Impact of patient motivation on compliance and outcomes for incontinence

Abstract

Objectives: Physiotherapeutic treatment of pelvic floor dysfunction in women has variable outcomes, and identification of the predictors of outcomes is important in developing service provision and treatment planning. This study explored whether patient motivation affects treatment compliance and outcomes of physiotherapeutic treatment in a cohort of patients with pelvic floor dysfunction.

Design, setting and participants: A prospective observational study of 141 adult female patients referred consecutively to the physiotherapy clinic of an urogynaecological outpatients unit at a UK hospital.

Intervention: A 6-month (one group session per month) pelvic floor muscle training programme, which included a home exercise programme.

Main outcome measures: Modified Oxford Grading System and Queensland Pelvic Floor Questionnaire ratings of pelvic floor function were taken pre- and post-intervention, and the University of Rhode Island Change Assessment Scale assessed patient motivation to change pre-intervention.

Results: Motivation to change predicted attendance at the intervention sessions and patient-rated improvements in function. Patients with higher baseline motivation to change also reported greater improvements in pelvic symptoms, given the same pelvic floor muscle strength improvement.

Conclusions: Patient motivation affects physiotherapeutic treatment adherence and outcomes, and should be considered as part of future assessment/screening procedures.

Clinical trial registration: NCT02549157.

Keywords: Attendance; Incontinence; Motivation; PFMT; Pelvic floor dysfunction; Prolapse.