Pelvic health physiotherapy delivered via telehealth for patients presenting with pelvic organ prolapse and urinary incontinence

ABSTRACT

Keywords Pelvic Health Physiotherapy, Telehealth, Service Delivery Purpose: During COVID-19 pelvic health physiotherapy had to change the delivery mode of their appointments to primarily telehealth provision compared to the previous service delivery of all face to face appointments. It was perceived that telehealth would provide equitable results in symptom improvement as measured by the Clinical Global Improvement Scale (CGIS) on discharge via this assessment and treatment method, this is despite not being able to perform an objective assessment of the pelvic floor muscle as would be done in previous service delivery. The aim of the service evaluation was to identify if pelvic health physiotherapy was as affective via telehealth as previous service delivery for patients referred with Urinary Incontinence (UI) and Pelvic Organ Prolapse (POP). Methods: Patients were included if they had only received physiotherapy via telehealth from the 1st April 2020 and were referred with POP or UI. On discharge between September 1st 2020 and March 31st 2021 patients were verbally asked the CGIS which requests people to rate their improvement on a 7 point scale from “very much better” to “very much worse”. The data was collated and compared against results of the CGIS obtained during a previous audit in 2019/2020 for patients presenting with POP and UI. Descriptive statistics were used to analyse the data. Results: There were a total of 118 that fitted the inclusion criteria. The mean number of appointments was 6.9 compared to 3.3 appointments with previous service delivery. There were 29% of patients who reported that they were “very much improved” following treatment via telehealth compared to 42% with previous service delivery. 30% of patients reported that they had “minimal” or “no improvement” from physiotherapy via telehealth compared 19% with previous service delivery. Conclusion(s) Whilst there is a proportion of patients that found telehealth beneficial for the treatment of UI and POP, data shows in comparison to previous service delivery that less patients reported that they were very much better from physiotherapy and more patients reported that they had minimal improvement or no improvement with a telehealth predominant service. Telehealth was also deemed to be less efficient with on average patients required twice the number of appointments compared to previous service delivery. With physiotherapy being the recommended first line management for patients presenting with UI and POP (Nice Guideline 123) it cannot be recommended that this is delivered predominantly via telehealth. Impact With redevelopment of service delivery in a post COVID environment it must be taken into consideration that for patients presenting with POP and UI that being able to perform a comprehensive objective assessment may influence the outcome of patient treatment. There is a percentage of patients that responded well to treatment via telehealth and the option to provide this method of service delivery is important to maintain and can be part of the shared decision making process. However the results of the service evaluation show that patients perceptions of symptom improvement as measured via the CGIS with pelvic health physiotherapy via telehealth is not as effective as previous service delivery. Funding acknowledgements No funding was provided to complete this service evaluation