Triangulation of a Needs Assessment on High Tone Pelvic Floor Dysfunction and Physical Therapy

Objectives: High tone pelvic floor dysfunction (HTPFD), a musculoskeletal subtype of chronic pelvic pain, is a complex condition challenging to manage effectively. Pelvic floor physical therapy (PFPT) is often utilized in the treatment of HTPFD, and relies on a synonymous effort between the physician, patient, and physical therapist. Collaboration is crucial for therapy success, but there is limited research including personal perspectives from these individuals. The objective of this qualitative study was to gain further insight from these groups in hopes to identify areas for improvement in patient counseling, communication, and understanding of the diagnosis of HTPFD and PFPT.

Methods: Participants in the following groups were recruited to participate in this grounded theory study; urogynecologists, pelvic floor physical therapists, and patients diagnosed with HTPFD. Subjects completed individual or small group interviews. The interview structure consisted of an initial conceptual framework that was used to develop a line of questioning focused on participant experience with HTPFD and PFPT, their knowledge of the topic, and surrounding phenomena. Several open-ended semi-structured interview questions were developed and tailored to the subgroups interviewed. Audio transcripts were de-identified and coded through both content and thematic analysis by two independent reviewers.

Results: Participants included 5 urogynecologists, 5 pelvic floor physical therapists, and 15 patients. Patients were placed into subgroups depending on their exposure to physical therapy: new (just recommended therapy) intermediate (in the middle of the therapy), and advanced (completed therapy). Interviews ranged from 30-60 minutes. Similarities amongst all groups (physicians, therapists, and patients) in key themes identified consisted of; 1) the usefulness of pelvic models and illustrations in patient counseling, 2) satisfactory physician descriptions of HTPFD, 3) motivating factors for patients, and 4) consistent reporting of patient barriers to completing therapy (cost, time and appointment availability). Several emergent themes also revealed a misalignment in perspectives; 1) patients reporting an unclear understanding of PFPT, 2) patient unawareness of the intimacy of PFPT, and 3) concerning reports of unsupportive and unemphatic 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 pelvic floor physical therapy. Acknowledging these comparisons and adapting practices could improve patient understanding and participation in their care.