Postpartum Physical Therapy Utilization Among Low-Income Patients in San Diego

Postpartum patients face significant musculoskeletal sequelae of childbirth, which may be compounded by medical characteristics and social determinants of health. These symptoms are treatable with pelvic floor physical therapy, yet postpartum physical therapy referral and adherence rates remain low. The reasons for this are understudied. Furthermore, most current research centers on non-Hispanic, middle- to upper-class White patients, limiting applicability to other populations.

The objectives of this study were to evaluate differences in physical therapy referral and adherence rates among medically underserved female patients and determine whether certain variables predicted or moderated adherence to outpatient postpartum physical therapy.

Data from a retrospective cohort study of electronic health records were analyzed using 2-way t tests, analysis of variance, and logistic regression techniques.

Hispanic patients were referred to physical therapy at a disproportionately low rate compared to other racial/ethnic groups (8.8% vs 16.7% and 14.7%, P  < 0.0001); older age and higher pain were present in both referred versus nonreferred ( P  < 0.0001, both) and adherent versus nonadherent ( P  < 0.05 and P  < 0.01, respectively) patients; patients who received referrals were significantly more depressed ( P  < 0.0001), more educated ( P  < 0.0001), had higher rates of grade 3-4 perineal laceration ( P  < 0.01), and had higher parity ( P  < 0.0001) and gravidity ( P  < 0.0001) compared to their nonreferred counterparts; pain, education, race, and age were important predictors of physical therapy adherence (predictor model P  = 0.0001); and Asian race moderated the relationship between physical therapy referral and adherence ( P  = 0.017).

In a postpartum population, physical therapy referrals were low and ethnic disparities were present. Adherence to physical therapy was also affected by patient demographics and medical history. Interventions to increase postpartum physical therapy referral and adherence should consider the patient's social determinants of health and medical needs.