Adherence to Behavioral Interventions for Stress Incontinence: Rates, Barriers, and Predictors
Identifieur interne : 000530 ( Pmc/Corpus ); précédent : 000529; suivant : 000531Adherence to Behavioral Interventions for Stress Incontinence: Rates, Barriers, and Predictors
Auteurs : Diane Borello-France ; Kathryn L. Burgio ; Patricia S. Goode ; Wen Ye ; Alison C. Weidner ; Emily S. Lukacz ; John-Eric Jelovsek ; Catherine S. Bradley ; Joseph Schaffer ; Yvonne Hsu ; Kimberly Kenton ; Cathie SpinoSource :
- Physical Therapy [ 0031-9023 ] ; 2013.
Abstract
First-line conservative treatment for stress urinary incontinence (SUI) in women is behavioral intervention, including pelvic-floor muscle (PFM) exercise and bladder control strategies.
The purposes of this study were: (1) to describe adherence and barriers to exercise and bladder control strategy adherence and (2) to identify predictors of exercise adherence.
This study was a planned secondary analysis of data from a multisite, randomized trial comparing intravaginal continence pessary, multicomponent behavioral therapy, and combined therapy in women with stress-predominant urinary incontinence (UI).
Data were analyzed from the groups who received behavioral intervention alone (n=146) or combined with continence pessary therapy (n=150). Adherence was measured during supervised treatment and at 3, 6, and 12 months post-randomization. Barriers to adherence were surveyed during treatment and at the 3-month time point. Regression analyses were performed to identify predictors of exercise adherence during supervised treatment and at the 3- and 12-month time points.
During supervised treatment, ≥86% of the women exercised ≥5 days a week, and ≥80% performed at least 30 contractions on days they exercised. At 3, 6, and 12 months post-randomization, 95%, 88%, and 80% of women, respectively, indicated they were still performing PFM exercises. During supervised treatment and at 3 months post-randomization, ≥87% of the women reported using learned bladder control strategies to prevent SUI. In addition, the majority endorsed at least one barrier to PFM exercise, most commonly “trouble remembering to do exercises.” Predictors of exercise adherence changed over time. During supervised intervention, less frequent baseline UI and higher baseline 36-Item Short-Form Health Survey (SF-36) mental scores predicted exercise adherence. At 3 months post-randomization, women who dropped out of the study had weaker PFMs at baseline. At 12 months post-randomization, only “trouble remembering” was associated with exercise adherence.
Adherence and barrier questionnaires were not validated.
Adherence to PFM exercises and bladder control strategies for SUI can be high and sustained over time. However, behavioral interventions to help women link exercise to environmental and behavioral cues may only be beneficial over the short term.
Url:
DOI: 10.2522/ptj.20120072
PubMed: 23431210
PubMed Central: 3664038
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Adherence to Behavioral Interventions for Stress Incontinence: Rates, Barriers, and Predictors</title><author><name sortKey="Borello France, Diane" sort="Borello France, Diane" uniqKey="Borello France D" first="Diane" last="Borello-France">Diane Borello-France</name><affiliation><nlm:aff id="aff1">D. Borello-France, PT, PhD, Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 104 Health Sciences Bldg, 600 Forbes Ave, Pittsburgh, PA 15282 (USA).</nlm:aff></affiliation></author><author><name sortKey="Burgio, Kathryn L" sort="Burgio, Kathryn L" uniqKey="Burgio K" first="Kathryn L." last="Burgio">Kathryn L. Burgio</name><affiliation><nlm:aff id="aff2">K.L. Burgio, PhD, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, and Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.</nlm:aff></affiliation></author><author><name sortKey="Goode, Patricia S" sort="Goode, Patricia S" uniqKey="Goode P" first="Patricia S." last="Goode">Patricia S. Goode</name><affiliation><nlm:aff id="aff3">P.S. Goode, MD, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, and Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center.</nlm:aff></affiliation></author><author><name sortKey="Ye, Wen" sort="Ye, Wen" uniqKey="Ye W" first="Wen" last="Ye">Wen Ye</name><affiliation><nlm:aff id="aff4">W. Ye, PhD, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.