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

Research output: Contribution to journalArticle

28 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)757-770
Number of pages14
JournalPhysical Therapy
Volume93
Issue number6
DOIs
StatePublished - Jun 2013

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Exercise
Random Allocation
Pelvic Floor
Stress Urinary Incontinence
Urinary Bladder
Pessaries
Muscles
Therapeutics
Urinary Incontinence
Health Surveys
Cues
Regression Analysis

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Borello-France, D., Burgio, K. L., Goode, P. S., Ye, W., Weidner, A. C., Lukacz, E. S., ... Spino, C. (2013). Adherence to behavioral interventions for stress incontinence: Rates, barriers, and predictors. Physical Therapy, 93(6), 757-770. https://doi.org/10.2522/ptj.20120072

Adherence to behavioral interventions for stress incontinence : Rates, barriers, and predictors. / Borello-France, Diane; Burgio, Kathryn L.; Goode, Patricia S.; Ye, Wen; Weidner, Alison C.; Lukacz, Emily S.; Jelovsek, John Eric; Bradley, Catherine S.; Schaffer, Joseph; Hsu, Yvonne; Kenton, Kimberly; Spino, Cathie.

In: Physical Therapy, Vol. 93, No. 6, 06.2013, p. 757-770.

Research output: Contribution to journalArticle

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 2013, 'Adherence to behavioral interventions for stress incontinence: Rates, barriers, and predictors', Physical Therapy, vol. 93, no. 6, pp. 757-770. https://doi.org/10.2522/ptj.20120072
Borello-France D, Burgio KL, Goode PS, Ye W, Weidner AC, Lukacz ES et al. Adherence to behavioral interventions for stress incontinence: Rates, barriers, and predictors. Physical Therapy. 2013 Jun;93(6):757-770. https://doi.org/10.2522/ptj.20120072
Borello-France, Diane ; Burgio, Kathryn L. ; Goode, Patricia S. ; Ye, Wen ; Weidner, Alison C. ; Lukacz, Emily S. ; Jelovsek, John Eric ; Bradley, Catherine S. ; Schaffer, Joseph ; Hsu, Yvonne ; Kenton, Kimberly ; Spino, Cathie. / Adherence to behavioral interventions for stress incontinence : Rates, barriers, and predictors. In: Physical Therapy. 2013 ; Vol. 93, No. 6. pp. 757-770.
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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.",
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AU - Borello-France, Diane

AU - Burgio, Kathryn L.

AU - Goode, Patricia S.

AU - Ye, Wen

AU - Weidner, Alison C.

AU - Lukacz, Emily S.

AU - Jelovsek, John Eric

AU - Bradley, Catherine S.

AU - Schaffer, Joseph

AU - Hsu, Yvonne

AU - Kenton, Kimberly

AU - Spino, Cathie

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N2 - 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.

AB - 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.

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