Operative Planning for Pelvic Floor Disorders: Comparing Treatment Plans during a Telehealth Visit and an in-Person Visit

Abstract

Study Objective To compare the treatment plan proposed at a new patient Telehealth consultation to a subsequent plan proposed after an in-person examination. Secondary objectives were to assess concordance of patient self-assessment of prolapse during Telehealth visit with provider assessment of prolapse via Pelvic Organ Prolapse-Quantification (POP-Q) examination during in-office visit and to calculate sensitivity and specificity of Pelvic Floor Distress Inventory-20 (PFDI-20) question number three responses with patient self-assessment of prolapse and POP-Q stage. Design Retrospective cohort analysis. Setting Telehealth new patient visits with in-person follow up. Patients or Participants Women presenting for new patient consultation via Telehealth visit who had in-person follow up with examination. Interventions N/A. Measurements and Main Results The primary outcome was concordance of treatment plans, either non-surgical or surgical, after Telehealth visit versus in-person follow-up examination. Secondary outcomes included patient demographics, comparison of patient self-assessment of prolapse stage to POP-Q stage noted on exam, and comparison of PFDI-20 question number three score to patient self-assessment of prolapse and provider assessment of prolapse. Between April 01, 2020, through October 31, of 2020, 100 patients completed a new patient Telehealth consultation visit and an in-person follow up examination. After the Telehealth consultation, 43% of patients elected to have non-surgical treatment; 57% of patients elected to undergo surgical treatment. After in-person follow-up, 42% versus 58% of women elected to have non-surgical versus surgical treatment. Concordance rates were 79% for non-surgical plans and 86% for surgical plans; overall 83% (p<0.001). Ninety-three patients underwent POP-Q examination and self-assessment was accurate for 48/93 patients (51.7%, p<0.01). The sensitivity and specificity for an affirmative response to vaginal bulge symptoms with Stage II prolapse or higher on patient self-assessment was 90.5% and 65.4% and on POP-Q examination 88.9% and 61.9% respectively. Conclusion Telemedicine consultations offer a feasible modality for creation of non-surgical and surgical treatment plans for women with pelvic floor disorders. To compare the treatment plan proposed at a new patient Telehealth consultation to a subsequent plan proposed after an in-person examination. Secondary objectives were to assess concordance of patient self-assessment of prolapse during Telehealth visit with provider assessment of prolapse via Pelvic Organ Prolapse-Quantification (POP-Q) examination during in-office visit and to calculate sensitivity and specificity of Pelvic Floor Distress Inventory-20 (PFDI-20) question number three responses with patient self-assessment of prolapse and POP-Q stage. Retrospective cohort analysis. Telehealth new patient visits with in-person follow up. Women presenting for new patient consultation via Telehealth visit who had in-person follow up with examination. N/A. The primary outcome was concordance of treatment plans, either non-surgical or surgical, after Telehealth visit versus in-person follow-up examination. Secondary outcomes included patient demographics, comparison of patient self-assessment of prolapse stage to POP-Q stage noted on exam, and comparison of PFDI-20 question number three score to patient self-assessment of prolapse and provider assessment of prolapse. Between April 01, 2020, through October 31, of 2020, 100 patients completed a new patient Telehealth consultation visit and an in-person follow up examination. After the Telehealth consultation, 43% of patients elected to have non-surgical treatment; 57% of patients elected to undergo surgical treatment. After in-person follow-up, 42% versus 58% of women elected to have non-surgical versus surgical treatment. Concordance rates were 79% for non-surgical plans and 86% for surgical plans; overall 83% (p<0.001). Ninety-three patients underwent POP-Q examination and self-assessment was accurate for 48/93 patients (51.7%, p<0.01). The sensitivity and specificity for an affirmative response to vaginal bulge symptoms with Stage II prolapse or higher on patient self-assessment was 90.5% and 65.4% and on POP-Q examination 88.9% and 61.9% respectively. Telemedicine consultations offer a feasible modality for creation of non-surgical and surgical treatment plans for women with pelvic floor disorders.