Chantal Dumoulin1,2, Dianne Alewijnse3, Kari Bo4, Suzanne Hagen5, Diane Stark6, Marijke Van Kampen7, Julia Herbert8, Jean Hay-Smith9,10, Helena Frawley11,12, Doreen McClurg13, Sarah Dean14. 1. School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada. 2. Urogynacological Health and Aging Chair, Research Centre of the Institut Universitaire de Geriatrie de Montreal, Montreal, Canada. 3. Patient Education, PR and Marketing, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands. 4. Departement of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway. 5. Health Services Research, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom. 6. Functional Bowel Service, Clinic 2 Balmoral Building, Leicester Royal infirmary, Leicester, United Kingdom. 7. Faculty of Kinesiology and Rehabilitation Sciences, K.U. Leuven, Leuven, Belgium. 8. Bradford University, Bradford, United Kingdom. 9. Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand. 10. Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. 11. School of Allied Health, La Trobe University, Melbourne, Australia. 12. Allied Health Research, Cabrini Health, Melbourne, Australia. 13. Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom. 14. Psychology Applied to Health, University of Exeter Medical School, Exeter, United Kingdom.
Abstract
AIMS: This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International Continence Society's 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations. METHOD: Data were amassed from a literature review and an expert panel (2011 conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and women and pelvic organ prolapse in women. RESULTS: The literature was scarce for most of the studied populations except for limited research on women with UI. OUTCOME MEASURES: Exercise diaries were the most widely-used adherence outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research, mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence. STRATEGIES: Few trials studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio prompts, use of established theories of behavior change, and user-consultations seem to increase adherence. CONCLUSION: The literature on adherence outcome measures, determinants and strategies remains scarce for the studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations.
AIMS: This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International Continence Society's 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations. METHOD: Data were amassed from a literature review and an expert panel (2011 conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and women and pelvic organ prolapse in women. RESULTS: The literature was scarce for most of the studied populations except for limited research on women with UI. OUTCOME MEASURES: Exercise diaries were the most widely-used adherence outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research, mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence. STRATEGIES: Few trials studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio prompts, use of established theories of behavior change, and user-consultations seem to increase adherence. CONCLUSION: The literature on adherence outcome measures, determinants and strategies remains scarce for the studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations.
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