Can effective supervised pelvic floor muscle training be provided by primary care nurses? A randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: To determine whether primary care nurses with no prior experience can, after training, provide effective supervised pelvic floor muscle training (PFMT) by a three-group parallel randomized controlled trial (RCT): primary care nurse, urogynaecology nurse specialist and controls undertaken in 11 primary care/general practices, covering urban and rural settings in SW England. The sample consisted of 337 women with weak pelvic floor muscles (Modified Oxford Score 2 or less) in a randomly sampled survey. METHODS: Following detailed instruction and training, primary care nurses recruited patients who were randomized to PFMT provided by them, a urogynaecology nurse specialist or a 'no training' control group. The primary outcome measure to assess the effectiveness of training was pelvic floor muscle strength as measured by perineometry. RESULTS: Two hundred forty women aged 19 to 76 (median 49) years were recruited. After 3 months there was an increase in strength in both intervention groups compared with controls: median differences (95% CI) were 3.0 (0.3, 6.0) cmH2O higher for the primary care nurse group (n = 50) compared to the control group (n = 56; p = 0.02) and 4.3 (1.0, 7.3) cmH2O for the urogynaecology nurse specialist group (n = 53) compared to control (p < 0.01); there was no difference between the primary care nurse and urogynaecology nurse specialist groups [1.3 (-2.0,4.7; p = 0.70]. CONCLUSIONS: PFMT provided by trained primary care nurses achieved improvements in pelvic floor muscle strength compared with controls (and comparable to that of a urogynaecology nurse specialist). This could have implications for the provision of PFMT for all women and potentially help in the prevention of pelvic floor dysfunction. TRIAL REGISTRATION: Registered with ClinicalTrials.gov; Identifier NCT01635894. This was done retrospectively to conform to current registration requirements. When the trial commenced (2003), there was no requirement to register; this was introduced in 2005. The International Committee of Medical Journal Editors (ICMJE) decided that from July 1, 2005, no trials would be considered for publication unless they are included on a clinical trials registry, hence the retrospective registration.