In this review: Implementation of Physical Therapist Services for Men Undergoing Radical Prostatectomy: An Administrative Case Report (PTJ: Physical Therapy & Rehabilitation Journal)

The Message

Although there is evidence that physical therapist treatment can decrease incontinence recovery and improve quality of life for men undergoing radical prostatectomy, few programs are in place to provide this preoperative and postoperative care.

This case report describes how researchers implemented PT services for men undergoing RP, which is the main surgical treatment for prostate cancer. In addition to developing a PT program for these patients, authors identified facilitators and barriers to implementing the program.

"Our aim is to document the implementation of physical therapist services for an underserved patient population and provide a guide for other health care systems to develop similar services for men undergoing RP," authors write.

The Study

During their initial review, researchers found that men undergoing RP were not routinely referred to PT services, and those who were often received an adaptation of a program developed to treat urinary incontinence in women.

A PT educator, an international PT, and an epidemiologist and prostate cancer expert organized a workshop to train PTs interested in helping men undergoing RP. This included 10 45- to 60-minute online trainings on evidence-based examination and management, in addition to two in-person trainings with transperineal ultrasound. The treatment program included assessment and treatment using transperineal ultrasound, pelvic floor exercises, and individualized education for each patient.

APTA members Mitchell Wolden, PT, DPT, PhD, and Scott Brown, PT, DPT, are among the co-authors of this study.

Participants

During the study period, four surgeons referred 24 patients to receive postoperative PT services. Eight of these patients also received preoperative services. Patients received treatment through a rural health care system in the Midwest. The average patient was 64 years old. Patients, on average, had two postoperative PT visits, their first being 20 days after surgery. For the eight patients who also received preoperative PT services, services began an average of 21 days before surgery.

Findings

From the first preoperative visit to the first postoperative visit:

• Patients saw significant worsening in their Incontinence Questionnaire-Urinary Incontinence Short Form scores, increasing by a mean difference of 10.7 points. In this measure, high scores indicate a worse quality of life.
• Patients also saw worsening Expanded Prostate Cancer Index Composite for Clinical Practice, or EPIC-CP, scores. EPIC-CP total scores increased by a mean difference of 13.5 points, while EPIC-CP urine scores increased by a mean difference of 6.5 points. Higher scores on these measures also indicated a lower quality of life for patients.

Between the first and last postoperative PT visits:

• Patients saw significant improvement in their incontinence questionnaire scores, decreasing a mean difference of 6.7 points.
• Patients also saw improvement in their EPIC-CP scores. EPIC-CP total scores decreased by a mean difference of 7.1 points, and EPIC-CP urine scores decreased by a mean difference of 1.7 points.
• Twelve patients completed a satisfaction survey, with participants reporting a mean 9.3 out of 10, indicating high levels of satisfaction with both preoperative and postoperative PT services.

Why It Matters

To ensure support for program implementation, researchers presented evidence of the benefits of PT interventions in this population to urologists, nurses, hospital administrators, and other key stakeholders. Authors pointed to important enablers for implementing the program, including engaging with urologists as key stakeholders and receiving administrative support to acquire the transperineal ultrasound equipment and train PTs on its use.

"Implementing preoperative and postoperative physical therapist services for men undergoing RP presents an opportunity for physical therapists to expand their scope of practice while providing high-quality, evidence-based care to an underserved patient population in the USA," they write.

Keep in Mind …

The authors note their study is limited to one hospital system in North Dakota and based on retrospective data, so there may be other factors beyond PT intervention that influenced postoperative incontinence. They call for future research to assess the widespread effects of implementing PT services for men undergoing RP.

To learn more about male pelvic health, register for the APTA Learning Center’s online course "3 Must-Know Secrets for Treating Male Pelvic Health."