Psychological support to enhance treatment compliance and outcomes for female pelvic floor dysfunction
Female pelvic floor dysfunction affects up to 25% of all women in the UK, and can significantly affect a woman’s quality of life. It can be treated effectively by pelvic floor muscle training (PFMT) physiotherapy, but it has been found that some women find it difficult to complete a course of PFMT. Research conducted by ourselves, at Swansea University and Singleton Hospital, Swansea, has found a range of psychological factors that impact on both attendance at PFMT sessions, and its outcomes, as well as ways in which women with these psychological characteristics can be supported through their PFMT.
Many women with pelvic floor dysfunctions show signs of depression and anxiety, as well as reduced motivation to engage with therapy and change their behaviours. All of these factors reduce their attendance at physiotherapy. Additionally, some women do not put the same value on their own health needs, as they do on extrinsic factors (such as the health of their family members), and so do not attend their physiotherapy appointments.
Based on this research, we have developed a screening tool predicting patient attendance, and have also developed psychological-support programmes that significantly reduce ‘did not attend’(DNA) rates, promote compliance and co-production, enhance outcomes, and generate NHS-savings through preventing the need for expensive and unnecessary operations.
A randomised controlled trial (RCT), concerning a brief (5-10 min) telephone call giving psychological support to patients on the waiting list, demonstrated greatly reduced DNA rates for PFMT sessions. An RCT of a brief motivational and health-values intervention for patients undergoing PFMT showed substantially elevated treatment attendance and adherence with PFMT.
These interventions reduced DNA rates, improved compliance, and enhanced clinical improvements in pelvic floor functioning, resulting in better patient outcomes and cost savings from preventing patients undergoing surgery. A finding also noted in a recent POGO benchmarking survey.
- Key predictors of non-attendance include: patient age, socio-demographic characteristics, levels of depression, anxiety, motivation, and health-values.
- A telephone-based support intervention, whilst on the waiting list, boosts initial attendance at PFMT sessions.
- Brief group-based psychological-support sessions boost PFMT completion, and enhance clinical outcomes.
- The estimated savings to the NHS, in terms of preventing unnecessary operations, are around £1,000 per patient referred.
- A screening tool has been developed to predict which women will benefit most from PFMT and psychological support.