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Barriers to Pelvic Floor Physical Therapy Regarding Treatment of High-Tone Pelvic Floor Dysfunction

Zoorob, Dani MD*; Higgins, Margaret MD; Swan, Kimberly MD; Cummings, Jennifer DPT§; Dominguez, Sarah DPT§; Carey, Erin MD, MSCR

Female Pelvic Medicine & Reconstructive Surgery: November/December 2017 - Volume 23 - Issue 6 - p 444–448
doi: 10.1097/SPV.0000000000000401
Original Articles

Objective Chronic pelvic pain is a prevalent and debilitating condition with a wide range of etiologies. An estimated 30% to 70% of chronic pelvic cases involve musculoskeletal component pain including high-tone pelvic floor dysfunction (HTPFD). Pelvic floor physical therapy has been shown to be a beneficial treatment for HTPFD, yet many patients do not have access to this treatment. The objective of this study was to identify the barriers preventing patients from following through with the first-line management, physical therapy.

Methods Participants with a diagnosis of HTPFD (n = 154) were identified from the list of referrals sent from the obstetrics and gynecology department to an affiliated PFPT center. Participants were contacted and asked to complete a phone survey addressing demographics and perceived barriers to care. Responses were collected in REDCap. Univariate and bivariate analyses were performed using a statistical analysis software.

Results Seventy surveys were completed. The top barriers identified by participants were financial constraints (51.4%), perceived lack of utility (37.1%), time constraints (30.0%), and travel issues (18.6%); 84.4% of participants had 1 or more comorbid pain condition. Whereas 51.4% expressed some level of anxiety regarding the PFPT option, only 9.6% of participants did not start treatment because of fear of treatment.

Conclusions The majority of treatment barriers identified were concrete restraints, with insurance noncoverage and time constraints being the top issues. A fair number of participants expressed anxiety about the treatment or felt they received unclear explanations of the treatment. These are areas in which providers can potentially alleviate some barriers to care.

Time, cost, logistics, and negative perceptions of pelvic floor physical therapy are among the barriers that hinder its use for the treatment of high tone pelvic floor dysfunction.

From the *Division of Female Pelvic and Reconstructive Medicine, Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS; †Department of Urology, University of Kentucky College of Medicine, Lexington, KY; ‡Department of Obstetrics and Gynecology, University of Kansas Medical Center; and §Foundational Concepts Pelvic Floor Physical Therapy, Kansas City, MO; and ∥Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Reprints: Dani Zoorob, MD, Division of Female Pelvic and Reconstructive Medicine, Department of Obstetrics and Gynecology, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2028, Kansas City, KS 66160. E-mail:

The authors declare that they have nothing to disclose.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.