Examination Survey (NHANES), the proportion of women experiencing at least one PFD increases with age, from 39% of women aged 60 to 79 years to 50% of women 80 years or older. 4 Men demonstrate similar age-related trends, with 4.4% prevalence of urinary incontinence between 19 and 44 years of age, increasing to 11.2% at 45 to 64 years of age, and peaking at 21.2% to 32.2% at older than 65 years. 5 By school age, 10% of children are unable to control urination during the day and at night. Furthermore, children of parents with a history of nocturnal enuresis (bed-wetting) have a 70% chance of bed-wetting. 6 Physical therapy (PT) is a successful treatment option for PFDs and is considered a mainstay in the care for incontinence and other lower urinary tract symptoms. 7–9 Whether combined or used alone, pelvic fl oor muscle training (PFMT) has been shown to 1 Notre Dame de Namur University, Belmont, California. 2 University of Pacifi c, Stockton, California. 3 Mount Saint Mary’s University, Los Angeles, California. Confl ict of Interest: Jennifer Kinder, PT, DPTSc, MS, is a member of the Women’s Health Section and of the Frontiers in Rehabilitation Science and Technology (FiRST) Council at American Physical Therapy Association. Dr Kinder is the Chief Pelvic Health Advisor for BlueJay Health. Todd Davenport, PT, DPT, MPH, OCS, is a member of the Frontiers in Rehabilitation Science and Technology (FiRST) Council at American Physical Therapy Association. Dr Davenport is the Chief Research and Academic Advisor for BlueJay Health. Alan Chong W. Lee, PT, PhD, DPT, CWS, GCS, serves as the lead telehealth coordinator for Frontiers in Rehabilitation Science and Technology (FiRST) Council at American Physical Therapy Association and Vice Chair of Technology Special Interest Group for Health Policy and Administration. Dr Lee is a telehealth consultant for BlueJay Health. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site ( http://journals.lww.com/jwhpt ). DOI: 10.1097/JWH.0000000000000120 Case Report Telerehabilitation for Treating Pelvic Floor Dysfunction: A Case Series of 3 Patients’ Experiences Jennifer Kinder , PT, DPTSc, MS 1 Todd Davenport , PT, DPT, MPH, OCS 2 Alan Chong W. Lee , PT, PhD, DPT, CWS, GCS 3 VOLUME 43 • NUMBER 1 • January/April 2019 The 3 participants rated the TR system as high quality (2/3) and very high quality (1/3). Using a mobile phone was the preferred digital device (2/3) compared with laptop use. All 3 participants felt their needs were met and that they received good care during the session. Summary: Telerehabilitation has the potential to deliver quality care with improved access for patients with PFD for both initial and follow-up visits. This case series presents 3 patients’ perceptions of using TR for pelvic health PT care.