A postgraduate program in pelvic floor physiotherapy (PFP) was created in 2010 to address training needs in the field. Prior to the creation of this program, there was no specialized university training in PFP in our country. Little to no training time was devoted to PFP in entry-to-practice level physiotherapy programs.(1) As a result, the number of physiotherapists with specialized training in PFP was inadequate to meet the demands of the population.(2) 

The main objective of the postgraduate program was to develop physiotherapists’ clinical skills in assessment, clinical reasoning, and treatment of pelvic floor dysfunction for a variety of clients and conditions, using evidence-based practice (EBP). The program consists of six courses, spread over six trimesters, and leads to a 15-credit postgraduate certificate. 

This study aimed to evaluate the satisfaction of new graduates with the program and their perception of how the program impacted their clinical practice in PFP.

This was a retrospective pre-post study using an online survey methodology. This design, which involves students providing their perceptions of impact after training, has been shown to be a valid method for assessing training outcomes, particularly when the training is expected to alter participants' frame of reference for assessing their own clinical practice.(3)

We used the New World Kirkpatrick Model (NWKM) as a general framework to evaluate this PFP program. This study focused on the first (i.e., learner reaction) and last (i.e., practice impacts) levels of NWKM evaluation.

A first survey was created in 2012 (Survey A) and was primarily intended to capture new graduates’ satisfaction with the PFP program. In addition, Survey A also inquired about the proportion of the graduates’ clinical practice devoted to PFP clients before and during the program. A second survey was created in 2015 (Survey B) and focused on studying the physiotherapists’ weekly caseload (% time and number PFP patients) before and during the program, as well as at the time of the survey (i.e., one to two years after program completion).

The two surveys were sent each year in June-July by a person, who was independent of the faculty or program director, via the online platform Survey Monkey. Since 2012, Survey A has been sent to successive physiotherapist cohorts a few months post-graduation. Since 2015, Survey B has been sent to successive cohorts of physiotherapists, one and two years after graduation. Survey results were collected and analyzed by an independent evaluator.

For Survey A, satisfaction with the program was presented as the percentage of participants providing different possible ratings on a 6-point Likert scale (1-Very Satisfied, 2-Satisfied, 3-Somewhat unsatisfied, 4-Unsatisfied, 5-Don't Know, 6-Not applicable). The Wilcoxon non-parametric statistic was used to test whether there were significant differences between the students’ caseloads devoted to PFP clients before or during the postgraduate program. For Survey B, Friedman's non-parametric test was used to assess whether there were significant differences between the student’s weekly caseload at three time points (before and during the program, and at the time of the survey). If the results were significant for the Friedman test, pairwise comparisons (post hoc) were performed using the Wilcoxon test. For all statistical tests, Bonferroni corrections were applied if necessary.

Since its inception, Survey A has been sent eight times, with 85 physiotherapists responding (response rate = 49.7%). Since its inception, Survey B has been sent five times, with 48 physiotherapists responding one-year post-program (response rate = 50,0%) and 40 physiotherapists responding two-years post-program (response rate = 45.5%).

Respondents’ characteristics: All respondents were female. In surveys A, B one-year after, and B two-years after, 64%, 57%, and 43% of respondents, respectively, had an age profile between 25 and 29 years, and 24%, 26%, and 45% were between 30 and 34 years. At the time of surveys A, B one-year after, and B two-years after, 67%, 77% and 78% of respondents, respectively, reported having a master's degree in physiotherapy. At the time of surveys A, B one-year after, and survey B two-years after, 79%, 92% and 77% of respondents, respectively, reported working in private practice, and 24%, 17% and 23% worked in public hospitals.

Survey A: Most respondents were “very satisfied” or “satisfied” with the training they received to treat the different types of PFP clients: adult females (satisfaction rate = 99%), adult males (94%), obstetrics (93%), geriatrics (90%) and pediatrics (87%). Most respondents were also satisfied with the program to treat the following PFP conditions: urinary incontinence (100%), fecal incontinence (96%), pelvic organ prolapse (91%) and perineal pain (86%). Furthermore, most were satisfied with skill development, such as clinical assessment (100%), clinical reasoning (97%), treatment plan implementation (99%), and patient education (100%).
Respondents surveyed a few months after the end of the program retrospectively reported on the proportions of their clinical practice devoted to PFP clients (as a % of their total caseload), which were significantly higher during the program than just before the program (Figure 1).
 
Survey B: In the one-year and two-year post-program surveys, the percentage of the total caseload and the number of PFP clients per week that physiotherapists report treating at the time of the survey were significantly higher than before and during the program (Figure 2).

Our findings suggest that new graduates were satisfied with the postgraduate program and had already reported devoting a higher proportion of their caseload to PFP clients during the program. Furthermore, the program appears to have a tangible impact on graduates’ clinical practice by significantly increasing the percentage of PFP clients in the total caseload and number of patients treated weekly.

The surveys support satisfaction of graduates with the program and perceived program impact on their PFP clinical practice.

Francis A, Madill S, Gentilcore Saulnier E, McLean L. Survey of Canadian Physiotherapists: Entry-Level and Post-professional Education in Women's Health. Physiotherapy Canada. 2012;64(3): 271-279.
Le Berre M, Dumoulin C. Accessibility of pelvic floor physiotherapy for treating urinary incontinence in older women in Quebec: an online survey. Physiotherapy Canada. 2022 Sept; https://doi.org/10.3138/ptc-2021-0089.
Bhanji, Gottesman, de Grave, Steinert, Winer. The retrospective pre–post: A practical method to evaluate learning from an educational program. Academic emergency medicine. 2012; 19(2): 189-194