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Cited by 5Telemedicine and Telehealth ImplementationPelvic floor disorders treatmentsHealth Literacy and Information Accessibility

Evidence for the Appropriate Use of Telemedicine in Female Pelvic Medicine and Reconstructive Surgery

Open access
Barrett, Francesca, Stewart, Lauren E., Brucker, Benjamin M.·2021·Current Bladder Dysfunction Reports
DOI 10.1007/s11884-021-00635-2PMC PMC8563823
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Abstract

Purpose of review To summarize the available literature regarding telehealth interventions in the management of pelvic floor disorders.Recent findings Most Female Pelvic Medicine and Reconstructive Surgery (FPMRS) patients own and feel comfortable operating the technology required to participate in telehealth interventions and would be willing to interact remotely with their providers. Telehealth may be an appropriate and effective tool for patient education about bladder and pelvic physiology and pathophysiology, remote pelvic floor muscle strengthening when in-person physical therapy is not accessible, overactive bladder follow-up and medication management, and for postoperative care following uncomplicated incontinence and prolapse surgery.Summary There is a growing body of literature specific to FPMRS supporting various telehealth interventions that could reasonably be expected to improve access to sub-specialty care while maintaining or improving healthcare quality and reducing costs to the patient and the healthcare system.

Integrity signals

Registry

Crossref · 10.1007/s11884-021-00635-2

Cites

21 of 21 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 33 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    No studies have examined the safety or effectiveness of telehealth that uses empiric antibiotics for recurrent UTIs outside the COVID-19 pandemic.

    “The safety and efficacy of telehealth interventions involving empiric antibiotic treatment of recurrent UTIs outside of the COVID-19 pandemic have not been studied.”
    Quote in the paperSubstantial claim
  • Interpretationcitation

    Telehealth can suitably and effectively deliver pelvic floor muscle strengthening remotely when patients cannot access in-person physical therapy.

    “remote pelvic floor muscle strengthening when in-person physical therapy is not accessible”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Barnes KL, Cichowski S, Komesu YM, et al. Home biofeedback versus physical therapy for stress urinary incontinence: a randomized trial. Female Pelvic Med Reconstr Surg 2020 https://doi.org/10.1097/SPV.0000000000000993. source

      Not checked in the free run.

  • Interpretationnone given

    Telehealth can serve as a suitable and effective means to educate patients on bladder and pelvic physiology and pathophysiology.

    “Telehealth may be an appropriate and effective tool for patient education about bladder and pelvic physiology and pathophysiology”
    Quote in the paperSubstantial claim
  • Interpretationcitation

    Telehealth can be appropriate and effective for overactive bladder follow-up and medication management.

    “overactive bladder follow-up and medication management”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [22] Hui E, Lee PS, Woo J. Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomized controlled trial. J Telemed Telecare. 2006;12:343–7. https://doi.org/10.1258/135763306778682413. source

      Not checked in the free run.

    • cites [23] Jones G, Brennan V, Jacques R, et al. Evaluating the impact of a ‘virtual clinic’ on patient experience, personal and provider costs of care in urinary incontinence: a randomised controlled trial. PLoS One. 2018;13:e0189174. source

      Not checked in the free run.

    • cites [24] Palmerola REC, Sussman R, Brandon C, Smilen S, Pape D, Rosenblum N, Brucker B. Can telemedicine improve follow up adherence and outcomes in patients with overactive bladder? Neurourol Urodyn. 2020;39:S108. source

      Not checked in the free run.

  • Interpretationcitation

    For older women with urinary incontinence, virtual visits appear to be a suitable substitute for in-person health education.

    “No difference in outcomes was found between the groups, suggesting that virtual visits are a good alternative to in-person health education in an older population.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Hui E, Lee PS, Woo J. Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomized controlled trial. J Telemed Telecare. 2006;12:343–7. https://doi.org/10.1258/135763306778682413. source

      Not checked in the free run.

  • May combine two claims. 12
  • Classified as probably not a substantial claim. 1

  • May combine two claims.

    Interpretationcitation

    Studies indicate that adding telemedicine to postoperative care for FPMRS patients is safe and yields patient satisfaction scores that are generally comparable.

