Return to Activity Postpartum: Factors for the Physical Health Professional to Consider and Patient Handout

Return to Activity Postpartum: Factors for the Physical Health Professional to Consider and Patient Handout

Emily Goodnight, SPT

 

Background

Before and during physical therapy school, I have found myself interested in a variety of topics. I am passionate about orthopedics with a curiosity about how pelvic health impacts general orthopedics. During our first year Musculoskeletal Level 1 course, we received a lecture on pelvic floor physical therapy. It was this point that I realized the significant role that pelvic health plays in overall musculoskeletal function. As I began to ask questions, I noted a gap of knowledge about pelvic health in general and in addition to the pregnant/postpartum population that many physical therapy students, clinicians, and other health professionals have. Within the pelvic health world, I became curious about the orthopedic physical therapist’s or other health/fitness professional’s role in helping patients/clients return to physical activity postpartum. I firmly believe that a strong orthopedic physical therapist, personal trainer, chiropractor, etc.. should understand changes that occur postpartum and the role of pelvic floor function when working with postpartum clients on return to activity.

Statement of Need

Return to sport or high level activity is predominantly researched and considered for the male population.¹ Women returning to sport or high level activity postpartum is a relatively new occurrence.¹ Postpartum women face unique challenges when returning to high levels of activity including greater risk of pelvic floor dysfunction, breathing changes, postural changes, abdominal wall dysfunction, and pain.¹ Up to 80% of women report lower activity levels at 3 months postpartum compared to their first trimester.² This could be due to a variety of reasons, indicating the need for a proactive, multidisciplinary approach to provide appropriate support for this population.¹ There is a need to educate orthopedic physical therapists, personal trainers, and other health professionals on how to work with postpartum patients. Additionally, these professionals and patients should be educated on when to see a pelvic floor physical therapist for more specialty care.

Overview and Purpose

The purpose of this capstone project is to provide more education to orthopedic physical therapists, personal trainers, chiropractors, or other health professionals that may use exercise to assist a postpartum client in return to activity. Through my presentation, professionals will understand common reasons postpartum clients may not return to activity with a primary focus on musculoskeletal changes and demands on the body during pregnancy and postpartum. These changes and demands relate to breathing pattern, posture, hip strength, and diastasis rectus abdominis. The audience will learn how to assess these musculoskeletal issues, address them with exercise intervention, and when to refer to a pelvic floor physical therapist. The audience will also be encouraged to consider other factors that may impede return to activity postpartum such as postpartum fatigue, socioeconomic status, lack of sleep, time, and the COVID-19 pandemic.

Additionally, I created a check-list for the mentioned professionals to use for determining when to send a client to see a pelvic floor physical therapist for more specialty care. I also created a patient handout to educate postpartum moms on symptoms or concerns that may benefit from working with a pelvic floor physical therapist.

Health Literacy

One component of my capstone is a patient handout to inform patients when to seek help from a pelvic floor physical therapist. I aimed to make the handout simple, clear, and visually appealing. It is recommended to  focus on what symptoms or concerns a patient may experience rather than educating on statistics or anatomy to catch and maintain the reader’s attention.³ This keeps the information relevant to the patient and focuses on the main educational point: to seek professional assistance in the circumstances mentioned and how to do so. In my handout, I state eight signs/symptoms that indicate working with a pelvic floor physical therapist may be beneficial. I directly state that patients may benefit from pelvic floor physical therapy if they experience any of the mentioned signs/symptoms. Directions on how to find a pelvic floor physical therapist are stated at the bottom. It is also recommended to use simple wording in short sentences and only say what is important.³ The signs/symptoms on my handout are bullet point style rather than full sentences. Making a handout too wordy could lose the viewer’s attention and/or distract from the main point. Using simple illustrations can assist viewers’ understanding of the message and make the handout more visually appealing.⁴ Above each sign/symptoms I have a simple, black outlined graphic to illustrate the symptoms being mentioned. To further assist simplicity, the layout should include white spaces so the handout is not over crowded.⁴ Each sign/symptom is evenly spaced out, highlighted by a non-distracting color with a white background.

My capstone also consists of a PowerPoint presentation and a handout for non-pelvic floor physical therapists, personal trainers, or other health/fitness professionals on when to refer to a pelvic floor therapist. I have presented a shortened version of this PowerPoint to personal trainers at Chapel Hill Training. Throughout the creation of the presentation, I aimed to highlight important information in an organized and clear fashion. I also aimed to make the presentation engaging and visually appealing. To do this, I limited what I put on the slides and planned for the main component of the presentation to be my speaking rather than the words on the slides. When a lot of information was needed on a slide, I categorized it to make it more learner friendly as recommended by McCulloch.⁵ Additionally, it is recommended to create structure in the PowerPoint to inform the audience on how the presentation will flow.⁵ I did this by keeping a similar structure for each main topic which followed: background on condition, assessing the condition, and using exercise to address the condition. To help the information stick, the presentation will be interactive and trainers will be prompted to try some of the different exam techniques and exercises in real time. I also recorded audio in a VoiceThread format so the material can be reviewed by the personal trainers and will be accessible to a wider audience. To further assist the audience in working with the postpartum population moving forward, I provided links to refer to a pelvic floor physical therapist and a handout with a client symptoms checklist to understand when to refer out.

The handout on when to refer a client to a pelvic floor physical therapist is quite simple and user friendly. It contains 9 observational items with instructions to “check any that apply.” The user is then instructed to refer out to a pelvic floor physical therapist if any of the items were checked. Directions on how to find a pelvic floor physical therapist are also included on the handout. This handout will serve as a reminder of examples on when a client may benefit from seeking pelvic floor physical therapy.

