A guide to physiotherapy in urogynecology for patient care during the COVID-19 pandemic

Cristine Homsi Jorge Ferreira, Patricia Driusso, Jorge Milhem Haddad, Simone Botelho Pereira, Ana Carolina Nociti Lopes Fernandes, Debora Porto, Bianca Manzan Reis, Lilian Rose Mascarenhas, Luiz Gustavo Oliveira Brito, Elizabeth Alves Gonçalves Ferreira, Cristine Homsi Jorge Ferreira, Patricia Driusso, Jorge Milhem Haddad, Simone Botelho Pereira, Ana Carolina Nociti Lopes Fernandes, Debora Porto, Bianca Manzan Reis, Lilian Rose Mascarenhas, Luiz Gustavo Oliveira Brito, Elizabeth Alves Gonçalves Ferreira

Abstract

Introduction and aim: Physiotherapy in urogynecology faces challenges to safely continuing its work, considering the adoption of social distancing measures during the COVID-19 pandemic. Some guidelines have already been published for urogynecology; however, no specific documents have been produced on physiotherapy in urogynecology. This article aimed to offer guidance regarding physiotherapy in urogynecology during the COVID-19 pandemic.

Methods: A group of experts in physiotherapy in women's health performed a literature search in the Pubmed, PEDro, Web of Science and Embase databases and proposed a clinical guideline for physiotherapy management of urogynecological disorders during the COVID-19 pandemic. This document was reviewed by other physiotherapists and a multidisciplinary panel, which analyzed the suggested topics and reached consensus. The recommendations were grouped according to their similarities and allocated into categories.

Results: Four categories of recommendations (ethics and regulation issues, assessment of pelvic floor muscle function and dysfunction, health education and return to in-person care) were proposed. Telephysiotherapy and situations that need in-person care were also discussed. Regionalization is another topic that was considered.

Conclusion: This study provides some guidance for continuity of the physiotherapist's work in urogynecology during the COVID-19 pandemic, considering the World Health Organization recommendations and the epidemiological public health situation of each region. Telephysiotherapy can also be used to provide continuity of the care in this area during the COVID-19 pandemic, opening new perspectives for physiotherapy in urogynecology.

Keywords: COVID-19; Pandemic; Pelvic floor muscles; Physiotherapy; Rehabilitation; Urogynecology.

Conflict of interest statement

The authors completed the ICJME Form for Disclosure of Potential Conflicts of Interest and reported no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study selection process

