Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study

Abstract

Background The postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry. Objective The aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women. Methods A 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne’s interpretive description approach. Results A total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77%), a cumbersome initiation process (n=8, 61%), and discomfort from the device (n=8, 61%) were reasons impeding intervention acceptability. Most participants (n=17, 74%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants. Conclusions Our pilot study demonstrated the potential for mHealth solution–enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth soluti...

Persuasive Technology in an mHealth App Designed for Pelvic Floor Muscle Training Among Women: Systematic Review

“…Of the 10 studies, 3 (30%) investigated the effectiveness of stand-alone apps [ 35 , 39 , 42 ], and 1 (10%) used an audio guidance app [ 43 ]. Another study (1/10, 10%) evaluated an app that uses Bluetooth technology to link data from biofeedback [ 36 ]. Of the 8 apps, except for 1 (13%) [ 40 ], all mHealth apps (n=7, 88%) provided asynchronous PFMT—there was no live communication with a trainer.…”

“…Meanwhile, the iBall app was unable to demonstrate improved adherence owing to technical difficulties and discomfort faced by study participants because of the external device [ 36 ]. Although the iBall app had various sophisticated persuasive features such as an interesting user interface, Bluetooth connection with an external device, and gamification, these features were not sufficient to overcome the problems with user acceptance of the external device.…”

The effectiveness of eHealth interventions on female pelvic floor dysfunction: a systematic review and meta-analysis

“…Selected studies were published between 2013 and 2021, of which 10 studies [ 32 – 36 , 41 , 43 , 44 , 47 , 48 ] were written in English and the remaining were written in Chinese, originating from 7 countries, including China (15 studies) [ 37 – 40 , 42 , 45 – 47 , 49 – 55 ], Brazil (2 studies) [ 32 , 34 ], Sweden (2 studies) [ 33 , 44 ], the US (2 studies) [ 43 , 48 ], the UK (1 study) [ 36 ], Canada (1 study) [ 35 ], and The Netherlands (1 study) [ 41 ]. The 24 studies included 3691 women who were diagnosed with pelvic floor disorders or at risk of PFD, among whom 1862 were allocated to the eHealth group and 1829 to the control group.…”

“…The 24 studies included 3691 women who were diagnosed with pelvic floor disorders or at risk of PFD, among whom 1862 were allocated to the eHealth group and 1829 to the control group. Among all the studies, various eHealth technologies were observed, including: mobile phone or tablet applications (7 studies) [ 32 , 33 , 36 , 38 , 40 , 41 , 45 ], internet (9 studies) [ 37 , 39 , 42 , 44 , 46 , 49 – 51 , 55 ], telemetry device (1 study) [ 34 ], video (2 studies) [ 43 , 54 ], audio (1 study) [ 47 ], telephone (2 studies) [ 52 , 53 ], and mixed technologies, where more than one eHealth modality was reported (2 studies combined telemetry devices with applications) [ 35 , 48 ]. The characteristics of eligible studies are displayed in Tables 1 and 2 .…”

Digitale Innovation in der Medizin – die COVID-19-Pandemie als Akzelerator von „digital health“

“…Am Beispiel Urolithiasis lässt sich zudem zeigen, dass Smartphone-Applikationen sogar teilweise schädlich sein können, wenn sie nicht medizinisch korrekten Inhalt gewährleisten [ 24 ]. Daneben wurden an der Schnittstelle zur Urogynäkologie in der Inkontinenzbehandlung der Frau zahlreiche digitale Behandlungsformen von Beckenbodentraining erprobt [ 25 ], wobei in hochmotivierten Probanden bessere Behandlungserfolge erzielt werden [ 26 ]. Perioperativ kann Aktivitätstracking eingesetzt werden, um Aktivitätsniveaus beispielsweise für Patienten zu erfassen, die sich einer Prostatektomie unterziehen [ 27 ].…”