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Janela D, Areias AC, Molinos M, Moulder RG, Magalhães I, Bento V, Cardeano M, Yanamadala V, Correia FD, Atherton J, Costa F. Digital Care Program for Urinary Incontinence in Females: A Large-Scale, Prospective, Cohort Study. Healthcare (Basel) 2024; 12:141. [PMID: 38255031 PMCID: PMC10815799 DOI: 10.3390/healthcare12020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
Female urinary incontinence (UI) is highly prevalent in the US (>60%). Pelvic floor muscle training (PFMT) represents first-line care for UI; however, access and adherence challenges urge new care delivery models. This prospective cohort study investigates the feasibility and safety of a remote digital care program (DCP) combining education and PFMT with real-time biofeedback with an average duration of 10 weeks. The primary outcome was the change in the Urinary Impact Questionnaire-short form (UIQ-7) from baseline to program-end, calculated through latent growth curve analysis (LGCA). Secondary outcomes included the impact of pelvic conditions (PFIQ-7), depression (PHQ-9), anxiety (GAD-7), productivity impairment (WPAI), intention to seek additional healthcare, engagement, and satisfaction. Of the 326 participants who started the program, 264 (81.0%) completed the intervention. Significant improvement on UIQ-7 (8.8, 95%CI 4.7; 12.9, p < 0.001) was observed, corresponding to a response rate of 57.3%, together with improvements in all other outcomes and high satisfaction (8.9/10, SD 1.8). This study shows the feasibility and safety of a completely remote DCP with biofeedback managed asynchronously by a physical therapist to reduce UI-related symptoms in a real-world setting. Together, these findings may advocate for the exploration of this care delivery option to escalate access to proper and timely UI care.
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Affiliation(s)
- Dora Janela
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
| | - Anabela C. Areias
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
| | - Maria Molinos
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
| | - Robert G. Moulder
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
- Institute for Cognitive Science, University of Colorado, Boulder, CO 80309, USA
| | - Ivo Magalhães
- Bloom, Sword Health Inc., Draper, UT 84020, USA; (I.M.); (M.C.); (J.A.)
| | - Virgílio Bento
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
| | - Marta Cardeano
- Bloom, Sword Health Inc., Draper, UT 84020, USA; (I.M.); (M.C.); (J.A.)
| | - Vijay Yanamadala
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
- Department of Surgery, Frank H. Netter School of Medicine, Quinnipiac University, Hamden, CT 06473, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT 06103, USA
| | - Fernando Dias Correia
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
- Neurology Department, Centro Hospitalar e Universitário do Porto, 4099-001 Porto, Portugal
| | - Jennesa Atherton
- Bloom, Sword Health Inc., Draper, UT 84020, USA; (I.M.); (M.C.); (J.A.)
| | - Fabíola Costa
- Clinical Research, Sword Health Inc., Draper, UT 84020, USA; (D.J.); (A.C.A.); (M.M.); (R.G.M.); (V.B.); (V.Y.); (F.D.C.)
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Smith D, Gugerty L, Schug S, Lipetskaia L. Triangulation of a Needs Assessment on High-Tone Pelvic Floor Dysfunction. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023:02273501-990000000-00155. [PMID: 38031275 DOI: 10.1097/spv.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
IMPORTANCE High-tone pelvic floor dysfunction is a complex condition that is challenging to manage effectively. Pelvic floor physical therapy (PFPT) is often used in the treatment and relies on a coordinated effort between the physician, patient, and physical therapist. Collaboration is crucial for therapy success, but there is limited research that includes personal perspectives from these individuals. OBJECTIVE The objective of this qualitative study was to gain further insight from these groups to identify areas for improvement in patient counseling and understanding of the diagnosis of high-tone pelvic floor dysfunction and the role of physical therapy. STUDY DESIGN The following participants were recruited: urogynecologists, pelvic floor physical therapists, and patients. Semistructured interviews were conducted exploring participant experiences with therapy and management of the condition and surrounding phenomena. RESULTS Participants interviewed included 5 urogynecologists, 5 pelvic floor physical therapists, and 15 patients. Similarities in key themes were identified: (1) the usefulness of pelvic models and illustrations in counseling, (2) appropriate descriptions of therapy, (3) motivating factors for patients, and (4) patient barriers to completing therapy. Several emergent themes revealed a misalignment in perspectives, including (1) patients reporting an unclear understanding of PFPT, (2) patient unawareness of the intimacy of therapy, and (3) reports of unsupportive and unempathetic physician providers. CONCLUSIONS There are both similarities and discrepancies in the perspectives among physicians, pelvic floor physical therapists, and patients regarding high-tone pelvic floor dysfunction and PFPT. Acknowledging these comparisons and adapting practices could facilitate patient-centered care and improve patient understanding of their diagnosis.
