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Assessing use of eau recommendations in diagnostic and therapeutic strategies for chronic pelvic pain syndrome: a case vignette study on dutch pelvic floor physiotherapists practices

BMC Women's Health volume 25, Article number: 272 (2025) Cite this article

Abstract

Background

Chronic Pelvic Pain Syndrome (CPPS) presents as pain located in the pelvic area lasting for at least six months, often with a multifactorial aetiology. The International Continence Society divides CPPS in multiple domains; one is the musculoskeletal domain. Pelvic floor physiotherapy is a recommended treatment and is advised in the European Association of Urologist (EAU) guidelines. However, in the Netherlands, it is unclear which treatment strategies are used by pelvic floor physiotherapists (PFPs) for CPPS patients due to the lack of a Dutch evidenced-based guideline for physiotherapists. This study provides an overview of the adherence to the EAU guideline by PFPs in managing CPPS patients.

Methods

A case vignette study using two case vignettes and a general questionnaire defining contextual data. Participants were PFPs treating patients with CPPS in primary care. We contacted 550 qualified PFPs registered in the Dutch national quality registry for physiotherapy. Main outcome measure: first, adherence to EAU guidelines and second, the adherence compared to level of education and caseload.

Results

Of the invited participants, 198 completed the survey. Of these, 29 (14.6%) scored higher than 80% for both case vignettes; fifty-four (27%) scored 80% for the male case vignette and 30 (15%) scored 80% for the female case.

Conclusions

Our findings show low adherence to the EAU guideline’s proposed diagnostic and treatment criteria. PFPs should become more familiar with implementation of this guideline.

Peer Review reports

Background

Chronic pelvic pain syndrome (CPPS) is pain in the pelvic region characterized by either continuous or intercurrent episodes of pain for over six months without clear evidence for clinical pathology [1]. CPPS is a syndrome found in both men and women with a prevalence in men ranging from 1.9—9.6% compared to 5.7—26.6% in women [2,3,4,5,6]. CPPS often presents with symptoms of the lower urinary tract and lesser pelvis inducing sexual, bowel and gynaecological dysfunction. The exact aetiology of CPPS remains unknown, but a high interference with gynaecologic, urologic, gastrointestinal, musculoskeletal and psychosocial comorbidities is observed [1]. In 22%—94% of CPPS cases, myofascial pelvic pain is involved [7]. Ideally, CPPS should be treated at a dedicated multidisciplinary centre specialized in chronic pain in the area of the lesser pelvis [8, 9].

The International Continence Society (ICS) has divided CPPS in nine different domains based on different organ systems. The fifth domain is the Musculoskeletal domain; this involves pain originated from the pelvic muscles, fascia, ligaments, joints, or bones. This subdivision of the domain chronic pelvic muscle pain (CPMP) is especially relevant for pelvic floor physiotherapists (PFPs) as they have expertise in diagnostic and treatment modalities for pelvic floor muscle dysfunctions [10]. Therefore, patients with CPMP are often referred to PFPs [1].

Currently, several CPMP treatment strategies are available, including myofascial manual techniques and biofeedback therapy as recommended in the annually updated, evidence based European Urology Association (EAU) guideline (see Table 1) [1, 11,12,13,14]. In the Netherlands, no national evidence-based physiotherapeutic guideline is available for Chronic Pelvic Pain, although using the general Chronic Pelvic Pain guidelines is taught and recommended in the master’s degree (MSc)-curriculum of PFPs. In recent years, the level of PFP training has evolved. Historically, PFPs were educated to the bachelor’s degree level (BSc). Since 2014, they can be awarded a master’s degree (MSc), which applies a different level of the European Qualifications Framework (level 7 instead of level 6), resulting in a higher qualification standard for PFPs. [15,16,17].

Table 1 Recommended strategies for assessing and managing a CPPS patient by Pelvic Floor Physiotherapists by the EAU guidelines
Full size table

We conducted a case vignette study to provide an overview of the adherence to EAU guideline by Dutch PFPs in managing CPPS patients. Moreover, we compared PFPs’ level of education and workload with the adherence to European guidelines.

Methods

Participants

The participating PFPs were accredited professionals with a sufficient case load and were all members of the Dutch Association of Pelvic Floor Physical Therapy. Eligible participants met the inclusion criteria if they had completed a licensed course in pelvic floor physiotherapy in the Netherlands and were registered in the National Quality Register for Physiotherapists (NQRP).[18].

