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

Abstract

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.

Digital Therapeutic Device for Urinary Incontinence

“…4 However, most women do not access skilled care, do not adhere to pelvic floor muscle training programs, or do not perform exercises correctly. [5][6][7][8][9] Emerging digital health technologies have shown promise in aiding treatment for female UI and promoting adherence to pelvic floor muscle training programs. 10,11 Digital therapeutics represent a category of digital health that includes evidence-based, softwareenabled products designed to prevent, treat, or manage a specific health condition.…”

“…4 However, most women do not access skilled care, do not adhere to pelvic floor muscle training programs, or do not perform exercises correctly. 5–9…”

Healthcare resource use and cost burden of urinary incontinence to United States payers

“…23 The limited number of PFMT visits reported in our study suggests that guideline adherence may be low in patients with SUI/MUI, findings evaluated to a greater degree in a companion manuscript. 24 Future studies should evaluate adherence to management and treatment guidelines for SUI/MUI patients and quantify its impact on healthcare resource use and costs.…”