    “Ultimately, studies indicate that incorporating telemedicine into postoperative care for FPMRS patients is safe and generally results in similar patient satisfaction scores.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [17] Derisavifard SRJ, Kocher N, Giusto L, Zahner P, Luo D, Dielubanza E, Li J, De Jesus MR, Gomelsky A. BalzarroM, Rackley R, VasavadaS, Moore C, Goldman H. Telemedicine optimizes early postoperative follow up after synthetic mid-urethral sling (MUS): a randomized, multi-institutional control trial [MP30-17]. J Urol. 2020;203:114–5.

      Not checked in the free run.

    • cites [20] Lee DD, Arya LA, Andy UU, et al. Video virtual clinical encounters versus office visits for postoperative care after pelvic organ prolapse surgery: a randomized clinical trial. Female Pelvic Med Reconstr Surg. 2020. https://doi.org/10.1097/SPV.0000000000000909. source

      Not checked in the free run.

    • cites [21] Thompson JC, Cichowski SB, Rogers RG, et al. Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial. Int Urogynecol J. 2019;30:1639–46. https://doi.org/10.1007/s00192-019-03895-z. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    A growing FPMRS-specific literature supports various telehealth interventions that plausibly enhance access to subspecialty care while preserving or improving quality and lowering costs for patients and the health system.

    “There is a growing body of literature specific to FPMRS supporting various telehealth interventions that could reasonably be expected to improve access to sub-specialty care while maintaining or improving healthcare quality and reducing costs to the patient and the healthcare system.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A survey of women with pelvic floor disorders reported that they possessed and could operate mobile technology, leading its authors to deem telemedicine feasible.

    “Overall, the authors found that this population did own mobile technology and was able to use the technology, concluding that telemedicine is feasible.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Lee DD, Arya LA, Andy UU, et al. Willingness of women with pelvic floor disorders to use mobile technology to communicate with their health care providers. Female Pelvic Med Reconstr Surg. 2019;25:134–8. https://doi.org/10.1097/SPV.0000000000000668. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Telehealth can be appropriate and effective for postoperative care following uncomplicated incontinence and prolapse surgery.

    “for postoperative care following uncomplicated incontinence and prolapse surgery”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [17] Derisavifard SRJ, Kocher N, Giusto L, Zahner P, Luo D, Dielubanza E, Li J, De Jesus MR, Gomelsky A. BalzarroM, Rackley R, VasavadaS, Moore C, Goldman H. Telemedicine optimizes early postoperative follow up after synthetic mid-urethral sling (MUS): a randomized, multi-institutional control trial [MP30-17]. J Urol. 2020;203:114–5.

      Not checked in the free run.

    • cites [20] Lee DD, Arya LA, Andy UU, et al. Video virtual clinical encounters versus office visits for postoperative care after pelvic organ prolapse surgery: a randomized clinical trial. Female Pelvic Med Reconstr Surg. 2020. https://doi.org/10.1097/SPV.0000000000000909. source

      Not checked in the free run.

    • cites [21] Thompson JC, Cichowski SB, Rogers RG, et al. Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial. Int Urogynecol J. 2019;30:1639–46. https://doi.org/10.1007/s00192-019-03895-z. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A growing body of evidence indicates that telemedicine can lower costs, boost efficiency, and raise patient satisfaction without reducing care quality.

    “Increasing data suggests that telemedicine is a cost-effective way to increase efficiency and improve patient satisfaction without sacrificing the quality of care.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Flodgren G, Rachas A, Farmer AJ, et al. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2015: CD002098. https://doi.org/10.1002/14651858.CD002098.pub2. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Available data suggest that OAB care may be more cost-effective if the first visit is in person, while remote follow-up for first- and second-line therapy is probably safe and may enhance adherence and progression to third-line treatment.

    “The available data suggests that care may be more cost-effective when the initial consultation is in-person, but follow-up for first- and second-line therapy is likely safe and may improve adherence to care and progression to third-line treatment.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [23] Jones G, Brennan V, Jacques R, et al. Evaluating the impact of a ‘virtual clinic’ on patient experience, personal and provider costs of care in urinary incontinence: a randomised controlled trial. PLoS One. 2018;13:e0189174. source

      Not checked in the free run.