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Affiliation(s)
- Devon Smith
- From the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of OBGYN, Cooper University Hospital, Camden, NJ
| | | | - Seran Schug
- Department Sociology and Anthropology, Rowan University, Glasboro, NJ
| | - Lioudmila Lipetskaia
- From the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of OBGYN, Cooper University Hospital, Camden, NJ
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Meriwether KV, Griego JL, Jansen SM, Abudushalamu F, Petersen TR, Dunivan GC, Komesu YM, Page-Reeves J. Beliefs and Narratives Associated with the Treatment of Chronic Pelvic Pain in Women. J Minim Invasive Gynecol 2023; 30:216-229. [PMID: 36509397 DOI: 10.1016/j.jmig.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE Female patients with chronic pelvic pain (CPP) face complicated healthcare journeys, but narrative perspectives on CPP treatment are lacking. DESIGN We collected data in English and Spanish from discussion groups and individual interviews with stakeholders around female CPP. SETTING A tertiary care center for gynecologic care. PATIENTS Patients with CPP who self-identified as women/female, community healthcare workers, and providers who care for women with CPP. INTERVENTIONS We conducted discussion groups with all 3 types of stakeholders and individual interviews with female patients who have CPP. MEASUREMENTS AND MAIN RESULTS Patient participants completed condition specific validated questionnaires. De-identified transcripts were coded with NVivo software. We contrasted patient characteristics and codes between patients with CPP who did and did not report opioid use in the last 90 days. The mean pain score of patient participants was 6/10 ± 2/10, and 14 of 47 (28%) reported recent opioid use, without significant differences between patients with and without recent opioid use. Thematic saturation was achieved. Five main themes emerged: the debilitating nature of CPP, emotional impacts of CPP, challenges in CPP healthcare interactions, treatment for CPP, and the value of not feeling alone. Common threads voiced by stakeholders included difficulty discussing chronic pain with others, a sense of inertia in treatment, interest in alternative and less invasive treatments before more involved treatments, and the need for individualized, stepwise, integrated treatment plans. Participants agreed that opioids should be used when other treatments fail, but women recently using opioids voiced fewer concerns about addiction and positive experiences with opioid efficacy. CONCLUSIONS These findings among female patients with CPP and also among community healthcare workers and providers advocate for a move toward patient-centered care, particularly the acknowledgment that every woman experiences pain in a singular way. Furthermore, stakeholders voice a deep need for development of individualized treatment plans.
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Affiliation(s)
- Kate V Meriwether
- Department of Obstetrics and Gynecology (Dr. Meriwether, Ms. Griego, and Dr. Komesu).
| | - Jamie L Griego
- Department of Obstetrics and Gynecology (Dr. Meriwether, Ms. Griego, and Dr. Komesu)
| | | | | | - Tim R Petersen
- Department of Anesthesiology and Critical Care Medicine (Dr. Petersen)
| | - Gena C Dunivan
- Department of Obstetrics and Gynecology, University of Alabama, Birmingham, Alabama (Dr. Dunivan)
| | - Yuko M Komesu
- Department of Obstetrics and Gynecology (Dr. Meriwether, Ms. Griego, and Dr. Komesu)
| | - Janet Page-Reeves
- and University of New Mexico Office of Community Health, Albuquerque, New Mexico (Dr. Page-Reeves)
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The Impact of Pelvic Floor Physical Therapy on Bladder and Bowel Function After Obstetric Anal Sphincter Injury. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:234-243. [PMID: 36735439 DOI: 10.1097/spv.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Women with obstetric anal sphincter injury (OASI) are at increased risk of pelvic floor disorders. No standard of care exists for management of pelvic floor dysfunction after OASI. OBJECTIVES The aims of this study were to evaluate the impact of pelvic floor physical therapy (PFPT) on bladder and bowel function after OASI and to describe adherence to PFPT. STUDY DESIGN A retrospective cohort study of women with OASI presenting at a postpartum care clinic from 2017 to 2021 was conducted. Women were grouped according to PFPT attendance. Urinary Distress Inventory 6 (UDI-6) and Fecal Incontinence Severity Index (FISI) were administered at baseline and 6 months. RESULTS A total of 430 women with OASI presented to a postpartum care clinic, of which 137 (31.9%) attended PFPT, and 293 (68.1%) did not attend. Baseline and 6-month questionnaires were completed by 169 women: 52 (30.8%) in the PFPT group and 117 (69.2%) in the non-PFPT group. Baseline UDI-6 and FISI scores were higher in the PFPT group. Improvement in UDI-6 was not different between groups (-5.8 ± 14.9 vs -3.7 ± 10.8, P = 0.36). The non-PFPT group had greater worsening of FISI compared with PFPT group (9.8 ± 15.2 vs 1.1 ± 11.5, P < 0.001). Sixty-six percent (n = 136) of women referred to PFFT attended at least 1 session, of which 32.4% (n = 44) completed all sessions. Completely adherent women were referred to PFPT earlier (18.5 vs 28.5 days postpartum, P = 0.027). CONCLUSIONS Women in both the PFPT and non-PFPT groups reported improvement in bladder leakage 6 months after OASI. Women who did not attend PFPT had significant worsening of bowel leakage. Early referral to PFPT in women with pelvic floor dysfunction following OASI should be considered.
