title: Analysis of a pilot program to implement physical therapy for women with gynecologic fistula in the Democratic Republic of Congo.
abstract: OBJECTIVE
  To describe components of a physical therapy pilot program for women with gynecologic fistula, and to report prospective data from the first 2 years of program implementation.
  
  
  METHODS
  A single-cohort observational study with repeated measures was conducted at HEAL Africa Hospital, Goma, Democratic Republic of Congo. Hospital staff received training in pelvic floor physical therapy. Guidelines for exercise, functional training, and reproductive health education were integrated into the existing program. Demographics, clinical findings, and functional outcomes were recorded. Key stakeholders were interviewed to understand the perceived strengths and limitations of the program.
  
  
  RESULTS
  A total of 205 women were followed up; 161 participated in physical therapy, with an average of 9.45 sessions. Of 161 women examined postoperatively, 102 (63.4%) reported no incontinence; they remained continent at discharge. Of 21 who indicated a change in level of incontinence during postoperative physical therapy, 15 (71.4%) improved. The program was feasible and well received by staff and patients.
  
  
  CONCLUSIONS
  Pelvic floor physical therapy could have significant results in women with gynecologic fistula, may be an important adjunctive treatment in comprehensive fistula care, and warrants further investigation.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: lkeyser2@jhmi.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Keyser
authors.affiliation: Center for Women's Health, Marathon Physical Therapy, Newton, MA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: McKinney
authors.affiliation: Department of Industrial Engineering and Engineering Management, Western New England University, Springfield, MA, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Salmon
authors.affiliation: Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of Congo.
authors.forename: Cathy
authors.initials: C
authors.lastname: Furaha
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Charité Maternelle, Goma, Democratic Republic of Congo.
authors.forename: Rogatien
authors.initials: R
authors.lastname: Kinsindja
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Nerys
authors.initials: N
authors.lastname: Benfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D015023:Democratic Republic of the Congo; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor; D010865:Pilot Projects; D011446:Prospective Studies; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy; D014624:Vaginal Fistula / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D055815:Young Adult
keywords: Community-based rehabilitation; Global health; Gynecologic fistula; Maternal morbidity; Pelvic floor physical therapy