Advertisement

International Urogynecology Journal

, Volume 24, Issue 8, pp 1361–1369 | Cite as

Do women with pelvic floor dysfunction referred by gynaecologists and urologists at hospitals complete a pelvic floor muscle training programme? A retrospective study, 1992–2008

  • Sigrid Tibaek
  • Christian Dehlendorff
Original Article

Abstract

Introduction and hypothesis

For decades women with pelvic floor dysfunction (PFD) have been referred to pelvic floor muscle training (PFMT), but there is only little information on whether the women complete the programmes and why. The objectives of this study were to investigate to which extent women completed a PFMT programme to which they were referred by gynaecologists and urologists and to identify associated factors for completion.

Methods

In a hospital-based, retrospective clinical design women with PFD referred to a free PFMT programme as outpatients were included. The PFMT programme consisted of: (a) vaginal digital palpation test of PFM, (b) individual instructions, (c) introduction (theory), (d) weekly supervised PFMT in groups for 3 months (12 sessions) and (e) progressive home exercises (10 sets).

Results

Data were analysed in 1,544 women, mean age 54 (SD 13) years, with PFD (urinary incontinence, n = 1,214; anal incontinence, n = 41; pelvic organ prolapse, n = 162; other PFD, n = 127). In total 747 (48 %) subjects completed (attended ≥8 sessions) the PFMT programme, 466 (30 %) dropped out and 331 (22 %) cancelled or stayed away. Age, year of referral and nationality were significantly different (p < 0.01) between completers and non-completers. Likewise, year of referral, distance from home to hospital, waiting list times and diagnosis were significantly different (p < 0.01) between dropouts and subjects who cancelled or stayed away.

Conclusions

The results showed that less than half of the women with PFD completed a PFMT programme to which they were referred by gynaecologists and urologists. The most important associated factors for completion were age, year of referral and nationality.

Keywords

Pelvic floor dysfunction Pelvic floor muscle training Completion Women 

Notes

Acknowledgments

The study was funded by the Department of Physiotherapy and Occupational Therapy, Copenhagen University, Glostrup, Denmark. The authors wish to thank Anne Kure and Susi Jeppesen, Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Glostrup for their secretarial assistance.

Conflicts of interest

None.

