Pelvic Floor Physical Therapy Research Articles

Low Referral Rates for Pelvic Floor Physical Therapy in MS Patients with Bladder Dysfunction: An Opportunity to Close the Gap

Low Referral Rates for Pelvic Floor Physical Therapy in MS Patients with Bladder Dysfunction: An Opportunity to Close the Gap

Treatment of Stress Urinary Incontinence: Does Race Matter?

The importance of this study was to examine treatment patterns and surgical complications for stress urinary incontinence (SUI). The aim of this study was to describe the treatment of SUI and associated complications in a racially and ethnically diverse population. This was a retrospective cohort study of patients with a new diagnosis of SUI. We identified patients who received treatment with a pessary, pelvic floor physical therapy, or surgery. Surgical complications were abstracted. Logistic regression was used to examine the association between race/ethnicity and treatment, as well as surgical complications. A total of 67,187 patients with a new diagnosis of SUI were included. The population was predominately Hispanic (47.5%) followed by White, Asian, Black, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native. Comparing no treatment to any treatment, all racial/ethnic groups, except American Indian/Alaska Native, had decreased odds of receiving treatment compared with White women. Hispanic and Native Hawaiian/Pacific Islander women had increased odds of referral for pelvic floor physical therapy compared with White women. All racial/ethnic groups, except for American Indian/Alaska Native women, had decreased odds of receiving a sling procedure compared with White women. When these racial/ethnic minority groups did receive treatment, it was more likely to be conservative treatment compared with White women. There were no significant differences in individual surgical complications. Racial minority women were 20-50% less likely to undergo a sling procedure, commonly posited as the gold standard surgical treatment. Racial minority women were 40-100% more likely to receive conservative management and 20-50% less likely to receive any treatment compared with White women.

Short-Term Telehealth Follow-up in Complex Gynecologic Conditions [ID 2683660

INTRODUCTION: Studies show up to 50% of patients leave health care appointments not understanding or remembering important information, instructions, or correct use of medications. The Rutgers Center for Vulvovaginal Health treats women referred for complex vulvovaginal or pain disorders and sexual dysfunctions. Despite receiving written instructions and diagrams at initial visit, many returned without having started or having discontinued treatment. We initiated a nurse practitioner telehealth visit 2–3 weeks after initial encounter to evaluate acceptance and benefit in this population. METHODS: This was a retrospective chart review of 50 telehealth visits for new patients seen at the center. Outcome measures were determined from questions presented to all women regarding understanding of condition, and adherence to medication and treatment plan. RESULTS: Overall, 98% of women found the telehealth visit helpful, and 46% had questions related to their first visit. Of the 43 prescribed medications, 37 initiated treatment (86%) and only 2 (4.7%) had not attempted to fill the prescription. Medication was changed in 10%, mostly because of side effects. Pelvic floor physical therapy and imaging studies were initiated in 75% and 67%, respectively. CONCLUSION: Women with complicated gynecologic problems viewed a short-term follow-up telehealth visit positively. This communication presents an opportunity for another point of contact that can be incorporated into a busy practitioner schedule without the requirement of an in-person visit, and allow convenience and reinforcement for women, as well as necessary treatment alterations. Further studies are needed to see if this short-term follow-up enhances long-term compliance or outcomes.

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer.

Urinary incontinence is a common presentation in general practice and can significantly affect a patient's quality of life. Stress urinary incontinence (SUI) is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (egsporting activities), or on sneezing or coughing'. There is a key role for primary care providers in the assessment and management of female SUI. To highlight the key diagnostic and management principles of female SUIingeneral practice and discuss management options. SUI can usually be diagnosed based upon clinical history and targeted physical examination. Pelvic floor physiotherapy and lifestyle interventions, including weight modification and management of co-morbidities, are important first-line therapies. Surgical options for both persistent or complex SUI include urethral bulking agents, Burch colposuspension and pubovaginal fascial slings. Synthetic (mesh) mid-urethral slings remain a viable surgical option for women suffering SUI.

Access to Urogynecologic Care in Federally Qualified Health Centers: A Mystery Caller Study.

