Use of the Leva Pelvic Digital Health System in Women With Fecal Incontinence

Study Overview
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Brief Summary
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Pilot study to understand the impact of a digital health system, including a phone app and a vaginal probe to treat fecal incontinence in women

Detailed Description
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Subjects meeting inclusion/exclusion criteria at screening will complete training in behavioral therapy for the treatment of fecal incontinence and training in the use of the Leva pelvic digital health system. Subjects will then participate in 10 weeks of at home pelvic floor muscle training using the leva device twice daily for 2 ½ minutes of training. Adherence to the training protocol will be observed digitally, and subjects will receive phone calls every other week from research assistants reviewing their adherence. Subjects are expected to participate in at least 80% of the weekly exercises (11 weekly). Subjects will return to clinic at 5- and 10-weeks during the study to complete questionnaires. At 5-weeks, subjects will review the use of the device with the study assistant, who will answer any questions and repeat training if the subject desires additional training. Following 10 weeks of training, subjects will be free to pursue any additional therapies, but will also retain the leva device and may continue its use if desired. Adherence will be monitored for one additional year, with follow up surveys to be completed by mail or digitally at 6- and 12-months

Official Title
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Use of the Leva Pelvic Digital Health System in Women With Fecal Incontinence: a Pilot Study

Conditions
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Fecal Incontinence

Intervention / Treatment
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* Device: leva


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥18 years Fecal incontinence defined as any uncontrolled loss of liquid or solid fecal material that occurs at least monthly over the last 3 months that is bothersome enough to desire treatment Ambulatory Exclusion Criteria: Absence of a vagina Stool consistency over the last 3 months that includes items 1 or 7 based on the Bristol Stool form scale (severe constipation or diarrhea) Current or past diagnosis of colorectal or anal malignancy Diagnosis of inflammatory bowel disease Current or history of rectovaginal fistula or cloacal defect Rectal prolapse (mucosal or full thickness) Prior removal or diversion of any portion of colon or rectum Prior pelvic floor or abdominal radiation Refusal or inability to provide written consent Inability to utilize smart phone technology (app use) Fecal impaction by exam Stage 3 or 4 pelvic organ prolapse Incontinence only to flatus Supervised anal sphincter exercise/pelvic floor muscle training with or without biofeedback currently or within the past 6 months. Childbirth within the last 6 months Neurological disorders known to affect continence, including spinal cord injury, advanced multiple sclerosis or Parkinson's disease and debilitating stroke Chronic abdominal pain in the absence of diarrhea Presence of an active (turned on) sacral neuromodulator within the last 6 months Pelvic floor surgery (including anal sphincteroplasty) within the past 6 months.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 89 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Leva Arm<br>Subjects will undergo training in the use of a vaginal device and its associated app, to be used twice daily to perform pelvic floor muscle exercises guided by the device/app for 10 weeks. | Device: leva<br>* Vaginal device used for pelvic floor muscle exercises<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| St. Mark's Incontinence Score | Validated survey of fecal incontinence severity, score ranges from 0-24, Higher scores indicate more severe symptoms | Baseline to 10 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Fecal incontinence episodes | Percent improvement= number of fecal incontinence episodes at 10 weeks divided by the number of incontinence epsiodes at baseline. | Baseline to 10 weeks | 
| Fecal Incontinence Quality of Life Scale (FIQoL) | Validated Survey evaluates four areas- coping, depression, lifestyle and embarrassment. Each area is scored from 1-5. Higher numbers indicate more severe symptoms. Area scores are not combined | Change in score from baseline to 10 weeks | 
| Cumulative adherence correlation with change in St. Mark's score | Adherence as a percentage of all expected exercise sessions (140) correlation with change in St Mark's Incontinence Score (1-24) | baseline to 10 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fecal incontinence, Women