Due to privacy constraints of the Dutch Association of Pelvic Floor Physiotherapists, we were unable to contact all PFPs directly via email. An online search provided contact information of 87% of PFPs, who were sent an email requesting for their participation. This email included the study’s background and a request for informed consent. Once informed consent was received, PFPs were sent a link to the online survey, and further contact remained by email. The online survey was administered using the database Castor EDC. PFPs completed the surveys in between February 2020 and May 2020. During this period, three reminders were sent.

Design

A case vignette study consisting of case vignettes and a general questionnaire containing baseline questions (contextual data, patient load and educational level) were developed based on the current EAU guidelines for Chronic Pelvic Pain [1]. Our study was approved by the Central Committee on Research Involving Human Subjects of Arnhem and Nijmegen (file number: 2023–16474).

The case vignette and general questionnaire

Two case vignette studies and a general questionnaire were developed by the research group (abbreviations of the researchers: MR-SW-KN-KV-MS),describing the case of a male and female CPPS patient (Figs. 1 and 2). A case vignette is a validated and generally accepted method for assessing the diagnostic steps and clinical reasoning of health care professionals [19,20,21,22]. Both cases consisted of six questions: two on the diagnostic strategy, two on the therapeutic options, and two on the number of treatment sessions needed. The multiple choice questions (questions 2–4 for each case) contained three or four answer options; the first question on diagnostic strategy had seven answer options. The respondents were asked to give the three most applicable options for each case.

Fig. 1
figure 1

Male vignette

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Fig. 2
figure 2

Female Vignette

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The general questionnaire included questions on contextual data, educational level (BSc or MSc), years of work experience, case load of patients in their practice, and different CPPS diagnostic and interventional strategies available in their practice.

Validation and pre-test

The case vignettes were developed by a group of experts including three accredited pain specialists (KV-MS-SW), a urogynaecologist (KN), and two PFPs (MR-LS). The case vignettes were developed based on real clinical cases and on the EAU guidelines for CPPS presented in the guideline [1]. The case vignettes were pilot tested by a panel of 5 PFPs (SS-CO-SH-SSp-MD). The results of the pilot were discussed in the research group and alterations were made if needed. The final versions of both case vignettes are presented in Additionl file 1: Appendix 1.

The scoring system

An expert group consisting of a PFP, urogynaecologist and pain specialist (MR-KN-SW) reviewed the results of both vignettes and compared the answer options with the EAU guidelines [1]. They divided 10 points for each answer option based on a consensus in the complete research group (MR-SW-KN-KV-MS-MW) and established the definite scoring system (see Additionl file 1: Appendix 1 and 2). The maximum score for both cases was 43 points (= equal to 100% agreement with the guideline). Based on expert consensus, we determined the cut-off value for success at 80% (i.e., 34 points). Secondly, we were interested whether a high case load or educational level of the PFPs would improve guideline adherence. A sufficient case load was defined at > 1 new patient per week and a high case load was defined at > 5 new patients per week.

Data analysis

The statistical analysis was performed with IBM SPSS Statistics for Windows, version 25. The general questionnaire and multiple choice questions were analysed using descriptive statistics and presented in frequencies, mean and standard deviation.

A Chi-square test was used to determine if there was a statistical significant association between educational level and case vignettes scores, and between case load and case vignettes scores, with a significance level of 0,05.

Results

Contextual data

Of the 635 registered PFPs in the Netherlands, 550 PFPs were approached based on availability of internet contact information and were invited to take part in this study. Of these 550 PFPs, 277 PFPs returned the survey (41%). Seventy-nine surveys were excluded as they were incomplete, leaving a total of 198 completed surveys (36%) for analysis (Fig. 3). The contextual data of the PFPs are summarised in Table 2.

Fig. 3
figure 3

Flow Chart Inclusion Respondents

Full size image
Table 2 Contextual data of the pelvic floor physiotherapists
Full size table

Table 2 presents contextual data of the pelvic floor physiotherapists including information on work experience and level of education.

The case vignettes

The complete case vignettes are presented in Additionl file 1: Appendix 1. A great variety of possible answers were given to the questions for both vignettes. The therapists were very divided which diagnostic or therapeutic modality should be used in the case vignettes.