    • cites [24] Palmerola REC, Sussman R, Brandon C, Smilen S, Pape D, Rosenblum N, Brucker B. Can telemedicine improve follow up adherence and outcomes in patients with overactive bladder? Neurourol Urodyn. 2020;39:S108. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Across several studies, telehealth programs for pelvic floor muscle training outperformed traditional written or physician-led instruction, and in one trial they matched supervised pelvic floor physical therapy.

    “Overall, telehealth interventions aimed at pelvic floor muscle strengthening had benefits over traditional models (written information and physician teaching) in multiple studies and were non-inferior to supervised pelvic floor physical therapy in one study.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [11] Asklund I, Nystrom E, Sjostrom M, et al. Mobile app for treatment of stress urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2017;36:1369–76. https://doi.org/10.1002/nau.23116. source

      Not checked in the free run.

    • cites [13] Sjostrom M, Umefjord G, Stenlund H, et al. Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training. BJU Int. 2015;116:955–64. https://doi.org/10.1111/bju.13091. source

      Not checked in the free run.

    • cites [15] Barnes KL, Cichowski S, Komesu YM, et al. Home biofeedback versus physical therapy for stress urinary incontinence: a randomized trial. Female Pelvic Med Reconstr Surg 2020 https://doi.org/10.1097/SPV.0000000000000993. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most FPMRS patients own and are comfortable using technology needed for telehealth and are willing to interact remotely with providers.

    “Most Female Pelvic Medicine and Reconstructive Surgery (FPMRS) patients own and feel comfortable operating the technology required to participate in telehealth interventions and would be willing to interact remotely with their providers.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Lee DD, Arya LA, Andy UU, et al. Willingness of women with pelvic floor disorders to use mobile technology to communicate with their health care providers. Female Pelvic Med Reconstr Surg. 2019;25:134–8. https://doi.org/10.1097/SPV.0000000000000668. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Other conditions often managed by FPMRS specialists-IC/BPS, pessary care, and recurrent UTI-may be well suited to telehealth, but evidence for their safety, effectiveness, and acceptability is still limited.

    “Several other disease states commonly treated by FPMRS specialists (IC/BPS, pessary management, and recurrent UTI) may lend themselves well to telehealth interventions; however, data supporting safety, efficacy, and acceptability remains sparse.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9••]

      Not checked in the free run.

    • cites [25] Lee MH, Wu HC, Tseng CM, et al. Health education and symptom flare management using a video-based m-health system for caring women with IC/BPS. Urology. 2018;119:62–9. https://doi.org/10.1016/j.urology.2018.05.027. source

      Not checked in the free run.

    • Rests on an assumption: Early IC/BPS care mainly involves educating patients, counseling on lifestyle changes, and managing medications.

  • May combine two claims.

    Interpretationcitation

    For OAB/UUI, the first assessment may be more cost-effective in person, whereas later telehealth follow-up may improve medication adherence and increase progression to third-line treatment.

    “The initial evaluation of OAB/UUI may be more cost-effective when performed in person, but subsequent telehealth follow-up may improve adherence to medication management and increase rates of progression to third-line therapy.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [23] Jones G, Brennan V, Jacques R, et al. Evaluating the impact of a ‘virtual clinic’ on patient experience, personal and provider costs of care in urinary incontinence: a randomised controlled trial. PLoS One. 2018;13:e0189174. source

      Not checked in the free run.

    • cites [24] Palmerola REC, Sussman R, Brandon C, Smilen S, Pape D, Rosenblum N, Brucker B. Can telemedicine improve follow up adherence and outcomes in patients with overactive bladder? Neurourol Urodyn. 2020;39:S108. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    Although most reviewed studies were randomized trials, many suffered from small samples and short follow-up periods.

    “While most of the studies reviewed above are randomized controlled trials, many are limited by small sample sizes and relatively short duration of follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Smartphone and internet-based programs may boost adherence to pelvic floor muscle training relative to written or verbal instructions, and better adherence may improve urinary incontinence outcomes.

