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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hay-Smith EJ, Herderschee R, Dumoulin C, Herbison GP. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2011;12:CD009508. https://doi.org/10.1002/14651858.CD009508.
Tibaek S, Dehlendorff C. Do women with pelvic floor dysfunction referred by gynaecologists and urologists at hospitals complete a pelvic floor muscle training programme? A retrospective study, 1992-2008. Int Urogynecol J. 2013;24(8):1361–9. https://doi.org/10.1007/s00192-012-2018-2.
Dumoulin C, Hay-Smith J, Frawley H, McClurg D, Alewijnse D, Bo K, et al. 2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 state-of-the-science seminar. Neurourol Urodyn. 2015;34(7):600–5. https://doi.org/10.1002/nau.22796.
Dumoulin C, Alewijnse D, Bo K, Hagen S, Stark D, Van Kampen M, et al. Pelvic-floor-muscle training adherence: tools, measurements and strategies-2011 ICS state-of-the-science seminar research paper II of IV. Neurourol Urodyn. 2015;34(7):615–21. https://doi.org/10.1002/nau.22794.
Frawley HC, McClurg D, Mahfooza A, Hay-Smith J, Dumoulin C. Health professionals’ and patients’ perspectives on pelvic floor muscle training adherence-2011 ICS state-of-the-science seminar research paper IV of IV. Neurourol Urodyn. 2015;34(7):632–9. https://doi.org/10.1002/nau.22774.
Hay-Smith J, Dean S, Burgio K, McClurg D, Frawley H, Dumoulin C. Pelvic-floor-muscle-training adherence “modifiers”: a review of primary qualitative studies-2011 ICS state-of-the-science seminar research paper III of IV. Neurourol Urodyn. 2015;34(7):622–31. https://doi.org/10.1002/nau.22771.
McClurg D, Frawley H, Hay-Smith J, Dean S, Chen SY, Chiarelli P, et al. Scoping review of adherence promotion theories in pelvic floor muscle training-2011 ICS state-of-the-science seminar research paper i of iv. Neurourol Urodyn. 2015;34(7):606–14. https://doi.org/10.1002/nau.22769.
Shannon MB, Genereux M, Brincat C, Adams W, Brubaker L, Mueller ER, et al. Attendance at prescribed pelvic floor physical therapy in a diverse, urban urogynecology population. PM R. 2018;10(6):601–6. https://doi.org/10.1016/j.pmrj.2017.11.008.
Shannon MB, Adams W, Fitzgerald CM, Mueller ER, Brubaker L, Brincat C. Does patient education augment pelvic floor physical therapy preparedness and attendance? A randomized controlled trial. Female Pelvic Med Reconstr Surg. 2018;24(2):155–60. https://doi.org/10.1097/SPV.0000000000000516.
Woodburn KL, Tran MC, Casas-Puig V, Ninivaggio CS, Ferrando CA. Compliance with pelvic floor physical therapy in patients diagnosed with high-tone pelvic floor disorders. Female Pelvic Med Reconstr Surg. 2019. https://doi.org/10.1097/SPV.0000000000000732.
Sangi-Haghpeykar H, Mozayeni P, Young A, Fine PM. Stress urinary incontinence and counseling and practice of pelvic floor exercises postpartum in low-income Hispanic women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):361–5. https://doi.org/10.1007/s00192-007-0438-1.
Kim H, Yoshida H, Suzuki T. The effects of multidimensional exercise treatment on community-dwelling elderly Japanese women with stress, urge, and mixed urinary incontinence: a randomized controlled trial. Int J Nurs Stud. 2011;48(10):1165–72. https://doi.org/10.1016/j.ijnurstu.2011.02.016.
Haynes RB, Taylor D, Sackett DL. Compliance in health care. Baltimore: The Johns Hopkins University Press; 1979.
Chen SY, Tzeng YL. Path analysis for adherence to pelvic floor muscle exercise among women with urinary incontinence. The journal of nursing research : JNR. 2009;17(2):83–92. https://doi.org/10.1097/JNR.0b013e3181a53e7e.
Alewijnse D, Mesters I, Metsemakers J, Adriaans J, van den Borne B. Predictors of intention to adhere to physiotherapy among women with urinary incontinence. Health Educ Res. 2001;16(2):173–86.
Hahn IMI, Fall M, Ekelund P. Long-term results of pelvic floor training in female stress urinary incontinence. Br J Urol. 1993;72:421–7.
Gallo MLSD. Cues to action: pelvic floor muscle exercise compliance in women with stress urinary incontinence. Neurourol Urodyn. 1997;16:167–77.
Lagro-Janssen ALMSA, Wan Weel C. Favourable effects of exercise therapy for urinary incontinence in the family practice especially dependent on adherence and motivation. Nederlands Tijdschrift voor Greneeskunde. 1994;138:1273–6.
Ashworth PDHM. Some social consequences of non-compliance with pelvic floor exercises. Physiotherapy. 1993;79:465–71.
Center for Medicare and Medicaid Services (CMS) Extension of the therapy cap exceptions process: CMS public use files. 2010. http://www.cms.gov/therapyservices. Accessed 2 Aug 2010.
Washington BB, Raker CA, Sung VW. Barriers to pelvic floor physical therapy utilization for treatment of female urinary incontinence. Am J Obstet Gynecol. 2011;205(2):152.e151–9. https://doi.org/10.1016/j.ajog.2011.03.029.
Acknowledgements
Dr. Brown is a Wisconsin Multidisciplinary K12 Urologic Research Career Development Scholar (NIH K12DK100022).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
All authors claim no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Brown, H.W., Barnes, H.C., Lim, A. et al. Better together: multidisciplinary approach improves adherence to pelvic floor physical therapy. Int Urogynecol J 31, 887–893 (2020). https://doi.org/10.1007/s00192-019-04090-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-019-04090-w