Episode 1701 - Screening for pelvic floor problems
#PTonICE Podcast
Pelvic Floor Dysfunction Screening Tool and Referral Recommendations
Exploration of a screening tool for pelvic floor dysfunction, detailing symptom identification, risk factors assessment, and referral protocols based on symptoms and risk factors.
Dr. Rachel Moore // #ICEPelvic // www.ptonice.com
In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses pelvic floor screens such as the PFD-SENTINEL and introduces a new pelvic floor screening resource coming soon to the ICE Physio App!
Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.
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EPISODE TRANSCRIPTION
INTROHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PTI Nice Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at signup to receive a one-month free grace period on your new Jane account.
RACHEL MOOREGood morning, PT on ICE Daily Show. I am getting lunched on YouTube and Instagram and we are good to go. All right, what's up? My name is Dr. Rachel Moore. I am here this morning to talk to you guys about screening for pelvic floor dysfunction especially if you are somebody who is maybe not familiar with the pelvic floor space or this is an entirely new space for you or you're somebody who is like identifying or classifying as a orthopedic PT and you're like I don't know anything about the pelvis. I want to clear things up with you guys and put together or we did put together a resource for you guys that is a pelvic floor screen that you're going to be able to access through the Ice Physio app under the resources section. So you'll be able to get that off of the app, download it, either have it in your intake forms, in your paperwork so that you can use that as people are coming in and kind of have an indicator of if this would be a person who would benefit from a referral for pelvic floor PT. Where this all came from, we've been asked at our courses before for just kind of an easy, quick, general screen. A lot of us use kind of a different option. So there was some people had a couple options that they were using. Other people were using different things. So what we did is we took all of these resources. We compiled them together and we really leaned into the research and what we have out there for pelvic floor screening. So we're going to chat a little bit about what that screen is and how we kind of adapted it or modified it for this really quick, easy, downloadable version that you can pull up and have as an 11 question fast screen for your patients. So This whole screen kind of is based around or adapted from a study that was published in the British Journal of Sports Medicine in December 2022. So the screen is called the PFD Sentinel Screen, S-E-N-T-I-N-E-L. What this was was a Delphi study and they basically polled professionals that are experts in this space. So they had PTs, they had urogynecologists, they had just different healthcare providers, physical medicine and rehab providers that all had either been in this space seeing patients or been in this space researching these topics. And what they did is they polled these providers to kind of come up with a consensus. Because prior to this, there really wasn't a validated published screen in any evidence. that we could really lean into for patients that would benefit from pelvic floor physical therapy. And so they created this screen kind of as a way to have a resource specifically for sports medicine providers, and this was really kind of leaning into sports medicine PTs, like orthopedic PTs, or sports medicine doctors that were already seeing female athletes, and they're kind of range or definition of female athletes was like super broad. So across all ages, across all sports, across all profession levels, whether it was amateur athletes or professional athletes, they came up with this screen based on this Delphi questionnaire, not questionnaire, but survey. And so what they landed on were five main pelvic floor dysfunction symptoms, and then 28 risk factors for pelvic floor dysfunction. So with that, in order to be included on this screen, they had to have over 67% of the consensus of the group. And this went through two rounds. So it was like 43 and 37 were the two rounds of number of professionals. So of those two rounds, 67% or higher had to agree that they felt that these were indicators for potential pelvic floor dysfunction screens. So with this screen, there was this top section of score A, which was five main pelvic floor dysfunction symptoms. So this was things like leaking urine, urinary urgency, leaking gas and stool. And with these five, if they answered yes to any one of these, then they recommend an automatic referral to a pelvic floor specialist. Doesn't necessarily specify PT, but could be a urogynecologist or somebody that specializes in treating the pelvic floor. From there, there was 28 risk factors that they delineated. With these 28 risk factors, they either landed in the categories of score B or score C. If they were score B, that means that they had greater than 14 of these risk factors. These risk factors were pretty broad. I actually really loved the things that they included. So this was things like whether or not somebody's in menopause, if they've been diagnosed with hypermobility or connective tissue disorder, if they have a family history of urinary incontinence or a family history of pelvic organ prolapse, their BMI being under or over a certain range. So they really took a lot into account here under the risk factors. And if they had a score of greater than 14 for those risk factors, then they fell under a score B, and that would be a recommended referral to a pelvic floor PT or pelvic floor specialist. So score A, for sure, send them. Score B, we recommend you get this checked out. And then score C was less than 14. So if they didn't have more than 14 of these risk factors, Then it was just monitor, kind of keep an eye on them and see how they do. And when they made this screen, they made it as a kind of touch point to repeat. So maybe you start this at the beginning of the season, and then as they begin off season, you start or you re-screen this. So this is kind of an easy ongoing screen to see how things are changing as these athletes are evolving potentially, whether they're in off season or in season. Or if, again, we're thinking about just our general population, maybe once a year when they're coming in or once every six months when they're coming in, we're doing this really quick and easy screen to determine if they would benefit from a referral for pelvic floor PT. One