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The role of self-efficacy in the outcome of physiotherapy for urinary incontinence

The role of self-efficacy in the outcome of physiotherapy for urinary incontinence

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The role of self-efficacy in the outcome of physiotherapy for urinary incontinence

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  1. The role of self-efficacy in the outcome of physiotherapy for urinary incontinence Demain S, Horn S, Monga A, McPherson K, Vits K University of Southampton, England

  2. Urinary Incontinence • Urinary Incontinence (UI) is a common problem – 25% UK women • Negative impact on QOL • Employment, social and family life, sexual relations • Associated with anxiety and depression • Physiotherapy recommended as first-line treatment (Berghmans et al, 1998 +RCOG)

  3. Physiotherapy for UI • Pelvic floor exercises proven in Stress UI • Bladder training indicated in Urge UI • ‘Self-Management’ utilised • Pelvic Floor Exercises, • Bladder Training & Lifestyle Management,

  4. Unanswered Questions • Why do some women benefit more than others from self-management? • Do psychological factors influence outcome? • Is self-efficacy an important factor?

  5. Self-Efficacy Theory (Bandura,1977) • Self - Efficacy : • How well can I do it ? • Outcome Expectancy: • If I do it, will it be effective ? • Situational (Bandura,1977) • Generalisable; (Schwarzer and Fuchs, 1996)

  6. Self-Efficacy and Health Behaviours • Role of SE explored in several conditions • Rheumatoid Arthritis, Osteoarthritis, Fibromyalgia, Cardiac disease and Chronic Pain • ↑SE → enhanced participation self-management • ↑SE → improved outcomes

  7. Self-Efficacy and UI • Svengalis et al (1995) • 71 women with SUI undertaking PFE • High SE (baseline) negatively correlated with outcome • Due to 3 outliers with extremely high baseline SE whose incontinence worsened • Initial overestimation of ability ⃗ demoralisation • Alewijnse et al (2001) • SE and severity of urine loss predict intention to adhere to PFE

  8. Aims • To explore the role of self-efficacy in the self-management programme utilised in Southampton • Are self-efficacy and outcome expectancy beliefs related to outcome ? • How do these beliefs change during treatment?

  9. Sample • 26 Women,18 years and over • Clinical diagnosis of stress or mixed urinary incontinence

  10. Procedure PHYSIO ASSESSMENT PHYSIO REVIEW SELF-MANAGEMENT 6 WEEKS BASE-LINE RESEARCH INTERVIEW FOLLOW-UP RESEARCH INTERVIEW POSTAL RETURN SELF-EFFICACY QUESTIONNAIRES

  11. Outcome measures - UI • Symptom Severity Index(Black et al) • Validated self-report measure • King’s Health Questionnaire (Kellerher et al) • Validated self-report QOL measure • Digital Vaginal Assessment (Laycock) • Subjective rating pelvic floor strength based on Oxford muscle grading • Inter and intra-rater reliability

  12. Incontinence SE and OE • Developed for this study, adequate internal consistency (α = 0.681) • Pelvic Floor self-efficacy (2 questions) • do the pelvic floor exercises correctly • do the pelvic floor exercises several times each day • Bladder Training self-efficacy (3 questions) • drink 3-4 pints of fluid each day • Limit the amount of caffeine I drink • Avoid emptying my bladder too frequently • Outcome expectancy (1 question) • If I follow the physio exercises and advice my bladder problem will be cured

  13. Generalised Self-Efficacy • Modified Generalised Self Efficacy Scale (Barlow et al, 1996) • Validated scale: 4 point likert, 10 item, • Example statement “It is easy for me to stick to my aims and accomplish my goals”

  14. Sample Characteristics

  15. Improvements in UI

  16. Relationships between baseline SE/OE and treatment outcome

  17. Changes in Incontinence SEQ Wilcoxon’s signed rank test

  18. Changes in Generalised SE

  19. Key Discussion Points • Limitations of correlational analysis • Multiple testing • Larger studies should utilise multiple regression analysis

  20. Key Discussion Points • Greatest improvements in PF Strength in women with ↑ SE and ↑ OE • What factors contribute to SE and OE in this context? • Qualitative studies to explore • Clinically measure SE and OE to target additional support

  21. Key Discussion Points • Pelvic Floor SE and OE fell during self-management • Implications for long term outcome “It was difficult to remember to do the exercises, they weren’t hard to do, just hard to remember to do. I wouldn’t consider doing it everyday for my whole life, thought it would be easier than it is” • How can we maintain SE and OE? • Support via self-management groups?

  22. Take home messages • SE and OE beliefs important • Inidicate success with physiotherapy in UI • Women may quickly lose faith in own abilities and in treatment effectiveness • Measures to enhance and maintain SE and OE should be employed