UNSUPERVISED BEHAVIORAL AND PELVIC FLOOR MUSCLE TRAINING PROGRAMS THAT TARGET WOMEN’S STORAGE-TYPE LOWER URINARY TRACT SYMPTOMS

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  • March 2, 2021
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  • Wu, Chen
    • Affiliation: School of Nursing
Abstract
  • Background: Storage-type lower urinary tract symptoms (LUTS), including urinary incontinence (UI), nocturia, urinary urgency, and urinary frequency, are prevalent and impactful burdens for women that should be addressed by population-level interventions. Unsupervised behavioral and pelvic floor muscle training (B-PFMT) programs are feasible for population-level applications, but evidence for their effectiveness is limited. Methods: This dissertation comprises three manuscripts based on symptom management theory (SMT). In Manuscript 1, the narrative synthesis is employed to synthesize the effects of unsupervised B-PFMT programs on storage-type LUTS among women. The other manuscripts present secondary analyses of data collected over 24 months from the Translating Unique Learning for Incontinence Prevention (TULIP) study. In Manuscript 2, mixed-effects modeling is used to identify and compare the effects of unsupervised B-PFMT programs on nocturia, urinary urgency, and urinary frequency among postmenopausal women who were assigned to attend a face-to-face class that lasted approximately two hours (2-hrClass) or view a 20-minute DVD-delivered video that presented the same information (20-minVideo). In Manuscript 3, k-means cluster analysis is used to explore women’s adherence to pelvic floor muscle exercises (PFME), which constitutes the key component of unsupervised B-PFMT programs. Frequency is used to describe within- and between-pattern changes over time, and logistic regression models are used to identify theory-derived factors influencing identified patterns. Results: Unsupervised B-PFMT programs are effective in treating women’s UI, but the effect sizes could not be synthesized. Secondary analyses show that unsupervised B-PFMT programs are effective in mitigating nocturia, urinary urgency, and urinary frequency. No significant between-group differences were found except for nocturia at 24 months when the effectiveness favored women in the 20-minVideo group. Four PFME adherence patterns were identified, and adherence pattern at a later point was associated with the previous pattern. Regulatory self-efficacy and task self-efficacy predicted both short- and long-term PFME adherence. Conclusions: Unsupervised B-PFMT programs are effective in improving women’s storage-type LUTS. SMT is useful in guiding the analyses of intervention effects and factors that can be modified to facilitate program adherence. Future studies should optimize unsupervised B-PFMT programs and expand their application to treat and prevent storage-type LUTS across women’s life course.
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Advisor
  • Palmer, Mary H.
  • Newman, Diane K.
  • Lynn, Mary
  • Yeo, SeonAe
  • Schwartz, Todd A.
  • Zou, Baiming
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2020
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