Objective: To examine characteristics associated with adherence to a prescribed pelvic floor muscle exercise regimen in homebound older adults with urinary incontinence.
Design: This study represented the secondary analysis of data collected during a prospective, controlled clinical trial with crossover design that examined the efficacy of behavioral interventions for UI in homebound older adults.
Population, Sample, Setting, Years: The population of interest was homebound older adults with urinary incontinence. The sample consisted of 85 cognitively intact subjects (mean age=77.2 years, 90.6% female and 91.8% white) who completed the 8 week treatment phase of the parent study. The evaluation and treatment occurred in subjects’ homes. The timeframe from the study was 1992 to 1998.
Variables: Baseline characteristics including the number of incontinent episodes per day at baseline and post-treatment (measured by self-report bladder diary), duration of incontinence, percent reduction in incontinence at the end of treatment, age, educational level, cognitive function (measured by the Folstein Mini Mental State Examination and Clock Drawing Test), depressive symptoms (measured by the 15 item Geriatric Depression Scale - GDS), functional status (measured by the Older American Research and Service Center (OARS) physical and instrumental activities of daily living scales), the time required to walk 15 feet and prepare to toilet (measured by the Performance Based Toileting Assessment), co-morbidity (measured by the number of medical problems), the number of prescribed medications taken daily, and the duration of incontinence were examined for their relationship to adherence the prescribed pelvic floor muscle regimen at the completion of treatment and 3 months later. Adherence was assessed by self-report. Subjects were considered adherent to the exercise regimen if they performed at least 80% of the prescribed exercises each day.
Methods: Homebound adults age 60 and older with urinary incontinence (UI) were referred to the study by home health care nurses from two large home health agencies in southwestern Pennsylvania, U.S.A. The intervention was delivered during 8 weekly in-home visits by one of two study nurse practitioners. Surface EMG biofeedback was utilized to teach subjects pelvic floor muscle exercises (PFME) and urge and stress strategies. Subjects were given verbal and written instructions to perform the PFME three to four times per day and to do 10-15 exercises at each session. They were told to do the exercises each day between treatment visits and that in order to control the involuntary loss of urine, they would need to continue to do them indefinitely. Following treatment, subjects were followed for 12 months with an in-home visits every 3 months; no additional instructions were provided.
Findings: By self-report, 69.4% of subjects were adherent to the exercise regimen at the completion of treatment. Baseline GDS scores (p=.02) and the number of prescription medications taken per day (p=.05) were significantly related to PFME adherence at the completion of treatment. Nine subjects did not have 3 month follow-up data. These individuals did not differ significantly on any of the baseline variables from those who completed the assessment. Seventy-six subjects completed the 3-month post-treatment assessment and 58.1% reported performing at least 80% of their prescribed exercises each day. None of the baseline characteristics were significantly associated with adherence at 3 months post-treatment.
Conclusion: Adherence to treatment recommendations tended to decline once active treatment ended. None of the characteristics examined were consistently associated with adherence to the PFME regimen.
Implications: Additional research is needed to identify predicators of adherence and to improve long-term adherence to pelvic floor muscle exercises for urinary incontinence.
Objectives: At the completion of this session, the participant will be able to:
Discuss characteristics associated with adherence to pelvic floor muscle exercises for urinary incontinence.
Identify areas for future research related to adherence to pelvic floor muscle exercises for urinary incontinence.
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