Assessing Attendance to Pelvic Floor Physical therapy in a Postpartum Patient Population

Objectives: Limited data exist describing attendance to pelvic floor physical therapy in a postpartum patient population. We aimed to describe attendance to pelvic floor physical therapy (PFPT) in a cohort of postpartum women at high risk for pelvic floor concerns. We secondarily compared attendance between patients with and without evaluation in a postpartum pelvic floor healing clinic (PPFHC versus pre-PPFHC), hypothesizing that the PPFHC cohort would have higher PFPT attendance and number of visits than the pre-PPFHC cohort.

Methods: Retrospective cohort study of two datasets (both convenience samples) from a large academic hospital. The PPFHC cohort comprised all postpartum vaginal delivery patients seen from July 2021-July 2022. The historical pre-PPFHC cohort comprised all patients with third or fourth-degree obstetrical lacerations after vaginal delivery from December 2019-January 2021. Our primary outcome was attendance at PFPT (attendance defined as at least one visit). Secondary outcomes included total number of PFPT visits, change in pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ) scores, and discharge status. We used T-tests, Mann-Whitney U, chi-square and Fisher’s exact for statistical analyses (IBM SPSS 28). This project was IRB approved.

Results: Our cohort consisted of 464 patients, 195 (42.0%) from pre-PPFHC and 269 (58.0%) from PPFHC. Among allcomers, 302 (65.1%) were referred to PFPT and 170 (56.3%) attended at least one visit. The majority (97.0%, n=261) seen in the PPFHC were referred to PFPT, compared to 22.0% (n=41) of pre-PPFHC (p< 0.01). Of patients referred, 53.5% (n=139) in the PPFHC versus 75.6% (n=31) in pre-PPFHC attended at least one PFPT visit (P< 0.01, Table 1). The median number of PFPT visits was similar between groups (pre-PPFHC 7 visits (IQR 4-10) vs. PPFHC 5 visits (IQR 3-10), P= 0.29). Overall, 48.2% were discharged from PFPT with goals met and not different between groups (Table 2). A subset of patients completed the PFDI (n=110) and PFIQ (n=109). The majority of patients demonstrated improvement in PFDI and PFIQ scores over the course of treatment (n=88, 80.0% and n=89, 81.7% respectively). Overall, median PFDI scores improved by 21.87 points (-55.20, -4.17) and median PFIQ scores improved by 19.04 points (-42.86, -4.76). There was no difference in PFDI or PFIQ scores among women seen in the historical cohort versus the PPFHC (Table 2).

Conclusions: Overall, rates of attending and completing postpartum PFPT were 56% and 48%, respectively. A dedicated postpartum pelvic floor healing clinic had more referrals, however lower PFPT attendance rates when compared to a historical cohort. Our data suggest that a more selective PFPT referral strategy is associated with improved attendance, although no difference in total number of PFPT visits or patient reported outcomes. The majority of patients who completed outcome questionnaires demonstrated symptomatic improvement in both groups.