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8. Factors Associated With Nonadherence to Pelvic Floor Physical Therapy Referral for the Treatment of Pelvic Pain in Women

Author

Aguirre, Frank, Heft, Jessica, and Yunker, Amanda

Subjects
Care and treatment, Analysis, Risk factors, Medical records -- Analysis, Physical therapy -- Analysis, Patient compliance -- Analysis, Pelvic pain -- Risk factors -- Care and treatment -- Analysis, Women -- Analysis, Pain management -- Analysis, Insurance, Comorbidity
Abstract

Pelvic pain, defined as noncyclic pain that is present for at least 3 to 6 months, is one of the most common patient reports encountered by gynecologists and affects nearly [...], Background. Patients with pelvic pain due to pelvic floor myofascial pain syndrome are often referred for pelvic floor physical therapy, the primary treatment option. However, many patients do not adhere to the treatment. Objective. The purpose of this study was to examine the adherence rate and outcomes of patients referred for physical therapy for pelvic floor myofascial pain syndrome and identify risk factors associated with nonadherence. Design. This was a retrospective cohort study. Methods. ICD-9 codes were used to identify a cohort of patients with pelvic floor myofascial pain syndrome during a 2-year time period within a single provider's clinical practice. Medical records were abstracted to obtain information on referral to physical therapy, associated comorbidities and demographics, and clinical outcomes. "Primary outcomes" was defined as attendance of at least 1 visit. Secondary outcomes included attendance of at least 6 physical therapist visits and overall improvement in pain. Statistical analysis was performed using chi-square, Fisher exact, and independent t tests. Nonparametric comparisons were performed using Wilcoxon signed rank test. Multivariate analysis was completed to adjust for confounders. Results. Of the 205 patients, 140 (68%) attended at least 1 session with physical therapy. At least 6 visits were attended by 68 (33%) patients. Factors associated with poor adherence included parity and a preexisting psychiatric diagnosis. The odds of attending at least 1 visit were 0.75 (95% confidence interval = 0.62-0.90) and 0.44 (95% confidence interval = 0.21-0.90), respectively. Patients who attended [greater than or equal to] 6 visits were more likely to have private insurance (78%) and travel shorter distances to a therapist (mean = 16 miles vs 22). Patients with an improvement in pain (compared with those who were unchanged) attended an average of 3 extra physical therapist visits (mean = 6.9 vs 3.1). Limitations. Limitations include reliance on medical records for data integrity; a patient population derived from a single clinic, reducing the generalizability of the results; the age of the data (2010-2012); and the likely interrelatedness of many of the variables. It is possible that maternal parity and psychiatric diagnoses are partial surrogates for social, logistic, or economic constraints and patient confidence. Conclusions. Initial adherence to pelvic floor physical therapy was less likely for multiparous women and women with a history of psychiatric diagnosis. Persistent adherence was more likely with private insurance or if the physical therapist location was closer. Pain improvement correlated with increased number of physical therapist sessions.

Published
2019
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28. Colaboradores

