Pelvic-floor-muscle training adherence: tools, measurements and strategies—2011 ICS state-of-the- science seminar research paper II

Chantale Dumoulin, Dianne Alewijnse, Kari Bo, Suzanne Hagen, Diane Stark, Marijke Van Kampen, Julia Herbert, Jean Hay-Smith, Helena Frawley, Doreen McClurg, Sarah Dean

Research output: Contribution to conferencePaper


Aims: This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International
Continence Society’s 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome
measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable
clinical and research recommendations. Method: Data were amassed from a literature review and an expert panel (2011
conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the
evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and
women and pelvic organ prolapse in women. Results: The literature was scarce for most of the studied populations
except for limited research on women with UI. Outcome measures: Exercise diaries were the most widely-used adherence
outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research,
mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the
exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence. Strategies: Few trials
studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio
prompts, use of established theories of behavior change, and user-consultations seem to increase adherence.
Conclusion: The literature on adherence outcome measures, determinants and strategies remains scarce for the
studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be
applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations.
Original languageEnglish
Number of pages8
Publication statusPublished - 12 Aug 2015



  • adherence
  • determinants
  • pelvic floor muscle training
  • facilitators

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