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Adherence to Pelvic Floor Physical Therapy Referrals in Women With Fecal Incontinence. Female Pelvic Med Reconstr Surg 2022; 28:e29-e33. [PMID: 35272329 DOI: 10.1097/spv.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine the incidence of patient adherence with prescribed pelvic floor physical therapy (PFPT) in women presenting with fecal incontinence (FI) and to describe patient characteristics associated with nonadherence. METHODS This is a retrospective cohort study of women presenting with FI who were prescribed PFPT between January 2010 and December 2019. Adherence with PFPT was defined as either completion of documented recommended physical therapy sessions or discharge from therapy by the therapist before completion of the prescribed sessions. RESULTS Complete data were available for 248 patients. A total of 159 (64.1%) patients attended at least 1 session of PFPT. Patients who did not attend any sessions were more likely to have a concurrent diagnosis of pelvic organ prolapse (69.7% vs 55.3%, P = 0.03). When controlled for confounding variables, concurrent prolapse remained associated with nonattendance (adjusted odds ratio of 1.9 [95% confidence interval, 1.0-3.3]). Of the patients who attended PFPT, the adherence rate was 32.7% (n = 50), whereas the rate was 20% for the total cohort. Nonadherent patients were more likely to have a higher body mass index (28.9 vs 26.9, P = 0.02), but this was no longer statistically significant once other patient characteristics were controlled for. Of the entire cohort, 136 (54.8%) followed up with their physicians after the initial referral to PFPT. Of the 59 patients, 43.7% were offered second-line therapy. CONCLUSION Of the women prescribed PFPT for a diagnosis of FI, approximately two thirds attended at least a single session, but only one third of those patients were adherent with the recommended therapy.
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Effect of Patient Use of Physical Therapy After Referral for Musculoskeletal Conditions on Future Medical Utilization: A Retrospective Cohort Analysis. J Manipulative Physiol Ther 2022; 44:621-636. [DOI: 10.1016/j.jmpt.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/18/2022]
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What Influences Women to Adhere to Pelvic Floor Exercises after Physiotherapy Treatment? A Qualitative Study for Individualized Pelvic Health Care. J Pers Med 2021; 11:jpm11121368. [PMID: 34945840 PMCID: PMC8706048 DOI: 10.3390/jpm11121368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 12/29/2022] Open
Abstract
Conservative treatment of pelvic floor dysfunction (PFD) includes therapeutic exercise for pelvic floor muscle (PFM) training or other complementary exercise modalities, such as hypopressive exercises. However, the long-term effectiveness of the conservative treatment depends on a patient's adherence to the exercises and the integration of professional health advice into their daily life. The objective of this study was to establish the adherence experience of women with diagnosed PFD in home-based exercises after an intensive face-to-face physiotherapy treatment. A qualitative study from an interpretive paradigm was developed. Semi-structured individual and group interviews were performed 6 months after finishing individual physiotherapy treatment. The interviews were recorded, fully transcribed and analyzed thematically by creating categories. Thirty-one women were interviewed. The women reported that their adherence to home PFM exercises depended on the exercise program itself, its efficacy, their personal experiences with the exercises, intrinsic factors such as self-awareness or beliefs, and extrinsic factors, such as professional or instrumental feedback. Thus, therapeutic adherence could be more likely with effective physiotherapy programs that include mutually agreed home exercises and simple movements women can build into their daily lives. Improving awareness and knowledge of the pelvic region and the importance of PFM treatment as well as consideration for potential worsening of PFD will also encourage women to adhere to the exercises.
