title: 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.
abstract: OBJECTIVE
  Do strategies to enhance self-efficacy and exercise mastery affect adherence to home-based pelvic floor muscle exercises in women with urinary incontinence?
  
  
  METHODS
  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.
  
  
  METHODS
  Eighty-six women with stress, urgency or mixed urinary incontinence.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Discussion of accomplishments and goals, a testimonial video and a reminder did not increase exercise adherence more than exercise mastery.
  
  
  BACKGROUND
  Brazilian Registry of Clinical Trials UTN:U1111-1128-8684.
authors.affiliation: CAPES Foundation, Ministry of Education of Brazil, Brasília.
authors.forename: Cinara
authors.initials: C
authors.lastname: Sacomori
authors.affiliation: Pelvic Care Center Maastricht, Maastricht University Medical Center.
authors.forename: Bary
authors.initials: B
authors.lastname: Berghmans
authors.affiliation: Department of Epidemiology, Maastricht University, Maastricht, Netherlands.
authors.forename: Ilse
authors.initials: I
authors.lastname: Mesters
authors.affiliation: Department of Epidemiology, Maastricht University, Maastricht, Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: de Bie
authors.affiliation: Department of Health Sciences, Centre of Health and Sports Sciences, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil.
authors.forename: Fernando Luiz
authors.initials: FL
authors.lastname: Cardoso
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction; D010349:Patient Compliance / Q000523:psychology*; D017773:Pelvic Floor / Q000503:physiopathology*; D012648:Self Care / Q000523:psychology*; D020377:Self Efficacy; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000523:psychology / Q000628:therapy*
keywords: Adherence; Exercise; Pelvic floor; Self-efficacy; Urinary incontinence