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Adherence to Pelvic Floor Physical Therapy during COVID-19 Pandemic - A Retrospective Analysis

Adherence to Pelvic Floor Physical Therapy during COVID-19 Pandemic - A Retrospective Analysis

Presenting Author(s)

Nicole P. Jenkins, D.O.

Resident
Division of Urogynecology, Hackensack Meridian Health - Jersey Shore University Medical Center
EATONTOWN, New Jersey, United States

Co-Author(s)

Gregory Vurture, MD

Resident
Division of Urogynecology, Hackensack Meridian Health - Jersey Shore University Medical Center
Neptune, New Jersey, United States
SS

Scott W. Smilen, M.D.

Chair of Obstetrics and Gynecology
Division of Urogynecology, Hackensack Meridian Health - Jersey Shore University Medical Center
New York, New York, United States
NJ

Nina Jacobson, MD

Assistant Professor
Division of Urogynecology, Hackensack Meridian Health - Jersey Shore University Medical Center
Neptune, New Jersey, United States

Objectives: Recent literature has shown that COVID-19 has been a significant stressor for patients suffering from pelvic floor disorders (PFD) with a negative impact on their quality of life. Currently, the impact of COVID-19 on pelvic floor physical therapy (PFPT) for PFD is unknown. The aim of this study is to analyze the impact of COVID-19 on PFPT adherence.

Methods: All patients greater than 18 years of age that received referrals for PFPT for PFD between March 1st 2018 and March 1st 2022 were included in this retrospective study. Referrals given prior to March 1st 2020 were designated as “pre-pandemic”. Clinical notes were reviewed in detail to determine the number of sessions attended and completion of PFPT. Non-adherence was defined as the failure to initiate PFPT within one year from referral. Patients self-reported ethnicity/race. Barriers to initiating or continuing PFPT were tracked. This study was powered to detect a 50% difference in treatment non-adherence. Comparisons were made using Fisher exact test and Chi2 test as appropriate for nominal variables, and Mann-Whitney test for continuous variables.

Results: 173 women (80 pandemic vs 93 pre-pandemic) met inclusion criteria for the analysis. Patients in both groups were similar in age (p=0.12), race (p=0.89), BMI (p=0.64), parity (p=0.96), insurance type (p=0.43) and reason for referral (p=0.57). Adherence rates to PFPT were similar between the pre-pandemic and pandemic groups (20.0% vs 18.8%, p=0.85). After the first PFPT session, 72% of patients completed the PFPT program. Of the patients who completed PFPT, 73% reported a subjective improvement in symptoms. Patient reported barriers to PFPT across both cohorts included: insurance coverage, transportation, and time commitment. Five patients reported their concomitant comorbidities precluded them from initiating physical therapy. The COVID-19 pandemic and closure of non-essential services was noted by five patients as an interruption to care in the pre-pandemic population and two of those patients were offered/continued with virtual PFPT. In the COVID-19 pandemic group, two patients listed COVID-19 as a barrier to initiation of PFPT.

Conclusions: There were no significant differences in adherence to PFPT before or during the pandemic. We report an overall adherence rate of 19.4%, which is consistent with recent literature. Patients who attended at least one visit were likely to complete treatment and report subjective improvement in PFD symptoms. Given the challenges posed by the pandemic, the use of in-network or local PFPT facilities or home visits by PFPT therapists, could potentially improve adherence rates. However, further prospective study is needed to determine whether these changes increase adherence to PFPT initiation. Overall, our study contributes to the understanding of adherence to PFPT during the COVID-19 pandemic and provides insights for healthcare providers to improve patient adherence to this crucial nonpharmacological treatment for PFD.