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

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.