Neumann Patricia B, Radi Nada, Gerdis Tamara Lynn, Tonkin Clee, Wright Chenaye, Chalmers K Jane, Nurkic Irena
Allied Health and Human Performance, University of South Australia, City East Campus, North Terrace, Adelaide, SA, 5000, Australia.
Curtin School of Allied Health, Curtin University, Perth, WA, 6845, Australia.
Int Urogynecol J. 2022 Feb;33(2):253-265. doi: 10.1007/s00192-021-04843-6. Epub 2021 Jun 5.
Vaginal support pessaries are intravaginal devices designed to relieve symptoms of pelvic organ prolapse, but they can cause serious medical complications if not managed well. Physiotherapists are well placed to manage pessaries, but there are no guidelines on the training required for competency in pessary management (PM).
A scoping review of current literature on PM training was conducted to develop draft competency standards, which were reviewed by a multidisciplinary focus group. Using e-Delphi methodology, a multidisciplinary and multinational expert panel then refined the standards. Three rounds of e-Delphi online surveys were conducted, with individual participant feedback and one videoconference to discuss items that did not reach consensus. Consensus was set at 80% agreement and stability measured using kappa coefficient.
Pessary training competency standards, developed by 29 experts, covered three key domains including: (1) prerequisite knowledge and understanding; (2) entrustable professional activities; (3) pessary-specific standards under ten key roles. Consensus was reached on all 73 (100%) competency standards and stability demonstrated for 95.9% of standards. There was no attrition of expert panel participants through the e-Delphi rounds.
This e-Delphi study provides the first, robust recommendations on training standards for physiotherapists in PM. These competency standards will provide clinicians with a self-assessment tool, and educators and training institutions with a benchmark in training for PM, which should improve options and reduce risk for women with prolapse being managed with a pessary.
阴道支撑子宫托是一种置于阴道内的装置，旨在缓解盆腔器官脱垂的症状，但如果管理不当，可能会引发严重的医学并发症。物理治疗师在子宫托管理方面具有优势，但目前尚无关于子宫托管理能力（PM）所需培训的指南。
对当前关于PM培训的文献进行了范围综述，以制定能力标准草案，并由一个多学科焦点小组进行了审查。然后，使用电子德尔菲法，一个多学科、跨国专家小组对标准进行了完善。进行了三轮电子德尔菲在线调查，提供了个人参与者的反馈，并召开了一次视频会议来讨论未达成共识的项目。共识设定为80%的一致率，并使用kappa系数来衡量稳定性。
由29位专家制定的子宫托培训能力标准涵盖三个关键领域，包括：（1）必备知识和理解；（2）可委托的专业活动；（3）十个关键角色下的子宫托特定标准。所有73项（100%）能力标准均达成了共识，95.9%的标准显示出稳定性。在电子德尔菲轮次中，专家小组参与者没有流失。
这项电子德尔菲研究为物理治疗师在PM方面的培训标准提供了首个有力建议。这些能力标准将为临床医生提供一种自我评估工具，并为教育工作者和培训机构提供PM培训的基准，这应能改善选择并降低使用子宫托治疗脱垂女性的风险。