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Sharpe JA, Thackeray A, Fritz JM, Martin BI, Magel J, Vanneman ME. Patients' use of physical therapy for lower back pain: A qualitative study. Musculoskelet Sci Pract 2021; 56:102468. [PMID: 34688104 PMCID: PMC8629949 DOI: 10.1016/j.msksp.2021.102468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/22/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors that influence a patient's decision to use physical therapy (PT) services for a low back pain (LBP) complaint. METHODS Semi-structured qualitative phone interviews were conducted with patients who were offered an early outpatient PT visit secondary to patients' primary appointment for LBP with a non-operative sports medicine specialist physician. Interviews were recorded, transcribed, and analyzed to identify themes using an iterative process. RESULTS Forty participants were interviewed; 20 accepted early PT services, and 20 did not. Patients' decisions were influenced by perceived provider training, costs, doctor recommendations, wait times, symptoms, and a desire for a diagnosis. Patients preferred the care of non-operative sports medicine doctors over physical therapists for LBP due to their beliefs that favored doctors' diagnosis and management of LBP. Patients perceived exercise as an effective treatment for back pain. Physical therapists were viewed as an adjunct service, despite positive comments about PT and the belief that exercise is one of the most effective treatments for LBP. CONCLUSION Barriers including costs, patient preferences, and knowledge about physical therapists limited patients' use of PT. Value-based care strategies aimed at improving the management of LBP increasingly promote the early use of PT. For these strategies to be effective, it is critical that patient perceptions and the influence of barriers on PT use are further understood. This study highlights the need to promote confidence in physical therapists' expertise in the management and diagnosis of lower back pain.
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Affiliation(s)
- Jason A. Sharpe
- Veterans Affairs Durham, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA,Corresponding author. VA Medical Center (152), HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC, 27701, USA. (J.A. Sharpe)
| | - Anne Thackeray
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Julie M. Fritz
- Veterans Affairs Durham, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Brook I. Martin
- University of Utah School of Medicine, Department of Orthopaedics, Salt Lake City, UT, USA,University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research, Salt Lake City, UT, USA
| | - John Magel
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Megan E. Vanneman
- University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research, Salt Lake City, UT, USA,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology Salt Lake City, UT, USA,Veterans Affairs Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Salt Lake City, UT, USA
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The Use of Ancillary Services Under a Bundled Care Versus a Fee-For-Service Payment Model. Female Pelvic Med Reconstr Surg 2021; 27:493-496. [PMID: 34261108 DOI: 10.1097/spv.0000000000001071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Colocated services in a team-based integrated practice unit (IPU) optimize care of pelvic floor disorders. Our goal was to compare ancillary service utilization in a multidisciplinary IPU between patients covered by a bundled payment model (BPM) versus a traditional fee-for-service model (FFSM). METHODS Medical records of women attending an IPU for pelvic floor disorders with colocated services, including nutrition, social work, psychiatry, physical therapy, and subspecialty care between October 2017 and December 2018, were included in this retrospective chart review. All patients were offered treatment with ancillary services according to standardized care pathways. Data extracted included patient demographics, pelvic floor disorder diagnoses, baseline severity measures, payment model, and ancillary services used. Univariate and multivariate logistic regression identified variables predicting higher uptake of ancillary services. RESULTS A total of 575 women with pelvic floor disorders presented for care during the study period, of which 35.14% attended at least 1 appointment with any ancillary services provider. Ancillary service utilization did not differ between patients in the BPM group and those in the FFSM group (36.22 vs 33.47%; P = 0.489). Social work services were more likely to be used by the BPM compared with the FFSM group (15.95 vs 6.28%; P < 0.001). The diagnosis of fecal incontinence was associated with a higher chance of using any ancillary service (odds ratio, 4.91; 95% confidence interval, 1.81-13.33; P = 0.002). CONCLUSIONS One third of patients with pelvic floor disorders receiving care in an IPU used colocated ancillary services. Utilization does not differ between payment models.
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Sharpe JA, Martin BI, Fritz JM, Newman MG, Magel J, Vanneman ME, Thackeray A. Identifying patients who access musculoskeletal physical therapy: a retrospective cohort analysis. Fam Pract 2021; 38:203-209. [PMID: 33043360 PMCID: PMC8679185 DOI: 10.1093/fampra/cmaa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Musculoskeletal conditions are common and cause high levels of disability and costs. Physical therapy is recommended for many musculoskeletal conditions. Past research suggests that referral rates appear to have increased over time, but the rate of accessing a physical therapist appears unchanged. OBJECTIVE Our retrospective cohort study describes the rate of physical therapy use after referral for a variety of musculoskeletal diagnoses while comparing users and non-users of physical therapy services after referral. METHODS The study sample included patients in the University of Utah Health system who received care from a medical provider for a musculoskeletal condition. We included a comprehensive set of variables available in the electronic data warehouse possibly associated with attending physical therapy. Our primary analysis compared differences in patient factors between physical therapy users and non-users using Poisson regression. RESULTS 15 877 (16%) patients had a referral to physical therapy, and 3812 (24%) of these patients accessed physical therapy after referral. Most of the factors included in the model were associated with physical therapy use except for sex and number of comorbidities. The receiver operating characteristic curve was 0.63 suggesting poor predictability of the model but it is likely related to the heterogeneity of the sample. CONCLUSIONS We found that obesity, ethnicity, public insurance and urgent care referrals were associated with poor adherence to physical therapy referral. However, the limited predictive power of our model suggests a need for a deeper examination into factors that influence patients access to a physical therapist.
