Effectiveness of Pelvic Floor Muscle Training for Urinary Incontinence: Comparison Within and Between Nonhomebound and Homebound Older Adults.

Abstract

To compare the effectiveness of a biofeedback-taught pelvic floor muscle training (PFMT) intervention in reducing urinary incontinence (UI) and improving general health-related and UI-specific quality of life in homebound and nonhomebound older adults. We also compared adherence rates to the prescribed PFM exercises and strategies (urge and/or stress) in the 2 groups of subjects. Secondary data analysis of initial 6-week PFMT intervention data from a randomized controlled trial designed to examine the efficacy of a relapse prevention intervention in sustaining improvements in UI following PFMT. The sample comprised 93 homebound and 185 nonhomebound community-dwelling men and women 60 years and older with urge, stress, or mixed UI at least twice a week for a minimum of 3 months. The intervention consisted of 6 weekly in-home visits during which biofeedback via transcutaneous electromyographic patches was used to teach subjects pelvic floor muscle exercises and, as indicated, stress and/or urge suppression strategies to prevent involuntary urine loss. Incontinence severity was measured by a 1-week bladder diary at baseline and at the end of the 6-week intervention. Health-related quality of life was measured at baseline and postintervention using the Medical Outcomes Study Short Form-36 (MOS SF-36) (general health-related quality of life), and the Modified Incontinence Impact Questionnaire (MIIQ). Self-reported adherence data were collected at each intervention visit. At baseline, homebound subjects had significantly more severe UI, more comorbid conditions, and higher levels of functional impairment than nonhomebound subjects. Following the intervention, there was a significant reduction in the number of incontinent episodes in both homebound and nonhomebound subjects, with no significant group differences (P = .25) in the median percent reduction in UI (64.5% in homebound vs 70.4% in nonhomebound subjects). UI-specific quality of life (MIIQ total scores) improved significantly in both groups without any significant between-group differences (P = .83). There were no significant changes in health-related quality of life in either group. Pelvic floor muscle adherence rates were higher than adherence rates to strategies in both groups, with no significant group differences. The biofeedback-guided PFMT intervention was equally effective in reducing UI and improving UI-specific quality of life in homebound and nonhomebound community-dwelling older adults.