Our primary objective was to determine if patient reported outcome measures (PROMs) in females referred for PT treatment for PFMP vary by treatment pathway. Our secondary objective was to describe co-morbidities, medication usage, number of PT appointments, and healthcare utilization of female patients with PFMP referred for PT.
We conducted a retrospective cohort analysis on females with a diagnosis of pelvic pain and PFMP referred for PT in our single center healthcare setting. Patients either received PT, medication management, injection therapy, or a combination of these treatments. We limited the analysis of PROMs to patients with both pre- and post-treatment PROM scores. Wilcoxon rank sum tests were used to compare PROM scores. We collected data on comorbidities, and recorded healthcare utilization patterns, medication usage, and number of PT appointments.
Out of 1,172 patients, only 7% to 19.2% completed both pre-and post-treatment PROMs limiting our ability to draw conclusions about PROMs. In the medication plus injection therapy group, there was a significant decrease in the PROM domain of fatigue. Otherwise, there were no statistically significant changes in PROM scores following treatment in any of the treatment groups. All patients were referred to PT, but 19.5% did not attend any PT sessions. Only 18% of patients attended 5 or more recommended PT sessions. Comorbid urinary dysfunction (48.5%) and bowel dysfunction (43%) was prevalent. Patients demonstrated high healthcare utilization as shown by numbers of consultations with multiple medical providers, including 72.3% attending one gynecology appointment, and 44.1% attending more than one gynecology appointment. Forty-one-point-six percent consulted with Physical Medicine and Rehabilitation, and 36.7% had a consultation in Gastroenterology. Vaginal diazepam suppositories were used by 41%. Most patients (57.1%) utilized opioid medication, and 49.7% utilized antidepressants.
We could not determine if different treatment pathways influence patient outcomes due to limited PROM data. Our study corroborates previous findings that pelvic pain and PFMP are associated with high utilization of resources, high opioid use, and low attendance to PT (Green 2024). Further investigation of PROMs in the treatment of females with pelvic pain and PFMP is needed to determine optimal care pathways and treatment results that matter to patients, providers, and other stakeholders.
Treatment outcomes of females seeking care for pelvic pain at our institution is unchartered territory and cannot be determined at this time. Unknown outcomes may lead to persistent or worsening chronic pain in this patient population, reduced quality of life, repeat episodes of care, unnecessary surgery, and increased financial burden (Engeler 2013). This study lays the groundwork for future investigations into outcomes of treatment comparing care pathways for females with PFMP.
physical therapy adherence
patient reported outcome measures
