| The purpose of this study was to examine the effectiveness of a pelvic floor muscle rehabilitation (PFMR) program in Taiwanese middle age and older women with urinary incontinence (UI), with a specific focus on comparing the effects of verbal and biofeedback-assisted instruction. A prospective randomized trial was conducted to examine the effects of two different instruction methods on UI frequency, pelvic floor muscle (PFM) activity, adherence to the prescribed PFMR program and UI-related quality of life. Ninety-eight subjects were included based on the inclusion and exclusion criteria, and 69 subjects completed the treatment protocol. The verbal instruction group received 8 verbal instruction sessions, while the biofeedback-assisted exercise group was taught pelvic floor muscle exercise through 8 weekly perineal electromyography-assisted instruction sessions. At baseline, there were no significant differences between the two groups in the severity or type of UI or in demographic and health-related characteristics. After the 8-week intervention, both groups demonstrated significant decreases in UI frequency, increased PFM activity and improved UI-related quality of life. The biofeedback-assisted instruction group performed significantly better on all outcome measures than the verbal instruction group. Secondarily, PFM self-efficacy and PFM outcome expectancy demonstrated significant positive correlations with PFMR adherence (p = .0001 and .003). However, a significant relationship between baseline UI-related quality of life and PFMR adherence was observed only when data were limited to those subjects who competed the protocol (n = 69), and was not significant when using all subjects (N = 98). Also, there was a significant correlation between percentage improvement in PFM activity and changes of UI frequency in standing, sitting, and lying positions when including all subjects. Finally, four factors (3 from the self-efficacy subscale and one from the outcome expectancy subscale) were extracted from the Chinese version Broome Pelvic Floor Muscle Self-Efficacy Scale with 73% of the variance explained. This is the first study in Taiwan designed to compare the effectiveness of a verbal and biofeedback-assisted PFMR program and to discuss potential influencing factors on PFMR adherence. The findings of this study have implications for clinical nursing practice and future research on the conservative treatment of UI. |
