Physiotherapeutic care for urinary incontinence in the context of age, sex, care situation, and informal provider networks - a longitudinal German claims data analysis.

Background: Urinary incontinence affects 5% to 35% of the older adult population. Untreated urinary incontinence is associated with reduced quality of life, amongst others. Pelvic floor muscle training is the first-line treatment. Existing evidence on the proportion of physiotherapy care remains limited, particularly regarding men with urinary incontinence, and insufficiently accounts for care situation- or age-specific disparities. This study investigated the proportion of physiotherapy care, differentiated by age, sex, care situation, informal provider networks, and temporal trends, to address these evidence gaps.

Method: We analysed health insurance fund claims data covering a period of 9 years (2008-2016), from up to 6,433,070 individuals aged 65+, and applied a network approach to identify patient sharing networks. We calculated the proportion of physiotherapy care on a quarterly basis.

Results: The proportion of physiotherapy care remained relatively stable over time. In the first quarter of 2016, it was 10.5% for people with incident urinary incontinence in total, 7.9% for those without care, 11.9% for people with home care, and 14.0% for nursing home residents. The lowest proportion of physiotherapy care (3.5%) was found among men with incident urinary incontinence in the 85 to 89 age group receiving no care, and the highest proportion (19.3%) among women with incident urinary incontinence in the age group 70 to 74 years living in a nursing home. The variation in the proportion of physiotherapy care between patient sharing networks was the highest for women and men in nursing homes (SD 9.7% and 9.2%, respectively).

Conclusions: These findings indicate a systematic underuse of physiotherapy services for both sexes across all age groups and care situations. Older men without care needs are particularly at risk for underuse.