title: Pelvic-Floor-Muscle Training Adherence: Tools, Measurements and Strategies-2011 ICS State-of-the-Science Seminar Research Paper II of IV.
abstract: OBJECTIVE
  This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International Continence Society's 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations.
  
  
  METHODS
  Data were amassed from a literature review and an expert panel (2011 conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and women and pelvic organ prolapse in women.
  
  
  RESULTS
  The literature was scarce for most of the studied populations except for limited research on women with UI.
  
  
  METHODS
  Exercise diaries were the most widely-used adherence outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research, mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence.
  
  
  METHODS
  Few trials studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio prompts, use of established theories of behavior change, and user-consultations seem to increase adherence.
  
  
  CONCLUSIONS
  The literature on adherence outcome measures, determinants and strategies remains scarce for the studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations.
authors.affiliation: School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada.|Urogynacological Health and Aging Chair, Research Centre of the Institut Universitaire de Geriatrie de Montreal, Montreal, Canada.
authors.forename: Chantal
authors.initials: C
authors.lastname: Dumoulin
authors.affiliation: Patient Education, PR and Marketing, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands.
authors.forename: Dianne
authors.initials: D
authors.lastname: Alewijnse
authors.affiliation: Departement of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
authors.forename: Kari
authors.initials: K
authors.lastname: Bo
authors.affiliation: Health Services Research, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hagen
authors.affiliation: Functional Bowel Service, Clinic 2 Balmoral Building, Leicester Royal infirmary, Leicester, United Kingdom.
authors.forename: Diane
authors.initials: D
authors.lastname: Stark
authors.affiliation: Faculty of Kinesiology and Rehabilitation Sciences, K.U. Leuven, Leuven, Belgium.
authors.forename: Marijke
authors.initials: M
authors.lastname: Van Kampen
authors.affiliation: Bradford University, Bradford, United Kingdom.
authors.forename: Julia
authors.initials: J
authors.lastname: Herbert
authors.affiliation: Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.|Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Jean
authors.initials: J
authors.lastname: Hay-Smith
authors.affiliation: School of Allied Health, La Trobe University, Melbourne, Australia.|Allied Health Research, Cabrini Health, Melbourne, Australia.
authors.forename: Helena
authors.initials: H
authors.lastname: Frawley
authors.affiliation: Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom.
authors.forename: Doreen
authors.initials: D
authors.lastname: McClurg
authors.affiliation: Psychology Applied to Health, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dean
mesh_terms: D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010349:Patient Compliance; D017773:Pelvic Floor / Q000503:physiopathology*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*
keywords: adherence; determinants; facilitators; pelvic floor muscle training