Factors influencing long‐term adherence to pelvic floor exercises in women with urinary incontinence

Abstract

Background and Objectives To ensure the effectiveness of Physical Therapy for urinary incontinence (UI), it is crucial that patients adhere to treatment in both the long and the short term. Treatment adherence may prevent symptom progression and the need for surgery, which is associated with higher costs and potential complications. Adherence is defined as carrying out a recommended behavioral modification or change. The World Health Organization (WHO) has established that adherence is a multifactorial phenomenon determined by the interaction of five dimensions, which include diverse factors that affect long‐term adherence on many levels. Aim To identify the factors that influence long‐term adherence to pelvic floor exercises in women with UI. Methods Observational, descriptive, cross‐sectional study. The sample was recruited from the “Centro Integral de Reeducación de Piso Pélvico” (CIREP), and included 61 women treated for UI at the center in 2014 and 2015. Participants completed a self‐administered, 28‐item questionnaire developed for this study based on the WHO five dimensions. Data analysis was performed using STATA 13.0 software. Results Having performed pelvic floor home exercises after discharge from Physical Therapy was significantly associated with self‐rated treatment adherence (P < 0.001). Patient‐related factors were significantly associated with long‐term adherence to the pelvic floor exercise program (P < 0.001). Conclusion Patient‐related factors, exerted the strongest influence on long‐term adherence to pelvic floor exercises in women with UI; forgetting to do the exercises and boredom with the exercises were the factors most strongly related to low treatment adherence, while motivation and commitment were associated with high adherence in this population.

Adherence Factors Related to Exercise Prescriptions in Healthcare Settings: A Review of the Scientific Literature

“…Data extracted were: age of participants, setting of intervention, risk factors, or chronic diseases, the method used to measure PA, PAP treatments, and PAP adherence, theories related to human behavior change, score of mentioned PAP adherence factors according to the WHO fivedimensional adherence model (WHO, 2003). All adherence-related factors are described in Table 1 and proposed by other authors in the scientific literature (Conraads et al, 2012;Venegas et al, 2018;WHO, 2003). Modified RATS review guidelines were used for this critical literature review, with more than five points (10 points Likert-type scale) for the following points: relevance of study question (regarding the quality in the research question/aim of the study?…”

“…Blackstock et al proposed the WHO model to measure non-adherence to both pharmacological and non-pharmacological treatments in Chronic Obstructive Pulmonary Disease patients (Blackstock et al, 2016;WHO, 2003). Recently, Venegas, et al used the model to analyze the influencing factors in long-term adherence to physical therapy for women with urinary incontinence (Venegas et al, 2018). In a similar way, Conraads et al used it with heart failure patients in 2012.…”

“…The ability of patients to follow treatments in an optimal manner is frequently affected by more than one factor. According to Venegas et al and WHO experts, adherence is a complex, dynamic, and multifactorial phenomenon, determined by the interaction of five set of factors, termed by WHO as dimensions, of which patient-related factors are just one of these (Venegas et al, 2018).…”

Promoting and maintaining urinary continence: Follow‐up from a cluster‐randomized trial of elderly village women in Bangladesh

“…Some earlier studies 2,3 have shown, as here, that continued adherence to exercise is the main factor in maintaining continence posttintervention. Feeling motivated to perform the exercises and committed to do so have been identified as significant factors in adherence 16 but here it was not practical to measure factors hypothesized to be associated with higher adherence: we cannot contribute to a discussion of whether, for example, those who continued exercise postintervention had higher expectations of self‐efficacy than those who did not 17‐19 . We cannot comment with any confidence either on the potential efficacy of continued group classes postintervention.…”

Design and Validity of a Choice-Modeling Questionnaire to Analyze the Feasibility of Implementing Physical Activity on Prescription at Primary Health-Care Settings

“…Previously, Desveaux et al proposed a questionnaire to find facilitators and barriers of patients and HC providers in regard to a community-based exercise program [ 29 ], in a similar way than Myles et al, in Canada [ 36 ], Bock et al, in Germany [ 30 ], Freene et al, in Austalia [ 35 ], and Oyeyemi et al, in Nigeria [ 37 ]. Trying to filling in the gap, we propose a new validated questionnaire for analyzing feasibility of PAP in HC settings considering all dimensions and their respective integrated factors, according to the WHO 5 dimensions adherence model [ 16 , 42 ].…”