Approximately 80% of people with multiple sclerosis (MS) experience bladder dysfunction (BD). BD decreases quality of life, reduces mobility, and increases disease burden. Pelvic floor physical therapy (PFPT) is an evidence-based, non-invasive, and effective treatment for MS-related BD. Here, we provide a descriptive study, leveraging longitudinally collected patient-reported (PRO) BD severity scores against coinciding electronic health record (EHR) reports, to understand barriers to timely evaluation and treatment of BD.

The FITriMS study is a prospective cohort of ambulatory participants with progressive or relapsing MS, which included PROs of BD at baseline, 6-months, and 1-year. This analysis compared BD PRO (with Bladder Control Scores ≥ 1) to evaluations performed by a neurologist on the same participants concurrently. Chart review categorized the clinical treatment plan.

74% (65/88) of participants met inclusion criteria. They were mostly female (57%), mean age 53.5 years (11.8), median disease duration 19 years (range 1-54), and moderate disability (median EDSS 5.5, range 0-6.5). At baseline, 88% of participants reported BD on their PRO, but only 30% had some treatment documented in the EHR: 44% referred Urology, 50% prescribed medication, 6% provided behavioral techniques. At 6-months, 90% of participants reported BD on their PRO, 38% EHR documented treatment (43% referred Urology, 29% prescribed medication, 28% behavioral techniques); the distribution was similar at the 1-year. 93% of participants reported BD; 33% had treatment plans in the EHR (36% prescribed medication, 36% referred Urology, and 28% behavioral techniques). 0% had a documented referral for PFPT.

A gap was found between participant reports of BD on PROs and those referred for treatment. No direct PFPT referrals were documented, despite it being an evidenced-based, effective treatment. Quality improvement and education efforts for timely PFPT referrals can potentially improve patient care and close this gap.

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