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Physical Examination Findings by Physical Therapists Compared With Physicians of Musculoskeletal Factors in Women With Chronic Pelvic Pain

Neville, Cynthia E. PT, DPT, WCS, BCB-PMD1; Fitzgerald, Colleen M. MD2,3; Mallinson, Trudy PhD, OTR/L4; Badillo, Suzanne Aceron PT, WCS2; Hynes, Christina K. MD2,4

Journal of Women’s Health Physical Therapy: September/December 2010 - Volume 34 - Issue 3 - p 73–80
doi: 10.1097/JWH.0b013e3181fceb82
Research Reports

Objective: To determine the degree to which physical therapists (PTs) and physiatrists (MDs) agree in their assessment of musculoskeletal examination findings in women with self-reported chronic pelvic pain (CPP).

Study Design: Prospective, cross-sectional study.

Background: Musculoskeletal factors are associated with CPP in women yet are often not recognized by frontline physicians. Physical therapists, who are skilled in the evaluation and treatment of women with CPP, may effectively act as a primary point of entry into care for these women.

Methods and Measures: One MD (physiatrist) and 1 PT performed 9 musculoskeletal examination maneuvers on each study participant. Examiners were blinded as to whether the participants were pain-free or had self-reported CPP.

Results: Participants with no pain had similar findings when examined by PTs and MDs. Participants with self-reported CPP had a higher number of positive examination findings when examined by a PT as compared with an MD. The PTs' examination reached a sensitivity of 68.4% and specificity of 93.1%, accurately differentiating 85% of self-reported CPP status of participants by musculoskeletal examination. Physiatrists maximized examination sensitivity at 68.4% and specificity at 69.0%, differentiating 69% of self-reported CPP status of participants from pain-free participants.

Conclusions: Physical therapists and physiatrists successfully identified women with self-reported CPP via physical examination maneuvers with high specificity and sensitivity. Access by women with CPP to PTs and MDs for the evaluation of musculoskeletal factors as a source of CPP may enable earlier and more precise diagnosis, and potentially earlier treatment, of musculoskeletal causes of pelvic pain.

1.Brooks Rehabilitation, Jacksonville, Florida

2.RIC Women's Health Rehabilitation Program, Rehabilitation Institute of Chicago, Chicago, Illinois

3.Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, Illinois

4.Division of Occupational Science and Occupational Therapy, University of Southern California.

Copyright © 2010 Section on Women's Health, American Physical Therapy Association
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