Federally Qualified Health Centers (FQHCs) play an important role in providing care to underserved populations. However, little is known about the availability of urogynecology services at FQHCs. This study aimed to assess the availability of appointments for urogynecology care and to determine the prevalence of FQHCs offering urogynecologic services. A total of 362 FQHCs across the United States were randomly selected from the Health Resources and Services Administration website, based on specific inclusion criteria. Researchers called the FQHCs and requested the earliest available appointment for pelvic organ prolapse. The availability of urogynecologic services such as pessary fittings, pelvic floor physical therapy, and urodynamic studies was also inquired. A total of 362 FQHCs located in 46 states and the District of Columbia were called. On average, the 362 FQHCs had been established for 19.9 (SD ±15) years, were located in urban areas, and served a median county population of 24,573. Of the 220 FQHCs successfully contacted, 81% (180/220) reported that they could provide care for a patient with pelvic organ prolapse at an appointment 29.1 business days (SD ±30 days) from the date of the call, on average. However, only a small percentage of these FQHCs offered in-office pessary fittings (11%), complex multichannel urodynamics testing (8.6%), or pelvic floor physical therapy (5%). The availability of treatments for pelvic floor disorders at FQHCs is limited. These findings highlight a potential disparity in access to urogynecology services for individuals with public insurance.

Telehealth in a Pelvic Floor Physical Therapy Clinic: A Retrospective Cohort Study.

Telehealth offers advantages to patients with pelvic floor disorders because they face unique barriers to care; however, attendance of telehealth appointments is unknown. The objective of this study was to examine the attendance of telehealth appointments in urogynecology patients receiving pelvic floor physical therapy as compared with in-person visits before and during the COVID-19 pandemic. We retrospectively collected electronic medical record data from patients engaging in pelvic floor physical therapy from 2019, and pre- and post-COVID-19 in 2020. Information included appointment type, attendance, age, primary diagnoses, insurance status, and zip code. Cohort differences were examined using the χ2 test and analyses of variance. Our sample included 359 individuals scheduled for in-person visits in 2019, 57 for telehealth visits in 2020, and 283 for in-person visits in 2020. Patients scheduled for telehealth appointments were younger (39 ± 13 years) than patients in 2019 (45 ± 14 years) or 2020 (42 ± 14 years) in-person cohorts (χ2 (2, 696) = 6.8, P < 0.001). Patients attended telehealth appointments at higher rates (73.7%) than in-person visits in 2019 (56.8%) and 2020 (45.6%; χ2 (2, 699) = 26.2, P < 0.001). Attendance did not differ across primary diagnoses. Proximity based on zip code was not associated with attendance. Pelvic floor physical therapy attendance rates were highest for patients with telehealth visits as compared with in-person visits. Our findings encourage health care providers to continue or begin to offer telehealth visits for pelvic floor physical therapy for the urogynecology patient population.

Adherence to pelvic floor physical therapy in postpartum patients with complex obstetric injuries

Adherence to pelvic floor physical therapy in postpartum patients with complex obstetric injuries

Pelvic Floor Physical Therapy Attendance Among High-Risk Postpartum Patients.

Limited data describe attendance to pelvic floor physical therapy (PFPT) in a postpartum patient population. The objective was describe attendance to PFPT in a cohort of postpartum women at high-risk of pelvic floor concerns. We secondarily compared attendance between patients with and without evaluation in a postpartum pelvic floor healing clinic (PPFHC). This was a retrospective cohort study of 2 convenience samples from an academic hospital. The PPFHC cohort comprised all postpartum vaginal delivery patients evaluated in the PPFHC from July 2021 to July 2022. The historical pre-PPFHC cohort comprised patients with third/fourth-degree obstetrical lacerations from December 2019 to January 2021. We abstracted attendance to PFPT, number of visits, Pelvic Floor Distress Inventory-20 (PFDI-20) scores, Pelvic Floor Impact Questionnaire (PFIQ) scores, and discharge status. Our cohort contained 464 patients, 195 (42.0%) from pre-PPFHC and 269 (58.0%) from PPFHC. Among all patients 302 (65.1%) were referred to PFPT and 170 (56.3%) attended at least 1 visit, 82 (48.2%) were discharged from PFPT with goals met, and the median number of visits was 6 (3-10). The majority of patients (97.0%, n = 261) seen in the PPFHC were referred to PFPT, compared with 22.0% (n = 41) of pre-PPFHC patients (P < 0.01). More patients in the pre-PPFHC cohort attended PFPT than in those the PPFHC cohort (75.6% vs 53.5%, P ≤ 0.01). Most patients exhibited improved PFDI and PFIQ scores after PFPT (n = 88, 80.0%, and n = 89, 81.7% respectively). Patients attending postpartum PFPT demonstrated high therapy completion rates. A dedicated PPFHC had more referrals, however, lower PFPT attendance rates, when compared with a historical cohort.

