Open Access Research article

Barriers and enablers to the provision and receipt of preoperative pelvic floor muscle training for men having radical prostatectomy: a qualitative study

Andrew D Hirschhorn12*, Gregory S Kolt1 and Andrew J Brooks3

Author Affiliations

1 School of Science and Health, University of Western Sydney, Sydney, Australia

2 Westmead Private Physiotherapy Services, Sydney, Australia

3 Western Urology, Sydney, Australia

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BMC Health Services Research 2013, 13:305  doi:10.1186/1472-6963-13-305

Published: 13 August 2013



Strong evidence exists to support preoperative pelvic floor muscle training (PFMT) to reduce the severity and duration of urinary incontinence after radical prostatectomy. Receipt of preoperative PFMT amongst men having radical prostatectomy in Western Sydney, however, is suboptimal. This study was undertaken to investigate barriers and enablers to provision/receipt of preoperative PFMT from the perspectives of potential referrers to and providers of PFMT, and of men having radical prostatectomy.


A qualitative research design was used. Semi-structured, one-to-one interviews were conducted with participants from three groups: (i) current and potential referrers to PFMT, including urological cancer surgeons, urological cancer nurses and general practitioners (n = 11); (ii) current and potential providers of PFMT across public and private sector hospital and outpatient settings, including physiotherapists and continence nurses (n = 14); and (iii) men having had radical prostatectomy at a specific public and co-located private hospital in Western Sydney (n = 13). Interview schedules were developed using Michie’s theoretical domains for investigating the implementation of evidence-based practice, and allowed participants to identify potential and actual barriers and enablers to preoperative PFMT. Transcribed interview data were analysed using a framework approach, and key themes were identified.


Participant groups concurred that a recommendation for PFMT from the urological cancer surgeon, accompanied with a referral to a specific provider, was a key enabler of preoperative PFMT. Perceived barriers varied between participant groups and across public and private healthcare settings. Perceptions of financial cost of private sector PFMT, limited knowledge amongst referrers of public sector providers of PFMT, and limited awareness amongst patients of the benefits of PFMT were all posited to contribute to suboptimal PFMT provision and receipt.


This study has provided valuable data on barriers and enablers to preoperative PFMT, with implications for the planning of a behaviour change intervention to improve provision and receipt of preoperative PFMT in Western Sydney.

Prostatectomy; Urinary incontinence; Translational research; Qualitative research; Physical therapy modalities