When comparing the responses to the advice in the EAU guideline, 29 (14.6%) of the 198 therapists scored 80% or higher for both case vignettes. Fifty-four (27%) therapists scored 80% for the male case vignette, and 30 (15%) scored 80% for the female case. Hundred and twenty six (64%) therapists scored for neither of the case vignettes 80%.

The PFPs’ educational levels are listed in Table 2. A schism is seen in educational level compared to the European Qualification Framework. The majority had an educational level of BSc (71%), the remainder qualified at MSc level (29%). Additionally, four PFPs were a PhD (candidate) (2%). Significantly more BSc therapists followed the EAU guidelines compared to MSc therapists; 27 of 141 compared to 2 of 57 respectively (p = 0,005) (Table 3).

Table 3 Overview adherence to the guideline based on education and caseload
Full size table

In addition to the comparisons of education and scoring, the number of patients treated was compared to the scoring. The PFP were asked how many new patients they admitted for diagnostic or therapeutic consultation in a week. A total of 136 PFPs had a high case load (defined as 5 new patients in a week) (Table 2). Eight of the 61 therapists, with less than 5 new cases a week, scored 80% or more for both case vignettes compared to 21/136 therapists with more than 5 new cases a week. No significant difference was found in adherence to the EUA guideline between therapists with a high or low caseload (p = 0.680) (Table 3).

Discussion

This is the first evaluation of the adherence to EAU multidisciplinary guidelines by Dutch PFPs, using a case vignette study. We assessed the clinical diagnostic and treatment strategies of chronic pelvic muscular pain by Dutch PFPs on a scoring system based on the EAU guidelines [1]. A poor adherence to the guideline recommendations was found, based on the answers given by the PFPs. There was a significant difference in adherence to the EAU guideline in favour of BSc-educated PFPs. The case load was not associated with adherence to EAU guidelines.

Only 15% of the therapists answered according to the EAU guideline in both case vignettes. Of the respondents, 26% scored 80% for one of the cases, answering according to current guidelines. This shows that, although the current EAU guidelines for CPPS provide a recommendation for how to treat a patient, this does not guarantee a good implementation of the guideline and/or a uniform physiotherapeutic approach and treatment. Compared to the literature on adherence to guidelines in general, the compliance wase found low [23]. For example, in a study amongst primary care physicians in the USA, 70% of the physicians understood that CPPS is a non-infectious disease; however only 5% referred patients to PFPs while antibiotic therapy was the chosen therapy by 72% of the primary care physicians [24]. This indicates that primary care physicians have little awareness of the current guidelines concerning CPPS.

Other case vignette studies have also described poor adherence to current guidelines [25,26,27,28,29,30,31]. For example, in palliative care of cancer patients, the adherence to the national Dutch guideline on the diagnosis and treatment of pain in patients with cancer was inconclusive: in case of a pharmacological treatment (99%) or invasive treatment (95%) adherence was high, in contrast to the recommendations on the use of a one-dimensional pain scale (23%) and performing a multidimensional pain assessment (15%) [25].

As noted above, a significant difference was found in guideline adherence in favour of BSc-educated PFPs. The EAU Chronic Pelvic Pain guideline is taught in its full extent in the MSc-curriculum, and the clinical reasoning is practiced with a patient case in small study groups. Therefore, a higher adherence was expected to the guideline in MSc-educated PFPs. We also expected a higher caseload would improve guideline adherence, but this was not confirmed by our results. This may be due to the extended interests of MSc-educated PFPs; their focus may shift from clinical practice to research or additional tasks, as would be expected of level 7 EQF educated PFPs [15,16,17]. Additionally, MSc-educated PFPs might choose for individualized treatments, as recommendations in guidelines are not always suitable for every patient and subsequently match the treatment with the patients’ needs [32]. Altered management strategies may be due to previous positive experiences or the attitude and beliefs of a PFP [33, 34].

Strengths

The majority of Dutch PFPs were invited to participate. Moreover, the study was supported by the board of the Dutch Association of Pelvic Floor Physiotherapists. Furthermore the case vignettes were developed and reconstructed by an expert group based on EAU guidelines for Chronic Pelvic Pain. The response rate of 41% was good, similar to other chronic pain studies with case vignettes (24–43%) [25,26,27]. Another strength is the involvement of an expert-based scoring system in which multiple experts participated. Despite the absence of formal validation, the expert-based approach offers several advantages. It leverages the specialized knowledge and experience of professionals who are deeply familiar with the subject matter, ensuring that the scoring reflects nuanced and contextually appropriate judgments. They reached consensus for the scoring system in comparing the case vignettes with the EAU guidelines. The expert group verified their consensus within the research team for validation and reached agreement for the practice based scoring system based.

