Occupational therapists’ (OTs’) role in addressing pelvic floor dysfunction (PFD) is documented, yet their perception of their unique contribution has not been well explored. The purpose of this study is to elucidate OTs’ perspectives about their therapeutic approach in PFD. This exploratory, qualitative descriptive study included an online demographic survey to purposively recruit and screen OTs. Thirteen one-on-one semi-structured interviews were audio-recorded and transcribed. We used an in-vivo coding approach, categorized codes with similar concepts, and generated themes. Participants’ stories mostly reflected clinical scenarios with adult female clients. Two themes describe how OTs believe their role in PFD is unique: (a) OTs use a whole-person approach which considers mental, physical, and environmental impacts on functioning and (b) OTs use occupation-focused interventions to empower clients to manage their own health. OTs’ holistic and psychosocial-focused approaches may complement existing biomechanical techniques. The inclusion of OTs into multidisciplinary teams may positively impact client outcomes.
Plain Language Summary
Identifying Occupational Therapists’ Perspectives on Their Unique Role in Pelvic Health Care
Pelvic floor dysfunction (PFD) negatively affects occupations, an area in which occupational therapists (OTs) are experts. The beliefs of OTs regarding their distinct contributions to this practice area have not been well explored. We recruited and screened participants using an online self-report demographic survey. Participants’ stories mostly reflected clinical scenarios where the client was an adult woman. Our inductive analysis of 13 interviews generated two beliefs: (a) OTs use a whole-person approach which considers mental, physical, and environmental impacts on functioning and (b) OTs use occupation-focused interventions to empower clients to manage their own health. Incorporation of OTs into multidisciplinary teams may positively impact client outcomes.
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process. The American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010p1–7412410010p87. https://doi.org/10.5014/ajot.2020.74S2001
2.
AndrewsA. P.AtlerK. E.Dickman PortzJ.VanPuymbroeckM.RoseC. M.SchmidA. A. (2021). Occupational therapists’ use of yoga in post-stroke care: A descriptive qualitative study. British Journal of Occupational Therapy, 84(4), 240–250. https://doi.org/10.1177/0308022620910371
3.
BedretdinovaD.FritelX.ZinsM.RingaV. (2016). The effect of urinary incontinence on health-related quality of life: Is it similar in men and women?Urology, 91, 83–89. https://doi.org/10.1016/j.urology.2015.12.034
BrandisS. (2024). Did you know. . . Occupational therapists assist in assessment and management of continence across the lifespan?The Australian and New Zealand Continence Journal, 30(1), 11–14. https://doi.org/10.3316/informit.T2024061100008101183519707
6.
BrækkenI. H.MajidaM.Ellström EnghM.BøK. (2015). Can pelvic floor muscle training improve sexual function in women with pelvic organ prolapse? A randomized controlled trial. The Journal of Sexual Medicine, 12(2), 470–480.
7.
BuggeC.AdamsE. J.GopinathD.StewartF.DembinskyM.SobiesuoP.KearneyR. (2020). Pessaries (mechanical devices) for managing pelvic organ prolapse in women. The Cochrane Database of Systematic Reviews, 2020(11), CD004010. https://doi.org/10.1002/14651858.CD004010.pub4
8.
BurkhartR.CouchmanK.CrowellK.JeffriesS.MonvillersS.VilenskyJ. (2021). Pelvic floor dysfunction after childbirth: Occupational impact and awareness of available treatment. OTJR: Occupation, Participation and Health, 41(2), 108–115. https://doi.org/10.1177/1539449220970881
ChengM.-C.LiuS.-P.ChuangY.-C.HsuK. C. P.ChowP.-M. (2022). Prevalence and impacts of male urinary incontinence on quality of life, mental health, work limitation, and health care seeking in China, Taiwan, and South Korea (LUTS Asia): Results from a cross-sectional, population-based study. Investigative and Clinical Urology, 63(1), 71–82. https://doi.org/10.4111/icu.20210259
11.
ChristiansenC.HaertlK. (2018). A contextual history of occupational therapy. In Boyt SchellB.GillenG. (Eds.), Willard and Spackman’s occupational therapy (13th ed., pp. 11–42). Wolters Kluwer.
