Authors

  1. Shelly, Elizabeth

Article Content

Purpose/Hypothesis: To investigate the characteristics of physical therapists (PTs) reporting high and low confidence in the examination of pelvic floor muscles (PFM) and to evaluate the common characteristics of PTs who use little to no PFM examination when treating patients with PFM dysfunction. Number of Subjects: Participants (N=1,175) who were women's health PTs solicited from the APTA Section on Women's Health, BCIA EMG courses, and personal PT contacts responded to a 38 question web-based survey. All students, PTAs and international PTs were excluded. Two hundred and three (n=203) PTs completed the survey (17.3% response rate). Materials/Methods: Survey questions, validated by 4 content experts, addressed education in PFM dysfunction (entry-level and post-professional education in PFM dysfunction, continuing education course work, self study, formal mentoring, on the job training); current frequency of use of 6 different types of PFM assessments, length of time in pelvic PT practice, and confidence in PFM examination skill. Results: Descriptive statistics were used to examine the data. Of all respondents, 91% reported high confidence in performing PFM examination, 9% reported low confidence. Characteristics of PTs with low confidence (LC) were compared to those with high confidence (HC) and included: (a) having 1 to 6 months of pelvic PT experience (31.5% LC vs. 4% HC); (b) participated in self study 1 to 3 times per year (44% LC vs 16% HC); (c) performed first vaginal examination less than 1 year ago (33% LC vs. 7% HC); (d) attended less than 1 day of continuing education (CEU) (11% LC vs. 1% HC). Other characteristics correlated with low confidence included treating with less frequency and duration (rs = .347, r2 = .12); more recent learning of pelvic floor muscle exam ( rs = .351, r2 = .12); less frequent self study (rs = .274, r2 = .08); and less post-professional continuing education (rs = .331, r2 = .11). Mentoring frequency and on the job training were not significantly related to confidence (p = .30 and p = .09, respectively). Respondents who reported higher confidence used external observation or perineal mobility (rs = .236, r2 = .05) and vaginal and/or rectal palpation (rs = .255, r2 = .06) and believed that PFM assessment was "important" (rs = .444, r2 = .20). Respondents who reported using little to no PFM examination (N = 7) received less CEU education, had learned the PFM examination technique less than 1 year ago, and had less confidence compared to PTs who use PFM examinations, (HC 57.1% and 94.4%, respectively). Conclusions: Confidence in evaluating the PFM is related to having more than 6 months of experience in pelvic PT, learning the PFM examination more than 1 year ago, having more than 6 days of CEU education, and participating in self study more than 1 to 3 times per year. Greater amounts of neither on the job training nor entry-level education can compensate for lack of post professional PFM CEU educational experiences and do not solely, increase confidence. PTs who do not examine the PFM have less experience, less education, and are not as confident as PTs who do examine the PFM. Clinical Relevance: Post graduate CEU training in PFM examination appears to play a major role in increasing confidence in examination skills. PTs interested in developing confidence in PFM examination should invest time in continuing education, direct patient care, and self study. Further study is needed to determine how these variables relate to patient outcomes.