Improving Pelvic Floor Dysfunction Screening in Primary Care

Background: Dysfunction means that something is not working appropriately. The pelvic floor is composed of a network of muscles, ligaments, and tissues that act like a hammock to support the organs of the pelvis: the uterus, vagina, bladder, urethra, and rectum. If the muscles of these organs become sensitive or strained, there may be pain in the pelvis or dysfunction of these muscles, formally referred to as Pelvic Floor Dysfunction (PFD). Purpose: To increase awareness in primary care providers of PFD and to facilitate the use of formalized PFD screening tools, proper PFD treatment, and timely referral for PFD. Methods: The setting was in an urban primary care community health clinic in the Salt Lake City region of Utah. A modified PFD screening tool and PFD algorithm were developed. A PFD knowledge pretest, education module, and posttest were administered. The modified PFD screening tool and PFD algorithm were implemented in the clinic for a three-month trial period. The providers completed a user survey regarding satisfaction, usability, and self-reported frequency of the PFD screening tool. Results: The pretest revealed a deficit in baseline knowledge of PFD with 33% of the providers scoring below 50% on the pretest. The educational module proved effective with 100% of the providers scoring 100% on the posttest. A paired signed rank Wilcoxon test on the PFD pretest and posttest results was a p value= 0.0975. The user survey revealed overall satisfaction with the tool, ease of use, and moderate probability for continued use. Conclusion: Based on provider feedback modifications were made to the algorithm. Continued research needs to take place to see if these changes make the providers more apt to use the algorithm and then further research needs to be completed on the specificity and sensitivity of the modified PFD screening tool.