Kristina Koch, PT, DPT, WCS, CLT is a board-certified clinical specialist in women’s health physical therapy and a certified lymphedema therapist. Kristina has been treating pelvic health conditions in individuals of all ages and genders since 2001 and works in private practice in Colorado Springs, CO. Kristina is a member of the HW faculty with her own course, Pharmacologic Considerations for the Pelvic Health Provider, scheduled next on February 4, 2024.

Why it is Important to Know Pharmacology

All rehab providers need to have a foundational understanding of pharmacology for numerous reasons, all of which contribute to providing safe, effective, and comprehensive care to their patients. In pelvic health, therapists often encounter patients who are taking numerous medications, and it is important for us to understand how these drugs may impact a patient's physical function, exercise tolerance, current complaints, and overall well-being.

Basic pharmacology knowledge includes:

1. Understanding drug classes
2. Pharmacokinetics and pharmacodynamics: how drugs exert their effect on the body and how the body impacts the drug
3. Drug interactions: recognizing potential interactions between medications and how they may affect a patient's response to therapy interventions.
4. Adverse Effects: awareness of possible side effects of medications that could impact a patient's ability to participate in therapy or contribute to their symptoms.

A more comprehensive understanding of pharmacology has clinical relevance on many fronts. The following bullet points highlight how understanding pharmacology has implications for clinical practice.

Assessment:

Pharmacological knowledge allows clinicians to conduct a more comprehensive assessment of their patients. Considering a patient's medication history as part of the overall health profile helps clinicians tailor treatment plans to individual needs and potential limitations.

Safe and Effective Patient Care:

Rehab providers often work with patients who are taking medications for various health conditions. Understanding pharmacology enables therapists to assess potential interactions between drugs and design safe and effective treatment plans.

Optimizing Rehabilitation Strategies:

Medications can impact a patient's response to exercise and rehabilitation. Understanding pharmacology enables rehab providers and therapists to modify treatment plans based on a patient's medication profile, potentially optimizing rehabilitation outcomes.

Pain Management:

Pain is a common reason our patients are seeking physical therapy. Knowledge of medications used for pain management enables therapists to collaborate with healthcare providers to create comprehensive pain management strategies for their patients.

Collaborative Care:

Clinicians often collaborate with physicians, nurses, and other healthcare providers. Knowledge of pharmacology facilitates effective communication, allowing therapists to discuss patient cases, contribute to treatment decisions, and foster a collaborative approach to patient care.

Educating and Empowering Patients:

Pelvic health practitioners and rehab providers play a vital role in educating patients about their health, including medications. Understanding pharmacology allows therapists to explain the purpose of medications, potential side effects, and the importance of compliance, encouraging patient engagement and adherence to treatment plans.

Recognition of Red Flags:

Knowledge of pharmacology enables pelvic health rehab providers to recognize signs and symptoms of adverse drug reactions, identify potential issues early, consult with healthcare providers, and modify treatment plans accordingly.

Informed Decision-Making:

In certain situations, therapists and rehab providers may need to make decisions regarding treatment plans and goals, treatment frequency, or modalities based on a patient's medication profile. A solid understanding of pharmacology contributes to informed decision-making.

Legal and Ethical Considerations:

Pelvic health practitioners need to work within their scope of practice. An understanding of pharmacology helps therapists recognize when it is appropriate to refer patients to other healthcare professionals for medication management.

Monitoring and Reporting:

Monitoring patients for signs of adverse reactions and knowing when to report concerns to other healthcare professionals or federal organizations.

Special Populations:

Pediatrics and geriatrics may require special consideration due to differences in pharmacokinetics and pharmacodynamics. Understanding how medications affect different age groups helps pelvic health therapists and rehab providers adapt our interventions accordingly.

As rehabilitation providers, we invest a substantial amount of time in direct interaction with our patients during their treatment sessions, surpassing the duration they spend with their primary care providers. This prolonged and more frequent engagement, spanning weeks or months, affords our patients an increased opportunity to communicate not only their physical concerns but also their apprehensions regarding medications and potential side effects. This dialogue exceeds what may occur with their physicians or primary care providers. Understanding the impact of medications on a patient is vital for effectively educating them about potential side effects and how these medications may contribute to their complaints, thereby augmenting the overall value of the treatment regimen.

With a solid grasp of pharmacology and insight into medications prescribed for pelvic health, therapists can engage in informed discussions with patients and collaborate effectively with other healthcare providers involved in their care. The capability to explore recent medications, supplements, or alternative approaches that may minimize side effects, mitigate impacts on quality of life, and enhance function. Remaining current on advancements in pharmacology is indispensable for delivering physical therapy interventions that are both effective and grounded in evidence-based practices.

