Pessary Use for Prevention of Stress Urinary Incontinence

Funding opportunity

Researchers are invited to apply for a new grant funding opportunity sponsored by Canadian Forces Health Services (CFHS) Women and Diversity Health program (WDH) to conduct a feasibility study. This research study is required to provide WDH with an understanding of the impact, acceptability and effectiveness of activity-specific pessary use for prevention of stress urinary incontinence (SUI) in women and diverse Canadian Armed Forces (CAF) members.

Anticipated timeline and budget

Background

Women and diverse populations have been historically under-researched in medicine. This has limited our knowledge of their unique health needs, including health risks, prevention, and treatment options. For these reasons, CFHS established the WDH program. WDH aims to optimize prevention and care for women and diverse members, using an intersectional lens, to improve their physical, mental, and psychosocial well-being. This is aligned with governmental priorities and current shifts in research.

Since the inception of the WDH program in 2022, WDH has focused on establishing relationships with stakeholders and partners to identify collaborative opportunities and minimize duplication of effort, as well as to begin to identify opportunities for high priority research.

A 2008-2009 survey suggests 12% of CAF women have urinary incontinence. This number is low compared to general population estimates of 40% (in Australia) and 30% in US military women. Women with involuntary leakage with physical exertion experience stress, anxiety, and decreased work performance and concerns for military readiness and duty. While pelvic floor muscle training can be effective, it can be time-consuming and difficult to access. A pessary is a nonsurgical, cost-effective, internal device that can be easy to self-manage after an initial vaginal fitting to support the bladder and urethra. The CAF is working toward an effective and accessible nonsurgical solution to mitigate limitations for CAF members due to SUI. This may include offering pessary fitting along with pelvic floor muscle training for eligible CAF members.

Research objectives

The broad aim of this project is twofold; to identify opportunities for improving primary clinician knowledge and skill in identifying and supporting military members with SUI; and to explore the feasibility of pessary use from the perspective of the clinician and the CAF member. This may involve identifying, reviewing or developing resources and training for providers and CAF members, identifying opportunities to increase the availability of vaginal pessaries for CAF members (including over-the-counter options), assessing patient satisfaction and effectiveness with the resources available to address SUI, assessing provider satisfaction with resources and training, and determining best-practices to identify CAF members appropriate for pessary fitting and/or self-management. The research team may wish to incorporate interdisciplinary and collaborative approaches. For example, primary care providers, nurse practitioners or physiotherapists could be trained to fit pessaries initially, then CAF members could be taught to self-manage (insert, remove and clean when needed).

Desired outputs

• A research study in the format of a report, including an Executive Summary, Abstract, Introduction, Methods, Data analysis, Results, Discussion and References, and the other specifications as described above. The research team is encouraged to publish their findings in one or more peer-reviewed publications. Any funds needed for publication should be accounted for in the budget.
• The research study should include:
  1. an environmental scan describing available pessary devices for SUI in Canada, and evidence on cost, effectiveness, and risks associated with each option. Can include particular focus on military populations, if evidence is available; and,
  2. developing and pilot testing training and resources (for providers and patients) with respect to increasing access to pessary use in the CAF population.
• In addition, the research study may address objectives such as:
  1. identifying gaps in clinician knowledge regarding diagnosis, referral, and treatment for SUI in women and diverse CAF members;
  2. evaluation of training for clinicians to fit pessaries and providing education on effectiveness and methods of pelvic floor muscle training;
  3. patient satisfaction and self-reported effectiveness of the various available pessaries during high impact activities in the CAF;
  4. identifying optimal strategies for assessing those members who would benefit from additional support for SUI; and
  5. any other objectives deemed relevant to the project aim.
• Comment on any additional considerations or evidence relevant to developing a policy approach or strategy relating to SUI or pessary use for women and diverse CAF members.
• Including a knowledge translation or knowledge transfer component.
• SAGER guidelines followed, with a detailed description of GBA+ considerations.
• Virtual presentation of findings to project sponsor (may take place after the project end date).
• Quarterly progress reports provided to WDH.

Applicant qualifications and requirements

• Principal investigator on the project must have a PhD, MD or equivalent in a relevant field.
• All appropriate academic research guidelines must be followed, including a research ethics board approval from Defence Research Development Canada (DRDC) or an accredited academic institution in Canada prior to funding being issued if applicable to the method(s) selected.
• Approval from the Surgeon General Health Research Board is required. A CFHS point of contact will be provided to facilitate this process once the research proposals are selected.
• All reports, publications, and presentations resulting from this funding opportunity must acknowledge that the research was conducted in response to a Funding Opportunity developed and funded by the CFHS WDH.

Application deadline

Please download and submit the Research Funding Application form.

Applicants are advised to include eight weeks of administrative lead-time in their timelines. This will allow for ethics board submission and approval, and the drafting and signing of the funding agreement.

Enquiries

Questions about this funding opportunity can be sent to the VAC Research office.