PROFILE OF PATIENTS TREATED IN THE PELVIC FLOOR REHABILITATION SERVICE OF A PUBLIC HOSPITAL IN TERESINA, BRAZIL

L. Lial¹, L. Araújo², N. Ribeiro³, A. Thrush¹, S. Dias⁴

¹Cleveland Clinic Abu Dhabi, Rehab Medicine, Abu Dhabi, United Arab Emirates, ²Centro Universitário Uninovafapi, Teresina, Brazil, ³Instituto Lato Sensu, Teresina, Brazil, ⁴Universidade Federal do Delta do Parnaíba - UFDPAR, Physiotherapy, Parnaíba, Brazil

Background: Existence and awareness of pelvic floor rehabilitation services in Brazil have grown but remain as an emerging area. Access to this service is hindered by a number of barriers, such as the availability of the service in primary healthcare and the variability in training and knowledge of health professionals.The pelvic floor muscles (PFM) support the pelvic organs and due to their location and function are susceptible to many dysfunctions. Understanding the common characteristics of patients who present with pelvic floor dysfunctions is essential for equitable, comprehensive, and quality patient care that can be based on scientific evidence.

Purpose: To characterize the profile of patients treated at an outpatient pelvic floor rehabilitation service in Teresina, Brazil.

Methods: A retrospective review was performed to summarize data from physiotherapy sessions at the Outpatient Pelvic Physiotherapy Service in an urban public hospital in Teresina, Piauí, Brazil. Patients were included if they received at least one physiotherapy session from 2017 to 2020, and if records contained the following information: gender, age, educational level, BMI, pelvic floor diagnosis and strength of the PFM measured by the Modified Oxford Scale (MOS). Descriptive data was used to summarize findings.

Results: 156 patients met inclusion criteria and are analyzed in this study. The number of sessions varied from 20-40 sessions per patient. The sample consisted 81% women,17% of men, and 2% children. Average age was 50.2 years and BMI mean was 25.4 kg/m². 35.9% of patients did not complete middle school. The most common diagnosis was urinary incontinence, with stress urinary incontinence accounting for 56.25% of all cases, followed by mixed urinary incontinence (25%) and urge urinary incontinence (18.75%). Among men, 96% had UI as a result of prostatectomy. The functional evaluation of the PFM showed a mean of 2.5±0.80 for power in the MOS, 2.7±0.27 seconds for endurance test of pelvic floor contraction, and 4±0.76 number of repetitions of fast contractions. 40% of patients could not elevate PFM appropriately at evaluation, and 80% were unable to isolate PFM appropriately.

Conclusions: The profile identified in this study was composed mostly of women, with low education levels, and overweight. All the patients were diagnosis with at least one type of urinary incontinence. Strength of the PFM was low with most of the patients scoring 2/5 muscle strength, considered a weak muscle contraction. The vast majority of men had UI from a surgical cause, but just like the female patients they also presented lower scores on the MOS. The reduced muscle strength is a contributor to pelvic floor dysfunctions which a specialized physiotherapy service can prevent and treat in order to improve patient quality of life.

Implications: Pelvic floor physiotherapy services is a specialized but uncommon service, and one that requires an enhanced understanding of the population being served. Findings from this study will facilitate this clinic in Brazil to better design and implement care considering the largely female population with lower education level, with several common medical diagnoses, and with a common pattern of significant PFM weakness.

Funding acknowledgements: This work is unfunded.

Keywords:
Urinary incontinence
Pelvic floor muscles
Pelvic floor rehabilitation

Topics:
Pelvic, sexual and reproductive health
Musculoskeletal
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: Hospital Getúlio Vargas in Teresina, Piauí, Brazil.

Committee: Ethics Committee for Research with Human Beings Hospital Getúlio Vargas

Ethics number: 2868073