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For the self-management of pelvic floor muscle dysfunction associated with stress urinary incontinence, urge, MUI, prolapse, bowel incontinence, pelvic pain & prostatectomy.
About
Squeezy enables women and men to understand, schedule, do and record their pelvic floor exercises. And of course it reminds them. Squeezy is available from the app stores at £2.99 per download. To date there have been over 250,000 paid downloads. In 2019 it was the 7th highest selling app on the Apple app store overall, as well as being #1 in the medical category.. A programme of pelvic floor muscle exercises are NICE recommended first-line treatment for women with stress urinary incontinence, but adherence is chronically low. Anecdotal clinical evidence from clinicians suggests that normal patient adherence to pelvic floor exercise programmes is less than 20%. Squeezy ensures much higher levels of adherence and consequential improvements to outcomes, as well as having the potential to reduce the number of appointments, investigations, and interventions that patients receive. Patients can also complete a bladder diary and email their findings to their clinician. There is also a remote management version of the product for healthcare providers called Living With Pelvic Health, which uses a connected version of Squeezy called "SqueezyCX"; it allows NHS and private clinics to make Squeezy available to all of its patients via a free download. Clinicians can then monitor adherence to pelvic floor exercise programmes, as well as reviewing bladder and bowel diaries and patient reported ICIQ outcomes received automatically from their patient’s app; they do this between or during appointments, from a web based dashboard. The connected SqueezyCX app is designed to reduce patient worry, stress and anxiety, and to improve their understanding of their condition. It is also designed to support active self-management in the period between appointments through content and resources and to improve motivation to follow the clinician directed plans to achieve improved outcomes.
Key Benefits
The self-management version of Squeezy has 2 key benefits for patients as recorded in self-management surveys in 2015 and 2017 and in an enormous amount of anecdotal patient and clinician feedback: • Adherence: Over 90% of users increase the frequency of their exercises • Efficacy: 78% of users experience improvements And long-term usage is very positive: 50% of users are over 3 months and 25% over 10 months. This is increasingly important as clinicians are increasingly recommending that women do their exercises for life The app works because there is a single driving reason to use it • “The app makes me do a much better contraction than without as I'm focused on the exercise rather than sometimes day dreaming!” (a hospital patient) • "The visuals help you squeeze and hold and are relaxing to watch!" (Bismamma) • "..allows you to concentrate on doing exercises correctly whilst it handles timings and no of repetitions" (Mooschu) • "the visual aid helps maintain the squeeze" (AuntySheShe56) • "I am walked through the exercises, making sure I complete the full set every time.." (Lrm20) It is simple, easy to use and fits patients' lifestyles - squeeze on the go – discreet, audio + vibrate settings • Watch your visual exercise cues • Feel your exercise cues • Listen to your exercise cues Clinicians and patients are advocates of the product • "This app was recommended at my occupational therapy session and it’s fantastic. The reminders keep me on track and you can set it to your own pace. I would not be keeping up with my exercises without it. Absolutely recommend it.” - Howiemoo via Apple App Store • I was presenting at a symposium to GP’s at the weekend. Many of whom were females. They loved the Squeezy App!!” - Jill xxx, Physio Detailed data from 3 NHS Trusts with several hundred patients (Wrightington, Wigan and Leigh; Barts and Aneurin Bevan) provides clear evidence of the substantial quality and cost benefits that the connected version of Squeezy, Living With Pelvic Health (LWPH), provides. References are made to the sources as follows: sources: Wrightington, Wigan and Leigh (1), Aneurin Bevan (2) and Barts Health NHS Trust (3) The innovation delivers the following benefits to patients with incontinence and other pelvic health problems: • Increased adherence to exercise programmes: o From a treatment as usual standard of <20% to 79% for patients using LWPH (1) o Adherence has increased from 21-23% to an average of 77% (3) • Improved outcomes