</nlm:aff></affiliation></author><author><name sortKey="Weidner, Alison C" sort="Weidner, Alison C" uniqKey="Weidner A" first="Alison C." last="Weidner">Alison C. Weidner</name><affiliation><nlm:aff id="aff5">A.C. Weidner, MD, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.</nlm:aff></affiliation></author><author><name sortKey="Lukacz, Emily S" sort="Lukacz, Emily S" uniqKey="Lukacz E" first="Emily S." last="Lukacz">Emily S. Lukacz</name><affiliation><nlm:aff id="aff6">E.S. Lukacz, MD, Department of Reproductive Medicine, University of California San Diego Health Systems, La Jolla, California.</nlm:aff></affiliation></author><author><name sortKey="Jelovsek, John Eric" sort="Jelovsek, John Eric" uniqKey="Jelovsek J" first="John-Eric" last="Jelovsek">John-Eric Jelovsek</name><affiliation><nlm:aff id="aff7">J-E. Jelovsek, MD, MMEd, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.</nlm:aff></affiliation></author><author><name sortKey="Bradley, Catherine S" sort="Bradley, Catherine S" uniqKey="Bradley C" first="Catherine S." last="Bradley">Catherine S. Bradley</name><affiliation><nlm:aff id="aff8">C.S. Bradley, MD, Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System and Department of Obstetrics and Gynecology, College of Medicine, University of Iowa, Iowa City, Iowa.</nlm:aff></affiliation></author><author><name sortKey="Schaffer, Joseph" sort="Schaffer, Joseph" uniqKey="Schaffer J" first="Joseph" last="Schaffer">Joseph Schaffer</name><affiliation><nlm:aff id="aff9">J. Schaffer, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, UT Southwestern Medical Center, Dallas, Texas.</nlm:aff></affiliation></author><author><name sortKey="Hsu, Yvonne" sort="Hsu, Yvonne" uniqKey="Hsu Y" first="Yvonne" last="Hsu">Yvonne Hsu</name><affiliation><nlm:aff id="aff10">Y. Hsu, MD, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.</nlm:aff></affiliation></author><author><name sortKey="Kenton, Kimberly" sort="Kenton, Kimberly" uniqKey="Kenton K" first="Kimberly" last="Kenton">Kimberly Kenton</name><affiliation><nlm:aff id="aff11">K. Kenton, MD, MS, Female Pelvic Medicine and Reconstructive Surgery, Loyola University Chicago, Stitch School of Medicine, Chicago, Illinois.</nlm:aff></affiliation></author><author><name sortKey="Spino, Cathie" sort="Spino, Cathie" uniqKey="Spino C" first="Cathie" last="Spino">Cathie Spino</name><affiliation><nlm:aff id="aff12">C. Spino, DSc, Department of Biostatistics, University of Michigan.</nlm:aff></affiliation><affiliation><nlm:aff id="aff13"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23431210</idno><idno type="pmc">3664038</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664038</idno><idno type="RBID">PMC:3664038</idno><idno type="doi">10.2522/ptj.20120072</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000530</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000530</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Adherence to Behavioral Interventions for Stress Incontinence: Rates, Barriers, and Predictors</title><author><name sortKey="Borello France, Diane" sort="Borello France, Diane" uniqKey="Borello France D" first="Diane" last="Borello-France">Diane Borello-France</name><affiliation><nlm:aff id="aff1">D. Borello-France, PT, PhD, Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 104 Health Sciences Bldg, 600 Forbes Ave, Pittsburgh, PA 15282 (USA).</nlm:aff></affiliation></author><author><name sortKey="Burgio, Kathryn L" sort="Burgio, Kathryn L" uniqKey="Burgio K" first="Kathryn L." last="Burgio">Kathryn L. Burgio</name><affiliation><nlm:aff id="aff2">K.L. Burgio, PhD, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, and Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.</nlm:aff></affiliation></author><author><name sortKey="Goode, Patricia S" sort="Goode, Patricia S" uniqKey="Goode P" first="Patricia S." last="Goode">Patricia S. Goode</name><affiliation><nlm:aff id="aff3">P.S. Goode, MD, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, and Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center.</nlm:aff></affiliation></author><author><name sortKey="Ye, Wen" sort="Ye, Wen" uniqKey="Ye W" first="Wen" last="Ye">Wen Ye</name><affiliation><nlm:aff id="aff4">W. Ye, PhD, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.</nlm:aff></affiliation></author><author><name sortKey="Weidner, Alison C" sort="Weidner, Alison C" uniqKey="Weidner A" first="Alison C." last="Weidner">Alison C. Weidner</name><affiliation><nlm:aff id="aff5">A.C. Weidner, MD, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.