title: Adherence to behavioral interventions for stress incontinence: rates, barriers, and predictors.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA 15282, USA. borellofrance@duq.edu
authors: Diane
authors: D
authors: Borello-France
authors: Kathryn L
authors: KL
authors: Burgio
authors: Patricia S
authors: PS
authors: Goode
authors: Wen
authors: W
authors: Ye
authors: Alison C
authors: AC
authors: Weidner
authors: Emily S
authors: ES
authors: Lukacz
authors: John-Eric
authors: JE
authors: Jelovsek
authors: Catherine S
authors: CS
authors: Bradley
authors: Joseph
authors: J
authors: Schaffer
authors: Yvonne
authors: Y
authors: Hsu
authors: Kimberly
authors: K
authors: Kenton
authors: Cathie
authors: C
authors: Spino
mesh_terms: D001521:Behavior Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010349:Patient Compliance; D010570:Pessaries; D011788:Quality of Life; D014550:Urinary Incontinence, Stress / Q000628:therapy*