o Average ICIQ-SF score when patients get discharged improved from 7 to 5 (1) o Outcomes are at least 25% better for LWPH patients (2) o Average ICIQ UI score improved from 9.8 in 12 months prior to using LWPH to 5.9 in subsequent 12 months (3) • Positive results irrespective of age. 14% of patients treated are over 65. Oldest patient was 76 and her level of adherence to exercises was 76%. (3) LWPH delivers clinicians the new knowledge to enable them to focus on patients with the greatest needs, postpone non-compliant patients and deliver improved patient outcomes. LWPH delivers the following cost savings to the NHS • Approximate annual cost savings of between £50,000 and £75,000 per Trust (1and 3). Scaling this up to the UK suggests potential nationwide annual cost savings of £11,000,000 to £16,500,000. Specific savings identified are: • Reduction in DNA’s: DNA’s have decreased by 14% for patients using LWPH versus patients not using LWPH in the last 6 months. Each appointment saved is £581. DNA’s have decreased by 22% for patients using LWPH versus patients not using the app in the last 12 months. Each appointment saved is £66, total savings of £8,712. (3) • Reduction in non-compliant appointments: In the 12 months before using LWPH the % of appointments lost as being non-compliant because patients were not doing their exercises was 16.2%. This has reduced to 4.6% for patients using LWPH. (1) • Face to face appointments converted to telephone: Approx 12.74% of appointments were converted to phone appointments. Each appointment saved at least £39. Cash saved £3,276. (1) • Reduction in appointments: o Average number of appointments per patient from intake to discharge reduced from 7.4 to 6.1 (1) o Average number of appointments per patient reduced from 6.2 to 4.4. Cost savings per patient are c £78.30 (3) • Reduction in surgery - annualised savings of between £16,800 and £24,7331. 92 Patients with Pelvic health issues have been referred to surgery in the last 12 months from the team at Whipps Cross only. In the previous 12-month period prior to the introduction of LWPH the number of referrals to surgery was 108 Patients. Analysis carried out by the team confirms that improvement in conservative treatment of patients and strong adherence to PFME are the reason for the reduction in numbers. This represents a saving of between £42,880 and £58,800 (3) • Reduction in referral to first appointment times o Shorter treatment cycles. Average treatment cycle reduced by 16.1% (1)
Applications
The consumer version of the Squeezy app is available from the Apple and Google app stores. It is targeted at men and women, but women are both the primary target and the primary users. Squeezy usage reflects the incidence of “incontinence” related conditions. The highest user base is 25-44 year old women who have given birth to one or more children. This accounts for 62% of users. The second highest usage group is women of menopause age between 45 and 55 years old. The third and fourth groups of users are women between the ages of 55-64 and 65-75. Age is no barrier to usage and we have many users in their 80’s. There is also a men’s version of Squeezy that is used very conscientiously by men, particularly for prostate related issues. The total male user base is now about 10% of the total users of Squeezy Living With Pelvic Health is live in 16 NHS Trusts across the UK, including Barts Health, Cardiff and Vale University Health Board, Cwm Taf University Health Board, Lewisham and Greenwich, London North West University Healthcare, Northern Health and Social Care Trust, Milton Keynes University Hospital, Birmingham Women’s and Children’s, Bradford Teaching Hospitals, Newcastle University Hospital, Stockport, Wrightington, Wigan and Leigh, Aneurin Bevan University Health Board and Nottingham University Hospital. Our clinical user today is primarily a Physiotherapist but the buyer is typically the Head of Therapies or the Service lead. We have worked closely with a number of different physiotherapists across these Trusts. In some cases as in Cardiff and Vale University Health Board, we are working with other clinicians including a colorectal surgeon on our faecal incontinence product. Some of these clinicians are now also using our related products like Living With Overactive Bladder, Living With Constipation and Living With Prolapse. The consumer version of Squeezy is bought all over the world. The connected version of Squeezy is used in 1 clinic in Switzerland and there is real interest in using it elsewhere, but we haven’t had the resource to expand further yet.