Geographic Disparities by Income in Pelvic Floor Physical Therapy Locations in Philadelphia, Pennsylvania

BACKGROUND: Pelvic floor dysfunction impacts 1 in 4 women and can be disabling. Colorectal surgeons treat many of these conditions, including fecal incontinence, pelvic constipation, and rectal prolapse. Pelvic floor physical therapy can be an effective nonsurgical treatment for pelvic floor dysfunction. However, utilization remains limited, with insurance noncoverage, geographic constraints, and lack of availability cited as barriers to care. OBJECTIVE: Evaluate the relationship between income and geographic distance to pelvic floor physical therapy locations in Philadelphia, Pennsylvania, a socioeconomically diverse city. DESIGN: Pelvic floor physical therapy locations within Philadelphia were identified and contacted by telephone. A semi-structured script was used to interview staff and obtain characteristics of each site and its treated patients. We used census tracts as a geographic unit and calculated the distance of each tract to the nearest pelvic floor physical therapy location. We used linear regression to identify the association of median income with distance to the nearest physical therapy location, adjusting for population size of each tract. SETTINGS: Philadelphia, Pennsylvania. MAIN OUTCOME MEASURES: Distance of each census tract to the nearest pelvic floor physical therapy location. RESULTS: Nineteen sites offered pelvic floor physical therapy, primarily located in areas of high median income. Distance to a pelvic floor physical therapist decreased as median income increased. People from the lowest quartile of income lived farthest from a physical therapy location (2.1 miles), compared to people from the highest quartile (1.0 miles, p<0.001). Urogynecologic or postpartum conditions were treated most often, with only 3 sites reporting expertise in anorectal disease. LIMITATIONS: Generalizability given focus on one city. CONCLUSIONS: Pelvic floor physical therapy remains underutilized and primarily focused on urogynecologic and postpartum conditions. In Philadelphia, we found that pelvic floor physical therapy was primarily located in areas of high median income, suggesting geographic access barriers for poorer patients. See Abstract Video .