| Objective:This study aims to construct an incontinence specialist nurse-led rehabilitation management programme for urinary incontinence after radical prostatectomy and validating its clinical application to improve the quality of rehabilitation management for urinary incontinence after radical prostatectomy and promote patient recovery.The study objectives include:(1)to screen and synthesize evidence-based management of urinary incontinence after radical prostatectomy and select evidence that is applicable for introduction into clinical practice;(2)to analyze the perceived barriers and facilitators of evidence-based practice by stakeholder groups(physicians,nurses,and pelvic floor rehabilitators)and patients’ experiences for rehabilitation management of urinary incontinence after radical prostatectomy;(3)to construct and validate a rehabilitation management program for urinary incontinence after radical prostatectomy;(4)to evaluate the clinical application of the rehabilitation management program for urinary incontinence after radical prostatectomy.Methods:Based on the Knowledge to Action(KTA)model,the high-level evidence related to the rehabilitation management of urinary incontinence after radical prostatectomy was classified and summarized,and the evidence suitable for clinical practice was selected through the expert meeting method and the review criteria were established.Participatory observation and qualitative study were used to evaluate the factors that promote and hinder the use of evidence in pilot wards,and the gap between the best evidence and clinical practice.Through the expert consultation method,the rehabilitation management program of urinary incontinence after radical prostatectomy was established to eliminate the obstacle factors.A non-synchronous control study was used to intervene in patients with urinary incontinence after radical prostatectomy,and the application effect of the intervention program was obtained.This study passed the review of Changhai Hospital Ethics Committee and the operation of the programme was managed and supervised by a multidisciplinary rehabilitation management team including incontinence specialist nurses.In this study,the Generalized Linear Mixed Model(GLMM)was selected for the multifactorial analysis of outcome variables,with the outcome variable as the dependent variable and the group variable,the time variable and the general information variable of patients all put into the model as covariates.The interactions for the outcome indicators in this study were all statistically significant,indicating that there was an interaction between group and time and that separate effects needed to be analyzed.For continuous variables with outcome variables that conformed to a normal distribution and chi-squared,the independent samples t-test was used for comparison between groups;for continuous variables with outcome variables that were not normally distributed,the Mann-Whitney U test was used.The test level used bonferroni correction,α=P/5=0.01,that is,P<0.01 was considered statistically significant.Results:1.Through a systematic search,a total of 19 literatures were finally included,including 1 clinical decision,3 guidelines,8 evidence summaries and 7 systematic reviews.41 pieces of best evidence for urinary incontinence management after radical prostatectomy were obtained.2.Through the expert meeting,13 pieces of evidence suitable for practice were obtained,which were divided into five modules,including risk notification of urinary incontinence,assessment and diagnosis of urinary incontinence,non-surgical intervention of urinary incontinence,nursing supplies of urinary incontinence and surgical treatment of urinary incontinence.13 standards for practice review were formulated.3.There is a large gap between the clinical practice and the best evidence of urinary incontinence rehabilitation management in pilot wards.(1)Current situation of evidence-based practice in pilot wards: poor auditing standards implementation,lack of urinary incontinence management system and process.(2)By conducting semi-structured interviews with 15 medical staff,the hindrance factors of evidence-based practice were obtained,including evidence,application process,organizational management,patient and physician factors.The promotion factors included evidence-based practice training,establishment of incontinence specialist nurse-led postoperative incontinence rehabilitation management protocols for radical prostatectomy,establishment of a standardized urinary incontinence management system,and support from the leadership.(3)A qualitative study of 10 patients with urinary incontinence after radical prostatectomy was conducted to obtain the practice experience of this group of patients with a urinary incontinence rehabilitation management programme for radical prostatectomy.Patients lacked professional,continuous rehabilitation guidance and tools to assess the severity of incontinence,and it is recommended that the urinary incontinence rehabilitation management process should be optimized.Clinical emphasis should be placed on health education on incontinence-related knowledge for patients,and an incontinence specialist nurse-led rehabilitation management programme for urinary incontinence after radical prostatectomy should be adopted to promote patient participation in rehabilitation management.(4)The rehabilitation management programme for urinary incontinence after radical prostatectomy was constructed through expert consultation,including seven time nodes: "preoperative stage","postoperative stage","catheter extraction day","the first month postoperatively ","the third month postperatively ","the sixth month postperatively " and "the twelfth month postoperatively and above".4.A non-concurrent controlled study was used to obtain a comparison of clinical outcome indicators between 114 prostate cancer patients in the pilot ward trial group and114 prostate cancer patients in the control group,both groups were consistent at baseline(P > 0.05).The differences in the 24-h urine pad test results between the two groups were statistically significant at the second month postoperatively as well as at the sixth month postoperatively(P < 0.01).The difference in ICIQ-SF scores between the two groups of patients was statistically significant at the first month postoperatively(P < 0.01).The differences in the total quality of life scores for urinary incontinence between the two groups were statistically significant at the first month,the second month,and the sixth month postoperatively(P < 0.01).The differences in total pelvic floor muscle exercise selfefficacy scores between the two groups were statistically significant at the first month postoperatively,the second month postoperatively,the third month postoperatively,and the sixth month postoperatively(P < 0.01).Conclusion:1.This study summarized the best evidence for the rehabilitation management of urinary incontinence after radical prostatectomy,aiming to provide reference for the rehabilitation management of urinary incontinence after radical prostatectomy.2.This study applied the KTA model for evidence-based practice of urinary incontinence rehabilitation management for radical prostatectomy.By identifying problems,evidence synthesis,identifying evidence suitable for introduction into practice,analyzing barrier factors and facilitation strategies,constructing a management programme and conducting an empirical study,the gap between evidence and practice was shortened.3.This study constructed an incontinence specialist nurse-led management programme for urinary incontinence rehabilitation after radical prostatectomy through evidence synthesis,qualitative interviews,and expert meeting methods,with good feasibility and validity.The programme significantly improved the rehabilitation outcomes of patients with urinary incontinence after radical prostatectomy. |