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Affiliation(s)
- Jason A Sharpe
- University of Utah, Department of Physical Therapy and Athletic Training
| | - Brook I Martin
- University of Utah School of Medicine, Department of Orthopaedics.,University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research
| | - Julie M Fritz
- University of Utah, Department of Physical Therapy and Athletic Training
| | - Michael G Newman
- Data Science Services, University of Utah, Data Science Services
| | - John Magel
- University of Utah, Department of Physical Therapy and Athletic Training
| | - Megan E Vanneman
- University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research.,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology.,Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Veterans Affairs Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Salt Lake City, UT, USA
| | - Anne Thackeray
- University of Utah, Department of Physical Therapy and Athletic Training.,University of Utah, Department of Population Health Sciences, Division of Health System Innovation and Research
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Nygaard AS, Haugstad GK, Wilsgaard T, Øian P, Stedenfeldt M. Baseline pain characteristics predict pain reduction after physical therapy in women with chronic pelvic pain. Secondary analysis of data from a randomized controlled trial. Scand J Pain 2020; 20:793-800. [PMID: 32609653 DOI: 10.1515/sjpain-2020-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/11/2020] [Indexed: 12/26/2022]
Abstract
Background and aims Women with chronic pelvic pain represent a heterogeneous group, and it is suggested that the existence of sub-groups can explain varying results and inconclusiveness in clinical trials. Some predictors of treatment outcome are suggested, but the evidence is limited. The primary aim of this study was to explore if selected pre-treatment characteristics of the participants in a recently conducted randomized controlled trial were associated with treatment outcome. Methods In this study secondary analysis of data collected in a randomized trial were conducted. The participants were women with chronic pelvic pain randomized to two different physical therapy treatments. Analyses in this study were performed for the whole group as a cohort. The primary outcome measure was change in pain intensity from baseline to 12 months, measured with the numeric rating scale (0-10). The women were asked to rate their mean pelvic pain intensity during the last 7 days. Based on previous research and on available variables from the randomized controlled trial four potential predictive factors were derived from the baseline data and assessed one by one in a linear regression model, adjusted for age and treatment group. The variables with strongest association (p < 0.10) with the primary outcome were further included in a multivariable linear regression model with backward selection, adjusted for age and treatment group. Results Fifty women (mean age 38.1, SD = 12.2) were included in the analysis. For these women the mean change in pain intensity was -1.2 points (95% CI -1.8 to -0.7) from baseline to 12 months. The multivariable regression model showed that pelvic pain duration of 6 years or more was associated with less decrease in pain intensity with a regression coefficient of 1.3 (95% CI 0.3-2.4). Baseline pain intensity was associated with higher pain reduction after PT treatment with a regression coefficient per SD increase in baseline pain of -0.6 (95% CI -1.1 to -0.1). None of the women with main pain site other places than in the pelvis reported any pain reduction after physical therapy treatment, but due to the small numbers the predictor was not included in the regression analysis. Conclusions We identified that pelvic pain duration of 6 years or more was associated with less pain reduction, and that higher baseline pain intensity was associated with higher pain reduction after physical therapy treatment in this sample of women with chronic pelvic pain. For the variable main pain site other places than the pelvis the results are unsure due to small numbers. Implications Based on our finding of long pain duration as a negative predictor for pain reduction, we emphasize that early intervention is important. Many of the participants in our RCT reported pelvic surgeries or other treatments prior to referral for PT, and we suggest that referral to a non-invasive intervention such as PT should be considered at an earlier stage. In order to tailor interventions to the individual women's needs, thorough baseline assessments, preferably in a multidisciplinary setting, should be performed.
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Affiliation(s)
- Ane S Nygaard
- Norwegian National Advisory Unit on Incontinence and Pelvic Floor Health, University Hospital of North Norway, Tromsø, Norway.,Women's Health and Perinatology Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Gro K Haugstad
- Institute of Physical Therapy, Oslo Met-Oslo Metropolitan University, Oslo, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Mona Stedenfeldt
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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