Outcomes of Pelvic Floor Physical Therapy in the Treatment of Levator Spasm and Voiding Dysfunction
Kakos D, Irish V, Diaz-Insua M, and Atiemo H. Outcomes of Pelvic Floor Physical Therapy in the Treatment of Levator Spasm and Voiding Dysfunction. Neurourol Urodyn 2018; 37:S606-S607.
Introduction: Pelvic Floor Physical Therapy (PFPT) is a validated, first line treatment for patients experiencing levator spasm (LS) and voiding dysfunction (VD); however, few studies have characterized the success rate of PFPT or barriers to treatment. This study aims to expand the scientific knowledge regarding the outcomes and utilization of PFPT for LS and VD, and to examine barriers to patient compliance with treatment regimens. Methods: A retrospective chart review was performed for all female patients diagnosed with LS and VD between January 2012 and December 2016. Patients seen by providers other than the Principal Investigator (PI), who received physical therapy services outside of a Henry Ford Facility, or who were under 18 years old were excluded. The incidence of referrals and completion rates of PFPT were recorded. Patient assessed outcomes using validated measures, the American Urological Association Symptom Score (AUASS), AUASS Quality of Life (QOL), the Michigan Incontinence Symptoms Index (M-ISI), and M-ISI Bother were recorded before and after PFPT attendance. For those patients who did not attend or complete PFPT, barriers to treatment were recorded. Statistical significance of the change in the quality of life instruments was examined with the paired t-test. Results: A total of 414 patients were included in the study. Of those, 249 (60%) were prescribed PFPT. 130 (52%) patients were compliant and attended PFPT. 61 (51%) patients completed PFPT. Patients who completed PFPT attended a mean of 6.1 ± 3.3 sessions. Data on 30 women who completed physical therapy was available. A significant improvement, illustrated by a decrease in baseline scores, was seen in AUASS (-6.2 ± 7.1 (n = 30), p < 0.001), AUASS QOL (-1.0 ± 1.5 (n = 26), p < 0.003), M-ISI (-5.3 ± 7.0 (n = 25), p < 0.001), and M-ISI Bother (-1.6 ± 1.5 (n = 27), p < 0.001). Patients listed transportation (n = 15), financial barriers (n = 14), and other medical issues (n = 15) as barriers to attending and/or completing PFPT. Conclusion: Patients diagnosed with LS and VD are significantly improved on validated urinary symptom scores after a mean of 6 PT sessions. The utilization of PFPT is about 60%, the compliance in attending PT is 52%, and 51% of patients complete PFPT. We have seen that transportation, financial barriers, and other health issues play a key role in preventing patients from attending and/or completing PFPT.