COMPLIANCE WITH PRESCRIBED PELVIC FLOOR PHYSICAL THERAPY WHEN
PATIENTS MEET WITH A PHYSICAL THERAPIST AT THEIR INITIAL UROGYNECOLOGIC EVALUATION
Hypothesis / aims of study
Hypothesis: Rates of compliance with pelvic floor physical therapy (PFPT) will be higher when the
patient meets with a physical therapist (PT) at the time of initial evaluation with urogynecology
than if she is referred to be seen by a PT at a subsequent encounter.
Study design, materials and methods
After IRB approval, we performed a retrospective review of billing data and medical records for all
patients seen in urogynecology consultation at our institution between February 1, 2014 and
February 1, 2015. We collected demographic data as well as information regarding urogynecologic
diagnoses, location of initial encounter (multidisciplinary pelvic wellness clinic versus single
discipline urogynecology clinic), whether a PT was involved in initial encounter, whether referral
to PFPT was placed, whether a patient saw a PT subsequent to the initial encounter, whether
prescribed PFPT was completed, and whether urogynecologic surgery was performed. Chi-square testing
was used to compare rates of PFPT attendance and completion among those patients who were seen in a
multidisciplinary clinic versus a single discipline clinic and among those who saw a PT during
their initial multidisciplinary pelvic wellness clinic visit versus those who did not. Logistic
regression was performed to identify factors associated with attendance and completion of
prescribed PFPT using SPSS 22.0.
A total of 958/982 patients (98%) identified met criteria for inclusion, of whom 23% (216/958) were
seen in a multidisciplinary
clinic with PFPT available. Overall, 92% (877) were non-Hispanic white; 60% (567) were married; and
45% (434) had government
insurance (Medicare/Medicaid). Age was between 18-40 years for 17% (165); 41-64 years for 44%
(425); and greater than 64
years for 38% (367). Forty-one percent (395) had a diagnosis of prolapse and 67% (646)
Referral to PFPT was made in 35% (334/958) of patients overall, in 55% (119/216) of patients seen
in the multidisciplinary clinic and in 29% (215/742) in the group seen in single discipline clinic
(p<.001). Complete data were available regarding PFPT attendance and completion for 98% (328/334),
of whom 67% (219/328) attended and 43% (140/328) completed PFPT. Among patients seen initially in
the multidisciplinary clinic, 79% (93/118) attended PFPT versus 60% (126/210) of patients seen in
single discipline clinic (p<.001). Rates of PFPT completion were not different between these two
groups (45% in the multidisciplinary group versus 41% in the single discipline group, p=.309).
Thirty-four percent (74/216) of patients seen in the multidisciplinary clinic saw a PT on the day
of initial consultation, and 91% of these (67/74) attended a subsequent PFPT visit, versus 61% of
those not seen by a PT at their initial consultation (157/259, p<.001). However, these patients
were not more likely to complete their prescribed course of PFPT (49% versus 41%, p=.148). Among
patients who attended PFPT, 61% (131/216) lived within 10
miles of the PT. Factors associated with PFPT attendance and completion are outlined in Tables 1
and 2, respectively.
Interpretation of results
Overall, 67% of patients referred for PFPT attended consultation and 43% completed PFPT. PFPT
attendance was higher among older women and among those who saw a PT at their initial consult in a
multidisciplinary clinic. The only factor statistically significantly associated with PFPT
completion in multivariate analysis was older age.
Joint appointments with PFPT and urogynecologic physician at the time of initial consultation
improves compliance with prescribed pelvic floor physical therapy in terms of attendance but not
affects rates of completion of PFPT. Further research is required to determine whether attendance
and completion of PFPT are independently associated with improved patient outcomes.