2.1 Integrative pelvic floor center

To effectively implement the integrative care model, a pelvic floor center assumes the role of a physical roof or one-stop hub, ensuring streamlined patient care pathways, and aiming for optimal patient outcomes. The multidisciplinary nature of these centers facilitates collaborative decision-making and the development of tailored plans that encompass medical and non-medical approaches. Patients benefit from the collective expertise and coordinated care provided by gynecologists, urologists, colorectal surgeons, physiotherapists, and other healthcare professionals specializing in pelvic floor health.

Beyond delivering clinical care, pelvic floor centers also engage in research, education, and advocacy efforts for best practices in the field.

2.2 Interdisciplinary team

Establishing a cohesive team through collaborative leadership is a crucial strategy in this model. The leadership should possess the expertise and ability to coordinate the resources of a multidisciplinary team in a patient-centered manner and optimize contributions from each specialty.

Effective leaders in this context excel by fostering a sense of belonging among team members, recognizing individual contributions, and maximizing the team's creative work ethic through effective communication strategies. This ultimately facilitates the delivery of a seamless continuum of high-quality care¹⁰ and optimizing patient outcomes.¹¹

2.3 Care pathway

A care pathway refers to a collaborative decision-making workflow that aligns with the principles of evidence-based medicine for advanced practice providers. It delineated a pathway that encompasses integral components of value-based care, enabling team members to operate independently and make informed decisions based on their specialized expertise.¹² The implementation of a care pathway is characterized by its integration, timeliness, professional collaboration, and the capacity to measure outcomes. Additionally, it requires the utilization of an Electronic Health Record (EHR) integrated with a patient portal to facilitate effective collaboration within the healthcare team.¹³

2.4 Endeavor from China

During my tenure at a tertiary teaching hospital in China, I had the privilege of leading a pelvic floor Multidisciplinary Team (MDT). Our team was responsible for establishing a well-defined care pathway that dictated the sequencing and timing of interventions, as well as the roles and responsibilities of professionals. What set our team apart was our unique treatment protocol of integrating acupuncture, herbal medicine, biofeedback, and surgery to comprehensively address pelvic floor dysfunction.

In addition to delivering patient care, we were deeply committed to promoting and training healthcare professionals across China in the integrative pelvic floor medicine model. This involved close collaboration with experts from colorectal surgeons, acupuncturists, nursing specialists, psychologists, gynecologists, urologists, radiologists, etc. We also sought guidance from a senior advisory board to ensure the highest standards of care. To facilitate effective teamwork, we utilized an online data management platform, which enabled comprehensive data collection, seamless communication, and efficient coordination among team members and trainees.¹⁴

We have weekly academic presentations and case study discussions for our researchers and fellows. Additionally, our involvement in international collaborative societies provided us with valuable opportunities to exchange knowledge and learn from experts worldwide to advance the understanding of pelvic floor disorders.

3.1 Patient-centered communication

Improving patient education is imperative due to the prevalent lack of understanding among patients regarding their pelvic floor disorders, regardless of prior treatments or counseling. Gaining insight into the patient's perspective is essential for identifying their goals, facilitating effective communication, and enabling personalized counseling. It also aids in managing expectations and evaluating treatment outcomes.¹⁵

Patient-centered communication is a potent tool for effectively involving patients in the long-term management of their symptoms. By providing clear and easily comprehensible information that takes into account both the physical and psychological aspects of the condition, healthcare providers empower patients to take ownership of their self-care and enhance their overall well-being.

3.2 Rome Foundation example for patient education

The Rome Foundation for functional gastrointestinal disorders set a good example for patient education.¹⁶ As a leading authority in research, providing clinical guidelines that incorporate the latest findings on brain-gut interaction, gut microbiota imbalance, and cognitive impairment, they have successfully translated research into tangible benefits for patients by integrating these discoveries into clinical practice, with patient health education as a crucial component. It brings a good resource for pelvic floor dysfunction patients.

3.3 Storytelling by patients and healthcare providers

Storytelling has been recognized as an effective method of patient health education. Allowing patients to share their experiences can positively impact attitudes, knowledge, behaviors, and outcomes related to health.¹⁷ Hearing personal stories can instill confidence in others facing similar challenges.

Healthcare providers can offer tailored evidence-based information and supporting evidence to address patients' concerns and enhance disease awareness. Considering the comprehensive nature of pelvic floor disorders, behavioral and lifestyle changes through educational and cognitive approaches are crucial for treatment outcomes and emotional well-being.

One approach to patient education is the use of video blogs or broadcast channels on social media platforms, providing easily accessible and accurate information for patients.

5.1 Potentials of acupuncture

In the clinical practice of pelvic floor integrative medicine in China, acupuncture as a specific treatment method has made significant progress. Clinical studies and randomized controlled trials targeting specific acupuncture points such as DU-20(Baihui), ST-25(Tianshu), BL-33(Zhongliao), BL-34(Xialiao), and BL-35(Huiyang) have demonstrated the multi-target and holistic regulatory effects on the central nervous system, enteric nervous system, sacral nerves, and pudendal nerve, highlighting its effectiveness and safety in treating refractory constipation,²⁰ urinary incontinence,²¹ pelvic pain²², and obstructive defecation disorders.³

These research findings provide a solid foundation for the application of acupuncture in pelvic floor integrative medicine, offering personalized treatment options for patients who have not responded well to conventional Western medicine and biofeedback therapy. Acupuncture holds great prospects in this field. The findings also highlighted the safety and economic profile as a non-invasive and well-tolerated option.

5.2 Potentials of telehealth

For patients, telehealth presents a promising solution to address the challenges faced by individuals with complex pelvic floor disorders in accessing specialized care. By leveraging these platforms, patients who encounter barriers to traditional healthcare institutions can now benefit from online consultations, remote monitoring, and personalized rehabilitation services, all from the convenience and comfort of their own homes. Research has confirmed that the quality of doctor-patient communication did not significantly differ between web-based and face-to-face consultations.²³ Telehealth has been shown to significantly improve urinary symptoms, pelvic floor muscle function, and quality of life.²⁴

For healthcare providers, training and shared decision-making are of paramount importance in effectively utilizing telehealth platforms and integrating the principles into their practice. Additionally, fostering a collaborative approach through shared decision-making between healthcare providers and patients holds significant promise in optimizing clinical outcomes for individuals with complex pelvic floor disorders.

Telehealth is still emerging, and more studies are needed to draw more conclusions. The recommendations of the governmental authorities, physical therapy councils, and corresponding associations of each country also need to be considered.²⁴