International Urogynecology Journal

, Volume 20, Issue 9, pp 1085–1093 | Cite as

The development of an Incontinence Treatment Motivation Questionnaire for patients undergoing pelvic floor physiotherapy in the treatment of stress incontinence

  • Susmita Sarma
  • Graeme Hawthorne
  • Kiran Thakkar
  • Wendy Hayes
  • Kate H. Moore
Original Article


Introduction and hypothesis

The aim of this paper is to develop a motivation questionnaire regarding perseverance in pelvic floor muscle training (PFMT) supervised by physiotherapists for stress urinary incontinence.


Sixteen semi-structured interviews were conducted in women with stress urinary incontinence that revealed 15 common themes; 117 items were constructed and reviewed by continence advisors. Surviving items (n = 73) were administered to 210 women. Data were analysed for item properties, factor analysis was used to examine the questionnaire structure and tests of convergence/divergence used to check for sensitivity.


The Incontinence Treatment Motivation Questionnaire (ITMQ) comprises 18-items in five scales, assessing attitudes towards treatment (72.62% of explained variance; α = 0.87), reasons for not doing PFMT (55.73%; α = 0.74), living with incontinence (62.70% variance; α = 0.70), desire for treatment (65.37% variance; α = 0.74) and the effect of incontinence severity on PFMT (51.62% variance, α = 0.68). Scales were generally sensitive to known group differences.


This study represents the first effort to develop a motivation scale for PFMT. This validated Motivation Questionnaire is an instrument to test the impact of motivation upon cure, in PFMT.


Motivation questionnaire Pelvic floor muscle training Treatment adherence Urinary incontinence 



We thank Wendy Allen, Hayley Leek, Katrina Parkin (research nurses and continence advisors), Janette O’Toole (pelvic floor physiotherapist) and Emmanuel Karantanis and William Kutessa (Urogynaecologists), for assistance with questionnaire design. We thank Kerrie Burgess for her assistance with administration of questionnaires.


The printing of questionnaires was funded by the Pelvic Floor Trust Fund. Staff costs were obviated by our 4th year medical student who assisted with this study as part of an Independent Learning Project (ILP) module with the University of New South Wales.

