title: Can primary care nurse administered pelvic floor muscle training (PFMT) be implemented for the prevention and treatment of urinary incontinence? A study protocol.
abstract: BACKGROUND
  We aim to evaluate if Pelvic Floor Muscle Training (PFMT) delivered in primary care results in fewer referrals to secondary care for urinary incontinence (UI), thereby reducing the number and associated costs of surgical procedures for UI. Methods / design: The study will consist of two populations - a prevention group and a treatment group who will both be offered PFMT in primary care. The prevention group will consist of parous women aged 25-64 attending for a routine cervical smear. Their pelvic floor will be assessed using the Modified Oxford Scale (MOS) and a baseline data form will be completed that asks about the frequency and associated bother of urine leakage. From the answers given, the group will be subdivided into two groups. The first (prevention) group will be subdivided into a primary prevention arm (no symptoms of urinary incontinence and pelvic floor strength ≤2 on MOS) and a secondary prevention arm (women reporting symptoms of urine leakage irrespective of MOS). The second (treatment) group will be women of any age who may or may not have had a vaginal birth presenting to their GP with UI. Semi-structured, in-depth interviews will be conducted with a subset of patients and staff with the aim of identifying barriers and facilitators in delivering PFMT in primary care.
  
  
  CONCLUSIONS
  A recently completed community study showed good outcomes with practice nurse delivery of PFMT. We suggest if this were to be implemented more widely it would reduce the need for referral to secondary care. We believe that this study will show whether implementing a package of PFMT delivered in primary care can treat as well as prevent UI and will also be helpful in exploring the benefits / drawbacks of such implementation, thus providing lessons for implementation in other Primary Care Trusts (PCTs).
authors.affiliation: Peninsula CLAHRC, National Institute for Health Research, The University of Exeter Medical School, Exeter, EX2 4SG, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Child
authors.affiliation: Peninsula CLAHRC, National Institute for Health Research, Plymouth University, Peninsula College of Medicine and Dentistry, Plymouth, PL4 8AA, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Bateman
authors.affiliation: Peninsula CLAHRC, National Institute for Health Research, The University of Exeter Medical School, Exeter, EX2 4SG, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Shuttleworth
authors.affiliation: Peninsula CLAHRC, National Institute for Health Research, Plymouth University, Peninsula College of Medicine and Dentistry, Plymouth, PL4 8AA, UK ; The Wesley Research Institute, Brisbane, 4066, Australia.
authors.forename: Christian
authors.initials: C
authors.lastname: Gericke
authors.affiliation: Department of Obstetrics and Gynaecology, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Freeman