IMPLEMENTATION OF PELVIC FLOOR PHYSICAL THERAPY CLINIC IN THE UAE: CHALLENGES & BARRIERS

Background: The PFPTC in Cleveland Clinic Abu Dhabi was established in 2018 upon increasing demands. Several challenges specific to the Middle Eastern culture were encountered during the implementation of this service.

Purpose: The purpose of this study is to share the growth, outcomes, and challenges encountered during the first two years of operation.

Methods: The following metrics and outcomes were derived retrospectively from the hospital database for 2018 and 2019: patient demographics, number of sessions completed, number of referring specialties, and patient experience reports. Administrative challenges from the perspective of the lead physical therapist are also provided.

Results: Since the inception of the program, Emirati nationals comprise 69.7% of all patients, and 66.1% are women. The most common age groups treated were 42-61 and 22-41 years of age (46.7% and 36%, respectively). The number of patients seen increased by 73% in the second year (to 519 patients). The number of female patients and male patients increased by 62% and 95%, respectively. The number of Emirati national patients increased by 59% while the number of expatriate patients increased by 117%. Patient experience scores increased in the second year which are attributed to an improvement in the waiting time for booking patients by increasing the service up to 40 hours/week in the second year, as limited availability was an initial source of dissatisfaction. The number of referring specialties increased from three to fifteen from the first to second year.

Conclusion(s): Based on its growth in the first two years of operations, we can conclude that PFPTC has been well received. In particular, growth in the rate of men seeking PFPT and the number of medical specialties referring to the service demonstrate the need that is being filled and improved awareness. However, there were significant challenges that were faced during the implementation of the PFPTC service, which includes: an initial lack of awareness of pelvic physical therapy services among the public and medical professionals; lack of patient compliance due to cultural and religious factors; seasonal fluctuations in demand due to the Ramadan holy month, language barriers, and poor self-management behaviors. The difficulty was also experienced in importing pelvic floor supplies and tools into a religiously conservative country. If establishing this service in a similar context, therapists should take into account the additional time and processes needed in order to: import devices and supplies such as vaginal dilator and pelvic wand, arranging referral and administrative processes, and building awareness of the public and medical professionals. During service planning, it may be preferable to have physical therapists of both genders available; however, alternative methods of assessment and education are possible during mixed-gender sessions that can overcome the resistance and barriers that are presented.

Implications: The likelihood of acceptance and success of a PFPT service in the context of a conservative country was unknown but has quickly proven to be a much needed and desired service that has grown rapidly. There are many lessons learned which are valuable to others seeking to provide this important service in similar contexts.

Funding, acknowledgements: The author(s) received no specific funding for this study.

Keywords: Pelvic Floor Physical Therpy, Pelvic Health, Service

Topic: Pelvic, sexual and reproductive health

Did this work require ethics approval? No

Institution: Cleveland Clinic Abu Dhabi

Committee: Research Ethics Committee

Reason: The purpose of this abstract is to summarize data gathered from a patient registry and does not address a research question.