Randomized Controlled Trial of the Effect of a Brief Telephone Support Intervention on Initial Attendance at Physiotherapy Group Sessions for Pelvic Floor Problems.

OBJECTIVE: To assess the efficacy of a brief telephone call to patients on a waiting list for physiotherapy treatment of pelvic floor dysfunction on initial attendance. DESIGN: Three-armed randomized controlled trial. SETTING: Outpatient physiotherapy clinic at a hospital. PARTICIPANTS: Female patients (N=130; mean age, 51.47±13.33y; range, 26-84y) with various pelvic floor dysfunction problems. INTERVENTIONS: Telephone support call (2-10min) 3 days before or 3 days after receiving an invitation letter to physiotherapy sessions. MAIN OUTCOME MEASURES: Attendance at the initial physiotherapy group session. RESULTS: Groups receiving a telephone call demonstrated 80% attendance at the session, with no significant difference between these groups. The group receiving no call had significantly lower attendance rates (50%) than did the call groups. The telephone support was more effective in those people who were older, came from less economically deprived areas, and had been on the waiting list for less time. CONCLUSIONS: A brief telephone support call may be an effective method to enhance patient attendance at treatment, but it may work best when targeted at certain groups of individuals.

Relationship between depression, anxiety, and attendance at pelvic-floor muscle training sessions.

OBJECTIVES: Psychological comorbidities are associated with non-attendance for pelvic-floor muscle training (PFMT) appointments and non-engagement with ongoing treatment. However, little direct work has examined the precise relationship between these variables. DESIGN: A prospective observational study of consecutively referred women patients with Pelvic-floor Dysfunction. Patients were assessed at intake for age, BMI, pelvic symptoms (measured by the Queensland Pelvic Symptom Scale), and anxiety and depression (measured by the Hospital Anxiety and Depression Scales). SETTING: A women's health physiotherapy outpatient unit of a metropolitan hospital. PARTICIPANTS: 433 consecutively-referred women with pelvic-floor dysfunction (PFD). INTERVENTIONS: Six sessions of PFMT, lasting over a period of 6 months. MAIN OUTCOME MEASURES: Attendance at PFMT sessions was the outcome, and was related to intake patient age, BMI, pelvic symptoms, as well as anxiety and depression. RESULTS: Psychological symptoms of depression and anxiety predicted attendance at PFMT sessions, over and above physical symptoms. Depression was the key predictor of non-attendance, with anxiety having a more complex relationship with attendance. There were few differences between these psychological variables and the different types of PFD, or between type of PFD and PFMT attendance. CONCLUSIONS: The findings add to the literature suggesting that consideration of patients' psychological state is important when designing treatment-regimes. CONTRIBUTION OF THE PAPER.

Patient and economic benefits of psychological support for noncompliant patients.

The current paper provides an overview of treatment noncompliance at various points in the treatment pathway, especially with respect to treatment for Pelvic-floor Dysfunction (PFD). The effects of noncompliance on healthcare are considered, and examples of supporting patients psychologically to increase compliance are discussed. An outline of a method to identify costs of non-compliance, and where such costs most intensely impact the healthcare system, is provided. It is suggested that psychological support is effective in terms of increased compliance and improved healthcare economics. The model is presented for PFD, but the principles developed can be generalised to many aspects of healthcare.

Impact of Strength and Nature of Patient Health Values on Compliance and Outcomes for Physiotherapy Treatment for Pelvic Floor Dysfunction.

OBJECTIVE: To determine whether patient values impact on compliance and outcome for physiotherapy treatment for pelvic floor dysfunction. Although studies have related "health values" to behaviors in the laboratory, or to behaviors such as exercise, there have been no studies of the impact of patient values on actual medical treatments. METHODS: A prospective observational study of the impact of patient values on compliance and outcomes for physiotherapy treatment for pelvic floor dysfunction was conducted in a physiotherapy clinic in the urogynaecological outpatients unit of a hospital. Two hundred eighteen patients were approached and agreed to participate. Prior to treatment, pelvic floor functioning was assessed using the Oxford Grading System, and Queensland Pelvic Floor Questionnaire, and values were assessed using the Personal Values Questionnaire (PVQ-II). Following a 6-month physiotherapy treatment programme, pelvic floor function was reassessed. RESULTS: The strength of patient health-related values measured by the PVQ-II significantly predicted compliance with the intervention, but the nature of health value (intrinsically-valued, as opposed to externally-controlled) predicted objective outcome. CONCLUSION: Patient values impact on physiotherapy adherence and outcomes, and could be considered as part of future assessment/screening procedures.