Presentation on theme: "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,"— Presentation transcript:
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
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)
Physiotherapy for UI Pelvic floor exercises proven in Stress UI Bladder training indicated in Urge UI Self-Management utilised Self-Management utilised –Pelvic Floor Exercises, –Bladder Training & Lifestyle Management,
Unanswered Questions Why do some women benefit more than others from self-management? Do psychological factors influence outcome? Is self-efficacy an important factor?
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)
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 enhanced participation self- management SE improved outcomes SE improved outcomes
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
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?
Sample 26 Women,18 years and over Clinical diagnosis of stress or mixed urinary incontinence
Procedure PHYSIO ASSESSMENT SELF-MANAGEMENT 6 WEEKS PHYSIO REVIEW BASE-LINE RESEARCH INTERVIEW FOLLOW-UP RESEARCH INTERVIEW POSTAL RETURN SELF-EFFICACY QUESTIONNAIRES
Outcome measures - UI Symptom Severity Index (Black et al) –Validated self-report measure Kings 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
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
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
Sample Characteristics Age (years) mean (sd) min-max 48.8 (7.5) 31- 64 Incontinence (years) median (IQR) min-max 4.75 (13.0) 0.75 - 41 Clinical Diagnosis Stress UI Mixed UI 62%38% Parity mean (sd) min-max 2.2 (1.0) 0-4 Surgery for incontinence YesNo8%92%
Improvements in UI BaselineFollow-up Mean change (95% CI) P value P value SSI Mean (sd) Min-max 12.0(3.5)4-189.6(4.1)0-172.4(0.9-3.9).003* KHQ Min-max 43.7(19.8)7.5-79.734.2(19.2)0-80.79.5 (6.5, 12.4).000* DVA Median (mean) Min-max 2.0(2.2)1.0-4.02.5(2.6)1.5-5.00.4(0.3,0.6).000** * paired t-test, ** Wilcoxons signed rank test
Relationships between baseline SE/OE and treatment outcome Improvement in Muscle Grade (DVA) Improvement in Symptom Severity (SSI) Improvement in QOL (KHQ) Pelvic Floor SE rho p433.034.386.051.005.980 Bladder Train SE rho p-.328.102.261.197-.016.938 OutcomeExpectancy rho p.542.006.331.099-.328.102 Generalised Self Efficacy rho p.215.314.423.031-.073.723
Changes in Incontinence SEQ Baseline Score Follow-upScore Mean change (95% CI) p value Pelvic Floor SE (0-10) 7.5 (7.4) 3-106.0(6.3)2-10-1.2(-2.2,-0.1).020 Bladder Training SE (0-15) 12.0(12.1)7-1511.0(10.9)5-15-1.2(-2.7,0.3).076 Outcome Expectancy (0-5) 4.0(3.7)1-53.0(3.2)0-5-0.5(-0.8,-0.1).012 Wilcoxons signed rank test
Changes in Generalised SE median (mean) min-max Mean Change (95% CI) P value* BaselineFollow-up Generalised Self Efficacy Scale (0 – 40) 32.0(30.0)16.0-37.0 31.0(30.2)12.0-39.0 0.2 (-1.4,1.7).600
Key Discussion Points Limitations of correlational analysis –Multiple testing –Larger studies should utilise multiple regression analysis
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
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 werent hard to do, just hard to remember to do. I wouldnt consider doing it everyday for my whole life, thought it would be easier than it is It was difficult to remember to do the exercises, they werent hard to do, just hard to remember to do. I wouldnt 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?
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