Top Banner
The role of self- The role of self- efficacy in the outcome efficacy in the outcome of physiotherapy for of physiotherapy for urinary incontinence urinary incontinence Demain S, Horn S, Monga A, McPherson Demain S, Horn S, Monga A, McPherson K, Vits K K, Vits K University of Southampton, England University of Southampton, England
23

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,

Mar 28, 2015

Download

Documents

Adam Jackson
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: 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,

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

urinary incontinenceurinary incontinence

Demain S, Horn S, Monga A, McPherson K, Vits KDemain S, Horn S, Monga A, McPherson K, Vits K

University of Southampton, EnglandUniversity of Southampton, England

Page 2: 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,

Urinary IncontinenceUrinary Incontinence

Urinary Incontinence (UI) is a common Urinary Incontinence (UI) is a common problem – 25% UK womenproblem – 25% UK women

Negative impact on QOLNegative impact on QOL– Employment, social and family life, sexual Employment, social and family life, sexual

relationsrelations

Associated with anxiety and depressionAssociated with anxiety and depression

Physiotherapy recommended as first-line Physiotherapy recommended as first-line treatment treatment (Berghmans et al, 1998 +(Berghmans et al, 1998 + RCOG)RCOG)

Page 3: 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,

Physiotherapy for UIPhysiotherapy for UI

Pelvic floor exercises proven in Stress UIPelvic floor exercises proven in Stress UI

Bladder training indicated in Urge UIBladder training indicated in Urge UI

‘ ‘Self-Management’ utilisedSelf-Management’ utilised– Pelvic Floor Exercises,Pelvic Floor Exercises,– Bladder Training & Lifestyle Management,Bladder Training & Lifestyle Management,

Page 4: 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,

Unanswered QuestionsUnanswered Questions

Why do some women benefit more than Why do some women benefit more than others from self-management? others from self-management?

Do psychological factors influence Do psychological factors influence outcome?outcome?

Is self-efficacy an important factor?Is self-efficacy an important factor?

Page 5: 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,

Self-Efficacy Theory Self-Efficacy Theory (Bandura,1977)(Bandura,1977)

Self - Efficacy : Self - Efficacy : – How well can I do it ?How well can I do it ?

Outcome Expectancy: Outcome Expectancy: – If I do it, will it be effective ?If I do it, will it be effective ?

Situational Situational ((Bandura,1977) Bandura,1977)

GeneralisableGeneralisable;; (Schwarzer and Fuchs, 1996) (Schwarzer and Fuchs, 1996)

Page 6: 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,

Self-Efficacy and Self-Efficacy and Health BehavioursHealth Behaviours

Role of SE explored in several conditionsRole of SE explored in several conditions– Rheumatoid Arthritis, Osteoarthritis, Rheumatoid Arthritis, Osteoarthritis,

Fibromyalgia, Cardiac disease and Chronic PainFibromyalgia, Cardiac disease and Chronic Pain

↑↑SE SE → enhanced → enhanced participation self-participation self-managementmanagement

↑↑SE SE →→ improved outcomes improved outcomes

Page 7: 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,

Self-Efficacy and UISelf-Efficacy and UI

Svengalis et al (1995)Svengalis et al (1995)– 71 women with SUI undertaking PFE71 women with SUI undertaking PFE– High SE (baseline) negatively correlated with outcomeHigh SE (baseline) negatively correlated with outcome– Due to 3 outliers with extremely high baseline SE Due to 3 outliers with extremely high baseline SE

whose incontinence worsenedwhose incontinence worsened

– Initial overestimation of ability Initial overestimation of ability ⃗ ⃗ demoralisationdemoralisation

Alewijnse et al (2001)Alewijnse et al (2001)– SE and severity of urine loss predict intention to SE and severity of urine loss predict intention to

adhere to PFEadhere to PFE

Page 8: 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,

AimsAims

To explore the role of self-efficacy in the To explore the role of self-efficacy in the self-management programme utilised in self-management programme utilised in Southampton Southampton

Are self-efficacy and outcome expectancy Are self-efficacy and outcome expectancy beliefs related to outcome ?beliefs related to outcome ?

How do these beliefs change during How do these beliefs change during treatment?treatment?

