Opportunities and Capabilities to Perform Pelvic Floor Muscle Training Are Critical for Participation: a Systematic Review and Qualitative Meta-Synthesis

Alesha Sayner, Clarice Tang, Kellie Toohey, Chennelle Mendoza, Irmina Nahon

Research output: Contribution to journalReview articlepeer-review

Abstract

Abstract
Objective
Pelvic floor muscle training (PFMT) is considered a behavioral task that requires the interaction of physical, social, and cognitive processes. Enablers and barriers to participation in PFMT has been explored primarily in women. This review aimed to identify the barriers and enablers that influence participation in PFMT in all adult populations.

Methods
A systematic review and meta-synthesis of qualitative literature was conducted. The inclusion criteria comprised qualitative studies with populations of people aged 18 years and older who have been recommended for PFMT. Line-by-line coding and an inductive thematic analysis identified themes that were applied to the Theoretical Domains Framework and Capabilities, Opportunities and Motivation Behavioural Model to determine behavioral influences on PFMT.

Results
Twenty full text articles met inclusion criteria. PFMT was mostly influenced by individual opportunities that were impacted by social determinants and competing demands. Capability of carrying out PFMT was impacted by knowledge, understanding, and appropriate skill acquisition that was linked to self-efficacy.

Conclusion
Increasing opportunities and capabilities for engagement in PFMT are the most important factors in optimizing positive behavior changes. Ways to address these factors include clear patient communication to boost confidence in skill acquisition and using technology to encourage autonomy and improve convenience. Future research should address the impact of health professionals’ beliefs about patient participation, assessing the role of social values and gender roles, and explore the timing of the implementation of behavioral change strategies to improve PFMT.

Impact
This is believed to be the first systematic review and qualitative meta-synthesis to consider the enablers and barriers to participation in PFMT for all adult populations, purposes, and symptom complexes. Patient opportunities and capabilities are the greatest influencers on participation and self-efficacy. Individualized treatment approaches that acknowledge and address social influencers and competing demands will optimize self-efficacy and participation.

Lay Summary
If you have pelvic floor muscle dysfunction, your opportunities and capabilities are the greatest influencers on participation and self-efficacy in PFMT. Your physical therapist can design individualized treatment approaches that acknowledge and address social influencers and competing demands to help you optimize participation.
Original languageEnglish
Article numberpzac106
Pages (from-to)1-11
Number of pages11
JournalJournal of the American Physical Therapy Association
Volume102
Issue number10
DOIs
Publication statusPublished - 1 Oct 2022

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