References

    1. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–1316. doi: 10.1001/jama.300.11.1311.
    1. Flegal K, Carroll MD, Brian K, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories. J Am Med Assoc. 2013;309(1):71–82. doi: 10.1001/jama.2012.113905.
    1. Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. 2019;366:l4570. doi: 10.1136/bmj.l4570.
    1. Grimes CL, Balk EM, Crisp CC, Antosh DD, Murphy M, Halder GE, et al. A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence. Int Urogynecol J. 2020;31(6):1063–1089. doi: 10.1007/s00192-020-04314-4.
    1. Online document World Physiotherapy . Accessed 12 July 2020.
    1. O’Connor M, Asdornwised U, Dempsey ML, Huffenberger A, Jost S, Flynn D, Norris A. Using telehealth to reduce all-cause 30-day hospital readmissions among heart failure patients receiving skilled home health services. Appl Clin Inf. 2016;7(02):238–247. doi: 10.4338/ACI-2015-11-SOA-0157.
    1. Lee A, Finnin K, Holdsworth L, Millette D, Peterson C. Report of the WCPT/INPTRA Digital physical therapy practice task force. WCPT/INPTRA Digital Practice Final Report vs.7 15 May 2019.
    1. Lindh A, Sjöström M, Stenlund H, Samuelsson E. Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year. Int Urogynecol J. 2016;27(12):1857–1865. doi: 10.1007/s00192-016-3050-4.
    1. Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training. BJU Int. 2013;112(3):362–372. doi: 10.1111/j.1464-410X.2012.11713.x.
    1. Firet L, de Bree C, Verhoeks CM, Teunissen DA, Lagro-Janssen AL. Mixed feelings: general practitioners’ attitudes towards eHealth for stress urinary incontinence-a qualitative study. BMC Fam Pract. 2019;20(1):21. doi: 10.1186/s12875-019-0907-x.
    1. Brusciano L, Gualtieri G, Gambardella C, Tolone S, Lucido FS, del Genio G, et al. When preserving life becomes imperative, quality of life is eclipsed! COVID-19 outbreak impacting patients with pelvic floor disorders undergoing pelvic floor rehabilitation. BJS. 2020;107(8):e242e242. doi: 10.1002/bjs.11675.
    1. Kaplan B, Litewka S. Ethical Challenges of Telemedicine and Telehealth. Camb Q Healthc Ethics. 2008;17(4):401–416. doi: 10.1017/S0963180108080535.
    1. Lee DD, Arya LA, Andy UU, Sammel MD, Harvie HS. Willingness of women with pelvic floor disorders to use mobile technology to communicate with their health care providers. Female Pelvic Med Reconstr Surg. 2019;25(2):134–138. doi: 10.1097/SPV.0000000000000668.
    1. Tiffin N, George A, LeFevre AE. How to use relevant data for maximal benefit with minimal risk: digital health data governance to protect vulnerable populations in low- income and middle-income countries. BMJ Glob Health. 2019;4(2):e001395. doi: 10.1136/bmjgh-2019-001395.
    1. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:CD005654. doi: 10.1002/14651858.CD005654.pub4.
    1. Bokne K, Sjöström M, Samuelsson E. Self-management of stress urinary incontinence: effectiveness of two treatment programmes focused on pelvic floor muscle training, one booklet and one internet-based. Scand J Prim Health Care. 2019;37(3):380–387. doi: 10.1080/02813432.2019.1640921.
    1. Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2017;12:CD007471. doi: 10.1002/14651858.CD007471.pub3.
    1. Vaccari NA, da Silveira LTY, Bortolini MAT, Haddad JM, Baracat EC, Ferreira EAG. Content and functionality features of voiding diary applications for mobile devices in Brazil: a descriptive analysis. Int Urogynecol J. 2020. 10.1007/s00192-020-04382-6.
    1. Mateus-Vasconcelos ECL, Ribeiro AM, Antônio FI, Brito LG de O, Ferreira CHJ. Physiotherapy methods to facilitate pelvic floor muscle contraction: a systematic review. Physiother Theory Pract. 2018;34(6):420–432. doi: 10.1080/09593985.2017.1419520.
    1. Bø K, Morkved S. Chapter 6: pelvic floor and exercise science: motor learning. In: Bø K, Berghmans B, Morkved S, van Kampen M, editors. Evidence-based physical therapy for the pelvic floor. 2nd. Elsevier: Philadelphia; 2015. pp. 111–116.
    1. Uechi N, Fernandes ACNL, Bø K, de Freitas LM, dela Ossa AMP, Bueno SM, et al. Do women have an accurate perception of their pelvic floor muscle contraction? A cross- sectional study. Neurourol Urodyn. 2019;39(1):361–366. doi: 10.1002/nau.24214.
    1. Andrade RL, Bø K, Antonio FI, et al. An education program about pelvic floor muscles improved women's knowledge but not pelvic floor muscle function, urinary incontinence or sexual function: a randomised trial. J Physiother. 2018;64(2):91–96. doi: 10.1016/j.jphys.2018.02.010.
    1. Vaz CT, Sampaio RF, Saltiel F, Figueiredo EM. Effectiveness of pelvic floor muscle training and bladder training for women with urinary incontinence in primary care: a pragmatic controlled trial. Braz J Phys Ther. 2019;23(2):116–124. doi: 10.1016/j.bjpt.2019.01.007.
    1. Barnes KL, Dunivan G, Jaramillo-Huff A, Krantz T, Thompson J, Jeppson P. Evaluation of smartphone pelvic floor exercise applications using standardized scoring system. Female Pelvic Med Reconstr Surg. 2018;25(4):328–335. doi: 10.1097/SPV.0000000000000563.
    1. Hay-Smith J, Peebles L, Farmery D, Dean S, Grainger R. Apps-olutely fabulous? - the quality of PFMT smartphone app content and design rated using the Mobile app rating scale, behaviour change taxonomy, and guidance for exercise prescription. Neurourol Urodyn 2019.
    1. Rao SSC, Valestin JA, Xiang X, Hamdy S, Bradley CS, Zimmerman MB. Home-based versus office-based biofeedback therapy for constipation with dyssynergic defecation: a randomised controlled trial. Lancet Gastroenterol Hepatol. 2018;3(11):768–777. doi: 10.1016/S2468-1253(18)30266-8.
    1. Bernard S, Boucher S, McLean L, Moffet H. Mobile technologies for the conservative self-management of urinary incontinence: a systematic scoping review. Int Urogynecol J. 2020;31(6):1163–1174. doi: 10.1007/s00192-019-04012-w.
    1. Leme Nagib AB, Riccetto C, Martinho NM, et al. Use of mobile apps for controlling of the urinary incontinence: a systematic review. Neurourol Urodyn. 2020;39(4):1036–1048. doi: 10.1002/nau.24335.
    1. Dantas LO, Barreto RPG, Ferreira CHJ. Digital physical therapy in the COVID-19 pandemic. Braz J Phys Ther 2020;S1413-3555(20)30402-0. 10.1016/j.bjpt.2020.04.006
    1. Li C, Gong Y, Wang B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2016;27(7):981–992. doi: 10.1007/s00192-015-2846-y.
    1. Mateus-Vasconcelos ECL, Brito LGO, Driusso P, Silva TD, Antônio FI, Ferreira CHJ. Effects of three interventions in facilitating voluntary pelvic floor muscle contraction in women: a randomized controlled trial. Braz J Phys Ther. 2018;22(5):391–399. doi: 10.1016/j.bjpt.2017.12.006.

Source: PubMed

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