Page 9: 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,

SampleSample

26 Women,18 years and over 26 Women,18 years and over

Clinical diagnosis of stress or mixed Clinical diagnosis of stress or mixed urinary incontinenceurinary incontinence

Page 10: 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,

ProcedureProcedure

PHYSIOASSESSMENT

SELF-MANAGEMENT6 WEEKS

PHYSIOREVIEW

BASE-LINERESEARCHINTERVIEW

FOLLOW-UPRESEARCH INTERVIEW

POSTAL RETURN SELF-EFFICACY

QUESTIONNAIRES

Page 11: 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,

Outcome measures - UIOutcome measures - UI

Symptom Severity IndexSymptom Severity Index (Black et al)(Black et al)– Validated self-report measureValidated self-report measure

King’s Health Questionnaire King’s Health Questionnaire (Kellerher (Kellerher et al)et al)– Validated self-report QOL measureValidated self-report QOL measure

Digital Vaginal Assessment Digital Vaginal Assessment (Laycock)(Laycock)– Subjective rating pelvic floor strength Subjective rating pelvic floor strength

based on Oxford muscle gradingbased on Oxford muscle grading– Inter and intra-rater reliabilityInter and intra-rater reliability

Page 12: 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,

Incontinence SE and OEIncontinence SE and OEDeveloped for this study, adequate internal Developed for this study, adequate internal consistency (consistency (αα = 0.681) = 0.681)Pelvic Floor self-efficacy (2 questions)Pelvic Floor self-efficacy (2 questions)– do the pelvic floor exercises correctly do the pelvic floor exercises correctly – do the pelvic floor exercises several times each daydo the pelvic floor exercises several times each day

Bladder Training self-efficacy (3 questions)Bladder Training self-efficacy (3 questions)– drink 3-4 pints of fluid each daydrink 3-4 pints of fluid each day– Limit the amount of caffeine I drinkLimit the amount of caffeine I drink– Avoid emptying my bladder too frequentlyAvoid emptying my bladder too frequently

Outcome expectancy (1 question)Outcome expectancy (1 question)– If I follow the physio exercises and advice my bladder If I follow the physio exercises and advice my bladder

problem will be curedproblem will be cured

Page 13: 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,

Generalised Self-EfficacyGeneralised Self-Efficacy

Modified Generalised Self Efficacy Scale Modified Generalised Self Efficacy Scale (Barlow et al, 1996)(Barlow et al, 1996)

– Validated scale: 4 point likert, 10 item, Validated scale: 4 point likert, 10 item, – Example statementExample statement

““It is easy for me to stick to my aims and accomplish It is easy for me to stick to my aims and accomplish my goals”my goals”

Page 14: 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,

Sample CharacteristicsSample CharacteristicsAge (years)Age (years) mean (sd)mean (sd)

min-maxmin-max

48.8 (7.5)48.8 (7.5)

31- 6431- 64

Incontinence Incontinence (years)(years)

median (IQR)median (IQR)

min-maxmin-max

4.75 (13.0)4.75 (13.0)

0.75 - 410.75 - 41

Clinical DiagnosisClinical Diagnosis Stress UIStress UI

Mixed UIMixed UI

62%62%

38%38%

ParityParity mean (sd)mean (sd)

min-maxmin-max

2.2 (1.0)2.2 (1.0)

0-40-4

Surgery for Surgery for incontinenceincontinence

YesYes

NoNo

8%8%

92%92%

Page 15: 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,

Improvements in UIImprovements in UI

BaselineBaseline Follow-upFollow-up Mean change Mean change (95% CI) (95% CI)

P value  P value  

SSISSI

Mean (sd)Mean (sd)

Min-maxMin-max

12.0(3.5)12.0(3.5)

4-184-18

9.6(4.1)9.6(4.1)

0-170-17

2.42.4

(0.9-3.9) (0.9-3.9)

.003* .003* 

KHQKHQ

Mean (sd)Mean (sd)

Min-maxMin-max

43.7(19.8)43.7(19.8)

7.5-79.77.5-79.7

34.2(19.2)34.2(19.2)

0-80.70-80.7

9.59.5

(6.5, 12.4) (6.5, 12.4)

.000*.000*

DVADVA

Median (mean)Median (mean)

Min-maxMin-max

2.0(2.2)2.0(2.2)

1.0-4.01.0-4.0

2.5(2.6)2.5(2.6)

1.5-5.01.5-5.0

0.40.4

(0.3,0.6) (0.3,0.6)

.000** .000** 

* paired t-test, ** Wilcoxon’s signed rank test* paired t-test, ** Wilcoxon’s signed rank test

Page 16: 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,

Relationships between baseline Relationships between baseline SE/OE and treatment outcomeSE/OE and treatment outcome

