Introduction of a patient-reported outcome measure in a physiotherapy obstetric anal sphincter injury service: an evaluation of its impact
Obstetric anal sphincter injury (OASI) is a growing concern. Patients with an OASI may present with symptoms of urinary and faecal incontinence, and sexual dysfunction. The Australian Pelvic Floor Questionnaire (APFQ) patient-reported outcome measure (PROM) is a tool for measuring these symptoms. The aim of this study was to evaluate the impact of the introduction of the APFQ on clinical standards, symptom reporting and patient experience in a physiotherapy OASI service (OASIS). The evaluation included an audit and online survey before and after the introduction of the APFQ. The audit standards were based on national guidelines. The survey included open and closed questions on patients’ experience of their appointment pre-and post-APFQ. The APFQ increased compliance in five of nine clinical standards, and significantly increased symptom reporting. There was a statistically significant improvement in perceived care post-APFQ, and a higher rating of experience of the physiotherapy OASIS compared to pre-APFQ. Content analysis highlighted the importance of: a confidential and supportive environment; administration; clinical expertise; communication; and patient activation. The suggested key recommendations from this evaluation are as follows. The APFQ should be used in OASIS appointments. Further research should be completed to establish the best PROM for the OASIS. Where appropriate, clinical criteria should be drawn up that enable telephone appointments. Patients should be informed that their appointment may include a physical examination. Leaflets providing information on and signposting for OASI should be revised and updated. An information leaflet on return to sexual activity postpartum should be produced for the OASIS. Finally, the physiotherapy OASIS should be re-audited in 6 months The APFQ was beneficial in this physiotherapy OASIS.
Keywords: obstetric anal sphincter injury, patient-reported outcome measure, pelvic health physiotherapy.