title: A survey of prolapse practice in UK women's health physiotherapists: what has changed in the last decade?
abstract: OBJECTIVE
  Prolapse is a common female problem, and conservative treatments such as pelvic floor muscle training (PFMT) are important options for women. Evidence supporting the effectiveness of PFMT for prolapse has grown over the last decade, and it was hypothesised that practice and practice guidelines would have developed in line with the evidence. To assess this, up-to-date information about the practice of physiotherapists working in women's health regarding their treatment of prolapse was required.
  
  
  METHODS
  An online survey sent to members of the Association of Chartered Physiotherapists in Women's Health and the Chartered Physiotherapists Promoting Continence. Results were compared with those of an earlier survey undertaken in 2002.
  
  
  RESULTS
  A 49 % response rate was achieved. The majority of respondents were senior physiotherapists (55 %) and had worked in women's health for more than 10 years. Respondents were treating significantly more women with prolapse than a decade before: 36 % vs 14 % treated more than 50 women per year in 2002 and 2013 respectively (p < 0.001). Individualised PFMT (93 %), lifestyle advice (92 %) and biofeedback-assisted PFMT (83 %) were the most common treatment elements, with four being the average number of appointments. Forty-eight percent had changed their practice as a result of recent research; however, scepticism amongst medics, the referral of women directly for surgery, and constraints on resources were thought to be barriers to wider implementation of the evidence of PFMT for prolapse.
  
  
  CONCLUSIONS
  There has been uptake of evidence-based prolapse practice by UK specialist physiotherapists in the last decade. Further research targeting the implementation of this evidence would be valuable in addressing potential barriers, and in supporting the need for physiotherapy in the treatment of prolapse.
authors.affiliation: Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK. s.hagen@gcu.ac.uk.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hagen
authors.affiliation: Functional Bowel Service, Glenfield Hospital, University Hospitals Leicester, Leicester, UK.
authors.forename: Diane
authors.initials: D
authors.lastname: Stark
authors.affiliation: Department of Psychology, University of Glasgow, Glasgow, UK.
authors.forename: Isla
authors.initials: I
authors.lastname: Dougall
mesh_terms: D001676:Biofeedback, Psychology; D037001:Directive Counseling / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000706:statistics & numerical data*; D005260:Female; D006176:Gynecology / Q000639:trends*; D006801:Humans; D008019:Life Style; D009774:Obstetrics / Q000639:trends*; D056887:Pelvic Organ Prolapse / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014572:Urology / Q000639:trends*
keywords: Evidence-based practice; Pelvic floor; Physiotherapy; Prolapse; Survey