Effectiveness of Pelvic Floor Muscle Training in Reducing Urge, Stress and Mixed Urinary Incontinence: Comparison in Non-homebound and Homebound Older Adults

Purpose: To compare (1) the effectiveness of biofeedback-taught pelvic floor muscle training in reducing urinary incontinence and improving quality of life and (2) self-reported adherence to the treatment regimen in homebound and non-homebound older adults.

 Methods:  This study utilized baseline data collected in an RCT examining the efficacy of a relapse intervention pelvic floor muscle training (PFMT) in homebound and non-homebound adults age > 60 years with urge, stress or mixed UI.  Subjects were treated with a 6-week program of biofeedback-assisted PFMT. Outcome data were collected on UI severity, quality of life, and adherence to the treatment regimen. T-tests or their nonparametric equivalents were used to compare within and between group differences in study outcomes.

 Results: 280 men and women (mean age = 76.4 years) were included.  They were incontinent for a mean of 7.4 years and most had mixed (51.8%) or urge (38.2%) UI. Homebound subjects were significantly older (p<.001), had more limitations in activities of daily living (p<.001), more comorbidities (p=.01), more often required ambulatory assistance (p<.001), required longer to get to the toilet (p<.001), had more incontinent episodes (p<.001), and worse quality of life (p<.001) than non-homebound subjects. Non-homebound subjects reported higher PFM self-efficacy and treatment efficacy beliefs than homebound subjects (p<.001). 

Both groups had a significant reduction in UI following the intervention (p<.001 for both) with no significant group differences. Both has small, but statistically significant improvements in UI-specific QoL with no significant group differences. There were no significant within or between groups changes in general health-related QoL. Self-reported adherence was highest to PFM exercises and lowest to urge strategies with no significant group differences.

Conclusions: Despite significantly greater functional impairments and more severe baseline UI in homebound than homebound elders, adherence to and the effectiveness of the PFMT was similar in both groups.