Your trial highlights how common pelvic floor dysfunction is after gynaecological cancer. What symptoms do women most often experience after treatment? 

Women treated for gynaecological cancer frequently report pelvic floor dysfunction, with urinary incontinence being one of the most common and burdensome symptoms. 

Pelvic pain, dyspareunia, vaginal discomfort and bowel symptoms such as urgency or faecal incontinence are also prevalent. 

These symptoms often persist beyond the end of cancer treatment and may coexist, substantially affecting daily activities, intimate relationships and quality of life. 

What motivated your team to test a telerehabilitation approach and what specific gaps in survivorship care were you hoping to address? 

Our motivation was strongly influenced by the COVID-19 pandemic, which highlighted the fragility of access to face-to-face rehabilitation services and reinforced pre-existing gaps in survivorship care. 

Even outside pandemic conditions, many women have limited access to specialised women’s health physiotherapy due to geographic distance, financial constraints or lack of trained professionals. 

We aimed to test whether a structured telerehabilitation program could provide an effective, accessible and scalable alternative to usual care for women after gynaecological cancer treatment. 

The results showed a large reduction in urinary incontinence and improvements in pain and sexual function. What aspects of the program do you think drove these effects? 

We believe several components contributed to these outcomes. 

The program combined supervised pelvic floor muscle training with education, behavioural strategies and gradual progression tailored to each woman’s symptoms and functional capacity. 

Regular therapist– patient interaction via videoconferencing allowed for individual feedback, symptom monitoring and adaptation of exercises, which likely enhanced treatment fidelity and effectiveness. 

Addressing pelvic floor function within a biopsychosocial framework may also have contributed to improvements in pain and sexual function. 

Adherence and satisfaction were very high in your study. What helped women stay engaged with the program across the 12 weeks? 

High adherence was likely supported by the flexibility and convenience of telerehabilitation, which reduced travel time and logistical barriers. 

Scheduled supervised sessions helped establish routine and accountability, while clear educational materials and goal-oriented progression increased participants’ confidence and self-efficacy. 

Women also reported feeling supported and listened to, which reinforced engagement throughout the 12-week program. 

Some outcomes, such as faecal incontinence and physical activity, showed unclear effects. How should clinicians interpret these findings? 

These findings should be interpreted cautiously. 

The study was not powered specifically to detect changes in all secondary outcomes, and baseline prevalence of some symptoms was relatively low. 

In addition, physical activity is influenced by multiple factors beyond pelvic floor function. 

Clinicians should view telerehabilitation as a promising intervention for key pelvic floor symptoms, while recognising that broader lifestyle or bowel-specific outcomes may require additional or targeted strategies. 

If you could design the next phase of research, what would you most like to investigate to strengthen the evidence for telerehabilitation in this population? 

Future research should focus on long-term outcomes. 

Cost-effectiveness and implementation studies are also essential to support integration into routine survivorship care. 

We are particularly interested in identifying which subgroups of women benefit most and how telerehabilitation can be optimally combined with in-person care within hybrid service models. 

>>Cristine Homsi Jorge is a women’s health physiotherapist and full professor at Ribeirão Preto Medical School, University of São Paulo, Brazil. She is editor-in-chief of the Brazilian Journal of Physical Therapy and scientific director of the Brazilian Association of Women’s Health Physiotherapy. 

>>Tatiana de Bem Fretta is a physiotherapist with a doctorate in rehabilitation and functional performance from the University of São Paulo. She is currently a postdoctoral fellow in the Department of Health Sciences at Ribeirão Preto Medical School, University of São Paulo.