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Optimizing Postpartum Pelvic Health Through Self-Scar Tissue Mobilization of Episiotomy

The EPIS Trial: A Pilot Randomized Control Trial

University of Calgary

Background

Episiotomy is a surgical incision to enlarge the vaginal opening during birth. It occurs in 14.6% of vaginal deliveries in Canada affecting approximately 26,700 Canadians per year. Episiotomy has been linked to increased incidences of fecal and urinary incontinence, pelvic pain, and difficult or painful sexual intercourse. Pelvic floor physiotherapy has been shown to be helpful in treating and managing these pelvic floor dysfunctions, but access to this therapy can be limited by financial, geographical, and cultural barriers. Scar tissue mobilization, a pelvic floor physiotherapy treatment involving pulling or stretching of healed scar tissue to improve its mobility and relieve pain and tension, is sometimes given as a home exercise to be self-performed by patients.

This pilot randomized control trial (RCT) will determine the feasibility of an RCT investigating if self-performed scar tissue mobilization of episiotomy incision can improve pelvic health outcomes and quality of life of those affected. Participants will be randomized into two groups: Group 1 will perform self-scar tissue mobilization after standard instruction; Group 2 will receive the current standard of postpartum follow up. Patient research partners will be sought to collaborate throughout this research to help inform intervention instruction, communication strategy, and knowledge translation. Two reliable and validated pelvic health questionnaires will be used for outcome measure taken at 6 weeks, 3 months, and 6 months postpartum. Recruitment, acceptability of intervention, descriptive statistics and comparisons of groups will be determined to inform a larger future interventional trial aimed at understanding the best approach to episiotomy care.

 

Roles and Responsibilities

This is a graduate student led project. I hope to recruit patient research partners that have lived experience of episiotomy or tearing from childbirth to form a Patient Partner Advisory Group to determine what information new mothers want in terms of episiotomy or tearing from childbirth care in the short and long term, and how self-scar tissue mobilization intervention education may be best designed and delivered. It is my hope that patient partners can offer ideas to aide in designing an effective intervention instructional video and ideas around delivery of intervention reminders and communication such as text messages or email reminders.

I would also like to explore participant recruitment strategy and receive help identifying obstacles and barriers to participation in this study. This will help inform a future trial which would then be designed to address these barriers and promote diversity and inclusivity in research participation.

It is also my intention to have patient partners inform the best approaches to knowledge translation and sharing of results with study participants, health care providers, and other community stakeholders.

 

Time Commitment

This 1-year project anticipates to start April 2023. It is anticipated there will be 6 meetings with the patient research partner working group. These meetings will be about 1.5 hours long and conducted over Zoom. Dates and times will be worked around patient research partner availability.

 

Reimbursement/Compensation

This is an online opportunity. There are no travel or parking costs associated with engagement. Patient research partners will be offered compensation for their attendance and essential contribution to the working group meetings.

For more information or to apply:

Gina-Marie Cerantola

Ginamarie.cerantola@ucalgary.ca

403.606.0953