Products

Link to VoiceThread Presentation for physical therapists, personal trainers, or other: https://unc.voicethread.com/share/19941065/

Capstone Outline with Evidence Tables

Postpartum Patient Handout

Refer to pelvic PT Check-list (for physical therapists, personal trainers, or other)

Evaluation

The patient handout was sent to 9 postpartum mothers along with a survey for evaluation. Their feedback is represented in this chart:

Responses to “what did you like about the patient handout?”:

“Simple, clear, easy to understand! Also aesthetically pleasing”

“it was concise and to the point”

“Very clear and easy to read and understand. The visuals and captions caught my attention.”

“Concise wording, helpful graphics”

“Clear images, font is easy to read, eye-catching overall.”

“Very easy to follow!”

“Like the use of infographics to make the information easy to digest.”

“I like the visuals and the simple wording. It makes it easy to relate to without having to read a lot of small or heavy text.”

“Great graphics”

Responses to “What feedback would you give to improve the handout?”:

“The only one I could see being confusing is “diagnosis of diastasis recti” and the graphic, if they are not familiar. But it’s still helpful because it might encourage someone to ask their doctor about it”

“A more detailed explanation on what pelvic floor therapy consists of and whether insurance will cover it”

“The directions for finding a PT are a little cramped at the bottom. Instead of a full hyperlink (since patients can’t click it) maybe do “pelvicguru.com” etc.”

“I think it looks great, no suggestions here!”

If you are a postpartum mom who reviews the patient handout, please feel free to provide feedback here: https://docs.google.com/forms/d/e/1FAIpQLSeQur5aX1IYQcgvnjzxtJnEI-hf1AE44aEFWg6I6iOmg89mEQ/viewform?usp=sf_link

The presentation and referral check-list was evaluated by the personal trainers at Chapel Hill Training. Their feedback is represented here:

Responses to “What did you like about the presentation?”:

“I would have loved to see this be a longer presentation, going into more depth.”

“The information was new to me so just making sure definitions of unknown words are redefined halfway through!”

Responses to “What feedback would you give to improve the presentation?

“This is such a great and necessary topic! Loved it”

“Great presentation, extremely confident speaker!”

If you are a physical therapist, personal trainer, or other fitness professional who views the full VoiceThread presentation and Referral check-list handout, please feel free to provide feedback here: https://docs.google.com/forms/d/e/1FAIpQLSc1uosYS4CwYGMoDuIrV7-SooSjHwVOIZynoiK2jg8T-KMQHA/viewform?usp=sf_link

Self-Reflection

This experience of creating a capstone project has been quite rewarding from start to finish. At the beginning, I quickly realized there were several different avenues I could go down to construct a project that successfully addressed my original learning objectives. My learning objectives were to learn more about what conditions limit the postpartum population from returning to their desired level of activity, current recommendations for returning to activity postpartum, recommendations for when to refer to a pelvic floor physical therapist, how to educate health professionals in working with postpartum patients, and how to educate postpartum patients on when to seek out pelvic floor physical therapy.

After several phone calls with my capstone committee members and a lot of research, I landed on the four specific musculoskeletal topics that made up the bulk of my presentation and was able to narrow down the information to include on my handouts. I feel that I successfully met my learning objectives and learned so much more beyond that. I am thrilled that the information I learned during this process has resulted in tangible skills that I can use with my personal training clients and with my future physical therapy patients.

The most rewarding part of the experience was both getting to work with my committee members and sharing my final products with my target audiences. I could feel all of my committee members’ passion for their work, educating me, and guiding me throughout the creation of this project. I felt that I got to share this similar passion and excitement surrounding this work with my target audiences. I am happy to know that my project has provided continuing education for at least the personal trainers who attended my in-person presentation and equipped at least a few postpartum moms with knowledge about symptoms that could benefit from working with a specialized physical therapist. I hope to continue spreading this information and using my new knowledge as I begin my career as an orthopedic physical therapist.

Acknowledgements

Lisa Johnston, PT, DPT – thank you for helping me organize my thoughts very early on in this project as well as continuing to provide helpful answers to questions and guidance throughout.

Smith Christenbury, PT, DPT – thank you for the phone calls, long emails, thoughtful feedback, encouragement, and education you provided throughout. I appreciate your guidance and mentorship before and during this process.

Jennifer Harrington, PT, DPT, WCS, CLT – thank you for meeting me to discuss my project, providing very insightful, clinical feedback and resources throughout this process. I appreciate your mentorship throughout this process and beyond.

Sonya Williams, MD – thank you for your excitement, support, and feedback surrounding this project. It was a pleasure getting to work with you.

Chapel Hill Training Personal Trainers – thank you for your attention and enthusiasm for my presentation. I appreciate the time you gave me to talk about my project content and the feedback you gave both in person and online.

Postpartum Moms – thank you for reviewing my patient handout and giving helpful feedback.

 

References:

1. Donnelly GM, Moore IS, Brockwell E, Rankin A, Cooke R. Reframing return-to-sport postpartum: the 6 Rs framework. Br J Sports Med. Published online November 26, 2021. doi:10.1136/bjsports-2021-104877
2. Gutke A, Lundberg M, Östgaard HC, Öberg B. Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. Eur Spine J. 2011;20(3):440-448.  doi:10.1007/s00586-010-1487-6
3.  DeWalt D, Pignone M, McCulloch K. Health Literacy 101 Defining The Problem and What We Can Do About It. Presented at the: PHYT 854 – VoiceThread; March 2, 2010.
4. Jensen GM. Teaching and Learning for Physical Therapists. In: Patient Education and Health Literacy. 3rd ed. ; 2013:199-216.
5. McCulloch K. PowerPoint Example – Live Presentation. Presented at the: PHYT 854 – VoiceThread; March 12, 2010.