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Full Course Details: Public course page
Learn more about our guests: Kyrsten Spurrier & Carlin Reaume
Agenda
Intro (5 minutes)
Breakdown and analysis of journal article (5 minutes)
- 00:00:00 Intro to Perinatal Pelvic Floor Therapy
- 00:01:30 OT Potential Podcast Intro
- 00:03:20 Urinary and Fecal Incontinence Postpartum
- 00:03:50 Treatment Options
- 00:04:48 Intent of this research
- 00:05:03 Research Methods
- 00:06:19 Research Results
- 00:07:47 Discussion
Discussion on practical implications for OTs (50 minutes)
- 00:09:16 Intro to Kyrsten
- 00:13:44 The Perinatal Pelvis
- 00:19:47 Impressions of this Article
- 00:22:33 Holistic Treatment Approach
- 00:28:05 Group-based Offerings
- 00:34:23 Memorable Client Story
- 00:40:14 Biggest Lesson Learned
- 00:45:20 What Does Success Mean
- 00:48:12 Supports for OTs to Start in Pelvic Floor Therapy
- 00:56:05 Ideal Vision for OT Perinatal Care
Supplemental Materials
Supporting Pelvic Floor Therapy Research
- Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women
- Prenatal high-low impact exercise program supported by pelvic floor muscle education and training decreases the life impact of postnatal urinary incontinence: A quasiexperimental trial
Supplemental Pelvic Floor Therapy Materials
Article Review
Read Full Text: Group-based pelvic floor muscle training for all women during pregnancy is more cost-effective than postnatal training for women with urinary incontinence: cost-effectiveness analysis of a systematic review
Journal: Journal of Physiotherapy
Year Published: 2021
The number of OTs providing perinatal care is on the rise—which is exciting (and necessary!).
There are still so many gaps in care for new and expecting moms, one of which is treatment for incontinence.
As we’ll see in today’s article, a staggering percentage of women experience postnatal incontinence—despite the known effectiveness of pelvic floor muscle training in addressing this issue. The article specifically explores the cost effectiveness of various models of pelvic floor therapy.
The main takeaway?
It is more efficient to offer incontinence prevention services during pregnancy than it is to provide incontinence management services postnatally—and group-based treatment can be a particularly cost-effective method of service delivery for expecting mothers.
Next week on the podcast, we’re excited to explore all of this with pelvic health occupational therapist Kyrsten Spurrier, owner of the Perinatal Pelvis.
Let’s dive in.
Postpartum Urinary and Fecal Incontinence
Urinary incontinence (UI) and fecal incontinence (FI) refer to the involuntary leakage of urine or stool, respectively. Pregnancy and childbirth are significant risk factors for both types of incontinence.
In fact, 33% of women experience urinary incontinence within the first 3 months after giving birth. In that same timeframe, rates of fecal incontinence range from 3% to 29%.
What are the treatment options?
Treatment options for both urinary and fecal incontinence include:
- pelvic floor muscle training,
- lifestyle modifications, and
- training around bowel and bladder habits.
Pharmacological and surgical treatment options are also available; however, these interventions are often associated with higher costs and greater risk for complications.
Because of this, pelvic floor muscle training is recommended as the first line of action for managing incontinence. Boasting level 1 evidence to support its effectiveness, pelvic floor muscle training is recommended for a period of at least 3 months before pharmacological or surgical interventions are considered.
But despite robust evidence supporting pelvic floor muscle training for the prevention and treatment of incontinence, there have not been any trials related to the cost-effectiveness of different models for delivering this care…which leads us to this paper.
What was the intent of this research?
The specific research question for this study was:
What is the most cost-effective way of providing pelvic floor muscle training (PFMT) to prevent or treat postpartum incontinence?
What were the authors’ methods?
The authors completed a meta-analysis and cost-effectiveness analysis of the PFMT delivery models included in a recent Cochrane systematic review.
All PFMT trials included participants who were:
- pregnant or within their first year post-pregnancy, and
- looking to prevent or treat UI or FI.
Pelvic floor muscle training was provided in individual sessions, group sessions, or a combination of the two. All treatments were delivered by physiotherapists.
Outcome measures for clinical effectiveness
The studies primarily used self-report assessment tools, including the following:
- Incontinence Impact Questionnaire
- Urogenital Distress Inventory
- Female Pelvic Floor Questionnaire
Calculation for cost-effectiveness
To calculate the financial impact associated with each intervention, the authors considered the following:
- Health service costs: Staffing hours, room use, and materials.
- Consumer costs: Out-of-pocket costs, child care, and lost work hours.
- Cost savings: Estimated reduction in pad usage.
Results
This meta-analysis included 17 trials. Three models of care were found to be clinically effective.
The 3 clinically effective models of care
Model 1: Individually supervised PFMT during pregnancy to prevent urinary incontinence.
Model 2: Group-based PFMT during pregnancy to prevent or treat urinary incontinence.
Model 3: Individually supervised postnatal PFMT to treat urinary incontinence and prevent or treat fecal incontinence.
The cost-effectiveness of these models
The authors made 3 key comparisons when calculating the cost-effectiveness of these models:
1. Individual prenatal prevention is more cost-effective than postnatal incontinence treatment.
2. Group-based PFMT for prevention DURING pregnancy is a more efficient model than individual PFMT service AFTER birth. This holds true for groups of 4 or more.
3. Group-based treatment DURING pregnancy can also be more efficient than individual prenatal care—again, as long as the group size is large enough. (The math on this one was more complicated, so I’ll refer you to the article.) 
Discussion and Recommendations
Given the clinical and cost-effectiveness of preventing incontinence during the prenatal period, the authors set forth these recommendations:
All continent pregnant women should have the opportunity to participate in UI prevention services. It is more efficient to provide group-based prevention services to all women during pregnancy than it is to provide individual treatment sessions to incontinent women postnatally. (Provided that the group includes at least 4 women.)
However, the article also emphasized that the value of treatment during the postnatal period should not be discounted given its important role in the management of both urinary and fecal incontinence.
Lastly, the authors pointed out that asymptomatic women need to be educated on the benefit of incontinence prevention in order to encourage engagement in prevention-based services—and health service providers must prioritize the prevention of incontinence by offering low-risk, cost-effective PMFT services. Therefore, incontinence prevention should be strongly supported by individual maternity care providers.
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