References

  1. 1.
    Abrams P, Blaivas JG, Stanton SL, Andersen JT (1990) The standardization of terminology of lower urinary tract function recommended by the International Continence Society. Int Urogynecol J 1:45–58CrossRefGoogle Scholar
  2. 2.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29(1):4–20PubMedGoogle Scholar
  3. 3.
    Bump RC, Norton PA (1998) Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 25(4):723–746PubMedCrossRefGoogle Scholar
  4. 4.
    Dumoulin C, Hay-Smith J (2010) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev (1):CD005654Google Scholar
  5. 5.
    Hagen S, Stark D, Cattermole D (2004) A United Kingdom-wide survey of physiotherapy practice in the treatment of pelvic organ prolapse. Physiotherapy 90:19–26CrossRefGoogle Scholar
  6. 6.
    Hay-Smith EJ, Herderschee R, Dumoulin C, Herbison GP (2011) Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev (12):CD009508Google Scholar
  7. 7.
    Bø K (2012) Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction. World J Urol 30(4):437–443PubMedCrossRefGoogle Scholar
  8. 8.
    Imamura M, Abrams P, Bain C, Buckley B, Cardozo L, Cody J et al (2010) Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technol Assess 14(40):1–188, iii–ivPubMedGoogle Scholar
  9. 9.
    Welsh A (2006) CG40: Urinary incontinence: the management of urinary incontinence in women. RCOG Press, LondonGoogle Scholar
  10. 10.
    Hay-Smith EJC, Bø K, Berghmans LCM, Hendriks HJ, de Bie RA, van Waalwijk van Doorn ES (2001) Pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev (1):CD001407. doi: 10.1002/14651858.CD001407
  11. 11.
    Wijewickrama AK, Tanakuwa S (2006) Simulation analysis of an outpatient department of internal medicine in a university hospital. In: 2006 Winter Simulation ConferenceGoogle Scholar
  12. 12.
    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA et al (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 39(8):1423–1434PubMedCrossRefGoogle Scholar
  13. 13.
    Bø K, Mørkved S (2007) Motor learning. In: Bø K BB, Mørkved S, Van Kampen M (eds) Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice. Churchill Livingstone Elsevier, Edinburgh, pp 113–119Google Scholar
  14. 14.
    Hruda KV, Hicks AL, McCartney N (2003) Training for muscle power in older adults: effects on functional abilities. Can J Appl Physiol 28(2):178–189PubMedCrossRefGoogle Scholar
  15. 15.
    de Groot GC, Fagerström L (2011) Older adults’ motivating factors and barriers to exercise to prevent falls. Scand J Occup Ther 18(2):153–160PubMedCrossRefGoogle Scholar
  16. 16.
    Miller JM, Sampselle C, Ashton-Miller J, Hong GR, DeLancey JO (2008) Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19(6):773–782PubMedCrossRefGoogle Scholar
  17. 17.
    Bø K (1990) Pelvic floor muscle exercise for treatment of female stress urinary incontinence. Methodological studies and clinical results. Doctoral thesis. The Norwegian University of Sport and Physical Education, OsloGoogle Scholar
  18. 18.
    R Development Core Team (2011) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
  19. 19.
    Harrell Jr FE (2011) Modeling strategies. R package version 3.3–2Google Scholar
  20. 20.
    Dacey ML, Renne A (2005) A client-centered counseling approach for motivating older adults toward physical activity. Top Geriatr Rehabil 21(3):194–205Google Scholar
  21. 21.
    James DV, Johnston LH, Crone D, Sidford AH, Gidlow C, Morris C et al (2008) Factors associated with physical activity referral uptake and participation. J Sports Sci 26(2):217–224PubMedCrossRefGoogle Scholar
  22. 22.
    Marzolini S, Brooks D, Oh PI (2008) Sex differences in completion of a 12-month cardiac rehabilitation programme: an analysis of 5922 women and men. Eur J Cardiovasc Prev Rehabil 15(6):698–703PubMedCrossRefGoogle Scholar
  23. 23.
    Gidlow C, Johnston LH, Crone D, Morris C, Smith A, Forster C et al (2007) Socio-demographic pattering of referral, uptake and attendance in Physical Activity Referral Schemes. J Public Health (Oxf) 29(2):107–113CrossRefGoogle Scholar
  24. 24.
    Margetts BM, Rogers E, Widhal K, de Remaut de Winter AM, Zunft HJ (1999) Relationship between attitudes to health, body weight and physical activity and level of physical activity in a nationally representative sample in the European Union. Public Health Nutr 2(1A):97–103PubMedCrossRefGoogle Scholar
  25. 25.
    Gidlow C, Johnston LH, Crone D, James D (2005) Attendance of exercise referral schemes in the UK: a systematic review. Health Educ J 64(2):168–186CrossRefGoogle Scholar
  26. 26.
    Romé A, Persson U, Ekdahl C, Gard G (2009) Physical activity on prescription (PAP): costs and consequences of a randomized, controlled trial in primary healthcare. Scand J Prim Health Care 27(4):216–222PubMedCrossRefGoogle Scholar
  27. 27.
    Sanderson BK, Phillips MM, Gerald L, DiLillo V, Bittner V (2003) Factors associated with the failure of patients to complete cardiac rehabilitation for medical and nonmedical reasons. J Cardiopulm Rehabil 23(4):281–289PubMedCrossRefGoogle Scholar
  28. 28.
    McGrady A, McGinnis R, Badenhop D, Bentle M, Rajput M (2009) Effects of depression and anxiety on adherence to cardiac rehabilitation. J Cardiopulm Rehabil Prev 29(6):358–364PubMedGoogle Scholar
  29. 29.
    Alewijnse D, Mesters I, Metsemakers J, van den Borne B (2007) Strategies to enhance adherence and reduce drop out in conservative treatment. In: Bø K, Berghmans B, Mørkved S, van Kampen M (eds) Evidence-based physical therapy for the pelvic floor: bridging science and clinical practice. Churchill Livingstone Elsevier, Edinburgh, pp 133–146CrossRefGoogle Scholar
  30. 30.
    Dumoulin C, Glazener C, Jenkinson D (2011) Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence. Neurourol Urodyn 30(5):746–753PubMedCrossRefGoogle Scholar
  31. 31.
    Hansen D, Astrup A, Toubro S, Finer N, Kopelman P, Hilsted J et al (2001) Predictors of weight loss and maintenance during 2 years of treatment by sibutramine in obesity. Results from the European multi-centre STORM trial. Sibutramine Trial of Obesity Reduction and Maintenance. Int J Obes Relat Metab Disord 25(4):496–501PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  1. 1.Department of Physiotherapy and Occupational TherapyCopenhagen University Hospital GlostrupGlostrupDenmark
  2. 2.Danish Cancer Society Research CenterDanish Cancer SocietyCopenhagenDenmark

Personalised recommendations