The BEST pelvic floor muscle training: Behaviour, Exercise, Syntheses, and Theories?

Jean Hay-Smith (see full bio here)

Learning Objectives - At the end of the lecture Jean expects that you will be able to:

• list text hereExplain what the pooled estimate of effect from key Cochrane reviews on pelvic floor muscle training means for you and for women in a clinical setting
• list text hereSee the benefits in applying theory (e.g. exercise science, health behaviour) to question what we are doing now, and what we could be doing even better, to get the best clinical outcomes for women
• list text herePlan and implement pelvic floor muscle training interventions giving equal emphasis to ‘best practice’ in exercise prescription and behavioural support.

Why is this topic important?
Simply, it is important because we are an audience that have power, opportunity, capability and motivation to help women lead flourishing lives through offering them opportunity and capability for pelvic floor muscle training, supporting their motivation to self-manage and experience control in their lives. In developed countries, in the current climate of fear about vaginal mesh (even though incontinence surgeries have low complication rates), more women than ever would prefer to avoid or delay surgery if they can. In developing countries, few women are offered the opportunity or capability for training. While the recommendation for pelvic floor muscle training as first line therapy for women with uncomplicated urinary incontinence has been consistent for some years now, the research informing what to do and how to do it well is progressing. Recent robust research has, for example, demonstrated that effective pelvic floor muscle training can be delivered in settings and using methods that can reach more women. More innovations of this sort are needed and this lecture is an opportunity to consider what we know, what we don’t know, and what it is most important to do next.

Recommended readings

Cacciari LP, Dumoulin C, Hay-Smith EJ. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a cochrane systematic review abridged republication. Braz J Phys Ther. 2019;23(2):93-107. doi:10.1016/j.bjpt.2019.01.002
Frawley HC, Dean SG, Slade SC, Hay-Smith EJ. Is pelvic-floor muscle training a physical therapy or a behavioral therapy? A call to name and report the physical, cognitive, and behavioral elements. Physical Therapy. 2017 Apr 1;97(4):425-37.
We ask Jean, why is the ICS important for international advances and training in Physiotherapy and allied health clinicians?
A definition of interprofessional learning is learning with, about, and from each other. The International Continence Society embodies this. Some clinicians are fortunate to work in co-located environments with other professions and this helps extend knowledge boundaries, fuel problem solving and creative solutions. However, many of us do not, or our clinical lives are so busy it is hard to connect with our colleagues or stay as up to date with new science as we would like to. Further, in some specialties the ‘allied health’ professions (where most of us are also women) can feel that medicine as a strong hierarchy where we are toward the bottom. The International Continence Society meetings are a cornucopia – a veritable feast of new knowledge and networks of like-minded people from many professions. The balance of profession-specific and interprofessional learning is unparalleled.