Hypothesis / aims of study
COVID pandemic had stormy impact in all health care systems over the world. Hong Kong had just gone through the peak of the Omicron wave in February 2022, which recorded the highest hospitalization and mortality rates across the whole pandemic. This COVID surge had led to much physical, emotional and social disturbances to our population, especially in the elderly group. This study aims to evaluate what was the impact of COVID in their daily life, emotion, practice of pelvic floor training and their pelvic floor symptoms.
Study design, materials and methods
Women who attended the urogynaecological clinic during this COVID surge, starting from 14 March to 31 March were interviewed. Their current occupation and vaccination record were asked. As currently there was no validated questionnaires addressing pelvic floor symptoms with COVID pandemic, we developed a novel questionnaire in Chinese to explore the impact of COVID to their daily life, emotion and the change of their outdoor activity during the last 4 weeks by using a VAS (Visual Analogue Scale) score of 0-10 (score 0 means no effect; score 10 means maximum effect). Any effect on their compliance of pelvic floor training, symptoms of pelvic organ prolapse, urinary frequency and urinary incontinence were included in the questionnaire. Either the attending gynaecologist or a research assistance helped with the patients to fill in the questionnaire.
Chi-square was used for the comparison of categorical variables between the two groups (incontinence versus prolapse group) and Student’s t-test for continuous variables. Correlation between the scores were tested by using Pearson correlation coefficient. A p-value < 0.05 was considered statistically significant. The SPSS system (IBM, Armonk, NY, USA, Version 23) was used for the analysis.
Results
Over the study period, total of 103 women were interviewed, with 26 (25.2%) new cases and 77 follow up cases in the clinic. The mean age was 68.7 (SD:11.4) years old. 46 (44.7%) women were retired from work, 28 (27.2%) were housewife, 13 (12.6%) were manual worker and 16 (15.5%) with other occupations. 78 (75.7%) of them regards as fully vaccinated (52 with 2 doses and 26 with booster doses) and 25 (24.3%) with had not yet completely vaccinated (13 did not receive any vaccine while 12 had only one dose). The impact of COVID causing depressive mood, stress or affecting daily life were reported in Table 1. The change of their compliance of pelvic floor exercise and pelvic floor symptoms were reported in Table 2. Vaccination record was not associated with their reported reduction of outdoor activity (score 6.5 in incomplete vaccinated group vs score 6.0 in vaccinated group, p=0.50) nor the effect on their emotion or daily living (p>0.05). The VAS score on their emotion including stress and depressive mood were correlated with their reported reduction of outdoor activity (p =<0.01 for daily activity and feeling stressful; p=0.05 for depressive mood). However, the reported reduction in outdoor activity was not associated with any change of their compliance of pelvic floor training. Neither the vaccination record, emotional impact or outdoor activity was not associated with the change of pelvic floor symptoms during this COVID surge. Only compliance of pelvic floor exercise was associated with the change of symptoms in urinary frequency (p<0.01).
Interpretation of results
The vaccination rate in women with pelvic floor dysfunction attended our clinic was comparable with the reported vaccination rate in this age group by government. However, the completion of vaccination was not associated with the impact on their emotion and daily living during the local COVID surge. The negative impact on their emotion was associated with their reported reduction of outdoor activity. Despite majority of them with reported depressed mood and stressful in their daily life, they have similar compliance on pelvic floor exercise Majority of them had similar pelvic floor symptoms including prolapse and urinary symptoms.