Adherence to behavioral interventions for stress incontinence: rates, barriers, and predictors
Diane Borello-France, Kathryn L Burgio, Patricia S Goode, Wen Ye, Alison C Weidner, Emily S Lukacz, John-Eric Jelovsek, Catherine S Bradley, Joseph Schaffer, Yvonne Hsu, Kimberly Kenton, Cathie Spino, Pelvic Floor Disorders Network, Mathew D Barber, Marie Fidela R Paraiso, Mark D Walters, J Eric Jelovsek, Linda McElrath, Donel Murphy, Cheryl Williams, Anthony G Visco, Jennifer Wu, Alison Weidner, Cindy Amundsen, Mary J Loomis, Linda Brubaker, Kimberly Kenton, MaryPat FitzGerald, Elizabeth Mueller, Mary Tulke, Kathy Jesse, Kathy Marchese, Holly E Richter, Kathryn L Burgio, R Edward Varner, Robert L Holley, Patricia S Goode, L Keith Lloyd, Alayne D Markland, Tracey Wilson, Velria Willis, Nancy Saxon, LaChele Ward, Lisa S Pair, Charles W Nager, Shawn A Menefee, Emily Lukacz, Margie Kahn, Karl M Luber, Leah Merrin, Giselle Zazueta-Damian, Patsy Riley, Lynn Hall, Judy M Condino, Cathie Spino, John T Wei, Morton B Brown, Donna DiFranco, John O L DeLancey, Dee Fenner, Nancy K Janz, Wen Ye, Zhen Chen, Yang Wang Casher, Joseph Schaffer, David Rahn, Clifford Wai, Marlene Corton, Gary Lemack, Philippe Zimmern, Kelly Moore, Shanna Atnip, Margaret Hull, Pam Martinez, Deborah Lawson, Ingrid Nygaard, Peggy Norton, Yvonne Hsu, Jan Baker, Linda Freeman, Katherine E Hartmann, Susan Meikle, Halina Zyczynski, Wendy Leng, Pamela Moalli, Chaira Ghetti, Jerry Lowder, Judy Gruss, Karen Mislanovich, Karen Debes, Geoffrey Cundiff, Victoria Handa, Jamie Wright, Mary Elizabeth Sauter, Laura Scheufele, Diane Borello-France, Kathryn L Burgio, Patricia S Goode, Wen Ye, Alison C Weidner, Emily S Lukacz, John-Eric Jelovsek, Catherine S Bradley, Joseph Schaffer, Yvonne Hsu, Kimberly Kenton, Cathie Spino, Pelvic Floor Disorders Network, Mathew D Barber, Marie Fidela R Paraiso, Mark D Walters, J Eric Jelovsek, Linda McElrath, Donel Murphy, Cheryl Williams, Anthony G Visco, Jennifer Wu, Alison Weidner, Cindy Amundsen, Mary J Loomis, Linda Brubaker, Kimberly Kenton, MaryPat FitzGerald, Elizabeth Mueller, Mary Tulke, Kathy Jesse, Kathy Marchese, Holly E Richter, Kathryn L Burgio, R Edward Varner, Robert L Holley, Patricia S Goode, L Keith Lloyd, Alayne D Markland, Tracey Wilson, Velria Willis, Nancy Saxon, LaChele Ward, Lisa S Pair, Charles W Nager, Shawn A Menefee, Emily Lukacz, Margie Kahn, Karl M Luber, Leah Merrin, Giselle Zazueta-Damian, Patsy Riley, Lynn Hall, Judy M Condino, Cathie Spino, John T Wei, Morton B Brown, Donna DiFranco, John O L DeLancey, Dee Fenner, Nancy K Janz, Wen Ye, Zhen Chen, Yang Wang Casher, Joseph Schaffer, David Rahn, Clifford Wai, Marlene Corton, Gary Lemack, Philippe Zimmern, Kelly Moore, Shanna Atnip, Margaret Hull, Pam Martinez, Deborah Lawson, Ingrid Nygaard, Peggy Norton, Yvonne Hsu, Jan Baker, Linda Freeman, Katherine E Hartmann, Susan Meikle, Halina Zyczynski, Wendy Leng, Pamela Moalli, Chaira Ghetti, Jerry Lowder, Judy Gruss, Karen Mislanovich, Karen Debes, Geoffrey Cundiff, Victoria Handa, Jamie Wright, Mary Elizabeth Sauter, Laura Scheufele
Abstract
Background: First-line conservative treatment for stress urinary incontinence (SUI) in women is behavioral intervention, including pelvic-floor muscle (PFM) exercise and bladder control strategies.
Objective: The purposes of this study were: (1) to describe adherence and barriers to exercise and bladder control strategy adherence and (2) to identify predictors of exercise adherence.
Design: This study was a planned secondary analysis of data from a multisite, randomized trial comparing intravaginal continence pessary, multicomponent behavioral therapy, and combined therapy in women with stress-predominant urinary incontinence (UI).
Methods: Data were analyzed from the groups who received behavioral intervention alone (n=146) or combined with continence pessary therapy (n=150). Adherence was measured during supervised treatment and at 3, 6, and 12 months post-randomization. Barriers to adherence were surveyed during treatment and at the 3-month time point. Regression analyses were performed to identify predictors of exercise adherence during supervised treatment and at the 3- and 12-month time points.
Results: During supervised treatment, ≥86% of the women exercised ≥5 days a week, and ≥80% performed at least 30 contractions on days they exercised. At 3, 6, and 12 months post-randomization, 95%, 88%, and 80% of women, respectively, indicated they were still performing PFM exercises. During supervised treatment and at 3 months post-randomization, ≥87% of the women reported using learned bladder control strategies to prevent SUI. In addition, the majority endorsed at least one barrier to PFM exercise, most commonly "trouble remembering to do exercises." Predictors of exercise adherence changed over time. During supervised intervention, less frequent baseline UI and higher baseline 36-Item Short-Form Health Survey (SF-36) mental scores predicted exercise adherence. At 3 months post-randomization, women who dropped out of the study had weaker PFMs at baseline. At 12 months post-randomization, only "trouble remembering" was associated with exercise adherence.
Limitations: Adherence and barrier questionnaires were not validated.
Conclusions: Adherence to PFM exercises and bladder control strategies for SUI can be high and sustained over time. However, behavioral interventions to help women link exercise to environmental and behavioral cues may only be beneficial over the short term.
Trial registration: ClinicalTrials.gov NCT00270998.
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Source: PubMed