Adherence to behavioral interventions for urge incontinence when combined with drug therapy: adherence rates, barriers, and predictors

Abstract

Background: Behavioral intervention outcomes for urinary incontinence (UI) depend on active patient participation.

Objective: The purpose of this study was to describe adherence to behavioral interventions (pelvic-floor muscle [PFM] exercises, UI prevention strategies, and delayed voiding), patient-perceived exercise barriers, and predictors of exercise adherence in women with urge-predominant UI.

Design: This was a prospectively planned secondary data analysis from a 2-stage, multicenter, randomized clinical trial.

Patients and intervention: Three hundred seven women with urge-predominant UI were randomly assigned to receive either 10 weeks of drug therapy only or 10 weeks of drug therapy combined with a behavioral intervention for UI. One hundred fifty-four participants who received the combined intervention were included in this analysis.

Measurements: Pelvic-floor muscle exercise adherence and exercise barriers were assessed during the intervention phase and 1 year afterward. Adherence to UI prevention strategies and delayed voiding were assessed during the intervention only.

Results: During intervention, 81% of women exercised at least 5 to 6 days per week, and 87% performed at least 30 PFM contractions per day. Ninety-two percent of the women used the urge suppression strategy successfully. At the 12-month follow-up, only 32% of the women exercised at least 5 to 6 days per week, and 56% performed 15 or more PFM contractions on the days they exercised. The most persistent PFM exercise barriers were difficulty remembering to exercise and finding time to exercise. Similarly, difficulty finding time to exercise persisted as a predictor of PFM exercise adherence over time.

Limitations: Co-administration of medication for UI may have influenced adherence.

Conclusions: Most women adhered to exercise during supervised intervention; however, adherence declined over the long term. Interventions to help women remember to exercise and to integrate PFM exercises and UI prevention strategies into daily life may be useful to promote long-term adherence.

Trial registration: ClinicalTrials.gov NCT00090584.

Figure 1.

Pelvic-floor muscle exercise frequency over time. Exercise frequency was high during the supervised intervention phase, with 81% of the women exercising 5 to 6 days or more per week at visit 4. Exercise frequency decreased throughout the follow-up phase, with only 32% of the women exercising at least 5 to 6 days per week.

Figure 2.

Number of pelvic-floor muscle contractions per day over time during the intervention period. Throughout supervised intervention, about 90% of the women reported doing at least 30 pelvic-floor muscle contractions in a typical day.

Figure 3.

Number of pelvic-floor muscle contractions per day over time during the follow-up period. By the 12-month follow-up, only slightly more than half of the women performed 15 or more pelvic-floor muscle contractions per day when they exercised.

Appendix 1.

Urinary Incontinence Treatment Network^{a a} Asterisks indicate participating clinical centers.

Appendix 2.

Exercise Barrier Questions