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

Abstract

PURPOSE: Perceived self-efficacy (S-E) (belief in one's ability to perform a behaviour) is a powerful mediator of health behaviours and outcomes in many areas (Bukelew et al 1996; Hellman 1997; Kores et al 1990; Rejeski et al, 1998). Physiotherapy for incontinence follows a self-management approach but evidence of the role of S-E is limited and conflicting. This study examined i) whether perceptions of S-E are related to outcome and ii) whether S-E beliefs change during treatment.
RELEVANCE:Urinary incontinence is a common condition with adverse psychosocial consequences. Physiotherapy, including pelvic floor exercises and bladder training, is advocated as a first-line management. Understanding the role of S-E in physiotherapy outcome may enable therapists to modify treatment to enhance S-E and maximise success.
SUBJECTS: 26 women (mean age 48.8 years) with stress and mixed urinary incontinence (median duration 4.75 years) referred to physiotherapy were recruited.
METHODS AND MATERIALS: S-E was measured before and after treatment using the validated Generalised Self Efficacy Scale and the Incontinence Self-Efficacy and Outcome Expectancy Questionnaire, designed for the study. Physiotherapy outcome was determined after 6 weeks of self-management using validated measures (i.e. Digital Vaginal Assessment, the Symptom Severity Index, and the Kings Health Questionnaire) and compared to baseline measurements.
ANALYSES: The analyses were conducted using SPSS. As the data were non-parametric and the sample size was small, Spearman's Rho was used to test associations between baseline self-efficacy and improvement in outcome measures and Wilcoxon's signed rank test was applied to changes in S-E scores.
RESULTS: Incontinence improvement was noted for all measures. Significant correlations were found between improvement in muscle grade and initial pelvic floor self-efficacy (p= .03 r=.43) and outcome expectancy (p=.01 r= .54) and between improvement in symptom severity and generalised self-efficacy (p=.03 r=.42). No change in generalised self efficacy was seen during treatment (p=.60 z=-.53) but there were significant reductions in pelvic floor exercise self-efficacy (p=.020 z=-2.32) and outcome expectancy (p=.012 z=-2.52). Cautious interpretation is required however, because of multiple testing.
CONCLUSIONS: Women with greater initial beliefs in their general coping abilities and ability to perform pelvic floor exercises experienced the greatest symptomatic improvement after 6 weeks physiotherapy. However, after 6 weeks treatment, women were significantly less positive about their ability to perform the exercises and the likely effectiveness of treatment. The findings suggest that current strategies may be failing to help patients maintain self-efficacy and a positive approach to outcome, which may adversely affect their maintenance of the exercise regime over a longer period.

More information

Identifiers

Catalogue record

Export record