Antenatal pelvic floor muscle exercise intervention led by midwives in England to reduce postnatal urinary incontinence: APPEAL feasibility and pilot randomised controlled cluster trial
Objectives To assess the feasibility of an intervention of midwifery support for antenatal pelvic floor muscle exercises (PFME) to prevent postnatal urinary incontinence (UI).Design Feasibility and pilot cluster randomised controlled trial. Clusters were community midwifery teams.Setting Community m...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e091248.full |
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| author | Karla Hemming Jonathan Bishop Sarah Dean Jean Hay-Smith Tim Coleman Elizabeth Edwards Christine MacArthur Debra Bick Mark Pearson Rohini Terry Eivor Oborn Sara Webb Eleni Gkini Victoria Salmon Ellie Jones Helena Frawley |
| author_facet | Karla Hemming Jonathan Bishop Sarah Dean Jean Hay-Smith Tim Coleman Elizabeth Edwards Christine MacArthur Debra Bick Mark Pearson Rohini Terry Eivor Oborn Sara Webb Eleni Gkini Victoria Salmon Ellie Jones Helena Frawley |
| author_sort | Karla Hemming |
| collection | DOAJ |
| description | Objectives To assess the feasibility of an intervention of midwifery support for antenatal pelvic floor muscle exercises (PFME) to prevent postnatal urinary incontinence (UI).Design Feasibility and pilot cluster randomised controlled trial. Clusters were community midwifery teams.Setting Community maternity antenatal care.Participants One hundred seventy-five women; 186 midwives.Intervention Midwifery training and resources for midwives and women to support antenatal PFME. Control clusters continued standard care.Outcomes Women reporting: that their midwife explained how to do PFME, PFME adherence and postpartum UI. Midwives reporting: pre-post-training PFME confidence, intervention acceptability. Fidelity of training delivery and implementation.Results Ninety-five midwives in intervention clusters; 91 midwives in control clusters. Of 998 women sent questionnaires, 175 responded: 15.8% in intervention, 16.4% in control clusters. Women’s characteristics in both trial arms were similar and characteristics of respondents and non-respondents were similar. Sixty-five percent (95% CI 56.9% to 72.4%) of women in intervention clusters reported their midwife explained how to do PFME vs 38% (95% CI 24.6% to 51.2%) in control clusters. Fifty percent (95% CI 24.1% to 77.1%) of women in intervention clusters vs 38% (95% CI 12.4% to 67.1%) in control clusters reported doing enough PFME to potentially prevent UI. Fourty-four percent (95% CI 32.0% to 56.1%) of women in intervention clusters reported UI vs 54% (95% CI 42.2% to 65.8%) in control clusters.Intervention training was delivered with fidelity and received positively. Midwives reported improvements in PFME confidence/knowledge (median increase of at least 1 point on a 0–4 scale for each of eight questions). Midwives (26%) most frequently reported insufficient time as an implementation barrier.Conclusions This pilot trial produced consistent new findings that training and resourcing midwives to teach and support pregnant women to undertake PFME is acceptable and feasible for women and midwives. It increased the number of women who are informed about PFME, with potential to improve PFME adherence and reduce postpartum UI. Recent changes to the National Health Service perinatal pelvic healthcare means a full trial is not possible.Trial registration number ISRCTN10833250. |
| format | Article |
| id | doaj-art-fdccddc03a0347aa88202386924c5aa5 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-fdccddc03a0347aa88202386924c5aa52025-01-21T08:05:12ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-091248Antenatal pelvic floor muscle exercise intervention led by midwives in England to reduce postnatal urinary incontinence: APPEAL feasibility and pilot randomised controlled cluster trialKarla Hemming0Jonathan Bishop1Sarah Dean2Jean Hay-Smith3Tim Coleman4Elizabeth Edwards5Christine MacArthur6Debra Bick7Mark Pearson8Rohini Terry9Eivor Oborn10Sara Webb11Eleni Gkini12Victoria Salmon13Ellie Jones14Helena Frawley15School of Health Sciences, University of Birmingham, Birmingham, UKBirmingham Clinical Trials Unit, University of Birmingham, Birmingham, UKUniversity of Exeter Medical school, University of Exeter, Exeter, UKRehabilitation Teaching and Research Unit, University of Otago, Wellington, New ZealandDivision of General Practice, University of Nottingham, Nottingham, UKBirmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UKSchool of Health Sciences, University of Birmingham, Birmingham, UKWarwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UKHull