Improvement in Improvement in Muscle Grade Muscle Grade (DVA)(DVA)

Improvement Improvement in Symptomin Symptom

Severity (SSI)Severity (SSI)

Improvement in Improvement in QOL (KHQ)QOL (KHQ)

Pelvic Pelvic

Floor SEFloor SE

rho

p

433433

.034.034

.386.386

.051.051

.005.005

.980.980

Bladder Bladder

Train SETrain SE

rho

p

-.328-.328

.102.102

.261.261

.197.197

-.016-.016

.938.938

Outcome

ExpectancyExpectancy

rho

p

.542.542

.006.006

.331.331

.099.099

-.328-.328

.102.102

GeneralisedGeneralised

Self EfficacySelf Efficacy

rho

p

.215.215

.314.314

..423423

.031.031

-.073-.073

.723.723

Page 17: 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,

Changes in Incontinence SEQChanges in Incontinence SEQ

Baseline Baseline ScoreScore

Follow-upFollow-up

ScoreScore

Mean change Mean change (95% CI) (95% CI) p valuep value

Pelvic Floor Pelvic Floor SESE

(0-10)(0-10)7.5 (7.4)7.5 (7.4)

3-103-10

6.0(6.3)6.0(6.3)

2-102-10

-1.2-1.2

(-2.2,-0.1)(-2.2,-0.1).020.020

Bladder Bladder TrainingTraining

SE (0-15)SE (0-15)

12.0(12.1)12.0(12.1)

7-157-15

11.0(10.9)11.0(10.9)

5-155-15-1.2(-2.7,0.3)-1.2(-2.7,0.3) .076.076

OutcomeOutcome

Expectancy Expectancy (0-5)(0-5)

4.0(3.7)4.0(3.7)

1-51-5

3.0(3.2)3.0(3.2)

0-50-5

-0.5-0.5

(-0.8,-0.1)(-0.8,-0.1).012.012

Wilcoxon’s signed rank testWilcoxon’s signed rank test

Page 18: 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,

Changes in Generalised SEChanges in Generalised SE

median (mean)median (mean)

min-maxmin-max Mean ChangeMean Change

(95% CI)(95% CI)P value*P value*

BaselineBaseline Follow-upFollow-up

Generalised SelfGeneralised Self

Efficacy ScaleEfficacy Scale

(0 – 40)(0 – 40)

32.0(30.0)32.0(30.0)

16.0-37.016.0-37.0

31.0(30.2)31.0(30.2)

12.0-39.012.0-39.00.2 (-1.4,1.7)0.2 (-1.4,1.7) .600.600

Page 19: 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,

Key Discussion PointsKey Discussion Points

Limitations of correlational analysisLimitations of correlational analysis– Multiple testingMultiple testing– Larger studies should utilise multiple Larger studies should utilise multiple

regression analysisregression analysis

Page 20: 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,

Key Discussion PointsKey Discussion Points

Greatest improvements in PF Strength in Greatest improvements in PF Strength in women with ↑ SE and ↑ OEwomen with ↑ SE and ↑ OE- What factors contribute to SE and OE in this What factors contribute to SE and OE in this

context?context?- Qualitative studies to exploreQualitative studies to explore- Clinically measure SE and OE to target Clinically measure SE and OE to target

additional support additional support

Page 21: 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,

Key Discussion PointsKey Discussion Points

Pelvic Floor SE and OE fell during self-Pelvic Floor SE and OE fell during self-managementmanagement– Implications for long term outcomeImplications for long term outcome

““It was difficult to remember to do the exercises, they It was difficult to remember to do the exercises, they weren’t hard to do, just hard to remember to do. I weren’t hard to do, just hard to remember to do. I wouldn’t consider doing it everyday for my whole life, wouldn’t consider doing it everyday for my whole life, thought it would be easier than it is”thought it would be easier than it is”

– How can we maintain SE and OE?How can we maintain SE and OE?– Support via self-management groups?Support via self-management groups?

Page 22: 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,

Take home messagesTake home messages

SE and OE beliefs importantSE and OE beliefs important

Inidicate success with physiotherapy in UIInidicate success with physiotherapy in UI

Women may quickly lose faith in own Women may quickly lose faith in own abilities and in treatment effectivenessabilities and in treatment effectiveness

Measures to enhance and maintain SE Measures to enhance and maintain SE and OE should be employed and OE should be employed

Page 23: 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,