K.-Y. Lin1,2, Y.-J. Tsai1,2, J.-F. Yang1,3, M.-H. Wu4,5
1National Cheng Kung University, Department of Physical Therapy, Tainan, Taiwan, 2National Cheng Kung University, Institute of Allied Health Sciences, Tainan, Taiwan, 3National Cheng Kung University Hospital, Physical Therapy Center, Tainan, Taiwan, 4National Cheng Kung University, Department of Obstetrics and Gynecology, Tainan, Taiwan, 5National Cheng Kung University Hospital, Department of Obstetrics and Gynecology, Tainan, Taiwan
Background: Women may experience many physical and psychological symptoms during pregnancy and after childbirth. However, pregnant/postpartum women are often reluctant to seek help from health professionals or utilize health care services.Emerging evidence suggests that age, sex, socioeconomic status, educational level, health status, and awareness or knowledge about physical therapy are associated with utilization of physical therapy. However, little is known about the factors associated with utilization of physical therapy specifically in pregnant/postpartum women.
Purpose: To explore factors associated with utilization of antepartum/postpartum physical therapy.
Methods: This is a secondary analysis of a cross-sectional survey of 298 women who were receiving or had received obstetric care at a medical center in southern Taiwan. Data were collected using an online questionnaire, which included demographic, medical, and obstetric details, the symptom severity questionnaires (six-point engorgement scale, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, Pelvic Floor Distress Inventory, Oswestry Disability Index, and Numerical Rating Scale), management strategies, and experience and perception about physical therapy. Descriptive statistics, independent t test, chi-square analysis and multivariate logistic regression model were used to analyze data.
Results: Participants who received physical therapy during pregnancy and/or after childbirth (n=53) had a median age of 32 years (interquartile range [IQR] = 7). Fifty six percent of participants in this cohort were postpartum. Participants who did not receive physical therapy during pregnancy and/or after childbirth (n=245) had a median age of 34 years (IQR = 7). Most of participants in this cohort were pregnant (67.8%) at the time of data collection. The most commonly reported pregnancy/postpartum-related symptoms by participants in both cohorts were fatigue, nausea, and morning sickness.
Significant differences were found in age (p=0.02), identity (pregnant/postpartum) (p=0.003), occupation (p=0.047), and highest level of education (p=0.017) between participants who did and did not receive antepartum/postpartum physical therapy. Participants who had received physical therapy reported having more experience of depressive symptoms during pregnancy and/or after childbirth compared to those who did not receive physical therapy (p=0.004). Participants who had received physical therapy reported significantly higher Oswestry Disability Index scores than those who did not receive physical therapy (p=0.007).
Multivariate analyses showed that being postpartum, having an associate degree and below, and experiencing depressive symptoms were associated with higher odds of utilizing physical therapy than being pregnant, having a bachelor degree and above, and not having depressive symptoms (postpartum: OR 3.039, 95%CI 1.530, 6.035; associate degree and below: OR 2.521, 95%CI 1.007, 6.316; depressive symptoms: OR 3.606, 95%CI 1.067, 12.185). The odds of utilizing physical therapy decreased with age (OR 0.935, 95%CI 0.874, 1.000).
Significant differences were found in age (p=0.02), identity (pregnant/postpartum) (p=0.003), occupation (p=0.047), and highest level of education (p=0.017) between participants who did and did not receive antepartum/postpartum physical therapy. Participants who had received physical therapy reported having more experience of depressive symptoms during pregnancy and/or after childbirth compared to those who did not receive physical therapy (p=0.004). Participants who had received physical therapy reported significantly higher Oswestry Disability Index scores than those who did not receive physical therapy (p=0.007).
Multivariate analyses showed that being postpartum, having an associate degree and below, and experiencing depressive symptoms were associated with higher odds of utilizing physical therapy than being pregnant, having a bachelor degree and above, and not having depressive symptoms (postpartum: OR 3.039, 95%CI 1.530, 6.035; associate degree and below: OR 2.521, 95%CI 1.007, 6.316; depressive symptoms: OR 3.606, 95%CI 1.067, 12.185). The odds of utilizing physical therapy decreased with age (OR 0.935, 95%CI 0.874, 1.000).
Conclusions: Individual factors, such as age, education level, pregnancy status, and experience of depressive symptoms, had a significant association with utilization of antepartum/postpartum physical therapy and should be considered when developing obstetric care pathways to optimize clinical and healthcare utilization outcomes.
Implications: Sociodemographic and health factors of pregnant/postpartum women should be examined when physical therapists become more actively participate in obstetric care.
Funding acknowledgements: The study was supported by the Ministry of Science and Technology (Taiwan) under Grant MOST 109-2314-B-006-041-MY3.
Keywords:
Physical Therapy
Pregnancy
Postpartum
Physical Therapy
Pregnancy
Postpartum
Topics:
Service delivery/emerging roles
Pelvic, sexual and reproductive health
Service delivery/emerging roles
Pelvic, sexual and reproductive health
Did this work require ethics approval? Yes
Institution: National Cheng Kung University Hospital
Committee: Institutional Review Board
Ethics number: --/A-ER-108-221
All authors, affiliations and abstracts have been published as submitted.