Association of Neighborhood-Level Socioeconomic Status With Prolapse Management Decision.

This study identifies how neighborhood-level socioeconomic status (SES) may affect patients' treatment decisions for pelvic organ prolapse (POP). This study aimed to evaluate the association of neighborhood-level SES with the decision of surgical versus conservative POP management. This was a retrospective cohort study of patients newly diagnosed with POP at a tertiary medical center between 2015 and 2021. Patients lost to follow-up or poor surgical candidates were excluded. Patient characteristics, demographics, and treatment selection were abstracted from the electronic health record. Conservative management was defined as expectant, pessary, and/or pelvic floor physical therapy. Five-digit zip codes were linked to the Area Deprivation Index and used as a surrogate for neighborhood-level SES. Area Deprivation Indices were dichotomized at or below the sample median (less disadvantaged area) and above the sample median (more disadvantaged area). Logistic regression models estimated the odds of choosing surgical versus conservative management as a function of the Area Deprivation Index. A total of 459 patients met the eligibility criteria (non-Hispanic White, 88.2%). The median age was 63 years (interquartile range, 52-70 years), and the majority had stage 2 POP (65.7%). Of all patients, 59.3% had Medicare/Medicaid, 39.9% were privately insured, and 0.9% were uninsured. Furthermore, 74.7% selected surgical management, and 25.3% chose conservative management. Increasing age and higher Pelvic Organ Prolapse Quantification System stage were significantly associated with selecting surgery (P = 0.01). Women residing in a more disadvantaged area had a 67% increased odds of choosing surgical over conservative management (adjusted odds ratio, 1.67; 95% confidence interval, 1.06-2.64) after adjusting for age, race/ethnicity, body mass index, and Pelvic Organ Prolapse Quantification System stage. Residing in a more disadvantaged zip code was associated with 67% increased odds of choosing surgical versus conservative POP management.

Obstetric outcomes of nulliparous women with pelvic pain undergoing fertility treatment

Research QuestionTo evaluate the association between pelvic pain disorders and primary caesarean delivery for patients undergoing assisted reproductive technology treatment. DesignRetrospective cohort study of nulliparous patients with singleton pregnancies who underwent assisted reproductive technology treatment and achieved a live birth from 2012-2020. Cases included patients with prior diagnoses of pelvic pain disorders. A 3:1 ratio propensity score matched population of patients without pelvic pain was included as Controls. Comparative statistics were performed using chi-square and students t-test. A multivariate regression analysis was conducted to evaluate the association between pelvic pain patients and mode of delivery. Results174 pelvic pain patients were compared to 575 controls. Pelvic pain patients reported a significantly longer duration of infertility (18.9±20 months vs. 14.0±14 months, p=0.003) compared to controls. Pelvic pain patients had a significantly higher rate of anxiety disorders (115±21.9 vs. 55±31.6, p= 0.009) and use of anxiolytics at embryo transfer (17±3.2 vs. 12±6.9, p=0.03). Pelvic pain patients had a higher rate of primary caesarean delivery compared with controls (59.7% vs. 49.1%, p=0.01). After adjusting for multiple variables, there was a significant association between pelvic pain patients and increased odds of primary caesarean delivery (aOR = 1.48, CI 95%; 1.02-2.1). ConclusionPelvic pain patients have significantly greater odds of primary caesarean delivery when compared to patients without pelvic pain history. The infertility outpatient setting may be uniquely positioned to identify patients at risk for undergoing primary caesarean delivery and could facilitate earlier intervention for pelvic floor physical therapy during the preconception and antepartum periods.

Hard flaccid syndrome symptoms, comorbidities, and self-reported efficacy and satisfaction of treatments: a cross-sectional survey.

