Reasons why patients referred to physiotherapy with continence or pelvic floor dysfunction fail to complete treatment

Author(s): F. J. Lennard - Pages: 56–63

Abstract

The aim of this study was to identify why patients with continence or pelvic floor dysfunction (PFD) fail to complete their treatment. A postal questionnaire was sent to patients who had attended for, but failed to complete, treatment within a physiotherapy department for continence or PFD during a specific year. In 2006, 112 patients (27%) with continence or pelvic floor disorders failed to complete their courses of treatment. Questionnaires were mailed to the 109 surviving patients and 60 (55%) of these were returned. Various reasons were given by subjects for not completing treatment: 34% cited difficulty attending appointments; 27% stated that they were "better"; 20% mentioned other health problems that took precedence; 18% reported that they either did not wish to be referred to physiotherapy or did not think that physiotherapy would benefit them; and 10% stated that they had undergone surgery for the problem (although 33% of this group reported that the surgery had been unsuccessful). Following the audit and in combination with the 18-week waiting initiative, the department gained more staff, which reduced the waiting times and allowed early-morning and lunchtime appointments to be offered. A patient information leaflet was produced that gave comprehensive explanations of conditions and treatments, and details of self-help groups. Extra emphasis was placed on pelvic floor exercises for all pregnant and postnatal women seen by the physiotherapists. In 2008, when the service was re-audited for patients seen in 2007, the percentage of patients who failed to complete treatment had reduced to 21.2%. Physiotherapists need to be aware of the barriers and costs faced by patients seeking treatment. Physiotherapy practice needs to continue to change to reduce these barriers and costs in order to maximize the benefits that physiotherapy can offer patients, and increase the effectiveness and efficiency of the physiotherapy services available to healthcare providers and users.

Keywords: failure to complete treatment, incontinence, pelvic floor dysfunction, physiotherapy.