Effects of Action Observation and Metaphorical Imagery in Pelvic Floor Muscle Training for Geriatric Urinary Incontinence

Investigation of the Effects of Pelvic Floor Muscle Training Applied Via Action Observation Method Accompanied by Metaphorical Imagery on Urinary Incontinence in Geriatric Women

This clinical trial investigates the effects of a 12-week Pelvic Floor Muscle Training (PFMT) program applied via Action Observation Therapy (AOT) with metaphorical imagery on urinary incontinence, quality of life, and treatment adherence in geriatric women. The study will be conducted between June 2025 and June 2026 in nursing homes in Istanbul, targeting women aged 65 and older who are diagnosed with stress or stress-predominant mixed urinary incontinence, possess normal cognitive function (Standardized Mini Mental Test score ≥ 24), and walk independently. Eligible participants will be divided into groups, where both will undergo a progressive exercise regimen involving twice-weekly 45-50 minute group sessions that advance from supine positions to standing and jumping movements. However, the AOT study group will uniquely perform these exercises while observing and imagining projected metaphor-themed visuals to enhance motor learning and motivation. Efficacy will be evaluated pre- and post-intervention using various standardized tools, including the Pelvic Floor Distress Inventory-20, a 24-hour pad test, the Incontinence Severity Index, the Movement Imagery Questionnaire-3, and the Incontinence Quality of Life Scale, to comprehensively assess improvements in incontinence severity, functional status, and overall well-being.

Study Overview

• Status: Recruiting
• Conditions: Urinary Continence
• Intervention / Treatment: Other: Pelvic Floor Muscle Training program; Other: Pelvic Floor Muscle Training via Action Observation Therapy

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: ARZU ÖZDİNÇLER, PROF; Phone Number: +90 216 910 1907; Email: arzu.ozdincler@fbu.edu.tr

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye), 34758
    • Recruiting
    • Fenerbahce University Department of Physiotherapy and Rehabilitation
    • Contact: ARZU ÖZDİNÇLER, PROF; Phone Number: +90 216 910 1907; Email: arzu.ozdincler@fbu.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosed with stress or stress-predominant mixed urinary incontinence by a physician
• Women aged 65 years and older
• Literate in Turkish to understand, interpret, and answer the questionnaires
• Scoring 24 or higher on the Mini-Mental State Examination (MMSE)
• Able to walk independently without the use of any walking aids (assistive devices)
• Having signed the informed consent form

Exclusion Criteria:

• Received pelvic floor muscle training within the past 6 months
• Presence of fecal incontinence
• Current genitourinary infection or use of medication for urinary incontinence
• History of urinary incontinence surgery or presence of symptomatic pelvic organ prolapse
• Presence of neurological, orthopedic, psychiatric, hematological, or cardiovascular conditions that would preclude participation in exercise
• Body mass index (BMI) ≥ 25 kg/m²
• Hearing or visual impairments that would negatively affect participation
• Presence of hematuria, urethral and/or bladder fistula, or a history of pelvic surgery

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Pelvic Floor Muscle Training program; Exercise	Other: Pelvic Floor Muscle Training program; Participants will engage in a 12-week Pelvic Floor Muscle Training (PFMT) program. The exercises will be conducted twice a week in group sessions lasting 45-50 minutes each. These sessions will be supervised by a physiotherapist and performed in small groups of five participants.
Experimental: Pelvic Floor Muscle Training via Action Observation Therapy; Exercise with AOT	Other: Pelvic Floor Muscle Training via Action Observation Therapy; Participants will be enrolled in a Pelvic Floor Muscle Training (PFMT) program using the action observation method accompanied by metaphorical imagery. This program will be administered over 12 weeks, consisting of twice-weekly group sessions lasting 45-50 minutes each. The exercise content is identical for both groups. However, during the sessions for this specific group, metaphor-themed visuals will be projected onto a screen, and participants will be given the instruction: 'Perform the movement by imagining it as shown in the visual.' To enhance physical participation and motivation, verbal cues and positive reinforcement will be provided by the physiotherapist. The exercises and the corresponding metaphors will be updated on a weekly basis. All sessions will be supervised by a physiotherapist in small groups of five participants.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Mini-Mental State Examination	Baseline and after 12-weeks
Pelvic Floor Distress Inventory	Baseline and after 12-weeks
The Incontinence Severity Index	Baseline and after 12-weeks
Movement Imagery Questionnaire-3	Baseline and after 12-weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Geriatric Self-Efficacy Index for Urinary Incontinence	Baseline and after 12-weeks
Incontinence Quality of Life Questionnaire	Baseline and after 12-weeks

Collaborators and Investigators

• Sponsor: Fenerbahce University

Study record dates

Study Major Dates

• Study Start (Actual): March 19, 2025
• Primary Completion (Estimated): July 27, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: April 20, 2026
• First Submitted That Met QC Criteria: April 20, 2026
• First Posted (Actual): April 27, 2026

Study Record Updates

• Last Update Posted (Actual): May 11, 2026
• Last Update Submitted That Met QC Criteria: May 8, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: geriatrics; action observation; urinary incontinence
• Additional Relevant MeSH Terms: Urogenital Diseases; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urination Disorders; Lower Urinary Tract Symptoms; Urological Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Urinary Incontinence
• Other Study ID Numbers: 1002-GERIATRICS-UI

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data will be shared upon reasonable request to the principal investigator/corresponding author for the purpose of meta-analysis or related academic research.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No