Hard flaccid syndrome (HFS) is a poorly understood condition with no formal consensus on its definition. We aimed to advance the understanding of HFS by evaluating symptom prevalence, cause of symptom onset, comorbidities, and self-reported efficacy and satisfaction with current treatments. An online, open, 42-question survey on Qualtrics with purposive and convenience sampling methods was conducted between May 9 and June 9, 2023 on participants self-identifying as having HFS. Participants were recruited through social media platforms. Only 58.0% of participants reported their HFS symptoms began following a specific incident/injury. Changes in penis shape/size (92.3%) and rigid penis when not erect (90.9%) were the most common complaints. Activities such as laying down and stretching improved symptoms in 73.0% and 44.1% of the participants, respectively, while masturbation and standing worsened symptoms in 75.9%, and 64.5% of the participants, respectively. Pudendal neuralgia (16.9%) was the most prevalent comorbid condition. Of those who participated in therapies, phosphodiesterase-5 (PDE5) inhibitor treatment had the highest patient global impression of change (PGIC) score (2.6 ± 1.1), indicating little to moderate improvement in symptoms. All other therapies scored between 1 and 2, indicating no change to little improvement in symptoms: pelvic floor physical therapy (PFPT) (1.8 ± 0.9), shockwave therapy (1.6 ± 1.1), diet/nutrition changes (1.6 ± 0.8), nerve blocks (1.6 ± 0.8), muscle relaxants (1.5 ± 0.6), anti-inflammatory medications (1.5 ± 0.7), cognitive therapy (1.4 ± 0.7), and nerve pain medications (1.4 ± 0.5). Overall, a direct injury to the penis may not necessarily be the only cause of HFS for some patients, and current therapies generally do not benefit most patients. A better understanding of the root causes of HFS and innovative treatment strategies are greatly needed for HFS patients.

Evaluation of a new management approach using a mobile application in the treatment of stress urinary incontinence in women

Pelvic floor muscle training (PFMT) is effective in the treatment of stress urinary incontinence (SUI). The aim of this randomized controlled trial was to investigate a new management approach involving the use of a mobile application (app) along with standard pelvic floor physiotherapy. The study included 30 female participants with SUI who were aged between 30 and 60 years. The women in the intervention group performed exercises at home using an app connected to an intravaginal probe. Those in the control group performed the same exercises using paper-based instructions. The period of the intervention was 3 months, and five parameters were analysed: adherence, compliance, SUI symptoms, pelvic floor functionality and quality of life (QOL). All participants received physiotherapy sessions in parallel with PFMT. The intervention group showed improvements in incontinence symptoms (P = 0.002), QOL (P = 0.003) and pelvic floor functionality over the course of treatment. Improvements in symptoms (P = 0.021), QOL (P = 0.008), and the strength and speed of contractions were observed in the control group. Intergroup tests only identified a significant difference for the PERFECT speed parameter (P = 0.011). A decrease in motivation was noted in both groups. This study did not show that an app connected to a probe was superior to paper-based instructions for PFMT. However, it did confirm that a home exercise programme combined with physiotherapy has a positive impact on SUI symptoms and QOL.

A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction.

To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.

Does pelvic floor physical therapy after delivery help reduce urinary incontinence?

Does pelvic floor physical therapy after delivery help reduce urinary incontinence?

Pelvic floor therapy program for the treatment of female urinary incontinence in Belize: a pilot study.

Urinary incontinence (UI) is highly prevalent in low- and middle-income countries (LMIC). Concurrently, the availability of surgical or conservative UI treatments in LMIC is limited. We conducted a prospective feasibility study of Belize women with UI treated with pelvic floor physical therapy (PFPT) and education (PFE). Patients received individual PFPT/PFE over 2 days, consisting of biofeedback-enhanced PFMT in addition to behavioral, dietary, and general pelvic education. Patient completed a daily 6-month home regimen including 7 PFMT exercises (total 70 repetitions) comprising both endurance and quick flick exercises. Patients also performed comprehensive dietary and behavioral modification activities. Outcomes were assessed at baseline and 6-months, including validated symptom (ICIQ-FLUTS) and QOL (IIQ-7) questionnaires, and strength testing (PERFECT score, perineometry). Twenty-eight patients underwent baseline assessment. Four patients were lost to in-person 6-month follow-up, with two of these patients completing subjective assessment only by telephone. The mean (±SD) patient age, BMI, and parity were 50.0 (±10.0) years, 33.2 (±5.8), and 2.8 (±1.5). Provider assessment demonstrated patient comprehension of basic, endurance, and quick flick pelvic floor contractions in 28 (100%), 24 (86%), and 24 (86%) patients, respectively. At 6-month follow-up, significant improvements were seen across multiple validated questionnaire and strength measurement assessments. Median patient-reported improvement level was 7.0 on a 10-point Likert scale. Study patients demonstrated good understanding of PFMT/PFE and program completion was associated with significant improvements across a variety of subjective incontinence and quality of life outcomes, as well as objective strength testing.

