Barriers to Pelvic Floor Physical Therapy Regarding Treatment of High-Tone Pelvic Floor Dysfunction

Zoorob, Dani; Higgins, Margaret; Swan, Kimberly; Cummings, Jennifer; Dominguez, Sarah; Carey, Erin T.

doi:10.1097/spv.0000000000000401

Cited by 29 publications

(13 citation statements)

References 16 publications

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Section: Discussionmentioning

confidence: 92%

“…Although treatments directed at the pelvic floor, such as PFPT, have shown efficacy in the management of CPP and myofascial pain [14], only 10 patients in this study started PFPT before hysterectomy. Many barriers to initiating or completing PFPT have been reported, including financial constraints, perceived lack of utility by patients, and lack of accessibility [14]. Despite these challenges, PFPT is widely supported and accepted as the first line treatment, given its noninvasive nature and long-lasting improvement in pain scores with incorporation of techniques such as biofeedback, manual massage, and dry needling [10].…”

Section: Discussionmentioning

confidence: 92%

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Myofascial Pain in Hysterectomy Patients

Abu-Alnadi

Frame

Moore

et al. 2021

Journal of Minimally Invasive Gynecology

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To assess the prevalence of myofascial pain in women undergoing uncomplicated, minimally invasive hysterectomy for chronic pelvic pain, to identify clinical and demographic factors associated with preoperative myofascial pain, and examine the association between myofascial pain and postoperative pain in hysterectomy patients. Design: A retrospective cohort study. Setting: A tertiary care teaching hospital. Patients: A total of 353 adult women who underwent uncomplicated, minimally invasive hysterectomy between January 2014 and 2016. Interventions: All women underwent a preoperative pelvic floor examination. Myofascial pain was diagnosed as tenderness and reproduction of pain symptoms in at least 2 of 6 pelvic floor muscles. Demographics, comorbidities, and intraoperative characteristics were compared between women with and without preoperative myofascial pain. Measurements and Main Results: Of the 353 women who underwent hysterectomy, the prevalence of myofascial pain was 42.7% (86.0% in patients with chronic pelvic pain [CPP] compared with 13.7% without CPP). Women with myofascial pain were more likely younger, Caucasian, sexually active, and with comorbid pain conditions. Patients with myofascial pain used a greater number of adjuvant pain medications before surgery including opiates (29.5%) but were only half as likely to use muscle relaxants (12.1%) for preoperative pain control. Contrastingly, in women without myofascial pain before surgery, controlled substances such as opiates (8%, p <.01) and benzodiazepines (3%, p <.01) were used at a three-fold lower frequency. Postoperative pain score was higher in patients with myofascial pain, with 37% reporting a visual analog scale score greater than 5 at the routine postoperative visit compared with only 1% of patients without myofascial pain. Conclusion: Myofascial pelvic pain must be considered in the evaluation of CPP, especially in surgical candidates. Women with myofascial pelvic use a greater amount of pain medication preoperatively and have higher pain scores postoperatively. Identification of these high-risk patients before surgery may improve pre and postoperative pain management with a multimodal therapy approach.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Myofascial Pain in Hysterectomy Patients

Abu-Alnadi

Frame

Moore

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Insurance coverage and time constraints have been cited as barriers to care among US women referred to PT for high-tone PFD and pelvic pain. 42 Health literacy is also a barrier, as low condition-specific health literacy has been documented among US women with PFDs even among women with high general health literacy. 43,44 Low health literacy may indicate that women lack an understanding of their condition, and in turn are limited in understanding the plan of care presented at the time of diagnosis, hindering their capacity to be fully engaged and to follow treatment recommendations.…”

Section: Discussionmentioning

confidence: 99%

Retrospective claims analysis of physical therapy utilization among women with stress or mixed urinary incontinence

