Uncategorized
Feb 18, 2021
Did you know that?
- 1 in 3 of women are incontinent of urine after having a baby (Hansen et al., 2012)
- 1 in 10 have faecal incontinence after childbirth (and many of these go on to have dyspareunia - painful sex)
- 1 in 12 have pelvic organ prolapse
- The relationship between incontinence and depression & poor mental health is well established (Melville et al 2009)
- Symptoms of pelvic floor dysfunction during and postpartum are a significant risk factor for poor maternal mental health (Swenson et al., 2018)
**Physiotherapy is by far the most cost-effective way to both PREVENT and TREAT these conditions!**
Did you also know that?
- Breast cancer is the worlds most diagnosed cancer (WHO, 2021)
- Unhealthy diets, insufficient physical activity, use of tobacco and harmful use of alcohol, have all contributed to the increasing cancer burden
- The points above about breast cancer are also risk factors for other gynaecological conditions such as PCOS / endometriosis / dysmenorrhea / infertility / IBS / fibromyalgia / chronic fatigue... and also for erectile dysfunction (ED) in men...and the list goes on
- If a man has ED, he has a greater risk of having heart disease (Dong et al., 2011)
- ED is associated with poorer mental health (Korfage et al., 2008)
- Individual, supervised physiotherapy services can significantly improve a man's quality of life following treatment for prostate cancer in terms of improving both urinary incontinence symptoms and ED (Millios et al., 2020)
**Physiotherapy can be pivotal in the health education and prevention of comorbidities that can exacerbate these conditions!
& specialist physiotherapists can improve quality of life, mental well being and outcome for these conditions **
The mandate from the Chartered Society of Physiotherapy (CSP) and the charity Pelvic Obstetric & Gynaecological Physiotherapy (POGP), in response to the NHS Longterm Plan NHS England Long Term Plan para 3.17., is that Specialised Physiotherapists must have a strong presence within MDT pelvic health clinics to offer expert pelvic assessment and rehabilitation; to share skills & knowledge with other health care professionals; to provide pathways for women to access appropriate care
https://www.csp.org.uk/system/files/documents/2019-04/001603_ERN%20LTP%20Briefing%20-%20Pelvic%20Health.pdf
The Jersey Care Model review summary (2020) advises on the necessity to move to a more sustained and improved model of healthcare - that of prevention and community based education & wellness as well as of course providing necessary hospital based and tertiary care and treatments when required.
Physiotherapy is well placed to deliver on this model of care by liaising with medical and non-medical, hospital and community based allied health, education, fitness & wellbeing professionals as well as members of the public, to develop and deliver appropriate and varied education that, via a theory of change model (Boulten et al., 2019) and with assistance of digital technology to enhance the dissemination of appropriate evidence informed empowering information to the right cohort, at the right phase in their life.
Prioritising prevention does not negate from the necessity to provide good quality and timely physiotherapy input for POGP & breast conditions. Physiotherapy in pelvic, obstetric & breast health demonstrates the best outcomes when care is person centred, individualised, and should involve improving the patients comorbidities, physical and biopsychosocial and neuroimmunological health, along with their primary presenting issue. Where technology has no doubt assisted and supported the delivery of services virtually during the Covid-19 pandemic, there remains a need for face to face care where this can be offered.
Key Priorities
Communication, Communication, Communication
The key to good outcomes with any health care model is to ensure that there is good communication between all stakeholders at all times.
In order to implement the radical change required by the Jersey Care Model there needs to be room for the POG & breast physiotherapy team to brainstorm ideas and opportunities within themselves and with their closer MDT and then further to this link closely with groups who already have the skills & expertise on delivering health promotion as well as digital technologists for multimodal delivery. Liaison with the key stakeholders on the JCM framework for ease of implementation and feasibility is key. The hospital based MDT service provision of care, as described by the NHS plan, is already a familiar form of service delivery and whilst the team may want to deliver improvements to the patient pathway and experience, this will be a more familiar process to follow.
Determinants for success
Darwin asserted that it is not the strongest or the most intelligent who will survive but those who are best able to adapt and adjust to change.
Success within the first year therefore will be less about quantitative outcomes and more about a smooth transition of thought process of how service delivery may look under the JCM framework and how POG & breast physiotherapy services can be more heavily involved within the community in education, both as a form of prevention, treatment but mostly for awareness of good mental and physical health and wellness. A theory of change model makes the assumption that if you swim upstream with your prevention and education techniques that you will reap the benefits downstream.
Critical factors for success in this regard will be that the POG & breast physiotherapy team and wider community experience good communication and have an established agreement in place on expectations in order that these can be met. This is the same for the patient and therapist relationship, where the key to success lies with marrying expectation with outcome.
Thank you for your time to read this brief article. Please share your experience, comments or questions if you are working within the JCM framework or the NHS longterm plan in the delivery of POGP and breast care services.
References & resources
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