Abstract
Introduction
Dysfunctional voiding (DV) is a pediatric bladder–bowel disorder managed with timed voiding and constipation treatment, with pelvic floor physical therapy (PFPT) reserved for refractory cases. PFPT may create financial strain through visit frequency, copays, and caregiver work absences. This study assesses financial toxicity (FT) among caregivers of children with refractory DV and evaluates PFPT as a contributing factor.
Methods
Patients aged 5-17 years with DV and ≥2 urology visits were included. Exclusion criteria were neurogenic bladder, cerebral palsy, chronic catheterization, prior bladder surgery, or structural anomalies. Caregivers completed a demographics survey, FACIT-COST financial toxicity instrument, and time/travel questionnaire; patients ≥8 years assented to chart review for PFPT utilization. Two-sided Pearson correlation, t-test, ANOVA, chi-square, and Fisher's exact tests were performed with p0.05 considered significant.
Results
Among 34 patient–caregiver dyads, median patient age was 10 years (IQR 7-14). Most patients were Caucasian (67.6%, n=23) and female (67.6%, n=23). Median FACIT-COST score for caregivers was 29 (IQR 18-38; range 3-44). PFPT was used by 31.3% (n=10). Dyads not attending PFPT had significantly higher FACIT-COST scores (greater financial well-being) than those attending (31.7 vs 18.5; p=0.002). FACIT-COST scores negatively correlated with number of PFPT visits (r = −0.44; p=0.012), indicating that more sessions predicted more FT. Neither FT nor PFPT use was significantly associated with race, ethnicity, or sex.
Conclusion
Considerable financial toxicity exists in pediatric DV management, particularly among families utilizing PFPT. While PFPT is non-invasive and non-pharmacologic, providers should be mindful of its potential financial burden on families.