Training important for pelvic pain therapists

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J Urol. 2015 Apr 22. pii: S0022-5347(15)03859-8. doi: 10.1016/j.juro.2015.03.130. [Epub ahead of print]

Patients with Pelvic Floor Muscle Spasm have a Superior Response to Pelvic Floor Physical Therapy at Specialized Centers.

Polackwich AS1, Li J2, Shoskes DA3.

INTRODUCTION: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a common condition that often requires multimodal therapy. CPPS patients have a high incidence of pelvic floor spasm, which can be treated with pelvic floor physical therapy (PFPT), however this is a specialized skill. We wished to compare outcomes of PFPT as part of multimodal therapy in CPPS patients between those treated at our institution and elsewhere.

METHODS: We identified patients seen between 2010 and 2014 from our CPPS registry with pelvic floor spasm with >1 visit. Patient phenotype was assessed with the UPOINT system and symptom severity with the National Institute of Health Chronic Prostatitis Symptom Index (CPSI). A 6-point drop in CPSI defined patient improvement.

RESULTS: 82 patients fit criteria with mean age of 41.6 years (range 19 to 75) and median symptom duration 24 months (3 to 240). Mean CPSI was 26.8 (10-41), median number of positive UPOINT domains was 3 (1-6) and 27 (32.9%) were local. At follow up 9 patients had refused PFPT, 24 had PFPT outside our institution and 48 had PFPT locally (CCF). Mean change in CPSI was refused 1.11 +/-4.1, outside -3.46 +/-6.7 and CCF -11.3 +/-7.0 (p<0.0001). Individual improvement was seen in 1 (11%) refused patient, 10 (42%) outside patients and 38 (79.2%) CCF patients (p<0.0001). By multivariable analysis, only CCF PT (OR 4.23, p=0.002) and symptom duration (OR 0.52, p=0.03) predicted improvement.

CONCLUSIONS: PFPT can be effective for CPPS with pelvic floor spasm but outcome depends on specialty training/experience of therapists.

[dshoskes]

Or, as I tell my out of town patients "if the PT starts to teach you Kegel exercises, turn around and run out the door"