Limitations

Due to privacy constraints, we were unable to communicate with the Dutch Association of Pelvic Floor Physiotherapists about PFPs’ email-addresses and therefore we were unable to reach all PFPs, however the overall response rate was good (41%). A further limitation was the use of case vignettes as this may cause bias related to socially desirable answers. However, case vignettes are the best option to represent clinical reality without case variety. We did not include a question in our questionnaire to determine knowledge about the (inter)national guidelines to avoid biased answers. Another limitation is the lack of an validated scoring system for the case vignettes. An evidence based scoring is not available and only a practice based scoring based on expert opinion was possible to review the results of the case vignettes as seen in other literature[25, 29, 30, 35]. We recognize the inherent limitations of using an unvalidated scoring system however expert-based scoring remains a valuable method for obtaining informed and contextually relevant evaluations of case studies.

The lack of adherence to the EAU guidelines for CPPS seen in our study marks the cruciality to enhance educational efforts and clinical training focused on EAU guidelines for PFPs. Strategies should be developed to improve implementation of EAU guideline among all practicing PFPs. A Dutch CPPS guideline specifically for PFPs might help for an improved adherence to the guidelines. However, more prospective randomized clinical trials are needed to provide evidence for the guidelines in recommendations in diagnostic and treatment modalities for CPPS by PFPs. Future research should explore the barriers and facilitators influencing guideline adherence among PFPs in different practice settings. This could inform tailored interventions aimed at optimizing guideline implementation and improving patient outcomes in the management of chronic pelvic pain.

Conclusion

Adherence to EAU guidelines is low resulting in a variety of CPPS diagnostic and treatment modalities used by PFPs; only 15% adhered to the guidelines in the case vignettes. To conclude, a minority of the Dutch PFPs follow the EAU CPPS guideline recommendations. Based on these results more attention should be paid to implementing the EAU guidelines in the Netherlands and developing a Dutch CPPS guideline.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to privacy restraints but are available on request.

Abbreviations

BSc:

Bachelor of Science

CPMP:

Chronic Pelvic Muscular Pain

CPPS:

Chronic Pelvic Pain Syndrome

EAU:

European Association of Urology

ICS:

International Continence Society

MSc:

Master of Science

NQRP:

The National Quality Register for Physiotherapists

PFP:

Pelvic Floor Physiotherapist

References

  1. D. Engeler APB, B. Berghmans, , J. Birch JB, A.M. Cottrell, , P. Dinis-Oliveira SE, J. Hughes, , E.J. Messelink RAP, M.L. van Poelgeest VT, Williams ACdC. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2023. http://uroweb.org/guidelines/compilations-of-all-guidelines/: EAU Guidelines Office, Arnhem, The Netherlands. ; 2023.

  2. Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):E141–7.

    Article  PubMed  Google Scholar 

  3. Ferris JA, Pitts MK, Richters J, Simpson JM, Shelley JM, Smith AM. National prevalence of urogenital pain and prostatitis-like symptoms in Australian men using the National Institutes of Health Chronic Prostatitis Symptoms Index. BJU Int. 2010;105(3):373–9.

    Article  PubMed  Google Scholar 

  4. Häuser W, Schmutzer G, Hinz A, Brähler E. [Prevalence and predictors of urogenital pain in men. Results from a survey of a representative German population sample]. Schmerz. 2012;26(2):192–9.

  5. Hedelin H, Johannisson H, Welin L. Prevalence of the chronic prostatitis/chronic pelvic pain syndrome among 40–69-year-old men residing in a temperate climate. Scand J Urol. 2013;47(5):390–2.

    Article  PubMed  Google Scholar 

  6. Wehbe SA, Fariello JY, Whitmore K. Minimally invasive therapies for chronic pelvic pain syndrome. Curr Urol Rep. 2010;11(4):276–85.

    Article  PubMed  Google Scholar 

  7. Ross V, Detterman C, Hallisey A. Myofascial Pelvic Pain: An Overlooked and Treatable Cause of Chronic Pelvic Pain. J Midwifery Womens Health. 2021;66(2):148–60.

