There are a myriad of devices on the market to assist in achieving and maintaining pelvic floor health. Recently I had the pleasure of reviewing the Elvie device, a pelvic floor muscle biofeedback trainer used to help build strength and train the coordination of the pelvic floor muscles. This is a completely unpaid and unsponsored review and something I took on as part of my Master’s in Pelvic health degree as well as to help justify implementing it’s use in our clinic. I not only looked at the device and it’s usability, but also the research that sits behind it to best inform our practice.
So what exactly is Elvie?
Elvie is a low energy Bluetooth linked biofeedback device designed to assist us in our home pelvic floor muscle training. It provides real time biofeedback to the user via an intravaginal transducer that contains both a triaxial accelerometer and a force sensitive resistor. In simpler words, it is an egg shaped device that sits inside the vagina and talks to your smart phone, giving it information on how much force you can generate with your pelvic floor muscle and weather you are lifting your muscles in the right direction.
The technology is very cool! The force generated against the transducer alters the electrical resistance of the unit to produce a force measure in newtons (N). Essentially, the device is capable of providing feedback in both angle and direction, as well as the force generating capacity of the pelvic floor muscle contraction.
The Elvie retails for around $290, which is is the upper end of the market for these sorts of devices. From what I can see, no other device on the market has the accelerometer to give us feedback on the lift component of the pelvic floor muscle training, making the Elvie quite unique.
It is relatively easy to use and the mobile app interface is friendly once you get use to it.
Why use the Elvie?
Pelvic floor muscle exercise therapy is a recommended first line management option for the treatment for pelvic floor dysfunction to give support to the pelvic organs, assist in closing the urethral (the tube that carries the urine from the bladder) and inhibit bladder muscle spasms in people with a “weak bladder”. Feedback is often cited in the research as among the most important factors for motor learning and in addition, there is level 2 evidence for the use of pelvic floor mobile applications in the management of urinary incontinence. Basically, the Elvie provides mobile app biofeedback for correct activation and monitoring of progress of the pelvic floor muscle, which of course keeps us motivated and accountable, and it’s fun too!
Are the measurements accurate?
The “validity” of the device is questionable, and certainly not as good as a dynamometer (another device we use to measure force and strength). This means, that in terms of accuracy, there are better devices on the market and better ways to measure. But unless we are using this device for research purposes, good enough may be good enough. Especially considering we are only using it on 1 woman at a time and using it to measure progress over time.
In a small study of 15 asymptomatic women, McCarthy, Khan and Graham (2017) found the pitch angle as measured by the Elvie to be similar to that measured by ultrasound, which is our current best standard of measurement. This means that the directional feedback that the device is giving, i.e. how much lift the muscles are producing, is pretty accurate (in this small study anyway!)
Research has shown there are greater effects in motivation, empowerment and adherence (sticking to it) after using devices such as the Elvie. It has also been shown to improve how we feel about ourselves and our training. We know the effects of pelvic floor muscle training reduces overtime, possibly due to long term adherence rates, which have been found to be as low as 23%, meaning we just don’t tend to stick to our programs in the long term. Biofeedback (through a device such as the Elvie) appears to improve adherence to training programs and as such the real value of the use the Elvie may be considered to lie within adherence strategies for long term success and decreased reliance on supervised physiotherapy sessions. Follow on benefits may also include access to feedback and monitoring of progress for remote patients, cost effectiveness when compared to surgical intervention or increased physiotherapy attendance and improved patient satisfaction.
Overall.. using the Elvie is fun, motivating and helps us to monitor our progress. Is it any better than just doing your exercises that your Physio gave you? Probably not (IF you are motivated enough to stick with them in the long term and do them diligently). Personally, I like the Elvie for it’s feedback and to have a friend on my side keeping me on track. Pelvic floor exercises can be BORING, and Elvie helps bring a little fun and game play to an otherwise monotonous task. I will be recommending it to clients also and stocking some in the clinic if client’s like the idea of it (it may not be for everyone!). Thumbs up from me (:
Be kind to yourself,
Bernard, S., Boucher, S., McLean, L., & Moffet, H. (2020). Mobile technologies for the conservative self-management of urinary incontinence: a systematic scoping review. Int Urogynecol J, 31(6), 1163-1174. https://doi.org/10.1007/s00192-019-04012-w
Czyrnyj, C. S., Bérubé, M. È., Brooks, K., Varette, K., & Mclean, L. (2020). Reliability and validity of a mobile home pelvic floor muscle trainer: The Elvie Trainer. Neurourology and Urodynamics, 39(6), 1717-1731. https://doi.org/10.1002/nau.24439
Hagen, S., Elders, A., Stratton, S., Sergenson, N., Bugge, C., Dean, S., . . . McClurg, D. (2020). Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial. BMJ, 371, m3719. https://doi.org/10.1136/bmj.m3719
Herderschee, R., Hay-Smith, E. J., Herbison, G. P., Roovers, J. P., & Heineman, M. J. (2011). Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev(7), CD009252. https://doi.org/10.1002/14651858.CD009252
Imamura, M., Abrams, P., Bain, C., Buckley, B., Cardozo, L., Cody, J., . . . Vale, L. (2010). Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technology Assessment, 14(40). https://doi.org/10.3310/hta14400
Latorre, G. F. S., de Fraga, R., Seleme, M. R., Mueller, C. V., & Berghmans, B. (2019). An ideal e-health system for pelvic floor muscle training adherence: Systematic review. Neurourol Urodyn, 38(1), 63-80. https://doi.org/10.1002/nau.23835
McCarthy, S., Khan, K., & Graham, C. (2017). Does Elvie compare with real-time transperineal ultrasound measurement of urethral movement direction? Journal of Pelvic, Obstetric & Gynaecological Physiotherapy, 120, 69-70.
Okeahialam, N. A., Dworzynski, K., Jacklin, P., McClurg, D., & Committee, G. (2022). Prevention and non-surgical management of pelvic floor dysfunction: summary of NICE guidance. BMJ, 376, n3049. https://doi.org/10.1136/bmj.n3049
Wu, X., Zheng, X., Yi, X., Lai, P., & Lan, Y. (2021). Electromyographic Biofeedback for Stress Urinary Incontinence or Pelvic Floor Dysfunction in Women: A Systematic Review and Meta-Analysis. Adv Ther, 38(8), 4163-4177. https://doi.org/10.1007/s12325-021-01831-6