CO-PRODUCING PELVIC HEALTH PHYSIOTHERAPY WITH WOMEN WITH MS. PART 2: EMPOWERING TODAY’S STUDENTS FOR TOMORROWS MS-CENTRED PELVIC PHYSIOTHERAPY

C. Addington¹, A. Bradshaw², S. Hagen³, D. McClurg³

¹Glasgow Caledonian University, Department of Physiotherapy and Paramedicine, Glasgow, United Kingdom, ²Kings College London, Faculty of Nursing, Midwifery & Palliative Care, London, United Kingdom, ³Glasgow Caledonian University, Health Services Research in the School of Health and Life Sciences, Glasgow, United Kingdom

Background: Multiple sclerosis can affect several systems within the body. For women with MS (WwMS), disruption to bladder, bowel, and sexual health are reported to have the greatest impact on quality of life. These symptoms, associated with disruption to pelvic floor muscle control/coordination (PFD), can lead to social isolation, relationship difficulties and disruption to self-identity. Given the evidence for physiotherapy to prevent and manage PFD, this should be made a key priority and incorporated into the treatment plan for WwMS. However, perhaps due in part to the segregation of physiotherapists into either neuro- or pelvic-specialists, there is reported lack of confidence in providing WwMS and PFD, treatment. Taken with our recent qualitative findings that many WwMS have not heard of pelvic physiotherapy or have faced dismissal when trying to get support for PFD, current physiotherapeutic service provision is inadequate.

Purpose: Within the UK there is currently only one specialist service that provides pelvic health for WwMS. As part of the lead authors doctorate in physiotherapy, the aim of this project (Part 2) was the second step in providing a change to physiotherapy practice that might better satisfy the needs and priorities identified in our previous ‘part 1’ study, with WwMS and PFD.

Methods: A user-centred design (UCD) was used to create a digital innovation that would aim to provide a solution to improve pelvic health physiotherapy for WwMS. The project followed the five steps of user design thinking. After mind-mapping potential solutions based on Part 1, initial meetings with specialists from both neuro- and pelvic-physiotherapy helped identify a proposed solution. From planning to designing, this was an iterative process involving; physiotherapy students, healthcare specialists, people with MS (including friends and family) and academic healthcare lectures who provided integral feedforward and feedback. This was facilitated by stakeholder analysis, focus groups, one-to-one meetings and surveys.

Results: The solution was an artefact that would be able to support the future workforce (i.e., physiotherapy students), to deliver the MS-centred pelvic physiotherapy. Together with key stakeholders a prototype mobile e-learning application (m-learning app) (named Flaw-Ed) was developed. This prototype was created using Figma. The digital app was broken down into weekly modules, which would complement a four-week neuro-physiotherapy practice placement. Through student-centred, multi-media learning, Flaw-Ed promotes anatomical /physiological knowledge, self-awareness, cultural and MS competencies and provides a collaborative community in which students can share knowledge.

Conclusions: After discussing the feasibility of developing a MS-centred service, it was suggested that the current workforce did not have the experience to provide MS-centred pelvic health physiotherapy. Flaw-Ed was created by working with physiotherapy students, academic lectures/researchers, physiotherapy clinicians and WwMS to start to embed the competencies needed for a workforce confident in providing MS-centred pelvic physiotherapy.

Implications: Scaling up of Flaw-Ed will be informed by two theoretical frameworks: the realist evaluation framework and RE-AIM. In this model, testing will begin with a case-study pilot at a local tertiary MS centre which is used for student placements. The next stage will be to apply for funding for both developing the software and feasibility testing.

Funding acknowledgements: This project was completed as part of the lead authors doctorate there was no funding associated with this project

Keywords:
User-centred-design
Multiple Sclerosis
E-Learning

Topics:
Neurology: multiple sclerosis
Pelvic, sexual and reproductive health
Education: methods of teaching & learning

Did this work require ethics approval? No

Reason: This work did not involve the recording of any identifiable data or formal research analysis. We used a user centred design methodology to co-create a prototype of a digital e-learning mobile application for physiotherapy students. The project followed the guidelines of theUK Standards for Public Involvement in Researchand INVOLVE.