Pelvic Floor Assessment and Treatment Guideline - 2020
The NSCPT expects all physiotherapists to practice within the scope of physiotherapy practice, and within their own individual knowledge, skills and abilities, and to recognize their limits and refer on to a peer with more expertise and experience when necessary to achieve optimum outcomes. The Nova Scotia College of Physiotherapists recognizes that intravaginal and intrarectal pelvic floor assessment and treatment falls within the scope of physiotherapy1 practice. 1The terms physical therapist, physiotherapist, physiotherapy, physiotherapy, and PT are protected terms and only used by licensed members. The terms physical therapist and physical therapy are synonyms for physiotherapist and physiotherapy respectively.
While some physiotherapy programs may teach basic pelvic floor assessment and treatment for urinary incontinence, Physiotherapists in Nova Scotia performing pelvic floor assessments and treatments for urogenital and rectal dysfunction must have completed post graduate education and training that meets the requirements of the College. The course must test and evaluate the physiotherapist's demonstrated competency and knowledgeable in the application of treatments and techniques taught and used during the course. Physiotherapists shall only use those treatments, techniques and procedures in ac-cordance with the level of training successfully completed. The training must include the competency evaluation and the certificate must be one of successful completion, not just attendance, in order for it to be considered appropriate for use in physiotherapy practice. Physiotherapists are expected to confirm from the course providers that the course they are taking meets meet the training and treatment guidelines as listed here.
In the interest of public safety, physiotherapists must have completed appropriate post graduate education and training in the assessment and treatment of urogenital and rectal dysfunctions in order to carry out internal pelvic assessments and treatments. They should be able to demonstrate:
- Knowledge of detailed anatomy, physiology and biomechanics of the thoraco-lumbo-pelvic region
- Knowledge and awareness of conditions that are amenable to treatment
- Knowledge and awareness of contraindications for assessment and treatment
- Practice of internal muscle testing for tone and contractility, and internal manual techniques specific to pelvic region
- Understanding of posture and treatment of postural problems
- Understanding of ultrasound, electrical stimulation and biofeedback techniques as well as the indication and contraindications of each
- Knowledge and application of infection control techniques and use of appropriate PPE.
- Knowledge of protocol and documentation for Adverse Events during pelvic health physiotherapy assessment and treatment
- Knowledge of appropriate lifestyle and behavioural education specific to this population
Pelvic floor treatments that fall within the scope of this practice standard include:
- Education and lifestyle modification
- Pelvic floor muscle re-education, including exercises
- Electrical muscle stimulation using internal/external electrodes
- Biofeedback using cones, internal/external treatment devices electrical or pressure
- Modalities – ultrasound/SWD/IFC/TENS/acupuncture
- Manual techniques - both internal and external
- Stretching with insertion devices for desensitization
- Acupuncture / Dry Needling
- Thermo and cryotherapy
Intra-pelvic Assessment and Treatment
The physiotherapist must obtain informed consent from their patient as follows:
- Informed consent must be obtained prior to proceeding with intra-pelvic assessment and treatment. See the National Core Standard on Consent as well as the NSCP Practice Standard on Informed Consent
- The clinical record must show documentation that informed consent for intra-pelvic assessment and treatment was obtained and must include what the patient has been told and the patient’s response.
- Informed consent must be obtained prior to each intra-pelvic assessment and treatment.
- Consent may be withdrawn by the patient at any time and must be documented ac-cordingly.
- The physiotherapist must advise the patient that the patient may have a third party of their choice present during their assessment and treatment.
- During intra-pelvic assessment and treatment, the dignity of the patient must be maintained, and the physiotherapist must exercise utmost discretion.
- A private secure treatment area must be used when providing intra-pelvic assess-ment and treatment.
Guidelines for Risk Management and Infection Control
Physiotherapists who have trained in pelvic floor assessment and treatment and have com-pleted a course in prescribing and fitting pessaries for pelvic organ prolapse may fit and dispense pessaries as well. They must have appropriate sterilization procedures in place including autoclaving when indicated.
- The potential for the development of infection exists with the introduction of a phys-iotherapist’s finger(s) and/or assessment/treatment device(s).The physiotherapist must adhere to World Health Organization Standard Precautions (https://www.cdc.gov/infectioncontrol/tools/index.html) and use current infection control procedures in keeping with Best Practices including use of medical grade gloves as appropriate.
- Each facility / practice site must set up an infection control program in consultation with a recognized infection control professional.
- Each facility / practice site must have a policy in place outlining the use and discard procedures for their chemical sterilization solutions.
- Each facility / practice site should use only sterile, bacteriostatic gels. (https://ipac-canada.org/photos/custom/Members/pdf/2017JanMedicalGel2016.pdf)
- Each clinic should have a Spill Kit available
- Electrotherapy contraindications apply.
- Physiotherapists must inform clients if probes are multi-user and give the client the option to purchase their own probes.
- If probes are multi-user, a condom is to be placed over the probe. Be-ware of clients with latex sensitivity when using condoms and other la-tex products. When the probe is removed, the condom is removed and disposed of in a garbage receptacle. The probe and leads are to be cleaned.
- Standard 1. Advertising
- Standard 2. Client Assessment, Diagnosis, Interventions
- Standard 3. Client-Centred Care
- Standard 4. Collaborative Practice
- Standard 5. Communication
- Standard 6. Competence
- Standard 8. Consent
- Standard 12. Infection Control
- Standard 18. Safety
- NSCP Informed Consent Standard
- NSCP Evidenced Based Practice Guideline
- Infection Prevention and Control Canada (IPAC) https://ipac-canada.org/
- Infection Prevention and Control Program Standard https://ipac-canada.org/photos/custom/pdf/IPAC_PROGRAM_STANDARD_2016.pdf
- World Health Organization Guidelines http://www.wpro.who.int/publications/docs/practical_guidelines_infection_control.pdf
- WHO Standard Precautions https://www.who.int/csr/resources/publications/EPR_AM2_E7.pdf
- Managing a Pessary Business https://www.suna.org/download/education/2014/article3203138145.pdf
- Pelvic Health Roster https://pelvichealthsolutions.ca/find-a-health-care-professional/out-of-province-physiotherapists/
- 4 Moments of Hand Hygiene
- Medical Gloves as PPE: https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/medical-gloves
- NSCPT Infection Control https://nsphysio.com/images/standards/Infection_Control_Standard.pdf
The Pelvic Floor Assessment and Treatment Guideline version history:
- Current version approved by NSCP Board December 16, 2020.
- Replaces Pelvic Floor Assessment and Treatment Practice Standard 2011.