Author

Aberle, Corinne M., Abu-Freha, Naim, Adams, Andrew B., Adams, Reid B., Agrawal, Nikhil, Ahuja, Vanita, Alexopoulos, Sophoclis, Aliano, Kristen A., Alvarez, Ronald D., Aribindi, Vamsi, Arrington, Amanda K., Atassi, Omar, Badell, I. Raul, Bakaeen, Faisel G., Barreto, Juan Camilo, Beauchamp, R. Daniel, Becker, Yolanda, Blears, Elizabeth E., Bobanga, Iuliana, Bonds, Morgan, Borrelli, Mimi R., Boukovalas, Stefanos, Brooke, Benjamin S., Brown, Carlos V.R., Carbonell, Alfredo Maximiliano, Carmichael, Samuel P., II, Carson, Joshua S., Champion, Howard C., Chiang, Kevin J., Chung, Dai H., Coburn, Michael, Cole, Eric L., Contreras, Carlo M., Cooney, Robert N., Dawson, Jack, DeAnda, Abe, Jr., Dennis, Bradley M., Dhupar, Rajeev, Diaz, Jose J., Dissanaike, Sharmila, Dmochowski, Roger R., Dudeja, Vikas, Duh, Quan-Yang, Economou, James S., Egger, Michael E., Ellis, C. Tyler, Evers, B. Mark, Farmer, Diana L., Farroni, Jeffrey S., Ferrantella, Anthony, Fields, Ryan, Finlayson, Samuel R.G., Finnerty, Celeste C., II, Nicholas A. Fiore, Fishbein, Thomas, Fong, Yuman, Fraser, Chuck D., Jr., Fried, Gerald M., Galandiuk, Susan, Gan, Tong, Goedegebuure, S. Peter, Gunter, Oliver L., Gurney, Jennifer M., Halpern, Jennifer L., Hawksworth, Jason, Hawn, Mary, Hernandez, Antonio, Herndon, David N., Heslin, Marty J., Hirose, Shinjiro, Ho, Trung, Hodin, Richard, Hofstetter, Wayne L., Holt, Ginger E., Hu, Michael S., Hu, Yinnin, Hunt, Kelly K., Hyman, Neil, Izhar, Uzi, Jensen, Eric H., Jurkovich, Gregory J., Kalaria, Shana S., Karp, Seth J., Kesseli, Samuel J., Khaitan, Leena, Khoo, Kimberly H., Kim, Jae Y., Klimberg, V. Suzanne, Knight, Patrick H., Kramme, Katherine E., Krasnick, Bradley A., Laird, Amanda M., Landmann, Alessandra, Larsen, Christian P., Liao, Lillian, Libutti, Steven K., Livhits, Masha, Longaker, Michael T., Lorenz, H. Peter, Madani, Amin, Mahvi, David A., Mahvi, David M., Marston, William, Martin, Matthew J., Martin, R. Shayn, McHenry, Christopher R., McMasters, Kelly M., Mehra, Saral, Mell, Matthew, Meredith, J. Wayne, Miller, Richard S., Mills, Joseph L., Sr, Morpurgo, Emilio, Mowery, Nathan T., Mueller, Carmen L., Nassar, Aussama K., Nelson, Elaine E., Netscher, David, Netz, Uri, Norbury, William B., Norris, Robert L., Oelschlager, Brant K., Omer, Shuab, OnKendi, Edwin, Padilla, Pablo L., Pallister, Zachary S., Park, Julie E., Pascarella, Luigi, Patel, Samip, Patterson, Joel T., Phillips, Linda G., Pipinos, Iraklis I., Postier, Russell, Poulose, Benjamin K., Prescott, Lauren S., Privratsky, Anna M., Pruekprasert, Napat, Radkani, Pejman, Rajaram, Ravi, Riall, Taylor S., Richards, William O., Richmond, Bryan, Rose, J. Bart, Rosen, Michael J., Rosengart, Todd K., Rosenthal, Ronnie A., Ross, Evan, Russo, Rachel M., Rutkow, Ira, Ryan, Christopher, Saadai, Payam, Saillant, Noelle N., Sandberg, Warren, Santos, Ariel P., Sawyer, Robert G., Saydi, John P., Schreiber, Martin Allan, Schwartz, Herbert S., Sepesi, Boris, Sherwood, Edward R., Sheth, Mihir, Sise, Michael J., Smith, Michael C., Smith, Sawyer Gordon, Smith, Thomas G., III, Sommerhalder, Christian, Sosa, Julie Ann, Spicer, Jonathan D., Stewart, Ronald M., Sudan, Debra L., Sugarbaker, David J., Suh, Insoo, Sun, Daniel, Taylor, Jennifer M., Thompson, Jonathan R., Todd, S. Rob, Tomlinson, James S., Torquati, Alfonso, Tosato, Sara Maria, Turnage, Richard H., Tyler, Douglas S., Umanskiy, Konstantin, Vickers, Selwyn M., Wald, Ori, Well, Andrew, Winslade, William J., Wolf, Steven E., Woo, Yanghee, Worsham, Jennifer, Yang, James C., Yarbrough, Wendell G., Yates, Robert B., Yeh, Michael W., Yepuri, Natesh, Yunker, Amanda C., Zanation, Adam, Sirvent, Ramón Zapata, and Zaydfudim, Victor M.

Published
2022
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29. Tips and advice for Essure removal

Author

Cohen, Sarah, Levie, Mark, and Yunker, Amanda

Subjects
Practice, Beliefs, opinions and attitudes, Usage, Research, Intrauterine devices -- Usage -- Beliefs, opinions and attitudes, Female sterilization -- Research, Surgeons -- Practice -- Beliefs, opinions and attitudes
Abstract

Essure tubal microinserts were not designed to be removed. However, a small minority of women are requesting removal because of regret, complications, or the development of pelvic pain and other [...]

Published
2017

35. Vaginal Cancer

Author

Gunderson, Camille C., primary, Nugent, Elizabeth K., additional, Yunker, Amanda C., additional, Rocconi, Rodney P., additional, Graybill, Whitney S., additional, Erickson, Britt K., additional, and Moore, Kathleen N., additional

Published
2013
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38. Creation of a Neovagina with Single Staged Uterine Anastomosis.

Author

Khan A, Baker M, Kaufman M, Yunker A, and Kassis S

Subjects
Humans, Female, Adolescent, Plastic Surgery Procedures methods, Robotic Surgical Procedures methods, Congenital Abnormalities, Vagina surgery, Vagina abnormalities, Uterus abnormalities, Uterus surgery, Uterus diagnostic imaging, Anastomosis, Surgical methods
Abstract

Introduction: While vaginal agenesis most often occurs with an absent or rudimentary, nonfunctioning uterus, it may also occur with a fully developed uterine body. In these scenarios, anastomosis of the functional uterus to a neovagina allows for both egress of menstrual blood as well as potential preservation of fertility: case reports exist of spontaneous conception following creation of a neovagina. However, prior attempts at anastomosis have all included delayed surgery with anastomosis to the uterus several months following the creation of the neovagina., Case Description: The patient was a 17-year-old female who presented with amenorrhea several years after thelarche. After noting a blind ending vagina and a 46XX karyotype, ultrasound and MRI revealed an apparently normal uterus with questionable presence of a cervix, and polycystic appearing ovaries, which may have accounted for the patients minimal hematometra. A multidisciplinary team including gynecology, urology, plastic surgery, and colorectal surgery was organized for creation of a neovagina and attempted anastomosis to the normal appearing uterus. In a single staged robotic procedure, a peritoneal neovagina created in a modified Davydov technique was successfully connected to the uterus. A foley catheter was placed in the uterine cavity to allow for canalization. Diagnostic hysteroscopy six weeks after surgery confirmed a canal into the uterus, and the patient reported ongoing cyclical bleeding with the use of oral contraceptives several months after surgery., Conclusions: In vaginal agenesis with a functional upper reproductive tract, peritoneal neovaginas may be successfully anastomosed to the uterus in a single stage robotic approach., (© 2024 by SLS, Society of Laparoscopic & Robotic Surgeons.)

Published
2024
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