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

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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.

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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.

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Corresponding author

Correspondence to Kate H. Moore.

Additional information

The work was carried out at the Pelvic Floor Unit, St George Hospital, Kogarah, NSW, Australia 2217.

Appendix1: Incontinence Treatment Motivation Questionnaire (ITMQ)

Appendix1: Incontinence Treatment Motivation Questionnaire (ITMQ)


  • When completing these questions, please just circle the number that best describes you. There are no wrong or right answers.

  • If you make a mistake, just cross out your first answer, and provide another answer.

Table 7

Please check that you have answered all the questions.


$$ {\text{MQS}}1 = \left( {{{\left( {{\text{Q}}1 + {\text{Q}}2 + {\text{Q}}3 + {\text{Q}}4} \right)} \mathord{\left/ {\vphantom {{\left( {{\text{Q}}1 + {\text{Q}}2 + {\text{Q}}3 + {\text{Q}}4} \right)} 4}} \right. } 4}} \right). $$
$$ {\text{MQS}}2 = \left( {{{\left( {{\text{Q}}5 + {\text{Q}}6 + {\text{Q}}7 + {\text{Q}}8} \right)} \mathord{\left/ {\vphantom {{\left( {{\text{Q}}5 + {\text{Q}}6 + {\text{Q}}7 + {\text{Q}}8} \right)} 4}} \right. } 4}} \right). $$
$$ {\text{MQS}}3 = \left( {{{\left( {{\text{Q}}9 + {\text{Q}}10 + {\text{Q}}11} \right)} \mathord{\left/ {\vphantom {{\left( {{\text{Q}}9 + {\text{Q}}10 + {\text{Q}}11} \right)} 3}} \right. } 3}} \right). $$
$$ {\text{MQS}}4 = \left( {{{\left( {{\text{Q}}12 + {\text{Q}}13 + {\text{Q}}14} \right)} \mathord{\left/ {\vphantom {{\left( {{\text{Q}}12 + {\text{Q}}13 + {\text{Q}}14} \right)} 3}} \right. } 3}} \right). $$
$$ {\text{MQS}}5 = \left( {{{\left( {{\text{Q}}15 * + {\text{Q}}16 * + {\text{Q}}17 + {\text{Q18}}} \right)} \mathord{\left/ {\vphantom {{\left( {{\text{Q}}15 * + {\text{Q}}16 * + {\text{Q}}17 + {\text{Q18}}} \right)} 4}} \right. } 4}} \right). $$

*Reverse score before scoring.

MQS1 “Positive attitude towards treatment”

MQS2 “Excuses for not doing PFE”

MQS3 “Living with incontinence”

MQS4 “Treatment participation”

MQS5 “Motivation to maintain PFE”

A note about scoring:

  • The scales have been designed so that scores from each of the scales fall on a common range, between 1 and 5, where the higher the score the more motivated the respondent to participate in PFE. Because of the different number of items within scales, the sum of raw scores for all items in each scale is divided by the number of items in the scale. This ensures that the scales have a common score range and that the results are very easy to quickly interpret. For example, any score in the range of 1-2 would indicate very weak motivation to participate in PFE.

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Sarma, S., Hawthorne, G., Thakkar, K. et al. The development of an Incontinence Treatment Motivation Questionnaire for patients undergoing pelvic floor physiotherapy in the treatment of stress incontinence. Int Urogynecol J 20, 1085–1093 (2009).

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