IMPACT: A Standardized Test for Assessment of Pelvic Floor Disorders

In this video, Liliana Bordeianou, MD, MPH, site director of Colorectal Surgery at Massachusetts General Hospital and professor of Surgery at Harvard Medical School, discusses IMPACT, the movement she and her team have started to develop a common language across disciplines that can be used to assess patients with pelvic floor disorders.

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Transcript

We have realized for many years that pelvic floor disorders don't affect one pelvic floor compartment in isolation. So patients with rectal problems or rectal prolapse or constipation or fecal incontinence will frequently suffer from parallel disorders of the bladder whether or not that is emptying problems or leakage and prolapse of the vagina and uterus.

At Massachusetts General Hospital, we have been providing multidisciplinary care as a part of our Pelvic Floor Disorder Center for more than a decade, but the care in the U.S. and in the world is a little bit more disjointed with the patient frequently getting assessed by one particular subspecialty without receiving parallel assessments and treatment by all the other experts.

We began a movement and the movement involved a call to action to all the various societies that take care of patients with pelvic floor disorders by specialty—The Euro Gynecological Societies, the Urological Societies, the Colorectal Societies, the Physiotherapist Societies, the gastroenterologists—calling them to team up and collaborate on the national level and on the international level to develop a common language as to how we assess patients with pelvic floor disorders, how we communicate with each other when trying to transmit information back and forth between clinics and how we write papers that could then be compared to each other in different analysis or for randomized controlled trials.

And so, the first thing we realized is that we needed a common language because sometimes the terminology is different from center to center and specialty to specialty—and that's how the IMPACT initiative was born.

IMPACT is an acronym that stands for "initial measurement of pelvic floor complaints." And it was the first initiative of the newly minted Pelvic Floor Disorders Consortium, which is an organization that combines together efforts from all of these disjointed professional societies across the nation. IMPACT started by trying to develop a language around how we characterize the symptoms of patients with pelvic floor disorders, and so the first movement was to organize a consensus meeting around what kind of questions each clinician in each clinic should be asking patients to try and characterize the symptoms of fecal incontinence, urinary incontinence, sexual dysfunction, whether they are a man or a woman, and finally constipation, which can have multiple kinds.

This work took about a year during which time we created six workgroups for each of these sets of symptoms. These workgroups performed an extensive literature search determining which of the validated instruments out there characterize the symptoms the best way. We made sure that the symptoms and these instruments were short enough to use in the clinical setting but powerful enough to be discriminatory so that they could also be used as a baseline measuring in research.

We reviewed this incredible amount of work that was done by these various experts that participated in the workgroups and finally reached a consensus agreement on the basic tools that all of us should use regardless of what our training is, regardless of what our specialty is, to assess patients with pelvic floor disorders so that no symptoms are missed, so that the measurement of the symptoms is similar across the board and so that we can now speak the same language when characterizing our patients and their complaints.

The IMPACT tool was followed by a second consensus meeting, which we held in 2019, where we have started to standardize the language around radiological imaging of pelvic floor disorders. We used a similar format of creating workgroups based on expertise and prior involvement with research on a topic and have now created an IMPACT MRI, IMPACT ultrasound and IMPACT fluoroscopy tool, which provides clinicians and researchers with a common language that characterizes findings on pathology. We now have a measure that can give all of us the same yardstick to describe symptoms. We also now have a measure regardless of what radiological imaging you use, to use the same yardstick to measure radiological findings. If we use these yardsticks consistently in our papers, in our communication with each other, we can finally push forward the care of this disadvantaged group with patients that has been ignored for so long.

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