</nlm:aff></affiliation></author><author><name sortKey="Lukacz, Emily S" sort="Lukacz, Emily S" uniqKey="Lukacz E" first="Emily S." last="Lukacz">Emily S. Lukacz</name><affiliation><nlm:aff id="aff6">E.S. Lukacz, MD, Department of Reproductive Medicine, University of California San Diego Health Systems, La Jolla, California.</nlm:aff></affiliation></author><author><name sortKey="Jelovsek, John Eric" sort="Jelovsek, John Eric" uniqKey="Jelovsek J" first="John-Eric" last="Jelovsek">John-Eric Jelovsek</name><affiliation><nlm:aff id="aff7">J-E. Jelovsek, MD, MMEd, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.</nlm:aff></affiliation></author><author><name sortKey="Bradley, Catherine S" sort="Bradley, Catherine S" uniqKey="Bradley C" first="Catherine S." last="Bradley">Catherine S. Bradley</name><affiliation><nlm:aff id="aff8">C.S. Bradley, MD, Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System and Department of Obstetrics and Gynecology, College of Medicine, University of Iowa, Iowa City, Iowa.</nlm:aff></affiliation></author><author><name sortKey="Schaffer, Joseph" sort="Schaffer, Joseph" uniqKey="Schaffer J" first="Joseph" last="Schaffer">Joseph Schaffer</name><affiliation><nlm:aff id="aff9">J. Schaffer, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, UT Southwestern Medical Center, Dallas, Texas.</nlm:aff></affiliation></author><author><name sortKey="Hsu, Yvonne" sort="Hsu, Yvonne" uniqKey="Hsu Y" first="Yvonne" last="Hsu">Yvonne Hsu</name><affiliation><nlm:aff id="aff10">Y. Hsu, MD, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.</nlm:aff></affiliation></author><author><name sortKey="Kenton, Kimberly" sort="Kenton, Kimberly" uniqKey="Kenton K" first="Kimberly" last="Kenton">Kimberly Kenton</name><affiliation><nlm:aff id="aff11">K. Kenton, MD, MS, Female Pelvic Medicine and Reconstructive Surgery, Loyola University Chicago, Stitch School of Medicine, Chicago, Illinois.</nlm:aff></affiliation></author><author><name sortKey="Spino, Cathie" sort="Spino, Cathie" uniqKey="Spino C" first="Cathie" last="Spino">Cathie Spino</name><affiliation><nlm:aff id="aff12">C. Spino, DSc, Department of Biostatistics, University of Michigan.</nlm:aff></affiliation><affiliation><nlm:aff id="aff13"></nlm:aff></affiliation></author></analytic><series><title level="j">Physical Therapy</title><idno type="ISSN">0031-9023</idno><idno type="eISSN">1538-6724</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>First-line conservative treatment for stress urinary incontinence (SUI) in women is behavioral intervention, including pelvic-floor muscle (PFM) exercise and bladder control strategies.</p></sec><sec><title>Objective</title><p>The purposes of this study were: (1) to describe adherence and barriers to exercise and bladder control strategy adherence and (2) to identify predictors of exercise adherence.</p></sec><sec><title>Design</title><p>This study was a planned secondary analysis of data from a multisite, randomized trial comparing intravaginal continence pessary, multicomponent behavioral therapy, and combined therapy in women with stress-predominant urinary incontinence (UI).</p></sec><sec><title>Methods</title><p>Data were analyzed from the groups who received behavioral intervention alone (n=146) or combined with continence pessary therapy (n=150). Adherence was measured during supervised treatment and at 3, 6, and 12 months post-randomization. Barriers to adherence were surveyed during treatment and at the 3-month time point. Regression analyses were performed to identify predictors of exercise adherence during supervised treatment and at the 3- and 12-month time points.</p></sec><sec><title>Results</title><p>During supervised treatment, ≥86% of the women exercised ≥5 days a week, and ≥80% performed at least 30 contractions on days they exercised. At 3, 6, and 12 months post-randomization, 95%, 88%, and 80% of women, respectively, indicated they were still performing PFM exercises. During supervised treatment and at 3 months post-randomization, ≥87% of the women reported using learned bladder control strategies to prevent SUI. In addition, the majority endorsed at least one barrier to PFM exercise, most commonly “trouble remembering to do exercises.” Predictors of exercise adherence changed over time. During supervised intervention, less frequent baseline UI and higher baseline 36-Item Short-Form Health Survey (SF-36) mental scores predicted exercise adherence. At 3 months post-randomization, women who dropped out of the study had weaker PFMs at baseline. At 12 months post-randomization, only “trouble remembering” was associated with exercise adherence.