York Medical School, University of Hull, Hull, UKUniversity of Exeter Medical school, University of Exeter, Exeter, UKWarwick Business School, Warwick University, Coventry, UKThe Royal College of Midwives, London, UKBirmingham Clinical Trials Unit, University of Birmingham, Birmingham, UKUniversity of Exeter Medical school, University of Exeter, Exeter, UKSchool of Health Sciences, University of Birmingham, Birmingham, UKMelbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, AustraliaObjectives To assess the feasibility of an intervention of midwifery support for antenatal pelvic floor muscle exercises (PFME) to prevent postnatal urinary incontinence (UI).Design Feasibility and pilot cluster randomised controlled trial. Clusters were community midwifery teams.Setting Community maternity antenatal care.Participants One hundred seventy-five women; 186 midwives.Intervention Midwifery training and resources for midwives and women to support antenatal PFME. Control clusters continued standard care.Outcomes Women reporting: that their midwife explained how to do PFME, PFME adherence and postpartum UI. Midwives reporting: pre-post-training PFME confidence, intervention acceptability. Fidelity of training delivery and implementation.Results Ninety-five midwives in intervention clusters; 91 midwives in control clusters. Of 998 women sent questionnaires, 175 responded: 15.8% in intervention, 16.4% in control clusters. Women’s characteristics in both trial arms were similar and characteristics of respondents and non-respondents were similar. Sixty-five percent (95% CI 56.9% to 72.4%) of women in intervention clusters reported their midwife explained how to do PFME vs 38% (95% CI 24.6% to 51.2%) in control clusters. Fifty percent (95% CI 24.1% to 77.1%) of women in intervention clusters vs 38% (95% CI 12.4% to 67.1%) in control clusters reported doing enough PFME to potentially prevent UI. Fourty-four percent (95% CI 32.0% to 56.1%) of women in intervention clusters reported UI vs 54% (95% CI 42.2% to 65.8%) in control clusters.Intervention training was delivered with fidelity and received positively. Midwives reported improvements in PFME confidence/knowledge (median increase of at least 1 point on a 0–4 scale for each of eight questions). Midwives (26%) most frequently reported insufficient time as an implementation barrier.Conclusions This pilot trial produced consistent new findings that training and resourcing midwives to teach and support pregnant women to undertake PFME is acceptable and feasible for women and midwives. It increased the number of women who are informed about PFME, with potential to improve PFME adherence and reduce postpartum UI. Recent changes to the National Health Service perinatal pelvic healthcare means a full trial is not possible.Trial registration number ISRCTN10833250.https://bmjopen.bmj.com/content/15/1/e091248.full |
| spellingShingle | Karla Hemming Jonathan Bishop Sarah Dean Jean Hay-Smith Tim Coleman Elizabeth Edwards Christine MacArthur Debra Bick Mark Pearson Rohini Terry Eivor Oborn Sara Webb Eleni Gkini Victoria Salmon Ellie Jones Helena Frawley Antenatal pelvic floor muscle exercise intervention led by midwives in England to reduce postnatal urinary incontinence: APPEAL feasibility and pilot randomised controlled cluster trial BMJ Open |
| title | Antenatal pelvic floor muscle exercise intervention led by midwives in England to reduce postnatal urinary incontinence: APPEAL feasibility and pilot randomised controlled cluster trial |
| title_full | Antenatal pelvic floor muscle exercise intervention led by midwives in England to reduce postnatal urinary incontinence: APPEAL feasibility and pilot randomised controlled cluster trial |
| title_fullStr | Antenatal pelvic floor muscle exercise intervention led by midwives in England to reduce postnatal urinary incontinence: APPEAL feasibility and pilot randomised controlled cluster trial |
| title_full_unstemmed | Antenatal pelvic floor muscle exercise intervention led by midwives in England to reduce postnatal urinary incontinence: APPEAL feasibility and pilot randomised controlled cluster trial |
| title_short | Antenatal pelvic floor muscle exercise intervention led by midwives in England to reduce postnatal urinary incontinence: APPEAL feasibility and pilot randomised controlled cluster trial |
| title_sort | antenatal pelvic floor muscle exercise intervention led by midwives in england to reduce postnatal urinary incontinence appeal feasibility and pilot randomised controlled cluster trial |
| url | https://bmjopen.bmj.com/content/15/1/e091248.full |
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