Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study

A comprehensive review of conservative therapies for female stress urinary incontinence: Advancements, efficacy, and future directions

Pelvic floor dysfunction poses a significant challenge to women worldwide. Female urinary incontinence is one of the most prevalent types of pelvic floor dysfunctions, affecting at least 50% of females, particularly those who are pregnant or menopausal. Among the various urinary incontinence subtypes, stress urinary incontinence takes the lead, characterized by involuntary urine leakage during activities that increase intra-abdominal pressure, such as sneezing, coughing, laughing, or exercising. This comprehensive review explores the latest advancements and critical insights into conservative treatments for stress urinary incontinence. Stress urinary incontinence symptoms result in profound physical and psychological consequences for individuals and impose a substantial medical and economic burden on society; however, only 5%-10% seek professional help. This narrative review meticulously examines a spectrum of interventions, ranging from lifestyle modifications to emerging modalities, such as laser treatment and electroacupuncture.

Do We Have Sufficient Evidence to Derive Innovative Approaches to Assessing Unmet Need, Delivering Education on Bladder and Bowel Continence Health, and Providing a Better Environment for Joint Decision-Making? ICI-RS 2024

CONTEXT

Improved continence outcomes are reliant on identification of unmet need, education delivery, and shared decision-making. The evidence base on which to derive innovative approaches in these areas was unclear.

METHODS

A debate held at the International Consultation on Incontinence-Research Society meeting, held in Bristol in June 2024, considered ways to improve research requirements to advance these areas.

RESULTS AND CONCLUSION

Artificial intelligence solutions and digital approaches to healthcare are emerging at pace and offer possibilities to improve these three key areas but this must be driven by person-centered approaches. Care must be taken to avoid increasing inequality through digital exclusion and language barriers. Research questions are highlighted to derive innovation in these three key areas.

Athletes' Knowledge of Pelvic Floor Dysfunction and Their Knowledge of and Engagement with Pelvic Floor Muscle Training: A Scoping Review

INTRODUCTION

Pelvic floor dysfunction (PFD) is prevalent among athletes. Investigating whether athletes are practicing pelvic floor muscle training (PFMT) will assist in delineating the factors underlying the burden of PFD in this population. Additionally, investigating athletes' knowledge of PFD and knowledge of and attitudes toward PFMT may inform interventions to improve the practice of PFMT.

AIMS

This scoping review aimed to collate the available evidence regarding athletes' knowledge of PFD and their knowledge of and engagement with PFMT. Furthermore, this review aimed to determine the types of athletes (sports and competition levels) research had been conducted on and the definitions of PFD and PFMT most used.

METHODS

Six databases were searched up to January 2024. No study design or publication types were restricted; however, non-English articles were excluded due to resource constraints. Additional publications were identified through the reference lists of included articles. Data were synthesized and presented under subheadings relevant to the aims of this review.

RESULTS

Thirty-five publications were included for data extraction. Athletes had low practice of PFMT, poor knowledge of PFD and PFMT, but positive attitudes toward PFMT. One publication reported that higher levels of knowledge were associated with a lower prevalence of PFD. The athletic population was heterogeneous in sport type and competition level, and the definitions of PFD and PFMT were ill-defined.

CONCLUSIONS

Athletes have a low practice of PFMT and poor knowledge of PFD and PFMT. The education of athletes may have a role in supporting pelvic floor health.