    Article  PubMed  Google Scholar 

  8. Baranowski AP, Mandeville AL, Edwards S, Brook S, Cambitzi J, Cohen M. Male chronic pelvic pain syndrome and the role of interdisciplinary pain management. World J Urol. 2013;31(4):779–84.

    Article  PubMed  Google Scholar 

  9. Grinberg K, Sela Y, Nissanholtz-Gannot R. New Insights about Chronic Pelvic Pain Syndrome (CPPS). Int J Environ Res Public Health. 2020;17(9).

  10. Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, et al. A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn. 2017;36(4):984–1008.

    Article  PubMed  Google Scholar 

  11. Anderson RU, Wise D, Sawyer T, Nathanson BH, Nevin SJ. Equal Improvement in Men and Women in the Treatment of Urologic Chronic Pelvic Pain Syndrome Using a Multi-modal Protocol with an Internal Myofascial Trigger Point Wand. Appl Psychophysiol Biofeedback. 2016;41(2):215–24.

    Article  PubMed  Google Scholar 

  12. Cornel EB, van Haarst EP, Schaarsberg RW, Geels J. The effect of biofeedback physical therapy in men with Chronic Pelvic Pain Syndrome Type III. Eur Urol. 2005;47(5):607–11.

    Article  PubMed  Google Scholar 

  13. Grinberg K, Weissman-Fogel I, Lowenstein L, Abramov L, Granot M. How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome? Pain Res Manag. 2019;2019:6091257.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Loving S, Nordling J, Jaszczak P, Thomsen T. Does evidence support physiotherapy management of adult female chronic pelvic pain? A systematic review Scand J Pain. 2012;3(2):70–81.

    Article  CAS  PubMed  Google Scholar 

  15. The European Qualifications Framework: Europass European Union; [Available from: https://europass.europa.eu/en/europass-digital-tools/european-qualifications-framework#:~:text=The%20EQF%20covers%20all%20types,and%208%20the%20highest%20level.

  16. The Dutch Qualification Framework: NLQF; [Available from: https://nlqf.nl/english.

  17. Europass. EQF en NLQF, het Europees kwalificatieraamwerk [Available from: https://www.europass.nl/eqfnlqf/.

  18. KNGF AVvh. REGLEMENT CENTRAAL KWALITEITSREGISTER FYSIOTHERAPIE 1997 [updated 28–09–2016. Available from: https://www.kngf.nl/binaries/content/assets/kngf/onbeveiligd/vakgebied/kwaliteit/ckr/reglement-centraal-kwaliteitsregister-fysiotherapie-28-september-2016.pdf.

  19. Bachmann LM, Mühleisen A, Bock A, ter Riet G, Held U, Kessels AG. Vignette studies of medical choice and judgement to study caregivers’ medical decision behaviour: systematic review. BMC Med Res Methodol. 2008;8:50.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Evans SC, Roberts MC, Keeley JW, Blossom JB, Amaro CM, Garcia AM, et al. Vignette methodologies for studying clinicians’ decision-making: Validity, utility, and application in ICD-11 field studies. Int J Clin Health Psychol. 2015;15(2):160–70.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kathiresan J, Patro BK. Case vignette: a promising complement to clinical case presentations in teaching. Educ Health (Abingdon). 2013;26(1):21–4.

    Article  PubMed  Google Scholar 

  22. Finch J. The Vignette Technique in Survey Research. Sociology. 1987;21(1):105–14.

    Article  Google Scholar 

  23. Mickan S, Burls A, Glasziou P. Patterns of “leakage” in the utilisation of clinical guidelines: a systematic review. Postgrad Med J. 2011;87(1032):670–9.

    Article  PubMed  Google Scholar 

  24. Calhoun EA, Clemens JQ, Litwin MS, Walker-Corkery E, Markossian T, Kusek JW, McNaughton-Collins M. Primary care physician practices in the diagnosis, treatment and management of men with chronic prostatitis/chronic pelvic pain syndrome. Prostate Cancer Prostatic Dis. 2009;12(3):288–95.

    Article  CAS  PubMed  Google Scholar 

  25. Besse K, Steegers M, Vernooij-Dassen M, Vissers K, Engels Y. Dutch Pain Specialists’ Adherence to the Multidisciplinary Guideline on Treating Pain in Patients with Cancer: A Case Vignette Study. Pain Pract. 2017;17(3):344–52.

