P. Neumann1, N. Radi2, T. Gerdis2, C. Tonkin2, C. Wright2, I. Nurkic2, J. Chalmers1
1University of South Australia: City East Campus, Faculty of Health Sciences, Adelaide, Australia, 2Curtin University, Faculty of Health Science, Perth, Australia
Background: Vaginal support pessaries are designed to relieve symptoms related to pelvic organ prolapse (POP). Internationally, pessary care has traditionally been within gynaecology scope of practice. In Australia, women’s health physiotherapists have been adopting pessary management (PM) as part of their holistic care of women with POP, as pessaries can allow women to resume normal physical activities. However, there are concerns about physiotherapy competence and public safety, as there are potentially serious complications from an incorrectly fitted, mismanaged, or forgotten pessary. Currently there are no national or international guidelines on the physiotherapy training needed for competence in PM.
Purpose: Our aim was to develop an expert consensus statement to recommend the training required for physiotherapy competence in PM.
Methods: We conducted a scoping review of the literature on PM training. A number of key themes and competencies were identified, which were summarised in a draft competency statement. These were structured around professional roles in line with the CanMEDS (2105) framework. A focus group, consisting of six experts in PM from urogynaecology, nursing and physiotherapy, reviewed and refined the document. Using e-Delphi methodology, with an iterative process of Qualtrics surveys and a video conference, the items in the competency statement were further refined by an expert panel consisting of the original focus group and a further 24 Australian and international physiotherapists with pessary expertise and a minimum of Master’s degree. Consensus was defined as >80% agreement on each of the items. The videoconference recording was provided to those unable to attend. A maximum of three rounds of online surveys with individualised participant feedback was decided à priori. Opportunity was provided to add or delete items, or change wording.
Results: We developed a consensus statement with a high level of agreement on the training recommended for physiotherapists providing PM. Consensus was reached on all 73 items, across 10 professional roles. Expert participation rate was 100% for the three Qualtrics surveys. 70% of experts participated in the videoconference in person. 100% consensus was reached on 73 items after round two of the survey. Stability was demonstrated with round three.
Conclusion(s): A robust consensus statement on the training recommended for physiotherapy competence in PM has been developed by a multidisciplinary and multinational panel of experts. The statement provides details of the recommended competencies, including agreement that PM should only be performed by women’s health physiotherapists with prior competence in the management of pelvic floor dysfunction.
Implications: These recommendations about the physiotherapy training required for competence in PM fill a gap in the international literature and provide a benchmark for physiotherapy training requirements. Our results should inform clinicians and professional bodies about the training required for safe and competent physiotherapy practice in PM and also guide educators when developing curriculum in training programs for PM. Our results should contribute to improved standards of physiotherapy care and public safety.
Funding, acknowledgements: This study was unfunded
Keywords: Training, Competence, Vaginal Support Pessary
Topic: Pelvic, sexual and reproductive health
Did this work require ethics approval? Yes
Institution: Curtin University: Perth
Committee: Curtin University Human Research Ethics Committee
Ethics number: 2020-0352
All authors, affiliations and abstracts have been published as submitted.
