Underutilization of Pelvic Floor Physical Therapy: Addressing Attitudes and Barriers

This Doctoral Scholarly project addressed the unnecessary negative impacts of pregnancy related pelvic floor dysfunction through increasing midwife provider knowledge and utilization of Pelvic Floor Physical Therapy (PFPT). To this end PFPT and pregnancy related condition facts were gathered and synthesized through a literature review and through content expert consultation. Dissemination occurred through writing, editing and submitting a manuscript for publication in the Journal of Midwifery and Women's Health. PFPT is a low-risk, minimally invasive treatment modality that improves functioning and quality of life for a variety of pelvic floor dysfunction and disorders, and should be used as a first-line treatment. However, a large number of women needlessly suffer from pelvic floor dysfunction across the lifespan because PFPT is underutilized by providers. Urinary incontinence affects approximately 19% of women aged 19-44 years, 25% of those aged 45-64 years, and 30% of those aged 65 years or older. Diastasis recti abdominis occurs in 30-70% of pregnancies and persists in about 60% of cases in the postpartum period. Pelvic Organ Prolapse (POP) affects up to 60-65% of premenopausal primiparous women and there is an 11-19% lifetime risk of women undergoing surgery to correct this dysfunction. Prevention of musculoskeletal disorders through the use of PFPT contribute to decreased morbidity and improved quality of life; however, providers must know how and when to recommend PFPT to patients. Midwives primarily care for women in their childbearing years, and with childbearing itself being the primary cause of much pelvic floor dysfunction and disorders, midwives are placed in an ideal position to aid in the prevention, screening and early identification of pelvic floor dysfunction. Midwives must understand the benefits of PFPT in treating pelvic floor dysfunction if they are to refer patients to PFPT in a timely manner. The objectives of this project included reviewing current literature regarding benefits of PFPT and pregnancy-related conditions; identifying a journal interested in publication; dissemination of and, finally, disseminating the findings through submission of manuscript for publication in peer-reviewed journal. In order to implement this project, a thorough literature review and communication with a content expert and writing mentor was done in order to identify current research and relevant conditions to discuss. Journal editors of various women's health journals were contacted to determine interest in a manuscript discussing this topic, and a journal was selected with approval from the content expert and project chair. The manuscript as written with frequent review and editing by the content expert, project chair, writing mentor and paid editor before being submitted to the selected journal. Achievement of the aforementioned objectives were evaluated by successfully selecting a journal that had not published an article on this topic, writing/editing the manuscript and submitting the manuscript for publication prior to graduation. Pelvic Floor Physical Therapy is an evidence-based, effective treatment modality that remains underutilized, because of a knowledge deficit among women's healthcare providers. This manuscript stands to contribute to the field of women's health and midwifery by summarizing current literature into a meaningful resource for women's healthcare practitioners.