Adherence and effectiveness of a single instruction of pelvic floor exercises: a randomized clinical trial
- 183 Downloads
Introduction and hypothesis
In Brazil there are limited knowledge and education about preventative exercises for pelvic floor muscles (PFMs). We hypothesised that a single pelvic floor muscle exercise (PFME) session immediately postpartum would be effective in preventing urinary incontinence (UI) in a 3-month postpartum period with good adherence rates.
Two hundred two women were approached for this randomised controlled trial and randomly assigned to two groups: the control group and experimental group. The intervention comprised a visual assessment of PFM contraction, a single PFME instruction session supervised by a physical therapist, and an educational approach through distribution of brochures about home-based PFME exercises (without supervision). Involuntary urinary loss and quality of life (QoL) were evaluated using the International Consultation on Incontinence Questionnaire Short Form (main outcome). Sociodemographic and clinical information was collected. Adherence and barriers were assessed via telephone/mobile phone surveys (secondary outcomes).
The adherence rate was 85.1%; only 37% of the women reported having some knowledge about PFME prior to participating in this study. The main barriers to PFME mentioned were forgetfulness (61.2%), lack of time (52.2%), and the need to take care of the baby (56.7%). One instruction session on postnatal PFME delivered in the immediate postpartum period was ineffective for improving urinary symptoms such as frequency of leakage (p = 0.821), amount of leakage (p = 0.746), and influence of leakage on QoL (p = 0.823). In addition, there was no difference in QoL 3 months post-partum (p = 0.872).
Although the proposed intervention did not prevent UI symptoms, the adherence rate to PFME was high.
KeywordsExercise therapy Pelvic floor Postpartum period Public health Randomised clinical trial Urinary incontinence
This research was conducted with the support of Leonice Boer and Camila Aguiar Fritzen.
Compliance with ethical standards
Conflicts of interest
- 5.Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD007471. https://doi.org/10.1002/14651858.CD007471.pub3
- 7.Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017;36:221–44. https://doi.org/10.1002/nau.23107.CrossRefPubMedGoogle Scholar
- 10.Hay-Smith J, Dean S, Burgio K, et al. Pelvic-floor-muscle-training adherence "modifiers": a review of primary qualitative studies-2011 ICS state-of-the-science seminar research paper III of IV. Neurourol Urodyn. 2015;34:622–31. https://doi.org/10.1002/nau.22771.CrossRefPubMedGoogle Scholar
- 16.Tamanini JTN, Dambros M, D'Ancona CAL, et al. Validation of the “International Consultation on Incontinence Questionnaire - Short Form”. (ICIQ-SF) for Portuguese. Rev Saude Publica. 2004; 38:438-44. https://doi.org/10.1590/S1677-55382005000500013
- 18.Slieker-ten Hove MCP, Pool-Goudzwaard AL, Eijkemans MJC, et al. Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society. Neurourol Urodyn. 2009;28:295–300. https://doi.org/10.1002/nau.20659.CrossRefPubMedGoogle Scholar
- 24.Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–59. https://doi.org/10.1249/MSS.0b013e318213fefb.CrossRefPubMedGoogle Scholar
- 27.Yu M, Chair SY, Chan CWH, Choi KC. A health education booklet and telephone follow-ups can improve medication adherence, health-related quality of life, and psychological status of patients with heart failure. Heart Lung. 2015;44:400–7. https://doi.org/10.1016/j.hrtlng.2015.05.004.CrossRefPubMedGoogle Scholar
- 28.Moossdorff-Steinhauser HFA, Albers-Heitner P, Weemhoff M, et al. Factors influencing postpartum women’s willingness to participate in a preventive pelvic floor muscle training program: a web-based survey. Eur J Obstet Gynecol Reprod Biol. 2015;195:182–7. https://doi.org/10.1016/j.ejogrb.2015.10.009.CrossRefPubMedGoogle Scholar
- 30.Porta Roda O, Díaz López MA, Vara Paniagua J, et al. Adherence to pelvic floor muscle training with or without vaginal spheres in women with urinary incontinence: a secondary analysis from a randomized trial. Int Urogynecol J. 2016;27:1185–91. https://doi.org/10.1007/s00192-015-2941-0.CrossRefPubMedGoogle Scholar