Timing is everything: an audit of process and outcomes from a pilot advanced scope physiotherapy model of care for women with pelvic floor conditions

Introduction: Incontinence and pelvic organ prolapse (POP) commonly affect many people for whom physiotherapy may be an important, front-line management strategy. However, traditional referral pathways in the tertiary health care system limit or delay access to this management option resulting in poor outcomes. Objective: The aim of this pilot study was to determine the impact of an advanced scope of practice physiotherapy model of care for women referred with incontinence and/or POP symptoms compared to traditional referral pathways in a tertiary hospital in Australia. Methods: A prospective audit was conducted with consecutive sampling of those triaged into the physiotherapy-led clinic during the trial period. A database was created to record patient demographic information, key dates in the patient pathway, and the clinical outcome measures obtained. Results: Forty-one women were assessed in the physiotherapy-led clinic during the trial period October 2015-March 2016. The results indicate improved access to care (time between referral to first consult during the trial was 27.3 days, compared with 169.6 days first consult using the traditional referral pathway), improved adherence to conservative management (96% attending their individual consultation compared to 55%) and positive patient satisfaction. Conclusion: This pilot study demonstrated that an advanced scope physiotherapy-led model of care such as the Gynecology Physiotherapy Assessment Service can result in improved access to care while positively impacting experiences of women with incontinence and/or POP symptoms. Keywords: advanced scope, physiotherapy, incontinence, pelvic organ prolapse, conservative management, physical therapy