1b31dcd52f77f22b02d7b20f3c282d31 336800.pdf 8b0f6c6a2ebc0524c9d5f049de044871edef9ad1 336800.pdf 5fb65967c40f5fd6e39cf7d60cc109025cd3b5e0e70072f9fdc878a65d563777 336800.pdf Title: Translating Patient–Professional Divergence into Care-Improvement Priorities in Pelvic Floor Rehabilitation: A Delphi-Dialogue Study Subject: Background/Objectives: Pelvic floor dysfunctions (PFDs) are highly prevalent chronic conditions associated with substantial functional and psychosocial burden. Although multidisciplinary pelvic floor rehabilitation is recommended as first-line management, its effectiveness depends not only on intervention efficacy but also on care delivery, communication, patient engagement, and long-term adherence. This study applied the Delphi-Dialogue Patients–Professionals (DDPP) framework to quantify patient–professional alignment and translate identified patient–professional perceptual differences into candidate service-improvement strategies. Methods: A two-phase observational study incorporating parallel stakeholder surveys and a modified Real-Time Delphi feasibility-assessment process was conducted under the auspices of the Spanish Society of Physical Medicine and Rehabilitation (SERMEF). In Phase 1, parallel online questionnaires were completed by 225 patients with PFD and 164 rehabilitation professionals. Shared items were rated on a six-point Likert scale, and patient–professional divergence was quantified using an operational composite index integrating standardized differences in mean ratings and high-agreement responses. In Phase 2, the implementation feasibility of 10 improvement recommendations was evaluated by a Delphi panel comprising 35 PM&R physicians and two representatives of the Spanish Incontinence Association (ASIA). Results: Patient–professional agreement was domain-specific. The greatest divergences concerned digital competence, timing of patient education, bladder and bowel diary use, and adherence to prescribed rehabilitation programmes. Professionals attributed greater value to bladder and bowel diaries and selected group-based interventions, whereas patients reported higher digital competence, more timely information delivery, and better adherence. Comparatively similar response patterns were observed regarding hybrid rehabilitation models, educational resources, app-supported follow-up, and overall satisfaction with rehabilitation care. The Delphi process identified structured home exercise programmes, adherence-monitoring strategies, and improved visibility of rehabilitation pathways as the recommendations with the highest perceived implementation feasibility. Conclusions: The findings suggest that important challenges in pelvic floor rehabilitation may arise from implementation-related factors in addition to the effectiveness of available interventions. The DDPP framework provides a structured, stakeholder-informed methodology for translating patient–professional divergence into candidate organizational recommendations with comparatively higher perceived implementation feasibility. Keywords: pelvic floor disorders; rehabilitation; patient-professional alignment; Real-Time Delphi; adherence; care delivery; value-based health care Author: Lourdes Gil-Fraguas, Soraya Hijazi-Vega, Michelle Catta-Preta, Alex Trejo-Omeñaca, Jan Ferrer-Picó, Isabel Montes-Posada, Jesús Vara-Paniagua, Carolina de Miguel-Benadiba, Josep Maria Monguet-Fierro and Helena Bascuñana-Ambrós Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Wed Aug 12 16:54:04 2026 CEST ModDate: Wed Aug 12 17:02:30 2026 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 29 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1694681 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HCMDAG+CMSY10 Type 1 Builtin yes yes yes 203 0 EJSHAK+URWPalladioL-Ital Type 1 Custom yes yes yes 204 0 WCFXBZ+VnURWPalladioL Type 1 Custom yes yes yes 205 0 ZEMWDF+URWPalladioL-Bold Type 1 Custom yes yes yes 206 0 AHLJNN+URWPalladioL-Roma Type 1 Custom yes yes yes 207 0 HNOELJ+PalatinoLinotype TrueType WinAnsi yes yes no 280 0 GIIJWT+EURM10 Type 1 Builtin yes yes yes 304 0 MPUDFL+PazoMath Type 1 Builtin yes yes yes 305 0 UOSVRN+EURB7 Type 1 Builtin yes yes yes 353 0 PDXFNG+PazoMath-Bold Type 1 Builtin yes yes yes 354 0 HNOELJ+PalatinoLinotype TrueType WinAnsi yes yes no 396 0 HNOELH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 397 0 HNOELJ+PalatinoLinotype TrueType WinAnsi yes yes no 386 0 HNOELH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 387 0 HNOELJ+PalatinoLinotype TrueType WinAnsi yes yes no 402 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-10-07 03:58:02 CEST RepresentationInformation: 336800.