In a recent interview, Assistant Professor Valerie Block, PT, DPTSc, shared her insights on the evolving landscape of remote treatment for patients with Multiple Sclerosis (MS) and other conditions, highlighting the potential of wearable technologies.
"Remote treatment was an interest even before COVID," Block said. "But the pandemic underscored how little time we have with our patients and how our one-time clinical measures can miss the fluctuating nature of MS. Seeing patients only in the clinic doesn't capture the full picture of their daily experiences."
To address this, Block's research explored using Fitbits as activity monitors to track patients' health outside the clinic. However, her interest soon expanded to bladder function—a topic often considered taboo but critical for many patients' quality of life.
"We had a patient in our Fitbit study whose clinic tests were stable over a year, yet his activity levels dropped significantly. It turned out his worsening bladder function led to social withdrawal. He even missed his daughter's wedding due to embarrassment and fear," Block said. "Bladder issues impact various aspects of life, and many conditions beyond MS, like postpartum recovery, could benefit from better management."
Block's team began using bladder wearables, such as the DFree device, which uses ultrasound to monitor bladder fullness, and the Perifit – a gaming pelvic floor exerciser. To date, bladder wearables have not been testing in isolation or combination in people with MS. "The DFree has the potential to be used for real-time feedback, as it can indicate when a patient should seek a restroom. For instance, if someone knows they leak at a level six, they can set an alarm for level four. This helps manage urgency more effectively."
A Lack of Treatment for MS Patients
In a retrospective analysis of the Fitbit Remote monitoring in MS (FITriMS) study, Student Physical Therapist Ilana Winawer assessed the treatment of bladder dysfunction (BD) among MS patients. The FITriMS study, conducted from 2015 to 2017, involved 97 MS patients who wore a Fitbit for a year and completed questionnaires (patient-reported outcomes; PROs) on MS symptoms, including BD, every three months. Ilana reviewed electronic medical records (EMRs) to note if BD was reported during neurologist visits and the actions taken—medication, referral to urology, behavioral management, or pelvic floor PT. Despite 88% of participants reporting BD at the start of the FITriMS study, only 30% had any treatment recorded in their EMR, with none referred to PFPT throughout the study period.
This research underscores the need for quality improvement and educational efforts aimed at increasing timely referrals to pelvic floor physical therapy, potentially enhancing the overall management of BD in MS and improving patient outcomes.
Block advocates for regular PT for MS patients, akin to the routine care provided in cardiac rehab. "You shouldn't need a referral for PT if you have MS. Annual PT sessions could significantly improve patient outcomes, and our research aims to prove this necessity."
Functional Electrical Stimulation
Another study, led by former DPTRS faculty member EJ Gann, titled Feasibility of Telerehabilitation-Monitored Functional Electrical Stimulation on Walking and Quality of Life in People with Multiple Sclerosis: A Case Series, which was published in the International Journal of MS Care, focused on using functional electrical stimulation (FES) monitored through online sessions to help improve walking and quality of life for people with MS.
Over eight weeks, participants tried out these devices, which help with foot drop—a common issue in MS. They had three check-ins via video call with a physical therapist to adjust the device and track progress. About 82% of participants showed enhanced mobility as per the Timed Up and Go (TUG) test, suggesting that telerehabilitation can effectively guide patients in using FES to improve functional mobility. The study also observed positive changes in quality of life, with significant improvements in MS-specific assessments, indicating that FES, coupled with telerehabilitation, has the potential to enhance daily living for patients.
Postpartum and Post-Prostatectomy Treatment
An additional research project aims to validate the effectiveness of wearables in a diverse group of patients, including men post-prostatectomy, postpartum women, and a general group of women (as controls) with bladder dysfunction. Block was awarded a grant, a RAP Pilot for Early Career Investigators entitled Exploring Clinical Utility of Wearables for the Bladder in Pelvic Health Physical Therapy Clinics. The award period is July 1, 2024 – June 30, 2025. Block’s team, consisting of Leah McIntyre (Né: Wylie), Jordan LaBrec, Jennifer Kinder, and mentor Richard Souza, is exploring the clinical utility of wearables for bladder management in pelvic health physical therapy (PHPT) clinics. They are using two devices selected by a stakeholder group of patients and experts—the wearable ultrasound (DFree) device and intravaginal exerciser (Perifit) that sends data directly to an app, allowing for remote monitoring and management of bladder dysfunction and related pelvic floor disorders. The research will test the correlation between traditional clinical measures and the data provided by these wearables, focusing on metrics like bladder fullness after voiding (PVR, and DFree-PVR) and pelvic floor strength (Conventional manual muscle test, and Perifit outcomes). The study assesses the usability and practicality of integrating these tools into everyday clinical practice. This includes patient and clinician feedback on the ease of use, satisfaction, and overall acceptability of the technology.
The significance of this study lies in its potential to bridge care gaps in bladder dysfunction management by providing continuous, real-time data. This could enable more timely and targeted interventions and a shift towards more personalized healthcare. The project also emphasizes the use of telehealth, which has become increasingly important in providing access to specialized care without the need for physical travel.
In essence, this initiative represents a significant advancement in the management of pelvic health, leveraging modern technology to enhance patient outcomes and optimize clinical workflows. If successful, this could set a new standard in how bladder-related disorders are managed in various patient populations. "Our goal is to integrate these devices into clinical practice to provide objective outcomes and remote treatments.”
Looking ahead, Block's work promises to bring substantial changes to how chronic conditions are managed, emphasizing continuous, patient-centered care supported by innovative technology.