Improving Care for Patients with Pelvic Floor Dysfunction

  • Laura Thomas

Student thesis: Unknown

Abstract

Abstract Introduction Pelvic floor dysfunction (PFD) is an umbrella term used to describe symptoms that occur as a result of disruption to the pelvic floor muscles or ligaments. Treatment of PFD is complex due to its concomitant symptomatology, spanning across different pelvic compartments. Efficient care for patients with PFD therefore requires multiple clinical specialisms to work closely and cohesively to offer holistic joined-up care (Knowles et al, 2021). In the United Kingdom (UK) alone, approximately 14 million people currently struggle with bladder problems, and a further 6.5 million adults live with some form of bowel dysfunction (NHS, 2018). Additionally, the data suggests that 9 million in the UK have experienced combined faecal and urinary incontinence (Hall, 2019) - a number which omits other PF symptoms. Therefore, the overall volume of patients with PFD involving more than one pelvic compartment is likely to be greater than this. The increasing burden of PFD on both patients and the overall healthcare system has triggered calls for increased clinician engagement, with the Pelvic Floor Report identifying possible areas for service development and improvement (Knowles et al, 2021). This work aims to summarise the current landscape for this group of patients and explore possible barriers to efficient care. Study Design and Methods Initially, clinical data was reviewed to establish the volume of patients presenting with greater than one pelvic floor (PF) symptom. Patients attending secondary care for physiotherapy (n = 52), urodynamics (n = 14,909), and anorectal physiology (n = 585) were included. Data was collected through clinical databases as well as clinic notes. This data was initially obtained through standardised questionnaires and clinical history taking. Patients were included if they reported any symptoms across more than one PF compartment. Qualitative data was then collected from clinical groups who provide care for patients with PFD. Service provider perspectives included general practitioners, community continence services, secondary care teams and commissioning, reflecting on referral pathways, a joint formulary electronic platform, and their care provision. Service user perspectives were provided by patients. A multi-channel approach to qualitative data collection was employed, including informal interviews, group workshops, think aloud activities and an anonymous survey. Results Reporting of concomitant PF symptoms in our patient groups ranged from 15% - 69%. During urodynamic history taking, 15% of patients reported bothersome bowel symptoms, 65% of those attending for anorectal physiology described bothersome urinary symptoms, and finally 69% of those attending physiotherapy stated experiencing at least one additional PF symptom to their primary referral indicator. Qualitative data and transcripts were reviewed, with thematic analysis being performed to identify common themes and topics associated with the management of PFD and the perceived barriers to good patient care. The themes focused on communication, education, specialist care, referral pathways and duplication of efforts. Commonly used words and phrases, along with problem statements which concisely outlined a current challenge or opinion, were also reviewed. Interpretation of Results Prevalence of concomitant PF symptoms (PFS) varies across local referral specialisms. This is possibly indicative of the physiological progression of PFD, but may also be attributed to different clinical questioning and clinician interests. Large bodies of work have highlighted the need for joined-up PF care. By exploring the themes extracted from our stakeholder interactions, we can address current barriers and make recommendations to facilitate better care for these patients. ‘Streamlining’ referral pathways may better ensure the right patients are seen by the right clinicians and at the right point in their healthcare journey. This could reduce the p
Date of Award1 Aug 2024
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorNikki Cotterill (Supervisor) & Kai Uus (Supervisor)

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