Group-Based vs Individual Pelvic Floor Muscle Training to Treat Urinary Incontinence in Older Women

Key Points Question Is pelvic floor muscle training (PFMT) delivered in a group setting noninferior to the recommended individual PFMT for urinary incontinence in older women (aged ≥60 years)? Findings In this noninferiority randomized clinical trial of 362 older women with urinary incontinence, the median percentage reduction in incontinence episodes at 1 year was 70% in individual compared with 74% in group-based PFMT intervention. The difference between groups fell below the noninferiority margin of 10%, supporting noninferiority of group-based PFMT. Meaning The findings of this trial show that group-based PFMT is noninferior to the recommended individual PFMT; widespread use in clinical practice could increase urinary incontinence treatment capacity for older women.

-Exercise maintenance was assessed with a standardized questionnaire, 6, 9 and 12 months after the baseline assessment.
Exercise diary and maintenance questionnaires included the number of completed contractions per set, sets per day and days per week for each of the 4 PFM exercises (strengthening, endurance, coordination and rapidity).
-Exercise maintenance was assessed with a standardized questionnaire, 6, 9 and 12 months after the baseline assessment.
Exercise diary and maintenance questionnaires included the number of completed contractions per set, sets per day and days per week for each of the 4 PFM exercises (strengthening, endurance, coordination and rapidity).

6
Detailed description of motivation strategies Motivational prompts were included in the exercise diary.
At the beginning of each treatment session, women reported their adherence to home exercise and tips and advice were given by the physiotherapist to improve adherence.
One education session (15 minutes) discussed motivation, exercise adherence, exercise maintenance and strategies to adopt in case of relapse.
Six-and nine-month follow-up phone calls were also used to reinforce strategies to improve adherence to home exercises.
Motivational prompts were included in the exercise diary.
At the beginning of each treatment session, women reported their adherence to home exercise and tips and advice were given by the physiotherapist to improve adherence.
One education session (15 minutes) discussed motivation, exercise adherence, exercise maintenance and strategies to adopt in case of relapse.
Six-and nine-month follow-up phone calls were also used to reinforce strategies to improve adherence to home exercises.

7a
Detailed description of decision rule(s) for determining exercise progression The treatment progression was standardized. The treatment progression was standardized.

7b
Detailed description of how exercise program was progressed The program included three phases of gradual exercise progression; that is, the gradual addition of increasingly difficult exercises in terms of duration, repetition, and body position. Each phase lasted four weeks.
The program included three phases of gradual exercise progression; that is, the gradual addition of increasingly difficult exercises in terms of duration, repetition, and body position. Each phase lasted four weeks. Four PFM exercises (same as in the PFM physiotherapy program): knack (coordination), maximal contraction (strengthening), fast contractions (rapidity) and podiums (endurance).
Five days a week, for the duration of the 12 week/treatment and 3 days a week, until 1-year followup.
The home program followed the treatment protocol progression. It was divided into three phases allowing for gradual exercise progression and one phase allowing maintenance; that is, the gradual addition of increasingly difficult exercises in terms of duration, repetition and position. Each of the three first phases lasted four weeks. The last phase lasted from the end of treatment to the one-year follow up. The complete content of the home exercise program was published previously. 1 Five days a week, for the duration of the 12 week/treatment and 3 days a week, until 1-year followup.
The home program followed the treatment protocol progression. It was divided into three phases allowing for gradual exercise progression and one phase allowing maintenance; that is, the gradual addition of increasingly difficult exercises in terms of duration, repetition and position. Each of the three first phases lasted four weeks. The last phase lasted from the end of treatment to the one-year follow up. The starting level was standardized. All participants started at the same level, which progressed every 4 weeks If the participant had difficulty completing the program, she was encouraged to do as much as possible every time.
The starting level was standardized. All participants started at the same level, which progressed every 4 weeks If the participant had difficulty to complete the program, she was encouraged to do as much as possible every time.

16a
Describe how adherence or fidelity to the intervention is assessed/measured The fidelity to the intervention was assessed using the written treatment protocol checklist The fidelity to the intervention was assessed using the written treatment protocol checklist 16b Describe the extent to which the intervention was delivered as planned