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Adherence to behavioral interventions for stress incontinence: rates, barriers, and predictors.

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.

journal_name

Phys Ther

journal_title

Physical therapy

authors

Borello-France D,Burgio KL,Goode PS,Ye W,Weidner AC,Lukacz ES,Jelovsek JE,Bradley CS,Schaffer J,Hsu Y,Kenton K,Spino C,Pelvic Floor Disorders Network.

doi

10.2522/ptj.20120072

subject

Has Abstract

pub_date

2013-06-01 00:00:00

pages

757-73

issue

eissn

0031-9023

issn

1538-6724

pii

ptj.20120072

journal_volume

pub_type

杂志文章,多中心研究

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Adherence to behavioral interventions for stress incontinence: rates, barriers, and predictors.