Better together: multidisciplinary approach improves adherence to pelvic floor physical therapy

Abstract

Introduction and hypothesis-To determine whether consultation with pelvic floor physical therapy (PFPT) at the time of initial urogynecologic evaluation increases adherence to PFPT and to identify factors associated with PFPT attendance and completion. Methods-We performed a retrospective chart review of all patients evaluated for new urogynecology consultation at our institution in a 1-year period, abstracting data about demographics, diagnoses, and PFPT referral, attendance, and completion. Descriptive analyses compared patients who were referred to, attended, and completed PFPT, stratified by whether they saw PFPT the same day as their initial urogynecologic consultation. Logistic regression identified factors associated with PFPT attendance, completion, and referral. Results-PFPT referral was made for 35% (335/958), of whom 67% attended and 42% completed PFPT. Patients who saw PFPT the same day as their first urogynecology visit were significantly more likely to attend PFPT than those who did not (91% vs. 61%, p < 0.001), but completion rates did not differ (49% vs. 41%, p = 0.15). PFPT attendance was higher among women who saw a PFPT the same day as their initial urogynecology appointment (p <0.001) and among those aged ≥ 65 years (p = 0.015). Age ≥ 65 years and white, non-Hispanic race/ethnicity were associated with PFPT completion. Patients with a diagnosis of pelvic organ prolapse or urinary incontinence and those seen in multidisciplinary clinic were more likely to be referred to PFPT. Conclusions-PFPT consultation at the time of initial urogynecologic evaluation improves attendance of initial PFPT appointment, but does not improve completion rates.

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

“…The optimal number of PT visits considered a "completed" episode of care has not been identified, and ranges from 3 to 8+ visits in the literature. [26][27][28][29][30] In our study, over 30% of women completed less than three PT visits, suggesting that many women do not complete PT once initiated.…”

“…It would seem reasonable then to expect the women in our cohort to continue to need care, enforcing the importance of working toward improvements in care provision and coordination. The optimal number of PT visits considered a “completed” episode of care has not been identified, and ranges from 3 to 8+ visits in the literature 26–30 . In our study, over 30% of women completed less than three PT visits, suggesting that many women do not complete PT once initiated.…”

Patient Access to Pelvic Floor Dysfunction Physical Therapy: Challenging Trends to Adequate Patient Care

“…11 Pelvic floor physical therapy (PFPT), also referred to as pelvic floor muscle training, is a conservative treatment modality for PFD that is widely accepted with recent quality studies indicating significant clinical effects for improvement of symptoms. [12][13][14][15] PFPT has minimal risk and is an evidence-based treatment for many urogynecologic disorders, including overactive bladder, mixed urinary incontinence, stress urinary incontinence, defecatory dysfunction, symptomatic pelvic organ prolapse, pelvic floor myofascial pain, and painful bladder syndrome. 12,[16][17][18] PFPT includes internal and external intervention with a trained physical therapist who teaches pelvic floor muscles strengthening, relaxation, and coordination exercises, as well as behavioral training intervention and home exercise program instruction.…”

“…12,19,20 Moreover, research supports that women are more likely to report improvement in symptoms when they are referred directly to supervised PFPT as opposed to performing recommended exercises without supervision. 14,15 Furthermore, studies support that PFPT contributes significantly to the multidisciplinary assessment and treatment of PFD due to its holistic approach. 21 Overall, the literature suggests a lack of awareness and understanding of PFD that impairs access to effective medical care.…”

Multidisciplinary approach between physicians and physiotherapists in urogynecology: how can we make it stronger?

“…Recent retrospective studies have revealed the importance of collaborative action between urogynecology and physical therapy in the treatment of female pelvic pain [8,9]. When addressing pelvic pain and female sexual dysfunction, physiotherapists can contribute to assessing and treating such women with the multidisciplinary approach, and clinical and scientific research indicate its efficacy and safety [10].…”