Evidenced-Based Physical Therapy for the Pelvic Floor Bridging: Science and Clinical Practice. Edited by K. Bo, B. Berghmans, S. Morkved, M. Van Kampen. Churchill Livingstone Elsevier, New York. 2015. Hard cover, 432 pages. $79.95.
This landmark text was first published in 2007. Since that time, there have been many quality studies in pelvic physical therapy (PT). In the foreword, the authors point out that we now have more than 65 randomized controlled trials on the use of pelvic floor muscle (PFM) training for stress and mixed urinary incontinence. This means that PFM training is no longer an "experimental" treatment. We have solid evidence in many areas of pelvic PT. The authors also note that as the body of evidence grows, it becomes evident that some treatments are not effective. It is our job to keep up with that literature and decrease usage of treatments that evidence shows do not have significant effect. Individualized treatments are still necessary, and evidence should inform those treatments. It is not enough to read 1 book or take 1 course series-this book is a must for those currently in practice to keep current and improve the quality of their treatments.
As in the previous issue, there is an impressive list of well-known contributors including many physical therapists, nurses, physicians, and researchers. Large sections of the text are devoted to measurements and test (>60 pages), female stress incontinence, overactive bladder, and pelvic organ prolapse (>150 pages). Other conditions examined in this text include sexual dysfunction in females, pelvic floor and sexual dysfunction in males, and anal incontinence. Special patient populations include patients with neurological diseases, elderly and pediatric patients, and athletes.
The 7 chapters on measurement techniques describe the techniques and review psychometric properties where available. Every test lists benefits and limitations and which assessments should target individual needs. Advanced clinicians can choose which tests to perform and more quickly arrive at a working diagnosis and treatment plan. Clinical recommendations are given, which help clinicians apply the information to clinical practice.
In this edition, there is an expended section on the treatment of chronic pelvic pain, which highlights the need for more quality research. This is certainly one area in which evidence is still lacking, and physical therapists must understand that many of the treatments offered do not yet have clear evidence. This is not to say they do not work but to say we do not have the ability to predict which types of patients will benefit and overall treatment planning relies on skill and experience. I believe this is an area skilled physical therapists should watch the research closely to refine clinical decision-making and increase success of future treatments.
Treatment research is summarized in a standard chart form and graded using the PEDro scale for quality of research. In addition, a discussion about the research helps therapists with less research experience understand the implications and apply the information to practice. For instance, it is often suggested that patients limit coffee consumption to decrease urgency and frequency of urination. Studies cited in this text did not find an association of coffee intake to any type of incontinence. However, there was a strong connection between high levels of tea intake and overactive bladder and nocturia. Understanding the new research gives us the tools to increase treatment success.
Updated references are used throughout the text, and tables provide quick view of information. It is not possible to learn pelvic PT from a book alone. This text provides a concise, evidence-based review of the field of pelvic PT. I would highly recommend this book to pelvic physical therapists of all levels.
Beth Shelly, PT, DPT, WCS, BCB PMD
Moline, Illinois