DIRECT ACCESS TO PELVIC FLOOR PHYSIOTHERAPY: PRACTICE DEVELOPMENT IN MACCABI HEALTHCARE SERVICES, ISRAEL

N. Beyar¹, M. Sade²

¹Maccabi Healthcare Services, Tel Aviv, Israel, ²Maccabi health services, Israel, physical therapy, modiin, Israel

Background: Access to physiotherapy services in public healthcare system in Israel has previously been attained only through a physician referral. Starting 2017, Maccabi Healthcare Services initiated a self-referral policy to physiotherapy in Musculoskeletal disorders. Due to its well-perceived integration, an expansion to other areas of expertise in physiotherapy was introduced in 2020 including pelvic floor rehabilitation. For pelvic floor evaluation and treatment it is essential to distinguish between patients who can be treated without a pre physician examination, patients who can be treated but needs a physician consultation, and patients who need an immediate physician examination or emergency care. For this initial first contact evaluation we developed a training program for physiotherapists. Here we present a “traffic light” identification process and evaluation program which defines green, yellow and red-flags.

Purpose: The purpose of this project was to establish a direct-access training program for pelvic floor physiotherapists so as to make physical therapy services accessible and safe for large numbers of patients.

Methods: A physiotherapy-related literature review was conducted in order to find defined red flags in various areas of pelvic floor therapy, as urology, gynecology, gastroenterology, dermatology and pelvic pain. As we could not find relevant publications, we defined our own criteria by categorizing patients’ complaints, symptoms and possible etiologies. After consultation with physicians specialized in these conditions a “traffic lights” (red, yellow or green) method was defined. We then conducted a This method was introduced into a training program for pelvic floor physiotherapists. This included a screening tool for the provision of safe treatments with direct access and an online training program through analysis of case studies. All physical therapists were required to undergo the training which qualified them to be “first contact” practitioners after passing an exam.

Results: It took two years to develop this project mostly by in-house district coordinators. We constructed tables detailing “traffic light” scenarios for twelve conditions - urinary incontinence, urinary infection, urinary retention, genital skin diseases, genital and vulvar infections and wounds, pelvic pain, vulvar pain, pelvic organ prolapse, fistula, constipation, fecal incontinence and pregnancy. All pelvic floor physiotherapists in Maccabi Health services underwent two hours of this online training and had to pass the exam with a minimum of 80 points. There was no increase in reported complaints of malpractice since the program’s establishment.

Conclusions: It is possible to develop direct access training program in pelvic floor physiotherapy by clinical physiotherapist along with collaboration with expert physicians in the relevant professions. Physiotherapists are sufficiently qualified to evaluate and treat pelvic floor dysfunction as first-line contact.

Implications: Publish definition of "traffic lights” in pelvic floor rehabilitation. Provide a platform for qualification of physiotherapists to treat patients through Direct Access

Funding acknowledgements: Unfunded

Keywords:
Direct access
Pelvic-floor

Topics:
Pelvic, sexual and reproductive health
Education: continuing professional development

Did this work require ethics approval? No

Reason: This work did not involved treatment or usage of patients information. It describes innovative ways in which established methods have been adapted to meet the changing needs of practice