12.
CiangolaC. I.CapuanoI.PerroneF.FranceschilliL. (2014). Epidemiology and prevalence of pelvic floor disorders. In GaspariA. L.SileriP. (Eds.), Pelvic floor disorders: Surgical approach (pp. 9–15). Springer Milan. https://doi.org/10.1007/978-88-470-5441-7_2
13.
ColorafiK. J.EvansB. (2016). Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal, 9(4), 16–25. https://doi.org/10.1177/1937586715614171
14.
CraswellG.DielemanC.GhanouniP. (2021). An integrative review of sensory approaches in adult inpatient mental health: Implications for occupational therapy in prison-based mental health services. Occupational Therapy in Mental Health, 37(2), 130–157. https://doi.org/10.1080/0164212X.2020.1853654
15.
DriverC.KeanB.OprescuF.LovellG. P. (2017). Knowledge, behaviors, attitudes and beliefs of physiotherapists towards the use of psychological interventions in physiotherapy practice: A systematic review. Disability and Rehabilitation, 39(22), 2237–2249. https://doi.org/10.1080/09638288.2016.1223176
16.
DumbraveanuI.CebanE.BanovP. (2018). Lower urinary tract symptoms and erectile dysfunction in men from the Republic of Moldova. Journal of Medicine and Life, 11(2), 153–159.
17.
EickmeyerS. M. (2017). Anatomy and physiology of the pelvic floor. Physical Medicine and Rehabilitation Clinics of North America, 28(3), 455–460. https://doi.org/10.1016/j.pmr.2017.03.003
18.
FisherA. G.MarterellaA. (2019). OTIPM: A model to guide true top-down, occupation-centered reasoning. In FisherA. G.MartellaA. (Eds.), Powerful Practice: A Model for Authentic Occupational Therapy (pp. 33–61). Center for Innovative OT Solutions, Incorporated.
Hojati AbedE.ShafaroodiN.AkbarfahimiM.ZareiyanA.ParandA. (2021). Effect of occupational therapy on self-determination skills of adolescents at risk of emotional and behavioral disorders: A randomized controlled trial. Medical Journal of the Islamic Republic of Iran, 35, 57. https://doi.org/10.47176/mjiri.35.57
21.
HongM.-K.DingD.-C. (2019). Current treatments for female pelvic floor dysfunctions. Gynecology and Minimally Invasive Therapy, 8(4), 143. https://doi.org/10.4103/GMIT.GMIT_7_19
22.
KatzL.FranssonA.PattersonL. (2021). The development and efficacy of an interdisciplinary chronic pelvic pain program. Canadian Urological Association Journal, 15(6), E323–E328. https://doi.org/10.5489/cuaj.6842
23.
KhorasaniF.GhaderiF.BastaniP.SarbakhshP.BerghmansB. (2020). The effects of home-based stabilization exercises focusing on the pelvic floor on postnatal stress urinary incontinence and low back pain: A randomized controlled trial. International Urogynecology Journal, 31(11), 2301–2307. https://doi.org/10.1007/s00192-020-04284-7
24.
LabuschagneE.van NiekerkM. (2023). Sensory processing dysfunction and genito-pelvic pain/penetration disorder: Women share their experiences of participating in a sensory-based home programme. South African Journal of Occupational Therapy, 53(1), 31–43. https://doi.org/10.17159/2310-3833/2022/vol53n1a5
25.
MacLennanA. H.TaylorA. W.WilsonD. H.WilsonD. (2000). The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG: An International Journal of Obstetrics and Gynaecology, 107(12), 1460–1470. https://doi.org/10.1111/j.1471-0528.2000.tb11669.x
26.
MilesM. B.HubermanA. M. (1994). Qualitative data analysis: An expanded sourcebook. Sage.
27.
