Effectiveness of pelvic floor muscle exercises intervention in improving knowledge, attitude, practice and confidence among pregnant women in Malaysia.

INTERVENTION: The intervention group received the newly developed pelvic floor muscles exercise (PFME) intervention which developed based on Health Belief Model and Motivational Interviewing in addition to the usual prenatal care. The PFME intervention consisted of single PFME education sessions delivered at baseline, a personalized short text message reminder and three booster sessions at the week 4 post‐education session, early third‐trimester and late third‐trimester. The whole intervention was facilitated by a primary researcher who was a physiotherapist. The first PFME education session was provided in a group of approximately 4 to 8 persons for about 40 to 45 minutes. During the session, the primary researcher actively engaged in facilitating discussion and providing information on urinary incontinence and PFME based on the perceived susceptibility and severity of UI, perceived benefit of PFME and perceived barriers to adhering to PFME. This session also involved teaching, demonstrating and practicing correct pelvic floor muscle contraction, together with educating on integrating the exercise into daily activities and healthy bladder habit strategies during and following pregnancy. This was followed by a weekly personalized short message reminder on adherence to PFME for eight week, examples “Remember your target PFME, 8‐12 repetitions hold for 6‐8 second three time daily" and "Don’t’ give up doing your PFME". The booster sessions took approximately 30 minutes which specifically focused on reinforcing the skills and aims for targeted PFME, discussing experiences, challenges and barriers in practicing PFME and to facilitate the continuous practice of PFME. The PFME is involves “squeeze with inward and upward liftâ€? movement around urethra, vagina and anus. This exercise targeting to increase the strength, endurance and to improve function of pelvic floor muscles specifically in prevention and treatment of urinary incontinence. The targeted pelvic fl CONDITION: Physical Medicine / Rehabilitation ‐ Physiotherapy Reproductive Health and Childbirth ‐ Antenatal care urinary incontinence in pregnancy; ; urinary incontinence in pregnancy INCLUSION CRITERIA: The inclusion criteria of this study were pregnant women at 18 weeks gestation, with a singleton pregnancy and had provided informed consent to participate in this study. PRIMARY OUTCOME: Another primary outcome was self‐efficacy in practicing PFME. The Self‐Efficacy Scale for Practicing Pelvic Floor Exercises (SESPPFE) was used to detect the changes in self‐efficacy (Sacomori et al., 2013)[The self‐efficacy of PFME was assessed at baseline, post‐intervention at early third trimester (28‐30 gestation weeks), late third‐trimester (36‐38 gestation weeks) and early postnatal (4‐6 weeks after childbirth)] The primary outcome was a composite measure of the levels of the knowledge, attitudes and practice of PFME. Knowledge, attitude and practice of PFME were measured using the Knowledge Attitude Practice (KAP) questionnaire which was adapted and modified with the permission of the author (Rosediani et al., 2012). [The knowledge, attitude and practice were assessed at baseline, post‐intervention at early third trimester (28‐30 gestation weeks), late third‐trimester (36‐38 gestation weeks) and early postnatal (4‐6 weeks after childbirth)] SECONDARY OUTCOME: Continence status was measured via self‐reporting by using a validated questionnaire based on the International Consultation on Incontinence Questionnaire‐Urinary Incontinence‐Short Form (ICIQ‐UI‐SF) (Lim et al., 2017)[Continence status was measured at baseline, post‐intervention at the early third‐ trimester (28‐30 gestation weeks), late third‐trimester (36‐38 gestation weeks) and early postnatal (4‐6 weeks after childbirth)] The severity of urinary incontinence was scored based on the first three questions in the ICIQ‐UI‐SF with an overall score between 0 and 21 awarded with the greater values of the overall scores indicated increased severity of UI (Klovning et al., 2009).[Severity of urinary symptom was measured at baseline, post‐intervention at the early third‐ trimester (28‐30 gestation weeks), late third‐trimester (36‐38 gestation weeks) and early postnatal (4‐6 weeks after childbirth)]