Who are pelvic rehab providers?

As many of you know, the Herman & Wallace Pelvic Rehabilitation Institute is currently developing a Pelvic Therapy Practitioner Certification process (PTPC). As part of the multi-step process involved in the development of a robust certification, the job task analysis survey was completed by more than four hundred providers (403 to be exact.) The Institute was thrilled that so many current, past, or future course participants believe in this process so strongly that even a seemingly endless survey could not deter you from completing the tedious, yet crucial questions that were posed. In another step of the process that occurred after the results of the survey were tallied, I was able to view the tables of responses and I found the information very interesting- I thought that you might also be interested to know a bit more about the answers that we received in the survey.

Keeping in mind that the pelvic rehabilitation specialty is one that is not as well-represented in the clinic as orthopedics, for example, and yet is a specialty that is gaining in popularity, it was interesting to note that nearly 1 in 5 therapists completing the survey had less than one year of experience working in pelvic rehabilitation. Approximately 82% of the more than 400 people completing the questions has been working within pelvic rehabilitation for 10 years or less. In terms of the education of the people represented, the highest degree earned at the time of the survey was a doctorate for 41.4% of people, with 8.4% of those represented by transitional doctorate degrees, and less than 1% by an academic doctorate.

Several people indicated that they had board certifications in either cardiovascular and pulmonary (2), geriatrics (2), neurology (1), pediatrics (1), sports (3), and orthopedics (23), or women's health (17). Other qualifications listed by those completing the survey included LANA certification for lymphedema therapy, manual therapy certifications, yoga, Pilates, and biofeedback certifications, to name a few that appeared frequently.

Geographically, most were from the United States, with the addition of 7 Canadians and 4 "Other." The states in the US most represented included California, with 54 people holding a license in that state, followed by Washington (38), New York (30), Illinois (27), and Florida (22).Employment status for the most part was reported as full-time salaried (55%), and part-time salaried (29%). Just over 13% of those responding reported that they were either full-time or part-time self-employed. Only 5% reported spending 50-100% of working hours in an acute care hospital setting, with approximately 3.5% working in acute care setting 90-100% of the time. 1 out of 3 respondents work exclusively in a health system or hospital-based outpatient setting, and an additional 1 of 3 people work in a private practice setting. Other work environments such as home care or rehabilitation hospital made up a very small percentage of work settings reported. Direct patient care constituted 71-100% of the workload for 92.1% of the group, and nearly 3/4 of the respondents reported spending 0% of his or her time completing administration. Nearly 90% answered "0" for percentage of time spent on research, and the most amount of time indicated for research (by one person) was 20%.

When addressing pelvic rehabilitation specifically, here is an approximate breakdown of time spent in treatment:

% time in pelvic rehab % of respondents

0-3% 7.2
5-10% 14.4
15-30% 20.6
30-50% 21.3
55-75% 16
80-90% 15.3
94-100% 10.3

74% reported never working with children ages 12 and younger, and 34% reported never working with adolescents 13-20 years of age. Other age groups were fairly evenly represented. In terms of how many therapist treat male patients, let's look at another breakdown.

Male patients treated % of respondents

0-3% 11.6
5-10% 13.1
15-30% 28.2
35-50% 42.9
55-70% 3.4
80% 2 (1 person)
100% 2 (1 person)

When we look at how the survey collected information about diagnoses, nearly 98% of respondents reported treating pelvic organ prolapse or fecal incontinence 0-20% of the time, whereas pelvic pain and urinary incontinence occurred more frequently as a condition treated. Many therapists listed general orthopedic conditions as appearing the most frequently on the caseload. Referral sources or providers who send patients for services include family practice, obstetrician/gynecologists, physician assistants, nurse practitioners, urologists, chiropractors, other physical therapists, sex therapists, psychologists, midwives, acupuncturists, yoga instructors, naturopaths, "the internet", former patients, and massage therapists.

One question on the survey asked "what motivated you to enter the pelvic rehabilitation field?" Of the 396 people who answered this optional question, almost 1 of every 4 chose "personal history or family history" as the reason. 40% chose "practice or clinic need" which certainly corresponds to what we hear at live courses. Very often we are told that a therapist who usually treated the pelvic rehabilitation population went on leave or moved, and so the clinic needed to train another therapist. Many therapists wrote in comments about how they wanted to serve a population with true need, or help restore quality of life. Salaries ranged from $25,000 or less (2.5%), $25,000-$50,000 (12.4%), $50,000-$75,000 (44.9%), $75,000-$100-000 (26.3%), $100-$125,000 (3.2%), $125,000-$150,000 (1.2%), and $150,000 and higher (1%). Of the 403 who completed the survey, 8 were men.

389 of those who completed the survey also indicated ethnic origin. Results indicated that 86.1% are Caucasian, 4.5% Asian or Pacific Islander, and 1.5% Hispanic, 1% Filipino, with less than 1% indicating African American, Native American, or Other (included Asian Indian, Caribbean, Eurasian, Latino non-Hispanic, Latino American, and Middle East represented as write-in options.) Reported ages included 21.5% being age 30 or younger, nearly 40% in the category of 31-40 years of age, 23% ages 41-50, 14% 51-60 years, and the remaining approximately 2-3% in the category of 61-74 years of age.

We want to keep in mind that this is a sample of primarily physical therapists who, for the most part, are currently involved in treating at some level patients who have pelvic dysfunction. It appears that many of those who responded are working in outpatient, orthopedic settings, nearly all respondents are female, and most are Caucasian. If I were to go so far as make recommendations or state hopes for the results of future surveys, it would be that more pelvic rehabilitation providers offer a solid representation of the various ethnicities which also make up our patient populations, that more male therapists are treating patients with pelvic rehabilitation needs, and that we find pelvic rehabilitation providers working in a wide variety of settings, with more pediatric patients and with more male patients, so that we can catch the dysfunctions early on in a patient's life, and so that men and women have more of an equal chance at healthy pelvic function. Thank you to Kriterion for providing such detailed and interesting data, to the Herman & Wallace Pelvic Rehabilitation Institute for investing in this endeavor towards a pelvic therapy certification, and mostly, to all of the participants in this survey who provided thoughtful replies so that we can generate meaningful data and most importantly, so that we can move forward in this process of recognizing those who strive to be excellent pelvic rehabilitation providers.

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