Perceived self-efficacy as a predictor of outcome of pelvic muscle exercises in the treatment of urinary incontinence
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Perceived self-efficacy (a person's confidence in her ability to perform a specific behavior in a specific situation) is a powerful mediator of health behavior changes in many areas. Despite the increasing attention paid to behavioral therapies for urinary incontinence, perceived self-efficacy has been largely overlooked. This preliminary study was conducted to evaluate the relationship between perceived self-efficacy and the treatment outcome of pelvic muscle exercises. Seventy-one women enrolled in a study assessing the outcome of a 3-month course of pelvic floor muscle exercises completing a self-efficacy questionnaire, which was administered at baseline and 3 weeks into treatment. Sixty-three of the women completed the questionnaire at 3 weeks. The primary outcome measure was number of incontinent episodes per day, as reported on a 3-day voiding diary. We defined improvement as ≥50% reduction in the number of incontinent episodes. There was a negative relationship between self-efficacy expectations at baseline and treatment outcome (r=−0.402). There was a trend toward a relationship between increases in self-efficacy between baseline and 3 weeks and improved treatment outcome (r=0.312,P<0.07). We examined behavioral factors which might affect exercise continuation, and found that both inaccessibility for telephone follow-up calls and incompletely recorded baseline voiding diary were associated with a higher dropout rate. Our preliminary results, then, are mixed, as we found no relationship between high initial self-efficacy and treatment outcome, but did find a possible association between increases in self-efficacy perception and treatment outcome. Self-efficacy may be another piece in the puzzle of how to improve outcome for non-surgical incontinence treatments, but it needs more evaluation. Our research suggests that healthcare providers should not be reticent to recommend a course of pelvic muscle exercises for those patients who express poor perceived self-efficacy at the outset of treatment. In addition, an incomplete or partially completed voiding diary should serve as a warning that a patient may be a suboptimal candidate for behavioral therapy.
KeywordsBehavioral treatment Pelvic muscle exercises Self-efficacy Urinary incontinence
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