FOTO Rehab Outcomes Blog

Barriers to Pelvic Floor Physical Therapy

Written by Selena Horner | Mar 1, 2017 11:00:00 AM

 This study seems to make sense as to why quite a few of the top notch pelvic floor specialists typically do not participate with insurance companies. It appears there may be a gap in insurance coverage for this problem. The best option for individuals who have persistent pelvic pain may be for them to pay for services out of pocket. This can obviously lead to a financial barrier to care.  Additionally, it appears that there may not even be adequate access to care due to the location for these services: too much travel and time constraints leading to another barrier.

It seems that the top notch physical therapists are doing a great job in promoting themselves and their services to reduce another barrier mentioned: perceived lack of benefit for the services.

Something to keep in mind for individuals who have persistent pelvic pain: these individuals will probably have a significant amount of anxiety. Environments and communication will need to be focused on helping reduce this anxiety.

Here's a quick view of the abstract. 

Barriers to Pelvic Floor Physical Therapy Regarding Treatment of High-Tone Pelvic Floor Dysfunction.

Author information

  • 1From the *Division of Female Pelvic and Reconstructive Medicine, Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS; †Department of Urology, University of Kentucky College of Medicine, Lexington, KY; ‡Department of Obstetrics and Gynecology, University of Kansas Medical Center; and §Foundational Concepts Pelvic Floor Physical Therapy, Kansas City, MO; and ∥Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC.



Chronic pelvic pain is a prevalent and debilitating condition with a wide range of etiologies. An estimated 30% to 70% of chronic pelvic cases involve musculoskeletal component pain including high-tone pelvic floor dysfunction (HTPFD). Pelvic floor physical therapy has been shown to be a beneficial treatment for HTPFD, yet many patients do not have access to this treatment. The objective of this study was to identify the barriers preventing patients from following through with the first-line management, physical therapy.


Participants with a diagnosis of HTPFD (n = 154) were identified from the list of referrals sent from the obstetrics and gynecology department to an affiliated PFPT center. Participants were contacted and asked to complete a phone survey addressing demographics and perceived barriers to care. Responses were collected in REDCap. Univariate and bivariate analyses were performed using a statistical analysis software.


Seventy surveys were completed. The top barriers identified by participants were financial constraints (51.4%), perceived lack of utility (37.1%), time constraints (30.0%), and travel issues (18.6%); 84.4% of participants had 1 or more comorbid pain condition. Whereas 51.4% expressed some level of anxiety regarding the PFPT option, only 9.6% of participants did not start treatment because of fear of treatment.


The majority of treatment barriers identified were concrete restraints, with insurance noncoverage and time constraints being the top issues. A fair number of participants expressed anxiety about the treatment or felt they received unclear explanations of the treatment. These are areas in which providers can potentially alleviate some barriers to care.

Female Pelvic Med Reconstr Surg. 2017 Jan 31. doi: 10.1097/SPV.0000000000000401. [Epub ahead of print]