    Article  PubMed  Google Scholar 

  26. te Boveldt N, Vernooij-Dassen M, Besse K, Vissers K, Engels Y. Adaptation of an evidence-based clinical practice guideline in cancer pain management by medical oncologists: a case vignette study. Support Care Cancer. 2015;23(5):1409–20.

    Article  Google Scholar 

  27. Tucker Edmonds B, McKenzie F, Austgen MB, Ashburn-Nardo L, Matthias MS, Hirsh AT. Obstetrical Providers’ Management of Chronic Pain in Pregnancy: A Vignette Study. Pain Med. 2017;18(5):832–41.

    PubMed  Google Scholar 

  28. Martinez V, Attal N, Vanzo B, Vicaut E, Gautier JM, Bouhassira D, Lantéri-Minet M. Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, “e” case-vignette survey. PLoS ONE. 2014;9(4): e93855.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rousseau A, Azria E, Baumann S, Deneux-Tharaux C, Senat MV. Do obstetricians apply the national guidelines? A vignette-based study assessing practices for the prevention of preterm birth. BJOG. 2020;127(4):467–76.

    Article  CAS  PubMed  Google Scholar 

  30. Rousseau A, Rozenberg P, Perrodeau E, Deneux-Tharaux C, Ravaud P. Variations in Postpartum Hemorrhage Management among Midwives: A National Vignette-Based Study. PLoS ONE. 2016;11(4): e0152863.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Glauser TA, Salinas GD, Roepke NL, Williamson JC, Reese A, Gutierrez G, Abdolrasulnia M. Management of mild-to-moderate osteoarthritis: a study of the primary care perspective. Postgrad Med. 2011;123(1):126–34.

    Article  PubMed  Google Scholar 

  32. Ford JJ, Hahne AJ, Surkitt LD, Chan AY, Richards MC, Slater SL, et al. Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. Br J Sports Med. 2016;50(4):237–45.

    Article  PubMed  Google Scholar 

  33. Swinkels ICS, van den Ende CHM, van den Bosch W, Dekker J, Wimmers RH. Physiotherapy management of low back pain: Does practice match the Dutch guidelines? Australian Journal of Physiotherapy. 2005;51(1):35–41.

    Article  PubMed  Google Scholar 

  34. Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review. Eur J Pain. 2012;16(1):3–17.

    Article  CAS  PubMed  Google Scholar 

  35. Haring MPD, de Haas RJ, van Vilsteren FGI, Klaase JM, Duiker EW, Blokzijl H, et al. Variation in the management of benign liver tumors: A European survey and case vignette study. Clin Res Hepatol Gastroenterol. 2023;47(3): 102094.

    Article  PubMed  Google Scholar 

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Acknowledgements

We are grateful to all the PFPs who participated. We would like to specifically thank the PFPs that helped develop the case vignettes (LS-SS-CO-SH-SSp-MD)

Funding

This work was supported by the Dutch Association of Pelvic Floor Physiotherapists to stimulate scientific research in the field of pelvic floor physiotherapy in Chronic Pelvic Pain Syndrome.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Radboudumc Nijmegen, Geert Grooteplein Zuid 10, Nijmegen, GA, 6525, The Netherlands

    Myrthe Wissing & Kim Notten

  2. Department of Anesthesiology Chronic Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands

    Marian Rombouts, Kris Vissers & Selina van der Wal

  3. Department of Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands

    Monique Steegers

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  1. Myrthe Wissing
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  2. Marian Rombouts
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Contributions

MW and MR wrote the main manuscript. MR and MW collected the data. MW and MR analyzed the data. MW prepared all figures. All authors were contributors of the project development and manuscript editing. MW and MR are joint authors.

Corresponding author

Correspondence to Myrthe Wissing.

Ethics declarations

Ethics approval and consent to participate

The Central Committee on Research Involving Human Subjects of Arnhem and Nijmegen approved this study (file number 2023–16474). All participants gave written informed consent before data collection was initiated.

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Consent for publication was included in the informed consent.

Competing interests

The authors declare no competing interests.

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Wissing, M., Rombouts, M., Steegers, M. et al. Assessing use of eau recommendations in diagnostic and therapeutic strategies for chronic pelvic pain syndrome: a case vignette study on dutch pelvic floor physiotherapists practices. BMC Women's Health 25, 272 (2025). https://doi.org/10.1186/s12905-025-03782-4

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