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-10-06 12:59:52 CEST Size: 1694681 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 565 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Objectives Children: Item: Title: General Objective Item: Title: Specific Objectives Item: Title: Materials and Methods Children: Item: Title: Study Design and Context Item: Title: Survey Development and Structure Item: Title: Participants and Recruitment Item: Title: Procedure Item: Title: Outcomes and Concordance Analysis Item: Title: Recommendation Development Process Item: Title: Real-Time Delphi Feasibility Assessment Item: Title: Ethics and Data Protection Item: Title: Results Children: Item: Title: Participant Characteristics Item: Title: Comparison of Experiences Between Patients and Professionals Item: Title: Second Phase: Structuring and Prioritization of Recommendations Item: Title: Exploratory Strategic Innovation Domains in Pelvic Floor Rehabilitation Item: Title: Discussion Children: Item: Title: Principal Findings and Contribution Beyond Existing Evidence Item: Title: Patient–Professional Divergences: Implications for Adherence and Self-Management Item: Title: Timing of Information Delivery and Communication: An Implementation Challenge Item: Title: Digital Health and Hybrid Rehabilitation: Broad Acceptance with Conditional Adoption Item: Title: Organizational Determinants: Access, Visibility, and Care Coordination Item: Title: Implications for Implementation and Service Redesign Item: Title: Limitations Children: Item: Title: Instruments and Self-Reported Data Item: Title: Cross-Sectional Design Item: Title: Exploratory Divergence Index Item: Title: Sampling and Selection Bias Item: Title: Delphi-Panel Composition and Feasibility Assessment Item: Title: Clinical Heterogeneity Item: Title: Generalizability Item: Title: Study Strengths Item: Title: Conclusions Item: Title: References Info: Title: Translating Patient–Professional Divergence into Care-Improvement Priorities in Pelvic Floor Rehabilitation: A Delphi-Dialogue Study Author: Lourdes Gil-Fraguas, Soraya Hijazi-Vega, Michelle Catta-Preta, Alex Trejo-Omeñaca, Jan Ferrer-Picó, Isabel Montes-Posada, Jesús Vara-Paniagua, Carolina de Miguel-Benadiba, Josep Maria Monguet-Fierro and Helena Bascuñana-Ambrós Subject: Background/Objectives: Pelvic floor dysfunctions (PFDs) are highly prevalent chronic conditions associated with substantial functional and psychosocial burden. Although multidisciplinary pelvic floor rehabilitation is recommended as first-line management, its effectiveness depends not only on intervention efficacy but also on care delivery, communication, patient engagement, and long-term adherence. This study applied the Delphi-Dialogue Patients–Professionals (DDPP) framework to quantify patient–professional alignment and translate identified patient–professional perceptual differences into candidate service-improvement strategies. Methods: A two-phase observational study incorporating parallel stakeholder surveys and a modified Real-Time Delphi feasibility-assessment process was conducted under the auspices of the Spanish Society of Physical Medicine and Rehabilitation (SERMEF). In Phase 1, parallel online questionnaires were completed by 225 patients with PFD and 164 rehabilitation professionals. Shared items were rated on a six-point Likert scale, and patient–professional divergence was quantified using an operational composite index integrating standardized differences in mean ratings and high-agreement responses. In Phase 2, the implementation feasibility of 10 improvement recommendations was evaluated by a Delphi panel comprising 35 PM&R physicians and two representatives of the Spanish Incontinence Association (ASIA). Results: Patient–professional agreement was domain-specific. The greatest divergences concerned digital competence, timing of patient education, bladder and bowel diary use, and adherence to prescribed rehabilitation programmes. Professionals attributed greater value to bladder and bowel diaries and selected group-based interventions, whereas patients reported higher digital competence, more timely information delivery, and better adherence. Comparatively similar response patterns were observed regarding hybrid rehabilitation models, educational resources, app-supported follow-up, and overall satisfaction with rehabilitation care. The Delphi process identified structured home exercise programmes, adherence-monitoring strategies, and improved visibility of rehabilitation pathways as the recommendations with the highest perceived implementation feasibility. Conclusions: The findings suggest that important challenges in pelvic floor rehabilitation may arise from implementation-related factors in addition to the effectiveness of available interventions. The DDPP framework provides a structured, stakeholder-informed methodology for translating patient–professional divergence into candidate organizational recommendations with comparatively higher perceived implementation feasibility. 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