title: Adherence to pelvic floor muscle training with or without vaginal spheres in women with urinary incontinence: a secondary analysis from a randomized trial.
abstract: OBJECTIVE
  Pelvic floor muscle training (PFMT) is widely recommended as first-line therapy for women with urinary incontinence. However, adherence to PFMT decreases over time, and information regarding barriers to PFMT is scarce. The primary aim of our study was to investigate whether a vaginal spheres device helped improve adherence to PFMT. The secondary aim was to assess determinants of adherence and the association with treatment outcome.
  
  
  METHODS
  This was a secondary analysis of a randomized trial with a 6-month follow-up in women with urinary incontinence (UI) in whom we evaluated adherence to PFMT, performed either with (spheres group) or without (control group) vaginal spheres. The Morisky-Green Questionnaire (MGQ) was used to assess adherence, defined as the extent to which participants corresponded to the agreed recommendations; participants were classified as adherent or nonadherent according to their responses. Efficacy of PFMT was assessed using the International Consultation on Incontinence Questionnaire Short Form scale (ICIQ-SF).
  
  
  RESULTS
  Seventy women were enrolled and data from 65 (35 treated and 30 controls) were suitable for analysis. There were no significant differences in adherence to treatment between groups at the end of follow-up (33.3 % in controls and 42.9 % in spheres). The largest group of nonadherent women in both arms were those who mainly forgot to do the exercises. ICIQ-SF results between adherent and nonadherent women did not differ significantly [mean 0.55, 95 % confidence interval (CI) 1.13-2.25]. No significant difference was observed between women who attained greater and lesser improvement in UI after treatment (4.5 %; 95 % CI -11.7 to 20.6).
  
  
  CONCLUSIONS
  In patients with UI, vaginal spheres as an adjunct to PFMT did not increase adherence to pelvic muscle exercises. Lack of persistence appeared to be due to forgetfulness and did not seem to be influenced by the efficacy of PFMT.
authors.affiliation: Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas, 90, 08025, Barcelona, Spain. oporta@santpau.cat.
authors.forename: Oriol
authors.initials: O
authors.lastname: Porta Roda
authors.affiliation: Department of Gynecology and Obstetrics, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Díaz López
authors.affiliation: Department of Physical Medicine and Rehabilitation, Pelvic Floor Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Vara Paniagua
authors.affiliation: Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas, 90, 08025, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Simó González
authors.affiliation: Department of Gynecology and Obstetrics, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Díaz Bellido
authors.affiliation: Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas, 90, 08025, Barcelona, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Espinós Gómez
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000295:instrumentation* / Q000379:methods / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D017773:Pelvic Floor / Q000503:physiopathology; D013030:Spain; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D014621:Vagina
keywords: Exercise therapy; Patient adherence; Pelvic floor; Urinary incontinence