Pelvic floor muscle training app provides biofeedback

San Francisco-A smartphone app for pelvic floor muscle training has valuable potential as a portal to patient care and education and for facilitating clinical outcomes research, according to its developers from the University of California, San Francisco. 

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Known as “Kegel Nation,” the app was created by Maurice Garcia, MD, and Peter Carroll, MD, to provide real-time biofeedback to patients performing pelvic floor muscle training. As a platform for collecting a variety of data, however, it can also serve as a clinical interface for physicians to track patient progress and relay treatment-related information. In addition, the app can be used as an instrument for collecting research data.

An initial assessment of the app, which was conducted in 10 non-medical subjects, validated its accuracy for recording the duration of muscle contraction and relaxation during Kegel exercises. Participant feedback about the app was also very positive.

“Kegel exercises are best coupled with biofeedback early on so that patients know they are doing the exercises correctly. To date, however, assessment of the duration of contraction is only feasible with in-office biofeedback. Furthermore, the efficacy of Kegel exercises also depends on the number of exercises completed, but we have observed that many patients do not reliably track that information,” said Dr. Garcia, assistant clinical professor in residence in the UCSF department of urology.

“As smartphones are ubiquitous and patients are comfortable using them, we hypothesized that a smartphone app giving feedback on parameters of Kegel exercise could be effective for improving outcomes. In addition, we expect it could serve as an interface platform for research and patient education.”

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The app is now on iTunes and will soon be available for Android users. The data collection for the public version of the app reflects Kegel contraction and active relaxation duration, which is recorded with tactile feedback from the user interfacing with a “button” that appears on the screen. Users can also enter information on urinary urgency, voiding, and urinary incontinence events and number of pads used. There is also a questionnaire element that records responses using a visual analogue scale.

The initial validation study enrolled men and women ages 40 to 70 years who were asked to complete 10 Kegel exercises using the app to measure contraction/relaxation duration. The contraction and relaxation times were recorded simultaneously with a stopwatch. Across all 10 subjects, there was <1 second difference between the Kegel contraction and relaxation times recorded using the two methods.

NEXT: Positive feedback from users

Positive feedback from users

Users were also queried about the ease of using the app, its usefulness for improving Kegel performance, and anxiety related to using wireless technology for transmitting their personal data for research purposes. Mean score for ease of use was 9.4 out of a best possible 10, and the participants’ responses to the other questions showed they had a very low level of privacy-related anxiety (mean score, 9.1) and considered the app to have a high degree of usefulness (mean score, 9.8).

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“As a limitation, our study enrolled all healthy volunteers. As pelvic floor muscle training has been shown to improve time to return of continence following radical prostatectomy, we will be implementing a research version of the app in a randomized controlled trial of men who are recovering from radical prostatectomy,” Dr. Garcia said.

The research app interfaces with a HIPAA-compliant server that collects the encrypted data remotely in real time.

Michael, MD, a urologic oncology fellow at UCSF, presented the project on behalf of Drs. Garcia and Carroll at the AUA annual meeting in New Orleans.