Prostate cancer is the most commonly diagnosed cancer among men in the United States and radical prostatectomy (RP) is the primary surgical option. With an increasing number of men undergoing RP and surviving prostate cancer, clinical management strategies have broadened to improve the preoperative and postoperative patient experience and minimize treatment-related functional consequences. Urinary incontinence is a predictable functional consequence of RP. Recent reviews recommend preoperative and postoperative physical therapist services as the standard of care for men undergoing RP to decrease the severity of urinary incontinence and improve patients' quality of life. Despite compelling evidence, the routine provision of physical therapist services preoperative and postoperatively for men undergoing RP are limited. The purpose of this case report is to describe the implementation of preoperative and postoperative physical therapist services for men undergoing RP in a United States health care system using the knowledge-to-action process and the Consolidated Framework for Implementation Research frameworks.
The implementation process included 4 steps: (1) development of a preoperative and postoperative physical therapist treatment program; (2) identification of barriers and enablers for implementation; (3) implementation of the treatment program; and (4) evaluation of the effectiveness of the implemented treatment program.
Outcomes from the implementation of a physical therapist treatment program for men undergoing RP included lower urinary incontinence rates, improved patient satisfaction, and increased physical therapist utilization.
This case report documents the implementation of physical therapist treatments for men undergoing RP. The use of implementation frameworks enabled the identification of unique enablers, barriers, and strategies for the implementation of physical therapist treatment for men undergoing RP.
Implementing preoperative and postoperative physical therapist services for men undergoing RP improves patient outcomes. The implementation process and outcomes can be considered by other health care systems when developing preoperative and postoperative physical therapist services for men undergoing RP.
Physical therapy. 2023 Nov 25 [Epub ahead of print]
Mitchell Wolden, Scott Brown, Sigrid V Carlsson, Thomas A Noah, Sean F Mungovan
Department of Physical Therapy, University of Jamestown, Jamestown, North Dakota, USA., Department of Physical Therapy, Sanford Health, Fargo, ND, USA., Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Urology, Sanford Health, Fargo, ND, USA., The Clinical Research Institute, Sydney, New South Wales, Australia.