Pelvic floor muscle training (PFMT) has been defined as an exercise intervention designed to improve strength, endurance, power and/or relaxation of the pelvic floor musculature [1]. PFMT is effective for many people with urinary incontinence (UI) and can be implemented across the lifespan [2], [3], [4], [5]. There is evidence of benefit for UI in women of all ages [2], [6], [7], during antenatal and postnatal periods [3], [8], for men with urinary dysfunction [9] and following prostate surgery [4], [10].
The experiences and beliefs of physiotherapists who use PFMT for UI has been explored to understand how they use research reports to inform practice [11]. Continence physiotherapists clearly articulated what information they needed to replicate PFMT interventions including more comprehensive descriptions of exercise components [12]. In instances where dosage was not reported clinicians unanimously reported applying the principles of progressive resistive exercise [13], [14].
Systematic reviews show that descriptions of PFMT content are often unclear or inadequate [2], [3], [9], [15], [16]. The authors of published reviews (Cochrane and non-Cochrane) have reported variability in reporting of elements such as exercise dosage, muscle contraction force, exercise intensity, supervision and adherence [2], [3], [9], [10]. The absence of clear reporting guidance for PFMT interventions may contribute to reporting variability, and the difficulty experienced by clinicians [9], [17]. Studies need to be reported comprehensively to enable clinicians to replicate the interventions in patient care and to inform clinical guidelines [18], [19].
Consistent with EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network [20] guidance for comprehensive reporting [21], [22] the Consensus on Exercise Reporting Template (CERT) [23] and the CERT Explanation and Elaboration Statement [24] were developed. The CERT has high inter-rater reliability when applied to exercise interventions for musculoskeletal conditions [25], [26]. It contains 19 items listed under seven headings pertaining to exercises and their delivery: (1) materials; (2) provider; (3) delivery; (4) setting; (5) dosage; (6) tailoring; and (7) fidelity to the protocol. Hay-Smith et al. (2019) investigated completeness of reporting and inter-rater agreement using the CERT to evaluate PFMT interventions [16]. Completeness of reporting was poor and raters found the CERT template in need of contextualising for PFMT. These findings endorse the need for a PFMT-specific CERT.
The aims of this paper were to: (i) amend the Consensus on Exercise Reporting Template (CERT) based on continence physiotherapist input and examples from the published literature and (ii) present a CERT Explanation and Elaboration statement and checklist specific to PFMT interventions for UI.
Qualitative methods were used to explore the perspectives of continence physiotherapists who manage urinary incontinence with PFMT [11], [12]. Following Monash University Human Ethics approval (8116) and written informed consent, data were collected by focus group interviews. Physiotherapists were recruited by purposive sampling from private and public settings in Melbourne, Australia. All had postgraduate qualifications in continence and pelvic floor rehabilitation and clinical experience in
Twenty-nine continence physiotherapists participated in seven focus groups (n = 3, n = 6, n = 4, n = 4, n = 5, n = 4, n = 3) and data collection ceased after saturation was reached. Details of participant characteristics such as age, qualifications, experience and work setting are listed in Table 1. Findings such as facilitators and barriers to PFMT implementation, strategies to assist uptake in clinical practice and continence clinician attributes are reported elsewhere [11], [12], [27]. Participants agreed
From a continence physiotherapist perspective, the CERT template is generalisable to PFMT for UI. The original CERT items appear adequate for informing exercise intervention design and reporting [24]. The authors used clinician input, and examples from published reports, to reword or suggest explanations that make the CERT specific to PFMT. This seems necessary because completeness and quality of reporting of PFMT is generally poor [2], [9], [15], [16] and clinicians value more detail than is
The current work provides PFMT-specific explanations for research design and reporting based on the needs of continence physiotherapists. The authors advocate routine use of the CERT-PFMT to inform intervention development and research protocols and for completion of manuscripts reporting PFMT interventions for UI.
Monash University Human Ethics approval (8116).
This study was funded by a grant from the Australian Bladder Foundation.
None declared. The Consensus on Exercise Reporting Template can be used for PFMT intervention reporting. Continence physiotherapists have preferences for the comprehensive reporting of the content of PFMT interventions. An intervention reporting guideline that is specific to PFMT and informed by continence physiotherapist perspectives. Explanation and elaboration of the CERT-PFMT to guide intervention protocols and reporting.Key messages
What new knowledge is added by this study?
In order that the study could monitor compliance with home exercise programmes, the participants were offered the opportunity to download the ‘SqueezyCX’ app. Use of a smartphone app to measure adherence to a protocol has been recommended [25]. While all those interviewed reported completing and saving their exercises regularly, the adherence levels recordings did not support this.
