Comparison of Pelvic Floor Physical Therapy Attendance Based on Referring Provider Specialty

Abstract

Objective: The objective of this study was to determine whether pelvic floor physical therapy (PFPT) attendance differs based on referring provider specialty and identify factors related to PFPT initiation and completion.Methods: This was an institutional review board-approved retrospective cohort study examining referrals from female pelvic medicine and reconstructive surgery (FPMRS) and non-FPMRS providers at a single academic medical center to affiliated PFPT clinics over a 12-month period. Demographics, referring specialty and diagnoses, prior treatment, and details regarding PFPT attendance were collected. Characteristics between FPMRS and non-FPMRS referrals were compared and multivariate logistic regression analyses were performed to identify factors associated with PFPT initiation and completion.Results: A total of 497 referrals were placed for PFPT. Compared with non-FPMRS referrals, FPMRS referrals were for patients who were older (54.7 years vs 35.6 years), and had higher parity; more were postmenopausal (56% vs 18%) and had Medicare insurance (22% vs 10%) (all P < 0.001). Most FPMRS referrals were for patients with urinary incontinence (69% vs 31%), whereas non-FPMRS referrals were for patients with pelvic pain (70% vs 27%) (both P < 0.0001). Pelvic floor physical therapy attendance was similar in both groups when comparing rates of initiation (47% vs 45%) and completion (13% vs 16%). In multivariate analysis, factors associated with initiation were age 65 years or older, additional therapy provided at referring visit, private insurance, Asian race, pregnant or postpartum at time of referral, and more than 1 referring diagnosis (all P < 0.05). No factors were associated with completion.Conclusions: Less than half of the patients referred to PFPT initiate therapy, and only 15% complete PFPT. The populations referred by FPMRS and non-FPMRS providers are different, but ultimately PFPT utilization is similar.

The Impact of Pelvic Floor Physical Therapy on Bladder and Bowel Function After Obstetric Anal Sphincter Injury

“…Patterns of referral to PFPT have evolved over the years and may vary based on the specialty of the referring health care provider and referring diagnoses 17 . In our institution, approximately half of all patients with OASI presenting to the PPCC were referred to PFPT.…”

“…Patterns of referral to PFPT have evolved over the years and may vary based on the specialty of the referring health care provider and referring diagnoses. 17 In our institution, approximately half of all patients with OASI presenting to the PPCC were referred to PFPT. Our referral rate is based on evolving practice trends during the study period, with increasing referral to PFPT seen as our experience, as well as that of the physical therapists, with caring for women with OASI accumulated.…”

Pelvic Floor Physical Therapy Attendance Among High-Risk Postpartum Patients

“…4,5 Prior published data show completion rates of 13-29% compared with 48% of our patients being discharged with goals of PFPT met. 4,5 Although speculation, this could be due to a variety of factors, including motivation for improvement, ability to attend visits during a parental leave, and ongoing healing of the postpartum pelvic floor. Factors motivating continued adherence to PFPT should be explored further.…”

“…Although current evidence does not focus on postpartum patients specifically, reported rates of initial attendance to PFPT for pelvic floor conditions range from 45% to 63% with therapy completion rates of only 13% to 29%. 4,5 The postpartum period is a time of significant transition with obvious obstacles to attending PFPT. Current qualitative research, primarily from international populations, indicates there are psychosocial burdens and specific motivations that affect engagement with postpartum PFPT, such as financial stress, worries about the baby, and effects on quality of life.…”

“…Despite the potential benefit of PFPT in promoting postpartum recovery and improving pelvic health, limited data exist regarding attendance and global symptom improvement in postpartum patient populations. Although current evidence does not focus on postpartum patients specifically, reported rates of initial attendance to PFPT for pelvic floor conditions range from 45% to 63% with therapy completion rates of only 13% to 29% 4,5 …”