thing to kind of note about this is it was specifically created for female athletes. Again, broad term for athletes here, but specifically created for females. So no males were included in this when they were breaking down the rationale for when somebody would benefit for a referral for PT. And so we don't really have a good resource of when our males need to be referred to PT just yet. Maybe that's something that'll be coming out in the research soon. And then also just note that this hasn't been like validated by any further research yet. This is kind of the kickstart point of, Hey, we've got this group of experts that have come together. We don't really have a lot of information in this space. Let's come up with something so that we can then push this out there and see how it flows. So, Love it. It's really awesome. PFT Sentinel is really in-depth. It has a lot of really great risk factors on there. When we were putting together our screen, our thought process was a little bit different. It was a little bit more leaning in towards something quick and easy that, like I said, we can put in our intake forms and just have people check things off. You could really even use this as marketing. So I actually do use a pelvic floor screen on the backside of my flyers. So on the front side, I have all of my business information. I've got a QR code for people to book a session pretty easily. And then on the back is the pelvic floor screen printed on it. So as people are setting these out, it's got our business logo on the top, set it on a counter at the chiropractor's office or at the gym or whatever, and they can pick up the screen and read through it. and it says at the top if you say yes to one of these following questions, you might benefit from Pelvic Floor PT. So, great option for marketing, great option just to have as part of your intake form in your paperwork. If you are not a Pelvic Floor PT and you're not really sure who you should be sending to Pelvic Floor PT, it's also a really great resource to have on hand. So, diving into our specific screen, what we really focused in on were what we felt were kind of the heavy hitters for recommendations for pelvic floor PT, and then maybe some of the things that doesn't necessarily jump out at somebody that's not in this space. So, some of the more obvious ones would be like experienced urinary leakage, urinary urgency or frequency, issues with remaining continent or holding in gas or stool, sensations or feelings of heaviness or seeing something bulging at vaginal opening and then really leaning into the pain side pain or discomfort and we really kept this grog because we've seen pelvic floor dysfunction show up as hip pain, we've seen it show up as low back pain, we've seen it show up as groin pain, and so we really wanted to kind of catch a broad range here, especially if you are the orthopedic PT who's maybe been seeing somebody for their hip and you're doing all the right things and you're like, I'm crushing this, but they're just not 100% better, maybe that would be the time to kick them over to a pelvic floor PT if you're not doing pelvic floor. and see if there's some contribution from the pelvic floor to that issue. Childbirth, whether it is a vaginal or a cesarean delivery, both of these situations we feel weren't a referral to pelvic floor PT, just to really kind of recalibrate and get things on the same page again. Being in menopause or perimenopause, A, from the education standpoint, there is so much education that we can provide to this population. but also just kind of staying ahead of any problems or symptoms that may arise as they're progressing into this low estrogen state. And then having a history of relative energy deficiency in sport. And this is something where we might need to lean into our providers to do some education. If somebody doesn't know what that is, really knowing if somebody's had irregular cycles, if they have these chronic injuries, or one week you're seeing them for their knee, the next month it's for their shoulder, the next month it's for their back, these signs of these chronic kind of nagging injuries would be a thing to hone in on that maybe they're potentially in this relative energy deficiency in sport state. We've got a lot of really great information out there, lots of podcast episodes about reds that we've done as the pelvic division. So if you're unsure about that, definitely go to YouTube and type that in the search bar and pull that up so you can learn a little bit more about that topic and really be able to screen that a little bit better. But again, we came up with this resource. I hope you guys love it. I hope it's helpful. We've been asked for it at our pelvic courses. I've been asked for it at our other courses that I've attended just as a participant. OrthoPTs that are like, I'm not really sure what I'm supposed to do. Can you please come up with a resource that we know how to screen? So we're really excited about this resource. It's going to be on the ICE app. So keep an eye out. In the app, we'll also blast it out on the pelvic newsletter. So if you're not signed up for the pelvic newsletter, go ahead and get signed up for that. And same thing with hump day hustling as well. Sign up for that. That way you know exactly when it gets posted, exactly when it goes live, and when you can download it to have it as part of your screens.
SUMMARY If you are somebody who wants to be in the pelvic floor space but maybe isn't in the pelvic floor space yet or you want to learn more about pelvic floor pt then jump into one of our courses We've got so many live courses coming up. Christina and I are actually teaching in Spring, Texas this weekend at my home gym. I'm so excited. We still have openings there if you want to come hang with us. But lots of offerings for our live course coming up, as well as our L1 coming up again. And then our L2 is sold out for this upcoming cohort, but we do still have spots open. in our fall cohort so head to the website figure out where you can jump into a pelvic course if you're interested in learning more about pelvic floor pt and how to treat these women If you're not really sure how to treat these women or who should be referred out, head to the resources link. You're going to see this resource posted in just a bit. And then we are excited for you guys to have it out there. Use it for marketing if you are a pelvic PT and let us know how it goes. Thanks for joining in. I appreciate it. I hope you guys have a great day.
OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
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