INTRODUCTION: Pelvic floor physical therapy (PFPT) for obstetric anal sphincter injury (OASIS) can reduce fecal incontinence and improve pelvic floor symptoms. Standardized approaches to specialized postpartum care in patients with OASIS are currently lacking, and significant disparities remain in accessing care for pelvic floor disorders. Importantly, whether specific social determinants of health (SDoH) or certain patient characteristics influence access to PFPT after OASIS is unknown. OBJECTIVE: To examine patient characteristics and social factors associated with referral to PFPT and patient attendance after OASIS. METHODS: This is a retrospective observational study of patients who had OASIS after vaginal delivery at 5 hospitals within a single health system from 2015 to 2025. Data were collected on demographic characteristics and SDoH, whether patients were referred to and attended PFPT, and the number of days until the first postpartum visit. Patients with cesarean delivery or home birth were excluded. Bivariate analysis was performed, utilizing Wilcoxon rank sum test, Kruskal–Wallis test, and Pearson correlation coefficients. Statistical significance was defined as p<0.05. RESULTS: Among 237 patients with OASIS, 20 (8.4%) were referred to PFPT, with only 1 (0.42%) referred at the time of hospital discharge and 19 (8.0%) at postpartum visits (6 at initial and 13 at later visits). Age, race, ethnicity, type of insurance, marital status, SDoH factors, and need for an interpreter were not associated with referral to PFPT. Of the 20 patients who were referred to PFPT, 13 (65%) attended at least one session, and 7 (35%) did not attend any. There was a statistically significant difference in attendance at PFPT amongst patients who required an interpreter versus those who did not; 0 out of 13 patients (100%) vs 3 out of 7 patients (42.9%), respectively; p=0.031. Patients who received PFPT referrals had significantly shorter median intervals to first postpartum visit than those who did not (13.0 vs 31.5 days; p=0.004). Patients who reported any domestic violence or barriers to food, housing, or finances had a longer interval to first postpartum visit than those who did not (40 vs 30 days; p=0.016), while the need for an interpreter was not associated with a longer interval to first postpartum visit (p=0.736). CONCLUSIONS: Referral to PFPT after OASIS was uncommon, occurring only in 8.4% of patients. Patients who need an interpreter may be less likely to attend PFPT and may require more support. Our findings highlight the need to implement standardized protocols to promptly identify patients with OASIS and evaluate their need for PFPT. Targeted approaches to postpartum care may ensure equitable access to PFPT.Table 1Table 2
Kim et al. (Fri,) studied this question.