Hypothesis / aims of study
The aim of our study is to document 8 years post pelvic floor muscle (PFM) physiotherapy intervention: the (i) types and frequency of PFM exercises still performed, (ii) exercises integrated into daily activities, (iii) barriers to PFM exercise adherence and (iv) lifestyle modifications study participant integrated into daily life.
Study design, materials and methods
This is an 8-year follow-up and secondary analysis of a non-inferiority randomized controlled trial (RCT) that compared individual physiotherapy with a group-based physiotherapy intervention for urinary incontinence (UI) in women over 60 years old [1]. Both intervention groups participated in weekly sessions over a 12‐week period. Each session featured a 15‐minute educational segment on lifestyle modifications followed by 45 minutes of progressively challenging PFM exercises complemented by PFM exercises to be completed five days/week at home. Upon completing the physiotherapy intervention, participants were asked to integrate lifestyle modifications and continue the PFM home exercises three days/week.
RCT participants who completed the 1-year follow-up were invited to participate in the 8-year follow-up study. Women were contacted by phone and completed a questionnaire after signing a consent form. The following information was collected: 1) the frequency and type of PFM exercises still being performed, 2) the preferred position for performing PFM exercises, 3) integration of PFM contractions in daily life activities, 4) reasons for non-adherence to PFM exercises, and 5) adherence to lifestyle modifications recommended during the physiotherapy program.
Data from the group-based and individual interventions were combined in the 8-year follow-up due to similar treatment outcomes at 1 year. Descriptive statistics, including numbers and percentages, means, and standard deviations, were used to summarize adherence data.
Results
Seventy-two percent, 231 of the 319, who completed the 1-year follow-up post RCT consented to participate in the study. Participants’ mean age and standard deviation (SD) was 75.3 (5.7) years. On average, there was a 7.6-year gap between the intervention start date and the follow-up.
Thirty-nine percent (89/230) of women continued the PFM exercises at least once a week, while 11.8% (27/230) only did them when symptoms reappeared. The most frequently performed exercise was the ‘Strength exercise’: 89.9% of the adherent women did it on a weekly basis (80/89). Additionally, 44% (99/225) of participants had integrated PFM contractions into their daily activities, performing them before engaging in activities or increased intra-abdominal pressure. See Table 1 for details related to exercises frequency and type.
The most frequently reported reasons for discontinuing PFM exercises were a lack of motivation in 32.6% (46/141), satisfaction with the current improvement in 22.7% (32/141) and time constraints 21.3% (30/141).
Regarding lifestyle modifications, more than three quarters of the women (161/212) maintained at least one lifestyle modification learned during the physiotherapy intervention. More than half of the participants implemented at least one modification related to defecatory habits (107/212), and 46.7% to their micturition habits (99/212). Table 2 presents details related to lifestyle modifications implemented by participants.
Interpretation of results
This is the first study to explore long-term adherence to a PFM physiotherapy intervention in older women with UI symptoms. At the 8-year follow-up, half of the participants were still practicing the PFM exercises, with more than a third doing them on a weekly basis. Nearly half had integrated a PFM contraction into daily activities, notably using them in response to the need to cough or sneeze. Moreover, three-quarters of the participants adopted lifestyle modifications.