Persuasive technologies design for mental and behavioral health platforms: A scoping literature review

This review investigates persuasive design frameworks within eHealth, concentrating on methodologies, their prevalence in mental and behavioral health applications, and identifying current research gaps. An extensive search was conducted across 8 databases, focusing on English publications with full text available. The search prioritized primary research articles, post-2011 applications, and eHealth platforms emphasizing treatment or support. The inclusion process was iterative, involving multiple authors, and relied on detailed criteria to ensure the relevance and contemporaneity of selected works. The final review set comprised 161 articles, providing an overview of persuasive design frameworks in eHealth. The review highlights the state of the art in the domain, emphasizing the utilization and effectiveness of these frameworks in eHealth platforms. This review details the restricted adoption of persuasive design frameworks within the field of eHealth, particularly in the mental and behavioral sectors. Predominant gaps include the scarcity of comparative evaluations, the underrepresentation of tailored interventions, and the unclear influence of persuasive components on user experience. There is a notable requirement for further scrutiny and refinement of persuasive design frameworks. Addressing these concerns promises a more substantial foundation for persuasive design in eHealth, potentially enhancing user commitment and platform efficiency.

Motivations, psychosocial burdens, and decision-making modes of post-partum women with stress urinary incontinence engaging in pelvic floor physical therapy: a qualitative research

INTRODUCTION AND HYPOTHESIS

This qualitative research explores the motivations, psychosocial burdens, and decision-making modes of post-partum women with stress urinary incontinence (SUI) engaging in pelvic floor physical therapy (PFPT).

METHODS

This study was conducted face-to-face in a treatment room using qualitative semi-structured interviews with post-partum women who received PFPT for SUI between May and October 2022. Participant interviews were transcribed verbatim and thematically analyzed using NVivo software, which is most commonly used for qualitative data analysis.

RESULTS

Themes that impacted participants' decisions to receive PFPT included avoiding deterioration of SUI symptoms, believing that the sooner it is treated the better, being unable to adhere to home exercise programs, and dissatisfaction with quality of life. Some participants experienced psychosocial burdens when receiving PFPT, including impact on daily activities, worries about the baby, financial burdens, and uncertainty about the effect. There were two modes of decision making, which brought different experiences. Some participants preferred participant-provider shared decision making and reported effective doctor-patient communication, and striving for autonomous decisions. Other participants preferred their clinicians to decide on PFPT protocols in view of their trust in their midwives, institutional reputation, and lacking knowledge of PFPT.

CONCLUSIONS

We discovered that participants had both motivations and psychosocial burdens when receiving therapy. Some participants preferred participant-provider shared decision making, whereas others preferred their midwives to make decisions. Further more standardized studies with more robust samples are needed.

App development in a sports science setting: A systematic review and lessons learned from an exemplary setting to generate recommendations for the app development process

The digital health sector is rapidly growing. With only 4% of publishers out of academic settings, it is under-represented in app development. The objective of this study is to assess the current state of app development with a systematic review and a survey within an exemplary academic setting along the following research questions: (Q1) Are software engineering principles sufficiently known in the sports science app development context? (Q2) Is the role of sports scientists in the context of app development sufficiently understood? The systematic review was conducted by two independent reviewers within databases Pubmed, Scopus, Web of Science, and IEEE Xplore. The PICO schema was used to identify the search term. We subtracted information about five main topics: development process, functional requirements and features, security, technology, and dissemination. The survey was developed by a multidisciplinary team and focused on five main topics. Out of 701 matches, 21 were included in the review. The development process was only described in seven studies. Functional requirements and features were considered in 11 studies, security in 3, technology in 13, and dissemination in 12 with varying details. Twelve respondents [mean age 33(7) years, 58% women] replied to the survey. The survey revealed limited knowledge in realization of security measures, underlying technology and source code management, and dissemination. Respondents were able to provide input on development processes as well as functional requirements and features. The involvement of domain experts is given in seven review studies and described in two more. In 50% of survey respondents, the role in app development is defined as a research assistant. We conclude that there is a varying degree of software engineering knowledge in the sports science app development context (Q1). Furthermore, we found that the role of sports scientists within app development is not sufficiently defined (Q2). We present recommendations for improving the success probability and sustainability of app development and give orientation on the potential roles of sports scientists as domain experts. Future research should focus on the generalizability of these findings and the reporting of the app development process.

