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

Effectiveness of registered nurses on patient outcomes in primary care: a systematic review

“…Quality scores, as assessed by the ICROMS tool, varied between studies. Four studies were scored at the minimum threshold for their study design [ 46 , 56 , 61 , 65 ], six studies scored 1–2 points above threshold [ 44 , 45 , 48 , 49 , 53 , 57 ], and thirteen studies exceeded the minimum cut-off score by 3 or more points [ 43 , 47 , 50 – 52 , 54 , 55 , 58 – 60 , 62 – 64 ].…”

“…The final sample consisted of n = 82 white patients with total cholesterol higher than 6.21 mmol/L Counseling provided by nurses to patients diagnosed with hypercholesterolemia using the Eating Pattern Assessment Tool and handouts with food advice Study involved 2 RNs; additional characteristics not identified RN provided intervention alone; in the pre-post study, RNs provided 5 counseling visits (1 month after referral, and at 3, 5, 7, and 12 months) to patients, which were focused on nutritional education and physical activity. In the follow-up matching study, intervention patients who attended 2 or more counseling sessions were matched with other patients in the practice Large multi-specialty group suburban primary care practice in Minneapolis 23; 24* Waterfield et al, 2021 [ 58 ] UK To determine whether primary care nurses with no prior experience can, after training, provide effective supervised PFMT, when compared to PFMT given by a urogynaecology nurse specialist and that of usual care Randomized controlled trial Sample consisted of 337 asymptomatic women with weak pelvic floor muscles (Modified Oxford Score 2 or less) in a randomly sampled survey. Two hundred forty women aged 19 - 76 (median 49) years were recruited PFMT delivered to patients with weak pelvic floor muscles at three levels: primary care nurse-delivered training (arm 1) v. urogynaecology nurse specialist training (arm 2) v. usual care (no training) Number of primary care nurses involved and additional characteristics were not indicated; at least one primary care nurse from each practice participated Primary care nurse provided intervention alone; the primary care nurse intervention group were provided training materials related to pelvic floor assessment and techniques involved in teaching PFMT.…”

“…prediabetes, coronary heart disease) ( n = 3) [ 50 – 52 ]. Other studies examined primary care RN-delivered smoking cessation support ( n = 4) [ 53 – 56 ], back pain education and management [ 57 ], pelvic floor muscle training [ 58 ], consultations aimed at increasing patient physical activity levels [ 59 , 60 ], and a telecare program for patients with diagnosed depression [ 61 ]. Four studies examined the impact of RN care in general (at an organizational-level); three of which focused on consultations with patients in general practice [ 62 – 64 ] and another which examined the impacts of a nurse-operated telephone consultation/triage service [ 65 ].…”

“…The presence and type of comparator group also differed across study designs. Specifically, five of the included studies compared a nurse-led intervention to the same intervention led by other health care providers [ 46 , 52 , 54 , 55 , 58 ]. Other studies compared nurse-led interventions with that of ‘usual care’ not associated with nurse involvement ( n = 4) [ 43 , 50 , 57 , 60 ], or with ‘usual care’ that was associated with reduced or alternative levels of nurse involvement ( n = 5) [ 44 , 49 , 53 , 56 , 59 ].…”

“…A total of 46 patient outcomes were identified across included studies (Table 3 ). Physiologic disease control outcomes, which were measured via biomarkers, included quality of care for diabetes (e.g., HbA1c, fasting blood glucose) [ 43 , 44 , 50 , 51 ], obesity (e.g., body mass index [BMI], waist circumference) [ 44 , 47 , 50 , 51 , 59 , 60 ], pelvic floor strength and endurance [ 58 ], hypercholesterolemia (e.g., total cholesterol) [ 49 ], and hypertension (e.g., blood pressure) [ 43 , 44 , 48 , 50 , 51 ]. Patient experience outcomes identified under the PREMs category included patient satisfaction with access to care (RN versus physician as first point of contact) [ 64 ], quality of self-management support (e.g., smoking cessation counseling, chronic disease services) [ 56 , 62 ], comfort/trust with primary care RN roles [ 45 ], and overall satisfaction or perceived quality of care with provider consultations, treatment, or advice/support received [ 45 , 51 , 55 , 57 , 63 , 65 ].…”