    “Studies have already suggested that smartphone app and internet-based interventions may improve compliance with pelvic floor muscle strengthening programs compared with traditional written or verbal instruction and this increase in compliance may result in improved outcomes for patients with urinary incontinence.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [11] Asklund I, Nystrom E, Sjostrom M, et al. Mobile app for treatment of stress urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2017;36:1369–76. https://doi.org/10.1002/nau.23116. source

      Not checked in the free run.

    • cites [13] Sjostrom M, Umefjord G, Stenlund H, et al. Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training. BJU Int. 2015;116:955–64. https://doi.org/10.1111/bju.13091. source

      Not checked in the free run.

    • cites [14] Araujo CC, Marques AA, Juliato CRT. The adherence of home pelvic floor muscles training using a mobile device application for women with urinary incontinence: a randomized controlled trial. Female Pelvic Med Reconstr Surg. 2020;26:697–703. https://doi.org/10.1097/SPV.0000000000000670. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    When in-person pessary maintenance visits are spaced six to twenty-four months apart, telemedicine check-ins could review symptoms and trigger an earlier office visit for new or unusual symptoms.

    “Although it has not been studied, it is reasonable to conclude that, if spacing in-person pessary maintenance visits to 6–24 months, interval telemedicine follow-up could be utilized to review symptoms and prompt an earlier in-person visit if new or unusual symptoms have occurred.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9••]

      Not checked in the free run.

13 of 13

  • The paper relies on this without support.

    Telehealth pelvic floor muscle strengthening interventions are inexpensive.

    “These interventions are inexpensive, have very few potential harms, and should be considered an effective first-line alternative for patients with urinary incontinence who lack access to trained pelvic floor physical therapists.”

  • The paper relies on this without support.

    A majority of clinicians believe that at least one follow-up visit after surgery must occur in person.

    “Most clinicians agree that at least one postoperative visit should be in-person, so the optimal timing of telemedicine visits remains a viable question.”

  • The paper relies on this without support.

    No standard postoperative visit schedule is recommended for FPMRS surgery.

    “There is no standard recommended schedule for postoperative visits after FPMRS surgery, although many providers suggest two postoperative visits during the typical 90-day global billing period.”

  • The paper relies on this without support.

    Early IC/BPS care mainly involves educating patients, counseling on lifestyle changes, and managing medications.

    “However, given that the first stages of treatment are characterized by patient education, counseling regarding lifestyle modification, and medication management, IC/BPS may be another appropriate condition for the integration of telehealth interventions.”

  • The paper relies on this without support.

    Using empiric antibiotics for uncomplicated cystitis in women is a well-established, safe, and effective practice.

    “Empiric treatment of uncomplicated cystitis in women is well-established, safe, and effective, but the empiric treatment of recurrent UTIs carries added risks including increased/unnecessary prescribing and antibiotic resistance, so it should be avoided when possible.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Postoperative follow-up groups do not account for all patients

    Minor

    Of 356 patients, 262 received telephone follow-up, leaving 94 rather than the reported 92.

    Reported 92 · recomputed 94

  • Follow-up retention percentage does not match the stated count

    Minor

    Retaining 46 of 62 participants gives 74.2%, not 75.4%.

    Reported 75.4 · recomputed 74.193548

2 of 2

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Authors
Barrett, F., Stewart, L. E., & Brucker, B. M.
Affiliations
NYU Langone Health (US)
Corresponding author
Brucker, Benjamin M.
ORCID
Venue
Current Bladder Dysfunction Reports
Publisher
Springer Science and Business Media LLC
Published
2021-11-03
Volume
16
Issue
4
Pages
97-104
ISSN
  • 1931-7212 (ISSN-L)
  • 1931-7220
DOI
10.1007/s11884-021-00635-2
PMC
PMC8563823
OpenAlex
W3210429636
Cited by
5
References
21
Citations by year
2024: 2 · 2023: 1 · 2022: 2
FWCI
1.08
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Bladder Dysfunction Reports (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
Keywords
telemedicine, urogynecology, pelvic floor dysfunction, pelvic floor muscle strengthening, overactive bladder, urinary incontinence, pelvic organ prolapse, postoperative care, patient education, health care access

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