What Influences Women to Adhere to Pelvic Floor Exercises after Physiotherapy Treatment? A Qualitative Study for Individualized Pelvic Health Care

Abstract

Conservative treatment of pelvic floor dysfunction (PFD) includes therapeutic exercise for pelvic floor muscle (PFM) training or other complementary exercise modalities, such as hypopressive exercises. However, the long-term effectiveness of the conservative treatment depends on a patient’s adherence to the exercises and the integration of professional health advice into their daily life. The objective of this study was to establish the adherence experience of women with diagnosed PFD in home-based exercises after an intensive face-to-face physiotherapy treatment. A qualitative study from an interpretive paradigm was developed. Semi-structured individual and group interviews were performed 6 months after finishing individual physiotherapy treatment. The interviews were recorded, fully transcribed and analyzed thematically by creating categories. Thirty-one women were interviewed. The women reported that their adherence to home PFM exercises depended on the exercise program itself, its efficacy, their personal experiences with the exercises, intrinsic factors such as self-awareness or beliefs, and extrinsic factors, such as professional or instrumental feedback. Thus, therapeutic adherence could be more likely with effective physiotherapy programs that include mutually agreed home exercises and simple movements women can build into their daily lives. Improving awareness and knowledge of the pelvic region and the importance of PFM treatment as well as consideration for potential worsening of PFD will also encourage women to adhere to the exercises.

Does the Contractile Capability of Pelvic Floor Muscles Improve with Knowledge Acquisition and Verbal Instructions in Healthy Women? A Systematic Review

“…Studies that conducted a follow-up after the intervention reported women’s perseverance in terms of the newly-acquired voiding habits [ 16 ] and PFM exercises [ 15 , 16 ], even though the follow-up was not supervised by professionals. Periodic face-to-face follow-up meetings may contribute to promoting adherence to the exercise programme or healthy behaviours, correcting misconceptions, answering questions, or modifying exercises based on individual progression [ 32 , 33 ].…”

Barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence: A qualitative analysis using the Theoretical Domains Framework

“…Additionally, we discovered that social support from a variety of sources, including information and advice provided by the healthcare team, support from family members, peer support, and support from group organisations such as the local community, were all positive facilitators of pelvic oor rehabilitation behaviours in pregnant patients. Navarro et al reported that the feedback provided by health professionals was also a condition for adherence to exercise [42].…”

Barriers and facilitators to overactive bladder therapy adherence

“…Adherence rates to PFMT are higher with supervised PFMT, yet wane over time with self‐directed PFMT, with rates as low as 32% at 12 months 29 . In a study of 31 women, adherence to home PFMT was dependent on the efficacy and simplicity of the exercise program, personal experiences with PFMT, as well as intrinsic factors (self‐awareness or beliefs), and extrinsic factors (professional feedback) 30 . The largest barriers to adherence are time and remembering to exercise.…”

“…29 In a study of 31 women, adherence to home PFMT was dependent on the efficacy and simplicity of the exercise program, personal experiences with PFMT, as well as intrinsic factors (selfawareness or beliefs), and extrinsic factors (professional feedback). 30 The largest barriers to adherence are time and remembering to exercise. Therefore, simplified, effective, mutually agreed upon programs with suggestions for incorporating them into daily routines may increase adherence.…”