</p></sec><sec><title>Limitations</title><p>Adherence and barrier questionnaires were not validated.</p></sec><sec><title>Conclusions</title><p>Adherence to PFM exercises and bladder control strategies for SUI can be high and sustained over time. However, behavioral interventions to help women link exercise to environmental and behavioral cues may only be beneficial over the short term.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Phys Ther</journal-id><journal-id journal-id-type="iso-abbrev">Phys Ther</journal-id><journal-id journal-id-type="hwp">ptjournal</journal-id><journal-id journal-id-type="pmc">ptjournal</journal-id><journal-id journal-id-type="publisher-id">PTJOURNAL</journal-id><journal-title-group><journal-title>Physical Therapy</journal-title></journal-title-group><issn pub-type="ppub">0031-9023</issn><issn pub-type="epub">1538-6724</issn><publisher><publisher-name>American Physical Therapy Association</publisher-name><publisher-loc>Alexandria, VA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23431210</article-id><article-id pub-id-type="pmc">3664038</article-id><article-id pub-id-type="publisher-id">2012-0072</article-id><article-id pub-id-type="doi">10.2522/ptj.20120072</article-id><article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>1309</subject><subject>1312</subject><subject>2103</subject><subject>2402</subject></subj-group><subj-group subj-group-type="heading"><subject>Research Reports</subject></subj-group></article-categories><title-group><article-title>Adherence to Behavioral Interventions for Stress Incontinence: Rates, Barriers, and Predictors</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Borello-France</surname><given-names>Diane</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Burgio</surname><given-names>Kathryn L.</given-names></name><xref ref-type="aff" rid="aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Goode</surname><given-names>Patricia S.</given-names></name><xref ref-type="aff" rid="aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Ye</surname><given-names>Wen</given-names></name><xref ref-type="aff" rid="aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Weidner</surname><given-names>Alison C.</given-names></name><xref ref-type="aff" rid="aff5"></xref></contrib><contrib contrib-type="author"><name><surname>Lukacz</surname><given-names>Emily S.</given-names></name><xref ref-type="aff" rid="aff6"></xref></contrib><contrib contrib-type="author"><name><surname>Jelovsek</surname><given-names>John-Eric</given-names></name><xref ref-type="aff" rid="aff7"></xref></contrib><contrib contrib-type="author"><name><surname>Bradley</surname><given-names>Catherine S.</given-names></name><xref ref-type="aff" rid="aff8"></xref></contrib><contrib contrib-type="author"><name><surname>Schaffer</surname><given-names>Joseph</given-names></name><xref ref-type="aff" rid="aff9"></xref></contrib><contrib contrib-type="author"><name><surname>Hsu</surname><given-names>Yvonne</given-names></name><xref ref-type="aff" rid="aff10"></xref></contrib><contrib contrib-type="author"><name><surname>Kenton</surname><given-names>Kimberly</given-names></name><xref ref-type="aff" rid="aff11"></xref></contrib><contrib contrib-type="author"><name><surname>Spino</surname><given-names>Cathie</given-names></name><xref ref-type="aff" rid="aff12"></xref><on-behalf-of>for the Pelvic Floor Disorders Network</on-behalf-of><xref ref-type="aff" rid="aff13"></xref></contrib><aff id="aff1">D. Borello-France, PT, PhD, Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 104 Health Sciences Bldg, 600 Forbes Ave, Pittsburgh, PA 15282 (USA).</aff><aff id="aff2">K.L. Burgio, PhD, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, and Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.</aff><aff id="aff3">P.S. Goode, MD, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, and Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center.</aff><aff id="aff4">W. Ye, PhD, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.</aff><aff id="aff5">A.C. Weidner, MD, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.</aff><aff id="aff6">E.S. Lukacz, MD, Department of Reproductive Medicine, University of California San Diego Health Systems, La Jolla, California.</aff><aff id="aff7">J-E. Jelovsek, MD, MMEd, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.