(270) Application of ISSWSH Consensus PGAD/GPD Diagnostic Algorithm to Eight Cases

Abstract Introduction Persistent Genital Arousal Disorder/Genito-Pelvic Dysthesia (PGAD/GPD) is a debilitating, but the mechanism of disease and treatment are poorly understood. To address this gap in knowledge, the ISSWSH consensus statement proposed a diagnostic and treatment algorithm for PGAD/GPD. The algorithm proposes five possible regions of etiologies for the purposes of diagnosis and treatment. These regions include end organ (clitoris, vagina, vulva, etc), pelvis/perineum, spinal cord, cauda equina and brain. Objective The purpose of this retrospective case series is to apply the ISSWSH diagnostic and treatment algorithm to nine cases, in order to demonstrate the efficacy of the algorithm, as well as present uniform manner for reviewing PGAD/GPD cases. Methods Individuals were identified by the Principal Investigator and colleagues. ISSWSH diagnostic and treatment algorithm was used to note pertinent positives and negatives in history and physical exam, as well as analyze treatment. Results Cases of eight patients are reviewed using the algorithm to analyze the treatments and possible etiologies of each patient. Patients presented anywhere from experiencing symptoms for five days to three years. Half of the patients experienced relief of symptoms with treatment of lumbar pathology demonstrated on MRI. Four of the patients found relief with spinal epidural injections performed by a pain medicine physician, two found relief with pelvic floor physical therapy and two found relief with medications including gabapentin and pregabalin. Conclusions These cases demonstrate the utility of the ISSWSH consensus algorithm in guiding initial diagnosis and treatment of PGAD/GPD. However, it has limitations due to the multifactorial nature of PGAD/GPD, it is helpful in guiding initial treatment of the disorder. The cases in this series illustrate the importance of MRI in diagnosis of PGAD/GPD etiologies. Fifty percent of the cases in this series included an MRI that revealed lumbar pathologies that could be managed by pain management physician. As shown in these cases, PGAD/GPD can have a significant negative impact on mental health and activities of daily living, therefore it is critical to be systematic and efficient. The steps demonstrated to be most important in these cases include review of recent medication changes, physical examination (with anesthesia testing, if possible), lumbar MRI and referral to pain medicine specialist. The primary limitation of this study is that it is a retrospective chart review and as such, there was no standardization of the work up for each patient and information on each patient was limited to the notes in their charts. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Johnson and Johnson.

