The most important societies in the field of urogynecology have written numerous guidelines recommending the treatment of women with pelvic floor disorders through the assistance of more than one health professional. An example is the inclusion of the physiotherapist in the multidisciplinary care group for managing urinary incontinence by the National Institute for Health and Care Excellence (NICE). However, the perceived lack of knowledge about physiotherapy interventions might be an essential factor in poor communication between physicians and physiotherapists. Individual learning during medical studies and weak interprofessional education during clinical residency may negatively influence professional collaboration.
Although evidence supports the recommendations that pelvic floor muscle training should be indicated as a first-line treatment for urinary incontinence, interprofessional is still challenging. Studies investigating the multidisciplinary work between physicians and physiotherapists are still scarce, with few studies on the topic. Therefore, according to the physicians' perspective, this study aims to verify the perception of the interprofessional interaction between physiotherapists and physicians that work in Women’s Health.

This is a  cross-sectional study approved by the ethics committee. All the participants agreed to participate before starting the data collection. Medical professionals attending patients with urinary incontinence (stress, urgency, or mixed urinary incontinence), legally exercising their profession in Brazilian territory, were invited to complete a semi-structured questionnaire that assessed the interprofessional relationship between physicians and physiotherapists regarding urinary incontinence treatment. Data collection was carried out online using Google Forms. Data analysis was performed using the SPSS program, version 21.0, and are presented descriptively in frequency and percentage.

One-hundred and seven participants were included, most of them being a woman (n=76, 71%; men=31; 29%)), had a post-doctoral degree (n=33; 30.8%), followed by a Ph.D. (n=30; 28). The age range varied from 21 to 30 years (n=10; 9.3%), 31 to 40 years (n=25; 23.4%), 41 to 50 years (n=33; 30.8%), 51 to 60 years (n=27; 25.2%) and more than 61 years old (n=12; 11.2%). Participants were working on gynecological (n=89; 83.2%), obstetric (n=62; 57.9%), urogynecological (n=44; 41.1%), mastology (n=6; 5.6%), oncologic (n=4; 3.7%) and colorectal area (n=1; 0.9%).

Most physicians reported a direct interaction with physiotherapists (n=94; 87.9%) and 100% of the participants recommend physiotherapeutic treatment to their patients. Physicians seem to indicate the physiotherapeutic intervention based on information from guidelines and scientific papers and positive experiences from their clinical practice. However, less than half of physicians reported usually recommend patients to look for a physiotherapist independently of their condition (40.9%) (Table 1).

Table 2 shows the physicians’ perception of interprofessional interactions between physicians and physiotherapists. Most participants considered the interprofessional relationship positive for the patients and considered both professions important for patient care. Nonetheless, they believed the interprofessional approach might improve by recommendations from guidelines about the importance of working as a team. In addition, professionals identified as good and excellent the physiotherapists’ qualification.

The present study highlighted physicians‘ perspectives on the interprofessional approach with physiotherapists during the management of patients in the Women’s Health context. A high percentage of participants are in favor of the interaction between physicians-physiotherapists and believed it may improve patient care. However, only 45.8% of physicians were working with a physiotherapist in their team. In addition, there are still some concerns about referring patients to a physiotherapist, as only 40% of the physicians would refer their patients to a physiotherapist, before a failure of previous treatment or the presence of a surgical procedure. 

Previous literature already highlighted the benefits of a multi-professional approach, especially with the inclusion of specialized physiotherapists in the work team, which resulted in a reduction of surgical and urodynamic procedures by 33%, increasing the level of satisfaction among patients seen at multi-professional urology and coloproctology, increasing the rates of adherence to physiotherapy treatment, and contributing to the evaluation and treatment of many dysfunctions, including urinary incontinence, female sexual dysfunctions, and pelvic pain.

According to the physicians‘ perspective, interaction with physiotherapists could be beneficial during the clinical care of patients, and this interprofessional approach might improve when recommended by guidelines. However, the criteria physicians use to refer patients to physiotherapy are still limited to failure in previous treatments and pre-and/or post-surgical procedures.

Slack, A., A. Hill, S. Jackson. Is there a role for a specialist physiotherapist in the multi-disciplinary management of women with stress incontinence referred from primary care to a specialist continence clinic?. Journal of Obstetrics and Gynaecology 28.4 (2008): 410-412.
Vrijens, Desiree MJ, et al. Patient-reported outcome after treatment of urinary incontinence in a multidisciplinary pelvic care clinic. International Journal of Urology 22.11 (2015): 1051-1057.