Patients Seeking Outpatient Pelvic Rehabilitation

In the current issue of the journal Physical Therapy, Wang and colleagues describe the characteristics of patients (and their pelvic floor diagnoses) presenting for outpatient physical therapy. 109 outpatient clinics participated in this data collection and included information about 2452 patients. The system used for collecting data is FOTO (Focus On Therapeutic Outcomes), and you may have heard the results of this research presented at the most recent Combined Sections Meeting of the American Physical Therapy Association. The results of the study include that most of the people presenting to the clinics for pelvic floor dysfunction were women (92%), and that many reported a combination of urinary, bowel, or pelvic pain symptoms. The authors found a mean patient age of 50 with a standard deviation of 16. Most patients reported symptoms as chronic (74%). You can see from the following chart that is adapted from the article that subgroups of patient populations were noted, and the categories used for reporting include urinary disorders, bowel disorders, and pain (not all subgroups of combinations of pain are included in the chart below.) In general, 67% of the patients reported urinary dysfunction, 27% reported bowel dysfunction, and 39% reported pelvic pain.

Breakdown of Diagnoses and Subtypes
Urinary Bowel Pain
Leakage (32.1%) Constipation (53.7%) Abdominal (15.1%)
Frequency (10.9%) Leakage (27.9%) Rectal (3.7%)
Retention (2.7%) Leakage, constipation (18.4%) Sacroiliac (5.9%)
Leakage, frequency (30.2%) Vaginal (23.9%)
Leakage, retention (5.1%) Abdominal, sacroiliac (4.5%)
Frequency, retention (4.7%) Abdominal, vaginal (17.1%)
Leakage, frequency, retention (14.3%) Abdominal, rectal, vaginal (5.1%)

This study delivers valuable information about who is showing up to outpatient clinics and receiving care for pelvic rehabilitation services. There are certainly reasons for which patient data may not have been captured, such as patients voluntarily choosing the portions of the data collection to complete. Although the authors attempt to extrapolate epidemiological incidence of male versus female pelvic floor dysfunction compared to population samples, we have to keep in mind that there are several confounding factors that can influence such attempts. Firstly, it is difficult to obtain accurate data for prevalence of pelvic floor dysfunction in either men or women when varying criteria and definitions are utilized and when symptoms are known to be underreported. It should also be taken into consideration that patients will attend a clinic for a program of rehabilitation when there is awareness on the part of the patient or the referring provider that a particular program exists. In other words, there is still a lack of awareness that pelvic rehabilitation providers are available, that there is a broad scope of what we can evaluate and treat, and that we treat both men and women for pelvic floor dysfunction. This brings us to the fact that not as many rehab therapists treat men, and therefore such a service is likely not being promoted and utilized to its potential in a community clinic.

Although this research targets outpatient physical therapy clinics, regardless of the setting or of the discipline involved in care of patients with pelvic rehabilitation, the use of outcomes data is critical. Some insurances will not reimburse for rehabilitation unless outcome data is collected. It should be a common practice to include at least one outcome tool in evaluation and in the discharge planning process. As pointed out by the authors of this research, the use of computerized systems for medical records allows increased access to patient demographics, diagnoses, and information about treatment. It is terrific to see pelvic rehabilitation highlighted in the Physical Therapy journal, and hopefully the inclusion of pelvic floor dysfunction in mainstream publications will continue to improve awareness of these diagnoses and to further normalize the dialog about such conditions.

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