(080) Outcomes After Isolated Epididymal Pain

Abstract Introduction Chronic epididymitis imposes significant physical and psychosocial distress on affected patients. Despite being a commonly encountered urologic condition, there remains a paucity of understanding and literature surrounding the management and natural history of isolated epididymal pain. Typically, patients who do not respond to conservative management undergo an epididymectomy. However, the literature on its efficacy is also scarce, with success rates varying widely from 10-90% in existing studies. Objective To better describe the etiology, pathogenesis and natural history of isolated epididymal pain. Furthermore, we aimed to describe the rates of success associated with epididymectomy. Methods A retrospective cohort study was conducted at the Manitoba Men’s Health Clinic, with approved by the University of Manitoba REB. All patients presenting with chronic epididymitis, defined as discomfort or pain localized to the epididymis for at least three months, were identified. Information regarding patient demographics, past medical and surgical history, duration of pain, localization of pain, findings on previous ultrasounds, STI testing results, prior conservative therapies trialed and response rates, as well as response rates to surgical therapy were collected. Results From April 2022 to 2023, a total of 274 patients with chronic orchialgia were identified, and among them, 74 patients specifically presented with chronic isolated epididymal pain. The average duration of symptoms was as follows: 21.6% (n=16) of patients experienced symptoms for 3-6 months, 9.5% (n=7) for 6-12 months, and 63.5% (n=47) for over 12 months. 13.5% (n=10) had associated ejaculatory pain, 8.1% (n=6) had lower urinary tract symptoms, and 4.1% (n=3) had erectile dysfunction. Ultrasound findings were observed in 68.9% of patients, with 31.1% having an epididymal cyst, 27.1% having a varicocele, 5.4% having a spermatocele, and 4.1% having a hydrocele. 49.4% (n=40) did not undergo any intervention prior to referral. After referral, 58.8% (n=43) of patients had undergone antibiotic treatment, 12.2% (n=9) had tried an NSAID, and one patient was referred for pelvic floor physical therapy. Among those who underwent conservative therapy, only 36.2% of patients reported a positive response. Surgical intervention was performed on 23 patients, including 16 who underwent an epididymectomy, three who underwent cord denervation, and two who underwent vasovasostomy and spermatocelectomy each. 81.3% of patients (n=13) who underwent an epididymectomy had a positive response to the surgical intervention, defined as satisfactory improvement of pain, while all patients undergoing other surgical interventions experienced a positive response. Conclusions Chronic epididymal pain is a condition with limited data surrounding its management. Prior to referral, a large proportion of patients did not undergo any conservative treatment, and of those that did, there was limited response rates. For those who underwent surgical intervention, all were pain free on follow up, except three patients who underwent and epididymectomy. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Objective Changes in Pelvic Floor Muscle Strength and Length in Women With High-Tone Pelvic Floor Dysfunction After Pelvic Floor Physical Therapy (RELAX Trial)

(Abstracted from Urogynecology 2023;29:872–879) High-tone pelvic floor dysfunction (HTPFD) can cause chronic pelvic pain and lower urinary tract symptoms and can significantly impact quality of life. One treatment for HTPFD is pelvic floor physical therapy (PFPT) that focuses on myofascial treatment; recent studies have shown this to be an effective way to reduce symptoms and improve quality of life.

Pelvic Floor Therapy and Initial Interventions for Pelvic Floor Dysfunction in Gynecologic Malignancies.

This review provides evidence-based updates for the first-line management approaches for pelvic floor disorders in patients with gynecologic malignancies, as well as important provider considerations when referring for pelvic floor physical therapy. Currently, there is strong evidence to recommend pelvic floor muscle training as initial treatment for urinary incontinence and for pelvic organ prolapse; some evidence to recommend a more targeted pelvic floor muscle training program for fecal incontinence; and mostly expertise-based evidence to recommend vaginal gels or estrogen to aid with dyspareunia causing sexual dysfunction. More research is greatly needed to understand the role of overactive pelvic floor muscles in survivors with chronic pelvic pain and the treatment of post-radiation pelvic complications such as vaginal stenosis and cystitis. While pelvic floor disorders are common concerns in gynecologic cancer survivors, there are evidence-based initial noninvasive treatment approaches that can provide relief for many individuals.

Quality of Pelvic Floor Therapy Videos on YouTube: Does Popularity Predict Reliability?

This study reviewed instructional videos on YouTube regarding pelvic floor physical therapy and assessed the association between the videos' popularity and the reliability of the videos' content. YouTube was searched using the terms relevant to pelvic floor muscle training. The first 100 videos for each search term were screened, and relevant metrics were collected for those meeting the inclusion criteria. Videos were assessed by 2 independent, trained health care professionals for reliability using the Medical Quality Video Evaluation (MQ-VET) tool, the modified DISCERN tool, the Journal of American Medical Association benchmark criteria, and the Global Quality Score. Popularity was assessed using the Video Power Index (VPI). Higher values for all scoring systems correlated with greater reliability and greater popularity, respectively. Five hundred videos were screened. Two hundred thirty-four videos were duplicates, and 99 did not meet the inclusion criteria. A total of 167 videos were reviewed. The median VPI and MQ-VET score was 201,114.76 (interquartile range, 7,194,020.29) and 48.00 (interquartile range, 12.75), respectively. Spearman's R value was 0.292 (P < 0.001), demonstrating a weak positive correlation between MQ-VET scores and VPI. The interrater reliability of the MQ-VET was good, with an intraclass correlation coefficient of 0.86 (95% confidence interval, 0.71-0.92). In summary, we identified a statistically significant but weak positive correlation between the reliability and popularity of YouTube videos about pelvic floor physical therapy.