Concepts and Application of Tai Ji in Stroke Rehabilitation: A Narrative Review

Stroke remains a leading cause of adult disability, and it decreases the health-related quality of life due to functional disability and poor functional recovery in stroke. Tai Ji has been recently introduced to overcome disabilities. This review aims to explain the effects of Tai Ji on functional recovery in stroke patients, linking it to current approaches, concepts and therapies such as Bobath and proprioceptive neuromuscular facilitation techniques. A compilation of recent literature on Tai Ji's use in stroke rehabilitation from Google scholar and PubMed Central (2018 to 2022). The benefits of Tai Ji in stroke functional recovery were studied and explained based on its similarity in concepts to current conventional stroke rehabilitation approaches. There were few randomized controlled trials on Tai Ji in functional recovery among stroke patients. However, all literature identified Tai Ji as beneficial in stroke rehabilitation. However, there was no literature on explaining the Tai Ji movement based on current conventional stroke rehabilitation approaches. Tai Ji carries similar theories to the current neurorehabilitation approach. Tai Ji can be modified and incorporated into stroke rehabilitation programs based on patients' needs to produce promising outcomes.

Feasibility and Usability of Kegel Exercise Pregnancy Training App (KEPT App) among Pregnant Women with Urinary Incontinence

Pelvic floor muscle training (PFMT) is crucial to improving urinary incontinence (UI). This study aimed to assess the Kegel Exercise Pregnancy Training (KEPT) app’s feasibility and usability. This is a subgroup analysis from a researcher-blinded, randomised controlled pilot feasibility study among pregnant women with UI. The Malay version of the mHealth App Usability Questionnaire (Interactive) evaluated the app’s usability. Ten pregnant women completed the study, with mean age (SD) of 28.9 years (3.1). The app’s feasibility was rated above average. The app was reported with usable in all domains, (1) system information arrangement (4.98/7.0), (2) usefulness (4.89/7.0) and (3) ease-of-use and satisfaction (5.03/7.0). Education level was negatively correlated with the app’s feasibility (r = −0.81, p < 0.001) and all domains of usability such as ease-of-use (r = −0.66, p = 0.01), system information (r = −0.81, p = 0.001) and usefulness (r = −0.81, p = 0.001). PFMT video was among the app features chosen to be helpful. This study demonstrates that the newly developed user-centred design KEPT app is feasible and usable. However, the future app should provide direct feedback about their exercise techniques to motivate PFMT adherence.

Preliminary Effectiveness of mHealth App-Based Pelvic Floor Muscle Training among Pregnant Women to Improve Their Exercise Adherence: A Pilot Randomised Control Trial

This pilot randomised control trial (RCT) aimed to evaluate the feasibility and preliminary effectiveness of conducting a full-powered trial for a newly developed pelvic floor muscle training (PFMT) app among pregnant women with urinary incontinence (UI) in Malaysia. This was a prospective, single-centre, single-blind, parallel, randomised controlled, pilot feasibility study—the Kegel Exercise Pregnancy Training app (KEPT app) trial. In total, 26 pregnant women with urinary incontinence from an urban healthcare clinic were recruited and randomly assigned to either intervention or waitlist control group. The intervention group received the KEPT app, while the control group received usual antenatal care (waitlist control). Of the 26 pregnant women, 16 (61.5%) completed the two-month follow-up. The recruitment rate was 54.2%, and the retention rate was 62.5% in the intervention group and 60% in the control group. There was a significant difference between intervention and control groups’ baseline measurement in the severity of UI (p = 0.031). The app improved their knowledge (p = 0.011) and self-efficacy (p = 0.038) after the first month and attitude (p = 0.034) after two months of intervention, compared with the control group. This study supports the feasibility of our future cluster RCT. The KEPT app demonstrates a promising effect in improving PFMT attitude and self-efficacy and potentially enhancing exercise adherence among pregnant women with UI. Trial registration: This study was prospectively registered on ClinicalTrials.gov on 19 February 2021 (NCT04762433).