An in-home rehabilitation program for the treatment of urinary incontinence symptoms in endometrial cancer survivors: a single-case experimental design study.

INTRODUCTION AND HYPOTHESIS: There is a high prevalence of urinary incontinence among endometrial cancer survivors. They are also known to present with pelvic floor muscle alterations. Evidence on the effects of conservative interventions for the management of UI is scarce. This study aims at verifying the effects of an in-home rehabilitation program, including the use of a mobile technology, to reduce UI severity in endometrial cancer survivors. METHODS: This study used a single-case experimental design with replications. Primary outcome for UI severity was the pad test, and secondary outcomes were the ICIQ-UI SF questionnaire and 3-day bladder diary. Pelvic floor muscle function was assessed using 2D-transperineal ultrasound and intravaginal dynamometry. Adherence was documented using mobile technology and an exercise log. Visual and non-parametric analyses of longitudinal data were conducted. RESULTS: Results show a reduction in UI severity for 87.5% of participants, with a significant relative treatment effect of moderate size (RTE: 0.30). Significant small relative treatment effects were found for the quick contraction and endurance dynamometric tests. CONCLUSION: This study provides new evidence that endometrial cancer survivors can improve the severity of their UI following an in-home rehabilitation program, including the use of a mobile technology. This mode of delivery has the potential to address a gap in access to pelvic floor physiotherapy services for survivors of EC living in rural and remote communities.

Design and validation of an automated dual-arm instrumented intravaginal dynamometer.

AIMS: (1) To present the design of a novel intravaginal dynamometer (IVD) capable of measuring vaginal closure force on both the anterior and posterior arms, (2) to use bench testing to validate the force, speed of arm opening, and positional accuracy of load measurement along the IVD arms, and (3) to present in vivo force measurements made with this device, comparing forces measured by the anterior and posterior arms. METHODS: IVD load measurements were validated against an Instron® Universal Tester, arm opening speeds were validated using video analysis, and position-load accuracy was validated against calibration weights. In vivo IVD data were acquired from female volunteers during passive opening and pelvic floor muscle contraction tasks. Anterior and posterior IVD arm force outcomes were compared. RESULTS: Forces measured by the IVD and Instron® exhibited a strong linear relationship with excellent model fit. The speed control system was valid when tested under physiological loading conditions, however smaller antero-posterior opening diameters (25 and 30 mm) exhibited some error. The loading position along the IVD arms had no effect on force outcomes. In vivo data exhibited differences between force outcomes measured at the anterior and posterior aspects of the vagina during active contraction and passive elongation of the pelvic floor muscles. CONCLUSIONS: This IVD design demonstrates valid load measurement and speed control during bench testing. Active and passive forces measured are consistent with the literature. With dual instrumented arms, this device allows for further investigation into the source of measured vaginal closure forces.