Is Group-Based Pelvic Floor Telerehabilitation an Acceptable Care Option for Older Women With Urinary Incontinence? A Qualitative Descriptive Study.

内容摘要

Purpose: Many older women experience urinary incontinence (UI). However, access to pelvic floor muscle (PFM) training, an effective first-line treatment, is limited. Group-based telerehabilitation appears cost-effective and could improve accessibility. Recent evidence suggests a group-based PFM telerehabilitation programme for treating UI in older women (teleGROUP) is feasible and clinically relevant. This qualitative study assessed teleGROUP's acceptability to both patients and a clinician. Method: Thirty-three older women who completed the teleGROUP programme, and the physiotherapist who led it, discussed their experiences in focus groups or interviews. We transcribed qualitative data and analyzed them using thematic analysis. Results: Participating women enhanced self-efficacy in managing symptoms and contracting PFMs, reporting high self-efficacy in attending sessions and completing home exercises. The programme fostered positive affective attitudes in participants and the physiotherapist, aligned with their values, and improved self-efficacy with technology. Participants and the physiotherapist perceived clinical effectiveness as high. Women identified time commitment as a burden; the physiotherapist found time management challenging. However, the women found remote participation convenient. They recognized that PFM exercises led to symptom improvement. Conclusion: The programme proved acceptable for older women and the physiotherapist. Pragmatic trials in real-life clinical settings and implementation studies are necessary for further validation. Many older women experience urinary incontinence. While pelvic floor muscle training is the first-line recommended treatment, access can be limited. Group-based telerehabilitation may offer a cost-effective and accessible option. While promising results have been shown for feasibility and clinical outcomes, its acceptability remains unknown. In this study, older women who participated in a group-based pelvic floor muscle training telerehabilitation, along with the physiotherapist who led it, were interviewed. The women felt more confident in their capacity to manage urinary incontinence symptoms, contract pelvic floor muscles, and their ability to attend the programme’s sessions and complete home exercises. The women and the physiotherapist both reported positive feelings toward the programme, which aligned with their values. They felt more confident using technology. They viewed the programme as effective in reducing urinary incontinence symptoms. However, the women identified the time commitment as a burden, and the physiotherapist found weekly session management challenging. Yet, the women found remote participation convenient. They also saw how completing the exercises led to an improvement in their urinary incontinence symptoms. Overall, group-based pelvic floor muscle training telerehabilitation appeared acceptable to both older women and the physiotherapist. Further research on the programme in real-life clinical settings is needed. Objectif: de nombreuses femmes âgées présentent de l’incontinence urinaire (IU). L’accès au renforcement des muscles du plancher pelvien (RPP), traitement recommandé en première intention, demeure toutefois limité. La téléréadaptation de groupe pourrait représenter une option abordable susceptible d’améliorer l’accessibilité. Des données récentes ont démontré qu’un programme de RPP en téléréadaptation de groupe (teleGROUP) destiné aux femmes âgées était faisable et prometteur sur le plan clinique. Cette étude qualitative visait à évaluer l’acceptabilité de teleGROUP pour les patientes et la physiothérapeute. Méthodologie: trente-trois femmes âgées ayant complété téléGROUP, ainsi que la physiothérapeute ayant animé le programme, ont partagé leurs expériences via des groupes de discussion et entrevues, qui ont été retranscrits puis analysés par analyse thématique. Résultats: les femmes ont renforcé leur auto-efficacité à gérer leurs symptômes et contracter les muscles de leur plancher pelvien et étaient confiantes quant à leur capacité à assister aux séances et à réaliser les exercices à la maison. Le programme a suscité des attitudes affectives positives chez les femmes et la physiothérapeute, s’alignait avec leurs valeurs, a amélioré leur aisance avec la technologie, et a été perçu comme cliniquement efficace. Les participantes ont toutefois mentionné que le temps requis représentait un fardeau, tandis que la physiothérapeute a souligné des défis de gestion du temps. Néanmoins, les femmes ont apprécié la commodité d’être à distance et ont reconnu que les exercices contribuaient à améliorer leurs symptômes. Conclusion: le programme teleGROUP s’est avéré acceptable pour les femmes âgées et la physiothérapeute. Des études pragmatiques en contexte clinique réel et de mise en œuvre seraient maintenant nécessaires.