Where best practice pain care and patient expectations for care meet: Exploring patient expectations around chronic pelvic pain, physiotherapy, and the biopsychosocial model of care

Michelle Hong, Allison Crone, Elza Gashi, Meghan Pietluch, Maddy Reinders, M.K. Reinders, Jayden Uchida, Junko Uchida, Adriano Nella, Crystal MacKay, Olivia Drodge, Rachael L. Bosma
In: Women's Health · 2025 · vol. 21 , pp. 17455057251349626 · doi:10.1177/17455057251349626 · PMID:40560036 · W4411639636
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This qualitative study interviewed patients on a pelvic physiotherapy waitlist, finding their expectations involve understanding pelvic physiotherapy's role, seeking new relief methods, and being open to treatment.

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Abstract

BACKGROUND: Pelvic physiotherapy (PT) is a holistic and evidence-based treatment for chronic pelvic pain (CPP). It is important to understand patient expectations for treatment to improve patient satisfaction and outcomes. The current literature lacks information about patient expectations for CPP pelvic PT. OBJECTIVES: To describe the expectations around treatment and the role of pelvic PT for patients with CPP. DESIGN: We conducted a qualitative study and interviewed 10 participants who were on the waitlist for CPP PT at Women's College Hospital in Toronto, ON, about CPP and pelvic PT. METHODS: We recruited patients on the pelvic pain PT waitlist who were assigned female at birth, 18 years of age or older, diagnosed with CPP for more than 6 months. The 1 -h long interviews were conducted via Zoom by two PT students before being transcribed with NVivo. Inductive content analysis was used to create themes and categorize the participant data. RESULTS: We describe three main themes to convey the experiences of participants living with CPP and their expectations for pelvic PT: (1) Expectations are clouded by a lack of understanding, (2) Pelvic PT will provide a new way to get relief, and (3) My role is to be open to try new things. CONCLUSIONS: Pelvic PT should incorporate education regarding CPP, strong therapeutic alliance with the patient, effective communication, and integration of the biopsychosocial approach to care to better meet patient expectations and improve quality of care. This study highlights the critical importance of providing patients with consistent, accurate, and comprehensive education on CPP, pain treatment and self-management strategies, and the role of pelvic PT. By delivering this foundational knowledge early in the patient's treatment plan, we can influence patient expectations, enhance both patient engagement and outcomes in pelvic PT, leading to a more holistic, informed, and effective approach to patient care.
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Methods

Study design Setting Research team Participants Recruitment Data collection Data analysis Rigor

Results

| Characteristic | Description | |---|---| | Experience with multidisciplinary pain clinic | | | Yes | 5 (50%) | | No | 5 (50%) | | Received pelvic physiotherapy previously | | | Yes | 7 (70%) | | No | 3 (30%) | | Mean age (years) | 36.1 (20–68) | | Gender identity | | | Cisgender woman | 9 (90%) | | Gender fluid | 1 (10%) | | Household income | | | $0–19,999 | 1 (10%) | | $20,000–39,999 | 2 (20%) | | $40,000–59,999 | 1 (10%) | | Prefer not to answer | 5 (50%) | | Highest level of education | | | Secondary school | 3 (30%) | | College | 3 (30%) | | University | 4 (40%) | | Living status | | | Rent | 3 (30%) | | Own | 2 (20%) | | Temporary housing | 4 (40%) | | Lodging | 1 (10%) | | Occupational status | | | Paid employment outside the home – full time | 1 (10%) | | Paid employment outside the home – part time | 1 (10%) | | Caregiver | 1 (10%) | | Student | 1 (10%) | | Retired | 1 (10%) | | Medical leave | 1 (10%) | | Other (did not specify) | 4 (40%) | | Method of household income | | | Paid employment | 3 (30%) | | Long-term disability | 1 (10%) | | Partner/spouse | 1 (10%) | | CPP disability benefit | 1 (10%) | | Other (did not specify) | 4 (40%) | Expectations are clouded by a lack of understanding It’s just pain, I guess. I can’t really explain the pain. (P1, age 34) At one point I thought that could it be my weight, but I’ve never really been obese. . . then another thing I thought [was that it] could be a lack of activities. . . [but] that wasn’t the case either because I did a lot of walking, a lot of bike riding. . . [and] at one point I thought certain types of food [contributed]. . . Everything is just so frustrating. (P2, age 52) I guess they will do something with my pelvic [region], probably massage. . . The other physiotherapist that I used to go to, she worked with her hands on me, and she applied pressure in certain areas. . . (P9, age 68) Just what I’ve been taught with the exercises. . . But other than that, nothing, really. (P2, age 52) [I] was only able to do an intake portion before insurance and some other stuff took over. (P8, age 30) Pelvic PT will provide a new way to get relief My role is to be open to try new things Because right now I really don’t know much. And I wasn’t really told how to manage pain other than taking . . . Advil [and] Naproxen for . . . the last 7 years or so. (P6, age 22)

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