McKinney

Datar

Pan

et al. 2022

Neurourology and Urodynamics

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Objective To describe the characteristics of women with stress or mixed urinary incontinence (SUI/MUI) receiving physical therapy (PT) services, including referral patterns and PT utilization. Methods Female patients with claims associated with an SUI or MUI diagnosis (International Classification of Disease—Clinical Modification [ICD‐9‐CM]: 625.6, 788.33, or ICD‐10‐CM: N39.3, N39.46) between July 01, 2014 and June 30, 2016 were identified in International business machines (IBM)'s MarketScan Research Database. Inclusion criteria included the absence of pregnancy claims and ≥80% medical and pharmacy enrollment pre‐ and postindex. First SUI/MUI diagnosis claim determined index. Patients were followed for 2 years, and associated UI‐associated PT encounters were identified. Descriptive statistics were calculated for patients with at least one PT visit during the postindex period. Results In a cohort of 103,813 women with incident SUI or MUI diagnosis, 2.6% (2792/103,813) had at least one PT visit in the 2 years following their diagnosis. Mean age at index PT encounter was 50.55 years. A total of 52.36% (1462/2792) women had one to four PT visits; 21.2% (592/2792) had >8 PT visits. In subanalysis of the PT cohort (1345/2792), women who received PT only had the lowest average 2‐year postindex total medical cost (mean: $12,671; SD: $16,346), compared with PT plus medications (mean: $27,394; SD: $64,481), and PT plus surgery (mean: $33,656; SD: $26,245), respectively. Over 40% had their first PT visit ≥3 months after their index date. Conclusions The percentage of women with a PT visit associated with an incident SUI or MUI diagnosis was low (2.6%), and 30% of this group completed three or more PT visits. This suggests poor adherence to clinical guidelines regarding supervised treatment of UI in women. Impact Statement Our study suggests underutilization of PT among insured women with SUI and MUI in the 2 years following diagnosis. Interventions to improve this gap in first‐line care may represent an opportunity for an increased role for PTs in the care of women with UI.

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“…While this disparity in pelvic floor dysfunction compared to physical therapy may be due to under-recognition, there are data that suggest that cost, travel, and inconvenience are also barriers to pelvic floor physical therapy. 20,21 Additionally, patients with pelvic pain in the setting of endometriosis may have concomitant diagnoses of painful bladder syndrome, irritable bowel syndrome, and psychological conditions. 16,17 In such patients with chronic pelvic pain, specialized interdisciplinary care has been shown to improve pain scores, quality of life, and healthcare utilization.…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns in women seeking care for endometriosis at an endometriosis center

Linder

Burnett

Weng

et al. 2021

Journal of Endometriosis and Pelvic Pain Disorders

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Objective: To determine the clinical characteristics and prior medical and surgical treatments in women undergoing surgical excision of endometriosis for pelvic pain at a single institution. Methods: In this retrospective cohort study we identified 140 women with pathology-proven endometriosis who completed a preoperative standardized pain form and underwent surgery at an endometriosis center. Women were stratified into three groups for analysis: no prior surgery, 1 prior surgery, and 2+ prior surgeries. Results: The most common treatments used prior to seeking care were hormonal contraceptives (51.6%) and surgery (46.1%). More than half of women were diagnosed with pelvic floor dysfunction at time of presentation or prior to consultation. There was a significant relationship between an increasing number of surgeries (none vs 1 vs 2+) and gonadotropin-releasing hormone (GnRH) agonist use (19.0% vs 27.5% vs 56.0%, p = 0.003). Though not significant, a trend was noted between increasing surgeries and opioid use (20.6% vs 30.0% vs 40.0%, p = 0.17). There was a statistically significant relationship between multiple surgeries and illicit drug use ( p < 0.001). Conclusion: Patients with pelvic pain and endometriosis who have undergone multiple surgeries are more likely to have used GnRH agonists and report illicit drug use prior to presenting to specialized care.

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Barriers to Pelvic Floor Physical Therapy Regarding Treatment of High-Tone Pelvic Floor Dysfunction

Cited by 29 publications

References 16 publications

Myofascial Pain in Hysterectomy Patients

Myofascial Pain in Hysterectomy Patients

Retrospective claims analysis of physical therapy utilization among women with stress or mixed urinary incontinence

Treatment patterns in women seeking care for endometriosis at an endometriosis center

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