23. Functional Impact of Pelvic Floor Physical Therapy on Adolescents with Biopsy Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series

Abstract

<h3>Background</h3> Chronic pelvic pain is a hallmark sign of endometriosis in adolescents and can persist in the form of musculoskeletal pain despite medical management. There is limited evidence to support that pelvic floor physical therapy (PT) is an effective intervention in treating chronic pelvic pain secondary to endometriosis in adolescents. The purpose of this case series is to describe the change in functional ability in adolescent females following pelvic floor PT management of chronic pelvic pain as part of a multidisciplinary approach. <h3>Case</h3> Participants included twenty adolescent females median age 16.5 years (IQR 3). Retrospectively, participants were included if they were referred to pelvic floor PT for chronic pelvic pain by Pediatric and Adolescent Gynecology between April 2018 and August 2019. All participants included had diagnostic laparoscopy performed with biopsy confirmed endometriosis. Fifteen participants had surgery before referral to PT and 5 participants had surgery after starting PT. The median duration of symptoms prior to referral to PT was 2 years (IQR 1.75). Pelvic floor PT included patient education, relaxation techniques to decrease pelvic floor muscle tone, manual therapy, breathing and postural retraining, and therapeutic exercise including pelvic floor muscle strengthening. Due to the adolescent age of the participants, all pelvic floor PT techniques were only performed externally. The Patient Specific Functional Scale (PSFS) assesses patient reported function and was utilized to determine functional improvements in participants referred to pelvic floor PT. The PSFS is a 0 to 10 point scale with 0 representing maximal disability and 10 representing no disability. Participants were able to self-report between one and three functional impairments with this outcome measure. In this case series, the PSFS score was represented as a percentage rather than a raw number to account for the variable number of impairments patients could report. Functional status was captured at initial evaluation and participants demonstrated a baseline score of 45.1% (IQR 16.66) on the PSFS. Functional status was captured throughout their course of PT care with the PSFS. Participants self-reported a clinically significant functional median improvement of 23.3% (IQR 41.66) over a median number of 12 visits (IQR 10.50) (p<0.001). <h3>Comments</h3> Participants in this case series reported significant functional improvement on the PSFS over the course of pelvic floor PT. This case series suggests that PT may be a helpful treatment option in the multidisciplinary approach to improve patient function in adolescents with endometriosis. Additional prospective controlled trials are warranted to assess the benefits of PT in this population.