Author

Jodi Dusi

Defense Date

2-25-2011

Graduation Date

2011

Availability

Immediate Access

Submission Type

dissertation

Degree Name

PhD

Department

Rehabilitation Science

School

Rangos School of Health Sciences

Committee Chair

Diane Borello-France

Committee Member

David L Somers

Committee Member

Amy L Phelps

Committee Member

Susan George

Keywords

Global impression of improvement, Health-related quality of life, Interventions, Pelvic symptoms, Physical therapy, Urinary incontinence

Abstract

The purpose of this study was to 1) determine the efficacy of physical therapy interventions to reduce pelvic symptoms and improve health-related quality of life and global impression of improvement in women with urinary incontinence; 2) determine the relationship between selected patient-related characteristics and treatment success; and 3) describe interventions utilized to manage the care of women with urinary incontinence.

Methods: A pragmatic study design was used to explore study aims. The physical therapy records of 100 female patients with urinary incontinence from Centers for Rehab Services provided data for this study. Data from routine clinical care was entered into an electronic database designed for quality improvement purposes. Outcome measures to determine improvements in pelvic symptoms and health-related quality of life included the Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7), respectively. Global impression of improvement was recorded using the Patient Global Index of Improvement (PGI-I) administered post-intervention. The relationships between patient-related characteristics and treatment success were explored using logistic regression. Descriptive statistics were utilized to describe the interventions received by women.

Results: Mean pre- to post-intervention PFDI-20 and PFIQ-7 scores were significantly reduced indicating that women's pelvic symptoms and health-related quality of life improved following physical therapy intervention. The median PGI-I score was "2" indicating symptoms were "much better" following intervention. Sixty-six percent of women met the study criteria for PGI-I defined treatment success. Women who achieved treatment success had a lower mean age (51.86±15.59 vs. 59.29±13.15 years) and had more physical therapy visits (9.05±5.51 vs. 5.74±2.55 visits) than those who did not perceive symptom improvement. Additionally, the distribution of the occurrence of barriers between women who did and did not perceive treatment success was different than would be expected by chance. When age, presence of barriers to intervention recommendations, and number of physical therapy visits were entered into the logistic regression model, only barriers to intervention recommendations (OR 12.82; 95% CI 4.05-40.55) and number of physical therapy visits (OR 1.26; 95% CI 1.07-1.50) were influential in predicting PGI-I outcome. Women in the study received a combination of treatments including education, exercise, modalities, and manual procedures.

Format

PDF

Language

English

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