Initiating a women's health physician–run rehabilitation clinic in the United States

Abstract

Pelvic dysfunction can lead to persistent impairment and disability when left untreated. While some diagnoses overlap with those seen in a general Physical Medicine and Rehabilitation (PM&R) outpatient setting and Obstetrics/Gynecology (Ob/Gyn), management varies with changes in biomechanics and function in contexts of fecundity, gravidity, post-partum status, post-menopause, history of surgical intervention, or history of sexual trauma. PM&R initiated a collaboration with Ob/Gyn to create a physician-run Women's Health Rehabilitation specialty clinic embedded within an established Ob/Gyn clinic at an academic university hospital in the United States. The clinic focuses on pelvic floor disorders and musculoskeletal issues associated with pregnant or post-partum women. Over 50 referrals were made from Ob/Gyn in the initial months of clinic launch. Diagnoses included low back pain and sacroiliac joint dysfunction related to pregnancy, pelvic floor instability, dyspareunia, post-partum thoracic back pain, and coccydynia. Management included education of biomechanics, referral to Pelvic Floor-specialized Physical Therapy (PFPT), medications, referral to Psychology, and injections. Despite significant enthusiasm from Ob/Gyn and the patients, initial referrals were delayed due misunderstanding regarding difference between PM&R and PT, failure to recall initiation of clinic, and flawed protocol with ancillary staff on scheduling process. Despite infrastructure of a large academic institution in a metropolitan area, there was a paucity of availability of PFPT multiple sites within the academic affiliation or the metropolitan area. Comprehensive Women's Health Rehabilitation lead by physiatrists can address biomechanical issues, treat pain, perform interventional procedures, and coordinate care with PFPT and other professionals to address contributing factors, like mood disturbances and life situations. Our clinic aim is to expand collaborations with increased marketing, face-to-face interaction, and visibility at multidisciplinary events. We expect to increase referral sources and numbers as well as educate more of the medical community about our specialty.