NtoumanisN.NgJ. Y. Y.PrestwichA.QuestedE.HancoxJ. E.Thøgersen-NtoumaniC.DeciE. L.RyanR. M.LonsdaleC.WilliamsG. C. (2021). A meta-analysis of self-determination theory-informed intervention studies in the health domain: Effects on motivation, health behavior, physical, and psychological health. Health Psychology Review, 15(2), 214–244. https://doi.org/10.1080/17437199.2020.1718529
28.
O’BrienB. C.HarrisI. B.BeckmanT. J.ReedD. A.CookD. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1245. https://doi.org/10.1097/ACM.0000000000000388
29.
OsbornH.ReekS.AndersonB. (2023). Interdisciplinary occupational and physical therapy approach to treating constipation and fecal incontinence in children. Physical & Occupational Therapy in Pediatrics, 43(2), 243–256. https://doi.org/10.1080/01942638.2022.2131499
30.
PadoaA.McLeanL.MorinM.VandykenC. (2021). The Overactive Pelvic Floor (OPF) and sexual dysfunction. Part 2: Evaluation and treatment of sexual dysfunction in OPF patients. Sexual Medicine Reviews, 9(1), 76–92. https://doi.org/10.1016/j.sxmr.2020.04.002
31.
PatnamR.SripadA. A.DenglerE.GellerE. J.WuJ. M. (2020). Moving on: How many women opt for surgery after pessary use for prolapse?Female Pelvic Medicine & Reconstructive Surgery, 26(6), 387–390. https://doi.org/10.1097/SPV.0000000000000731
32.
PorgesS. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.
33.
QuaghebeurJ.PetrosP.WyndaeleJ.-J.De WachterS. (2021). Pelvic-floor function, dysfunction, and treatment. European Journal of Obstetrics & Gynecology and Reproductive Biology, 265, 143–149. https://doi.org/10.1016/j.ejogrb.2021.08.026
34.
RyanR. M.DeciE. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford Publications.
35.
SaldanaJ. (2016). The coding manual for qualitative researchers (3rd ed.). Sage Publications.
36.
SarangS. D.KarnamA. G.VanmaliB. A.PhulpagarP. R. (2020). Effect of mindfulness-based stress reduction occupational therapy program in parents of children with autism spectrum disorder: An interventional study. Indian Journal of Occupational Therapy (Wolters Kluwer India Pvt Ltd), 52(4), 132–138. https://doi.org/10.4103/ijoth.ijoth_25_20
37.
SchmitzJ. R.SchoenerH.AtlerK.FruhaufC. A.PearceD.SchmidA.MathiasK. (2023). Women’s experience receiving OT for pelvic floor dysfunction: A case series. The American Journal of Occupational Therapy, 77(Suppl. 2), 7711510310p1. https://doi.org/10.5014/ajot.2023.77S2-PO310
38.
ScottA.DigwoodK.TeslowR.BloomA. (2022). Addressing pelvic floor dysfunctions in older women. The Open Journal of Occupational Therapy, 10(2), 1–10. https://doi.org/10.15453/2168-6408.1896
39.
ShentonA. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22(2), 63–75. https://doi.org/10.3233/EFI-2004-22201
40.
SinglaM.JonesM.EdwardsI.KumarS. (2015). Physiotherapists’ assessment of patients’ psychosocial status: Are we standing on thin ice? A qualitative descriptive study. Manual Therapy, 20(2), 328–334. https://doi.org/10.1016/j.math.2014.10.004
41.
VerbeekM.HaywardL. (2019). Pelvic floor dysfunction and its effect on quality of sexual life. Sexual Medicine Reviews, 7(4), 559–564. https://doi.org/10.1016/j.sxmr.2019.05.007
42.
VrijensD.BerghmansB.NiemanF.van OsJ.van KoeveringeG.LeueC. (2017). Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions—A cross sectional cohort study at a Pelvic Care Centre. Neurourology and Urodynamics, 36(7), 1816–1823. https://doi.org/10.1002/nau.23186
43.
WeberM. A.KleijnM. H.LangendamM.LimpensJ.HeinemanM. J.RooversJ. P. (2015). Local oestrogen for pelvic floor disorders: A systematic review. PLOS ONE, 10(9), Article e0136265. https://doi.org/10.1371/journal.pone.0136265
