Multidisciplinary evaluation of chronic pelvic pain patients increases compliance with pelvic floor physical therapy

Abstract

Pelvic floor physical therapy (PFPT) is widely accepted as a first line therapy for pelvic floor dysfunction. Despite studies demonstrating a 50-90% improvement in pelvic pain in women undergoing PFPT, adherence and follow up with PFPT is poor. The primary aim of this study was to evaluate whether the presence of a pelvic floor physical therapist at the initial consultation for chronic pelvic pain (CPP) resulted in greater compliance with PFPT. Secondary aims evaluated patient characteristics and provider practice patterns. We performed a retrospective chart review of all patients evaluated for CPP from June 2019- June 2020 in both a CPP multidisciplinary center as well as a traditional gynecology office. In both settings, patients were evaluated by fellowship-trained minimally invasive gynecologic surgeon. At the multidisciplinary center, patients were evaluated by the same surgeons, in addition to a pelvic floor physical therapist. Descriptive analyses compared patients who were referred to, attended, and completed PFPT, stratified by whether they saw PFPT the same day as their initial consultation. Kruskal-Wallis test or Pearson's chi-square test were used to determine whether distributions of continuous or categorical variables differed by clinics. 556 patients included in this study, 172 (31%) were seen in the CPP multidisciplinary center and 384 were seen in the traditional gynecology office. A total of 177 (32%) were referred to PFPT. A greater percentage of referrals were made from those patients in the CPP center (n=86;50%) as compared to the traditional office (n=91; 24%). Patients seen by a PFPT at the initial evaluation in the multidisciplinary center were more likely to complete at least one PFPT visit (n=57; 66%) when compared to those seen in a traditional gynecology clinic (n=26;29%, p <0.001). Patients seen in the multidisciplinary center who were also seen by PFPT at the time of referral had more PFPT visits on average as compared to those patients when referred from the traditional office (5.8 vs 2.0 respectively; p<0.001). A multidisciplinary approach to CPP increases the number of patients who establish care with PFPT. Future studies should focus on developing interventions to increase compliance to prescribed physical therapy regimens.