We are finally emerging from this pandemic greeting the opening of society with relief and joy. Fully vaccinated people became a favored class finally able to embrace the world. While some relished the separation necessitated by the pandemic, using this time to take stock and reflect on life, others hated it and were overburdened with added responsibilities. Many just endured the frustrations inherent in dealing with a remote, online life. The pandemic has left its mark and we are all personally changed by this shared experience. It has heightened our awareness of issues previously unnoticed or overlooked.
There now is a dichotomy between the people who are fully vaccinated and those who refuse or are unable to get a vaccination. In some individuals, vaccine reluctance can stem from a lack of understanding that the virus life cycle depends on unwitting hosts. Any human will do. Borrowing the cellular machinery of an unwitting host is how a virus reproduces to live another day. Yet many remain unvaccinated due to lack of access, unable to find the time and place to become vaccinated. We have seen this disparity before, maybe it just went unnoticed as well.
The health care disparities, which existed prepandemic, have become more prominent, as we grasp the consequences of these deficiencies. What does this mean for physical therapy? In 2021, Odonkor et al1 examined the literature finding limitations in access to rehabilitation care, fewer referrals, and lower utilization rates resulted in racial disparities in the rehabilitation of individuals with neurological, musculoskeletal, cardiac, and pulmonary dysfunction. Similarly, Flores et al2 found that the Hispanic population may be at risk for poor outcomes for these conditions due to the nonbiologic factors of low access to rehabilitation services and disparities in the referral process. Despite improvements in women's health, racial and ethnic disparities persist in access and outcomes of reproductive health.3
On a day-to-day basis, limited access to health care and the social determinants of health are probably not in the forefront of your mind. But it does impact on your practice if you are only seeing the proportion of our society privileged enough to have both good health insurance and savvy enough to find their way to a specialized physical therapist. We have a shared responsibility beyond an awareness that these inequalities exist to partner with government and health care agencies to help improve the health of the underserved. Perhaps one of the most important lessons of this pandemic is the health of the few affects the health of the many.
—Cynthia M. Chiarello, PT, PhD
1. Odonkor CA, Esparza R, Flores LE, et al. Disparities in health care for black patients in physical medicine and rehabilitation in the United States: A narrative review. PM R. 2021;13(2):180–203. doi:10.1002/pmrj.12509.
2. Flores LE, Verduzco-Gutierrez M, Molinares D, Silver JK. Disparities in health care for Hispanic patients in physical medicine and rehabilitation in the United States: a narrative review. Am J Phys Med Rehabil. 2020;99(4):338–347. doi:10.1097/PHM.0000000000001342.
3. Sutton MY, Anachebe NF, Lee R, Skanes H. Racial and ethnic disparities in reproductive health services and outcomes, 2020. Obstet Gynecol. 2021;137(2):225–233. doi:10.1097/AOG.0000000000004224.
Highlights in This Issue:
This issue contains valuable articles, which are immediately applicable in your pelvic health practice. Dockter and colleagues surveyed physical therapy students from 3 distinct programs regarding their comfort level in discussing sexual issues with patients including the influence of demographics and perceived barriers. In a retrospective study of individuals with interstitial cystitis, Crouss and Whitmore compared voiding dysfunction in those with nonsevere and severe pelvic floor dysfunction. They also examined the relationship between urodynamic and cystoscopic findings to symptom severity in those with interstitial cystitis. Fricke and associates completed a systematic review on the impact of pelvic floor muscle training interventions on urinary incontinence in women older than 50 years. The authors incorporate clinical recommendations based on the findings of this review. In a prospective study, Foster et al compared hip muscle strength and pelvic floor muscle strength and endurance in women with and without the lower urinary tract symptoms of urgency and frequency. The authors advocate incorporating hip muscle strengthening in the care of these individuals. Completing this issue, Crowle and Harley present a clinical case series of 33 women illustrating the clinical outcomes of biotensegrity-focused therapy for pelvic organ prolapse.