In summary, a strong understanding of pharmacology enhances the overall quality of physical therapy practice. It ensures that physical therapists and rehab providers can provide patient-centered, evidence-based care while collaborating effectively within the broader healthcare team.

Join Kristina in Pharmacologic Considerations for the Pelvic Health Provider on February 4, 2024, to learn about the medications frequently used in pelvic health, their side effects, the clinical impact they may have on your patients, and possible alternatives to consider to improve patient outcomes and quality of life.

Kristina Koch, PT, DPT, is a board-certified clinical specialist in women’s health physical therapy and a certified lymphedema therapist. Kristina has been treating pelvic health conditions in individuals of all ages and genders since 2001 and works in private practice in Colorado Springs, CO. She has served as a guest lecturer for the pelvic health curriculum at Regis University in Denver and for the 3^rd year medical students at the University of Colorado, Colorado Springs campus. She is the creator of Pharmacologic Considerations for the Pelvic Health Provider.

Although it is not within the scope of practice for rehab therapists to manage medications, it’s important that we review patient medications during the initial evaluation and on an ongoing basis. Therapists have a duty to assess medications impact on treatment and patient outcomes and to ensure patient safety. The population is aging and many patients over the age of 65 are on more than 5 medications, increasing the risk of medication side effects, adverse drug reactions, and drug interactions.

Primary care providers spend approximately 14-17 minutes with a patient during a visit, and the patient gets about 5 minutes to discuss their concerns, leaving little time for medication reconciliation or discussion regarding medication side effects (Tai-Seale, McGuire & Zhang, 2007). As therapists, we tend to see our patients for longer periods of time and more frequently, giving the patient more of an opportunity to discuss their signs and symptoms. Additionally, patients referred for pelvic health issues are often seeing multiple specialty providers (Ob/Gyn, urology, urogynecology, pain management, etc.) for their care, and each one is typically prescribing medications, potentially leading to polypharmacy. Understanding a medication’s actions, its impact on therapy, the side effects, and potential adverse drug reactions, can help guide treatment and improve patient outcomes.

A recent patient example is a post-menopausal cisgender female, referred by her primary care physician, for urinary urgency and nocturia. Her past medical history was significant for breast cancer. Her medications included an aromatase inhibitor, antihistamine due to seasonal allergies, and Vitamin C. After reviewing her medications and history, I recommended a non-hormonal vaginal lubricant and within 2 weeks her symptoms were 80% improved. Understanding the side effects of her medications allowed me to educate the patient about the effects of her medication and how to manage her symptoms.

More and more patients are attending therapy through direct access. As the first point of contact for patients, it's imperative that rehab professionals have a foundational knowledge of the medications often prescribed to treat pelvic floor conditions, GI, GU, and reproductive health issues. The ability to have educated conversations with our patients and other healthcare providers involved in their care can greatly improve the quality of care and outcomes, and maintain patient safety. The ability to discuss medications, vitamins, and supplements or complementary alternatives, that can minimize side effects, have fewer impacts on quality of life, and enhance function is an integral part of comprehensive patient care.

Join Kristina on Saturday, January 7, 2023, for Pharmacologic Considerations for the Pelvic Health Provider. This one-day, remote course will discuss the importance of understanding pharmacology and medication review, the current research regarding the pharmacologic treatment of numerous pelvic and reproductive health conditions and their side effects, drug interactions, and non-pharmacologic alternatives that are available for pelvic and reproductive health. Registration information and additional details are available at www.hermanwallace.com. #hermanwallacepelvicrehab, @hermanwallacepelvicrehab

References:

Ciccone, C. D. (2007). Pharmacology in Rehabilitation. (4^th ed.). F.A. Davis Company.

Tai-Seale, M., McGuire, T.G., & Zhang, W. (2007). Time allocation in primary care office visits. Health Services Research. 42(5), 1871-1894. Doi: 10.1111/j.175-6773.2006.00689.x

Janes, M., & Kornetti, D. (2017). Medications: defining the role and responsibility of physical therapy practice. https://www.fsbpt.org/Portals/0/documents/free-resources/WinterForum2017Medications.pdf?ver=pf8bn4ZwoorAAg1PECZLfw%3D%3D

Pharmacologic Considerations for the Pelvic Health Provider

Course Dates:
January 7, 2023

Price: $200
Experience Level: Beginner
Contact Hours: 7.5

Description:  This seven-and-a-half hour, one-day remote learning course will discuss medications used for the treatment of pelvic floor and genitourinary conditions as well as common side effects of medications routinely used for pelvic floor dysfunction. This course will be taught by Kristina Koch, PT, DPT via Zoom. Medications for constipation and GI dysfunction, as well as pelvic pain conditions such as Vulvodynia, Chronic Prostatitis, and Endometriosis, will be covered. The course will also cover medications and side effects in Gender-Affirming Care for patients who are transitioning.