Conflicts of interest



  1. 1.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol and Urodyn 21:167–178CrossRefGoogle Scholar
  2. 2.
    Hay-Smith EJC, Dumoulin C (2006) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev CD005654 Review.Google Scholar
  3. 3.
    Moore KH, O’Sullivan RJ, Simons A, Prashar S, Anderson P, Louey M (2003) Randomized controlled trial of nurse continence advisor therapy versus standard urogynaecology regime for conservative incontinence treatment: efficacy, costs and two year follow up. BJOG 110:649–657PubMedCrossRefGoogle Scholar
  4. 4.
    Nygaard IE, Kreder KJ, Lepic MM, Fountain KA, Rhomberg A (1996) Efficacy of pelvic floor muscle exercises in women with stress, urge, and mixed urinary incontinence. Am J Obstet and Gynecol 174:120–125CrossRefGoogle Scholar
  5. 5.
    Diokno A, Yuhico M (1995) Preference, compliance and initial outcome of therapeutic options chosen by female patients with urinary incontinence. J Urol 154:1727–1730 discussion 1731PubMedCrossRefGoogle Scholar
  6. 6.
    Bartlett JA (2002) Addressing the challenges of adherence. J Acquir Immune Defic Syndr 29(Suppl 1):S2–S10PubMedGoogle Scholar
  7. 7.
    Blanchard CM, Courneya KS, Rodgers WM, Murnaghan DM (2002) Determinants of exercise intention and behavior in survivors of breast and prostate cancer: an application of the theory of planned behavior. Cancer Nurs 25:88–95PubMedCrossRefGoogle Scholar
  8. 8.
    Maclean N, Pound P, Wolfe C, Rudd A (2002) The concept of patient motivation: a qualitative analysis of stroke professionals' attitudes. Stroke 33:444–448PubMedCrossRefGoogle Scholar
  9. 9.
    Blanchard CM, Courneya KS, Rodgers WM, Fraser SN, Murray TC, Daub B et al (2003) Is the theory of planned behavior a useful framework for understanding exercise adherence during phase II cardiac rehabilitation? J Cardiopulm Rehabil 23:29–39PubMedCrossRefGoogle Scholar
  10. 10.
    Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I (1998) Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med and Rehabil 79:475–487CrossRefGoogle Scholar
  11. 11.
    Friedrich M, Gittler G, Arendasy M, Friedrich KM (2005) Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine 30:995–1000PubMedCrossRefGoogle Scholar
  12. 12.
    Swanson AJ, Pantalon MV, Cohen KR (1999) Motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients. J of Nerv Ment Dis 187:630–635CrossRefGoogle Scholar
  13. 13.
    Tappin DM, Lumsden MA, Gilmour WH, Crawford F, McIntyre D, Stone DH et al (2005) Randomised controlled trial of home based motivational interviewing by midwives to help pregnant smokers quit or cut down. BMJ 331:373–377PubMedCrossRefGoogle Scholar
  14. 14.
    Moore KH (2000) Conservative therapy for incontinence. Balliere Clin Obstet Gynaecol 14:251–289CrossRefGoogle Scholar
  15. 15.
    Laycock J (1994) Clinical evaluation of the pelvic floor. In: Schussler B, Laycock J, Norton P et al (eds) Pelvic Floor Reeducation. Springer, London, pp 42–48Google Scholar
  16. 16.
    Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23:322–330PubMedCrossRefGoogle Scholar
  17. 17.
    Guadagnoli E, Velicer W (1998) Relation of sample size to the stability of component patterns. Psychol Bull 103:265–275CrossRefGoogle Scholar
  18. 18.
    Pedhazur E, Schmelkin L (1991) Measurement, Design and Analysis: An integrated approach. Erlbaum, HillsdaleGoogle Scholar
  19. 19.
    Streiner D, Norman G (2006) Health measurement scales: a practical guide to their development and use, 3rd edn. OxfordGoogle Scholar
  20. 20.
    Simoneau H, Bergeron J (2003) Factors affecting motivation during the first six weeks of treatment. Addict Behav 28:1219–1241PubMedCrossRefGoogle Scholar
  21. 21.
    Alewijnse D, Mesters I, Metsemakers J, Adriaans J, van den Borne B (2001) Predictors of intention to adhere to physiotherapy among women with urinary incontinence. Health Educ Res 16:173–178PubMedCrossRefGoogle Scholar
  22. 22.
    Alewijnse D, Metsemakers JF, Mesters IE, van den Borne B (2003) Effectiveness of pelvic floor muscle exercise therapy supplemented with a health education program to promote long-term adherence among women with urinary incontinence. Neurourol Urodyn 22:284–295PubMedCrossRefGoogle Scholar
  23. 23.
    Bo K, Kvarstein B, Nyggard I (2005) Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years. Am J Obstet and Gynecol 105:999–1005Google Scholar
  24. 24.
    Karantanis E, Stanton S, Parsons M, Robinson D, Blackwell A, Cardozo L et al (2003) Women’s preferences for treatment for stress incontinence—physiotherapy or surgery. Neurourol Urodyn 22:522–523Google Scholar

Copyright information

© The International Urogynecological Association 2009

Authors and Affiliations

  • Susmita Sarma
    • 1
  • Graeme Hawthorne
    • 2
  • Kiran Thakkar
    • 3
  • Wendy Hayes
    • 3
  • Kate H. Moore
    • 3
    • 4
  1. 1.The University of New South WalesSydneyAustralia
  2. 2.Department of PsychiatryThe University of MelbourneMelbourneAustralia
  3. 3.Obstetrics and GynaecologyThe University of New South WalesSydneyAustralia
  4. 4.SydneyAustralia

Personalised recommendations