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Strategies to enhance self-efficacy and adherence to home-based pelvic floor muscle exercises did not improve adherence in women with urinary incontinence: a randomised trial [with consumer summary]
Sacomori C, Berghmans B, Mesters I, de Bie R, Cardoso FL
Journal of Physiotherapy 2015 Oct;61(4):190-198
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

QUESTION: Do strategies to enhance self-efficacy and exercise mastery affect adherence to home-based pelvic floor muscle exercises in women with urinary incontinence? DESIGN: Two-arm, parallel, randomised, controlled trial with intention-to-treat analysis. Randomisation was performed using computer-generated random numbers in five blocks of 20 women. PARTICIPANTS: Eighty-six women with stress, urgency or mixed urinary incontinence. INTERVENTION: All participants underwent three individual physiotherapy clinic visits at day 0, 15 and 30, and 2 further months of home-based pelvic floor muscle exercises. The experimental group also received self-efficacy enhancing interventions, including a structured discussion on accomplishments and goals, a 9-minute video with testimonials, and a reminder. OUTCOME MEASURES: The primary outcome -- adherence to at least 20 fast and 20 slow contractions every day -- was evaluated with a structured questionnaire at 15, 30 and 90 days after enrolment and completion of a daily diary. A validated questionnaire was used to assess urinary incontinence. Self-efficacy and pelvic floor muscle function were also measured. RESULTS: Seven women withdrew from each group before the day-30 assessment. There was no difference in adherence to pelvic floor muscle exercises at 90 days between the groups (MD 0.5 points, 95% CI -1.1 to 2.1) on the questionnaire, which was scored from 2 to 21. At day 90, 56% of the experimental group and 44% of the control group were performing the exercises every day. Adherence scores of both groups decreased during the 2-month follow-up period without any supervised physiotherapy session (p < 0.05). The groups did not differ on the remaining secondary outcomes. CONCLUSION: Discussion of accomplishments and goals, a testimonial video and a reminder did not increase exercise adherence more than exercise mastery. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials UTN U1111-1128-8684.

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