A multicomponent theory-based intervention improves uptake of pelvic floor muscle training before radical prostatectomy: a 'before and after' cohort study.
OBJECTIVE
To assess the effect of a multicomponent theory-based intervention, incorporating patient information guides, an evidence summary, audit and feedback processes and a provider directory, in the provision/receipt of preoperative pelvic floor muscle training (PFMT) among patients undergoing radical prostatectomy.


METHODS
Over an 18-month period (9 months before and 9 months after the intervention), we measured the provision/receipt of preoperative PFMT using surveys of patients undergoing radical prostatectomy at one public hospital (n = 32) and two private hospitals (n = 107) in Western Sydney, Australia, as well as practice audits of associated public sector (n = 4) and private sector (n = 2) providers of PFMT. Self-report urinary incontinence was assessed 3 months after radical prostatectomy using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Form (ICIQ-UI Short Form).


RESULTS
There was a significant increase in the proportion of survey respondents receiving preoperative PFMT post-intervention (post-intervention: 42/58 respondents, 72% vs pre-intervention: 37/81 respondents, 46%, P = 0.002). There was a corresponding significant increase in provision of preoperative PFMT by private sector providers (mean [sd] post-intervention: 16.7 [3.7] patients/month vs pre-intervention: 12.1 [3.6] patients/month, P = 0.018). Respondents receiving preoperative PFMT had significantly better self-report urinary incontinence at 3 months after radical prostatectomy than those who did not receive preoperative PFMT (mean [sd] ICIQ-UI Short Form sum-scores: 6.2 [5.0] vs 9.2 [5.8], P = 0.002).


CONCLUSIONS
The intervention increased the provision/receipt of preoperative PFMT among patients undergoing radical prostatectomy. Additional component strategies aimed at increasing the use of public sector providers may be necessary to further improve PFMT receipt among patients undergoing radical prostatectomy in the public hospital system.
School of Science and Health, University of Western Sydney, Penrith; Westmead Private Physiotherapy Services, NSW, Australia.
Andrew D
AD
Hirschhorn
Gregory S
GS
Kolt
Andrew J
AJ
Brooks
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005081:Exercise Therapy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009517:New South Wales; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D017773:Pelvic Floor; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D011471:Prostatic Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D011788:Quality of Life; D012371:Robotics; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000628:therapy*
pelvic floor muscle training; prostatectomy; translational research; urinary incontinence