{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:49:46Z","timestamp":1791618586456,"version":"4.3.4"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2019,3,27]],"date-time":"2019-03-27T00:00:00Z","timestamp":1553644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100016220","name":"CTSA","doi-asserted-by":"crossref","award":["UL1TR000445"],"award-info":[{"award-number":["UL1TR000445"]}],"id":[{"id":"10.13039\/100016220","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000016","name":"US Department of Health and Human Services","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Advancing Translational Sciences"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Patients with pelvic pain due to pelvic floor myofascial pain syndrome are often referred for pelvic floor physical therapy, the primary treatment option. However, many patients do not adhere to the treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The purpose of this study was to examine the adherence rate and outcomes of patients referred for physical therapy for pelvic floor myofascial pain syndrome and identify risk factors associated with nonadherence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>This was a retrospective cohort study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>ICD-9 codes were used to identify a cohort of patients with pelvic floor myofascial pain syndrome during a 2-year time period within a single provider's clinical practice. Medical records were abstracted to obtain information on referral to physical therapy, associated comorbidities and demographics, and clinical outcomes. \u201cPrimary outcomes\u201d was defined as attendance of at least 1 visit. Secondary outcomes included attendance of at least 6 physical therapist visits and overall improvement in pain. Statistical analysis was performed using chi-square, Fisher exact, and independent t tests. Nonparametric comparisons were performed using Wilcoxon signed rank test. Multivariate analysis was completed to adjust for confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 205 patients, 140 (68%) attended at least 1 session with physical therapy. At least 6 visits were attended by 68 (33%) patients. Factors associated with poor adherence included parity and a preexisting psychiatric diagnosis. The odds of attending at least 1 visit were 0.75 (95% confidence interval\u00a0=\u00a00.62\u20130.90) and 0.44 (95% confidence interval\u00a0=\u00a00.21\u20130.90), respectively. Patients who attended \u2265 6 visits were more likely to have private insurance (78%) and travel shorter distances to a therapist (mean\u00a0=\u00a016 miles vs 22). Patients with an improvement in pain (compared with those who were unchanged) attended an average of 3 extra physical therapist visits (mean\u00a0=\u00a06.9 vs 3.1).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Limitations<\/jats:title>\n                  <jats:p>Limitations include reliance on medical records for data integrity; a patient population derived from a single clinic, reducing the generalizability of the results; the age of the data (2010\u20132012); and the likely interrelatedness of many of the variables. It is possible that maternal parity and psychiatric diagnoses are partial surrogates for social, logistic, or economic constraints and patient confidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Initial adherence to pelvic floor physical therapy was less likely for multiparous women and women with a history of psychiatric diagnosis. Persistent adherence was more likely with private insurance or if the physical therapist location was closer. Pain improvement correlated with increased number of physical therapist sessions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzz050","type":"journal-article","created":{"date-parts":[[2019,3,23]],"date-time":"2019-03-23T04:19:12Z","timestamp":1553314752000},"page":"946-952","source":"Crossref","is-referenced-by-count":18,"title":["Factors Associated With Nonadherence to Pelvic Floor Physical Therapy Referral for the Treatment of Pelvic Pain in Women"],"prefix":"10.1093","volume":"99","author":[{"given":"Frank","family":"Aguirre","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of South Carolina Medical School, Columbia, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Heft","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Yunker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, 1161 21st Ave, MCN B-1100, Nashville, TN 37232 (USA)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,3,27]]},"reference":[{"key":"2023011902195741200_bib1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/0029-7844(95)00458-0","article-title":"Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates","volume":"87","author":"Mathias","year":"1996","journal-title":"Obstet Gynecol"},{"key":"2023011902195741200_bib2","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1067\/mob.2002.124940","article-title":"Health-related quality of life measurement in women with common benign gynecologic conditions: a systematic review","volume":"187","author":"Jones","year":"2002","journal-title":"Am J Obstet Gynecol"},{"key":"2023011902195741200_bib3","first-page":"594","article-title":"Chronic pelvic pain","volume":"101","author":"Howard","year":"2003","journal-title":"Obstet Gynecol"},{"key":"2023011902195741200_bib4","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1097\/AOG.0b013e318283ffea","article-title":"Musculoskeletal causes of chronic pelvic pain: what a gynecologist should know","volume":"121","author":"Gyang","year":"2013","journal-title":"Obstet Gynecol"},{"key":"2023011902195741200_bib5","first-page":"185","article-title":"Prevalence of pelvic musculo-skeletal disorders in a female chronic pelvic pain clinic","volume":"51","author":"Tu","year":"2006","journal-title":"J Reprod Med"},{"key":"2023011902195741200_bib6","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.pmrj.2011.07.006","article-title":"Pelvic floor pain: physical therapy versus injections","volume":"3","author":"Clinton","year":"2011","journal-title":"PMR"},{"key":"2023011902195741200_bib7","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1002\/nau.22700","article-title":"Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis","volume":"34","author":"Dumoulin","year":"2015","journal-title":"Neurourol Urodyn"},{"key":"2023011902195741200_bib8","first-page":"S75","article-title":"Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urologic chronic pelvic pain syndromes","volume":"139","author":"Fitzgerald","year":"2013","journal-title":"J Urol"},{"key":"2023011902195741200_bib9","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1002\/nau.22794","article-title":"Pelvic floor muscle training adherence; tools, measurements, and strategies: 2011 ICS state-of-the-science seminar research paper II ov IV","volume":"34","author":"Dumoulin","year":"2015","journal-title":"Neurourol Urodyn"},{"key":"2023011902195741200_bib10","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1007\/s00192-014-2606-4","article-title":"A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain","volume":"26","author":"Zoorob","year":"2015","journal-title":"Int Urogynecol J"},{"key":"2023011902195741200_bib11","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/JNR.0b013e3181a53e7e","article-title":"Path analysis for adherence to pelvic floor muscle exercise among women with urinary incontinence","volume":"17","author":"Chen","year":"2011","journal-title":"J Nurs Res"},{"key":"2023011902195741200_bib12","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/SPV.0000000000000516","article-title":"Does patient education augment pelvic floor physical therapy preparedness and attendance? 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