How often should we be seeing Pelvic Health clients?

In the Musculoskeletal physio world, it is common and expected, by both patients and therapists, that they may be seen up to 2-3 times per week for the first few weeks of treatment.

In contrast, I have heard (and was taught) the belief that because pelvic physio conditions aren’t as ‘acute’ as those seen in general msk AND that as “strength gains” in the pelvic floor occur slowly we won’t see a change in patient’s function from one week to the next. Thus leading to the common, but my most despised expression in pelvic health physio, ‘I’ll see you in a month’.

Can we learn something from our musculoskeletal colleagues here? 

Although our pelvic health clients may not typially be driven by acute painful injuries, I know from experience that we absolutely do see changes in patient function within the space of a week or even sooner. So much of the early pelvic health treatment journey is based around teaching motor control and ensuring this is correct. We all know how much our clients can mis-interpret between one appointment and the next. The evidence even suggests up to 80% is forgotten and of the remaining 20% about half is misinterpreted. So if we leave our clients with a well-intentioned page of exercises and advice and ask them to return in a fortnight, or (forbid), a month; what is going to happen?

Firstly, what a wasted opportunity to help our patients refine and master the key aspects of their muscle retraining program. If they are off, doing the completely wrong exercise or under-cooking their training parameters then we have wasted their time and money as they are unlikely to see any improvement or outcome. In the patient’s mind, they’re not sure if they’re doing things right, they don’t achieve results or self efficacy and they lose motivation, making it very easy to put off that next visit in a few weeks because “I haven’t done my exercises”. Critically, by not prioritising the urgency of that review visit with the patient in the first week, you have given them permission (unwittingly) to not prioritise that review either.

I have heard many Physios say, “I worry about their finances if they have to see me more frequently”. My answer to that is, firstly don’t assume anything about anyone’s finances and what they want to spend their money on. You are not their financial manager. And secondly, I personally worry more about the money they have invested and wasted on treatment when they see you monthly for 4 months and get nowhere because they lost motivation and didn’t complete the treatment plan.

Finally, value what you can offer; if you don’t value the life-changing benefit of what pelvic physio can offer clients then this will come through in your communication with patients and they will not place adequate value on your care either. 

So what is the optimal cadence?
In my clinic I challenged my staff to see all their clients (irrespective of presenting condition) weekly (minimum) for the first 4 weeks. And the result? A significant reduction in patient-driven cancellation rates in those who were booked for ‘4 in 4’. 

And here is the hot tip…if someone is rescheduling because they have not done their exercises, they are much more likely to cancel that rescheduled appointment. Patients need contact with us and guidance. 

Would you like to know what I believe is the other ‘toxic trait’ of pelvic floor physios that impacts cancelation rates and patient retention? Keep an eye out for our nextblog!