Use of an electronic patient-reported outcome measure for symptom-based remote triage of patients awaiting conservative treatment for pelvic floor dysfunction

The impact of the COVID-19 pandemic substantially increased waiting times for UK patients prescribed conservative treatments for pelvic floor disorders. The purpose of this study was to use an electronic patient-reported outcome measure, the electronic Personal Assessment Questionnaire – Pelvic Floor (ePAQ-PF), to assess symptoms, impact on quality of life (QOL) and risk of harm for female patients waiting to be seen for conservative treatment. The aim was to facilitate triage and expedite appointments for those at greatest risk. All patients awaiting care in community services for pelvic floor dysfunction (n = 328) were asked to complete the ePAQ-PF, which includes 20 scored domains assessing symptoms and QOL in pelvic floor disorders, and free-text concerns, goals and questions. Quantitative analysis of symptom and impact domain scores, and qualitative thematic analysis of free-text responses were undertaken. In total, 175 eligible responses were received (response rate = 53.4%). Of these, 141 respondents provided consent to the use of their data for research. The highest mean symptom scores (out of 100) were in the Urinary – QOL (39.5), Vaginal – Prolapse (31.6), Sexual – Vaginal (33.9) and Sexual – General Sex Life (37.1) domains. The highest mean impact scores (out of 3) were in the Urinary – Overactive Bladder (1.4), Urinary – Stress Incontinence (1.3) and Vaginal – Prolapse (1.3) domains. Eighty-eight respondents (62.4%) were identified as at risk of harm using thresholds of 80/100 for symptom scores or 3/3 for impact scores in any domain. Post-hoc adaptation of the protocol to specify that a symptom score over 80 and impact score 3/3 had to be reached in the same domain reduced this rate to 25.5%. Free-text concerns aligned well with ePAQ-PF domain scores, with urinary incontinence and pelvic organ prolapse symptoms predominant (both raised by 17.9% of respondents). Free-text questions modally included treatment options (32.5%) and advice (13.0%). Using valid electronic patient-reported outcome measures to collect data from patients awaiting assessment could provide an effective, patient-centred method of evaluating pelvic floor symptoms. In turn, this might have an impact on QOL by ensuring that symptoms align with referral to appropriate services, and triaging the urgency of appointments. This could become part of routine care. Further work on translated instruments and ensuring access for those in digital poverty is required.