Survey of clinical practice: pre- and postoperative physiotherapy for pelvic surgery

The objective of this survey was to obtain information about current physiotherapy practice for patients undergoing pelvic surgery. The aims were to evaluate whether differences exist in service provision between women's health physiotherapists (WHPTs) and hospital physiotherapists (HPTs) and in the guidelines used by physiotherapists to direct their service delivery. METHODS. A questionnaire was posted to the members of the Victorian Continence and Women's Health Physiotherapy Group (n = 130) and physiotherapists working in metropolitan and rural hospitals (n = 90). The questionnaire comprised questions relating to the aspects of treatment, including how referrals are made, funding, interventions provided and how they are delivered, and use of outcome measures. Data were summarized using descriptive statistics and Chi-square analysis of differences between WHPTs and HPTs.

The response rate was 75.9%. In 67% of cases, service delivery was initiated by surgeon request, and most commonly for gynecologic patients (85%). Individual consultations were used on 96% of occasions and 8% were group sessions. Content of physiotherapy treatment for in-patients varied, with WHPTs significantly more likely to prescribe pelvic floor muscle exercises (P = 0.003), bowel advice (P = 0.001), avoidance of risk activities (P = 0.002), and awareness of postoperative symptoms (P = 0.001). Conversely, HPTs were significantly more likely to perform respiratory checks (P = 0.002) and mobilization (P = 0.001). Eighty-seven percent of respondents regarded their service as suboptimal, citing the need for evidence to support the content and best timing of intervention.

Differences exist in physiotherapy treatment for pelvic surgery patients. Further research is required to establish whether, and which, elements of physiotherapy intervention are effective.