</aff><aff id="aff8">C.S. Bradley, MD, Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System and Department of Obstetrics and Gynecology, College of Medicine, University of Iowa, Iowa City, Iowa.</aff><aff id="aff9">J. Schaffer, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, UT Southwestern Medical Center, Dallas, Texas.</aff><aff id="aff10">Y. Hsu, MD, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.</aff><aff id="aff11">K. Kenton, MD, MS, Female Pelvic Medicine and Reconstructive Surgery, Loyola University Chicago, Stitch School of Medicine, Chicago, Illinois.</aff><aff id="aff12">C. Spino, DSc, Department of Biostatistics, University of Michigan.</aff><aff id="aff13">Pelvic Floor Disorders Network (see list of participating clinics, investigators, and participants in<xref ref-type="app" rid="app1">Appendix 1</xref>).</aff></contrib-group><author-notes><corresp>Address all correspondence to Dr Borello-France at: <email>borellofrance@duq.edu</email>.</corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>21</day><month>2</month><year>2013</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>12</month><year>2013</year></pub-date><pmc-comment> PMC Release delay is 6 months and 0 days and was based on the
<volume>93</volume><issue>6</issue><fpage>757</fpage><lpage>773</lpage><history><date date-type="received"><day>22</day><month>2</month><year>2012</year></date><date date-type="accepted"><day>14</day><month>2</month><year>2013</year></date></history><permissions><copyright-statement>© 2013 American Physical Therapy Association</copyright-statement><copyright-year>2013</copyright-year></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="zad00613000757.pdf"></self-uri><abstract><sec><title>Background</title><p>First-line conservative treatment for stress urinary incontinence (SUI) in women is behavioral intervention, including pelvic-floor muscle (PFM) exercise and bladder control strategies.</p></sec><sec><title>Objective</title><p>The purposes of this study were: (1) to describe adherence and barriers to exercise and bladder control strategy adherence and (2) to identify predictors of exercise adherence.</p></sec><sec><title>Design</title><p>This study was a planned secondary analysis of data from a multisite, randomized trial comparing intravaginal continence pessary, multicomponent behavioral therapy, and combined therapy in women with stress-predominant urinary incontinence (UI).</p></sec><sec><title>Methods</title><p>Data were analyzed from the groups who received behavioral intervention alone (n=146) or combined with continence pessary therapy (n=150). Adherence was measured during supervised treatment and at 3, 6, and 12 months post-randomization. Barriers to adherence were surveyed during treatment and at the 3-month time point. Regression analyses were performed to identify predictors of exercise adherence during supervised treatment and at the 3- and 12-month time points.</p></sec><sec><title>Results</title><p>During supervised treatment, ≥86% of the women exercised ≥5 days a week, and ≥80% performed at least 30 contractions on days they exercised. At 3, 6, and 12 months post-randomization, 95%, 88%, and 80% of women, respectively, indicated they were still performing PFM exercises. During supervised treatment and at 3 months post-randomization, ≥87% of the women reported using learned bladder control strategies to prevent SUI. In addition, the majority endorsed at least one barrier to PFM exercise, most commonly “trouble remembering to do exercises.” Predictors of exercise adherence changed over time. During supervised intervention, less frequent baseline UI and higher baseline 36-Item Short-Form Health Survey (SF-36) mental scores predicted exercise adherence. At 3 months post-randomization, women who dropped out of the study had weaker PFMs at baseline. At 12 months post-randomization, only “trouble remembering” was associated with exercise adherence.</p></sec><sec><title>Limitations</title><p>Adherence and barrier questionnaires were not validated.</p></sec><sec><title>Conclusions</title><p>Adherence to PFM exercises and bladder control strategies for SUI can be high and sustained over time. However, behavioral interventions to help women link exercise to environmental and behavioral cues may only be beneficial over the short term.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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