Date of Award

2015

Degree Name

Doctor of Philosophy (School of Physiotherapy)

Schools and Centres

Physiotherapy

First Supervisor

Associate Professor Anne-Marie Hill

Second Supervisor

Adjunct Professor Richard G Berlach

Abstract

Background: Guidelines recommend that when pregnant women attend antenatal education they gain adequate knowledge about pregnancy-related topics, including the function of pelvic floor muscles and how to undertake a pelvic floor muscle exercise programme. Evidence is limited about how this information can be optimally delivered to pregnant women such that they gain knowledge, confidence and motivation to engage in a pelvic floor muscle exercise programme during the antenatal period. The primary objectives of the research were to evaluate the effect of delivering a web-based pelvic floor muscle education intervention in addition to usual antenatal care on primiparae women’s awareness; knowledge; confidence in and beliefs about engaging in and adhering to a pelvic floor muscle exercise programme compared to provision of usual antenatal care alone. Secondary objectives were to investigate pregnant women’s attendance at antenatal education; self-reported urinary incontinence; and usage of the Internet for pregnancy-related information.

Methods: The research was conducted in two phases. Phase 1 consisted of surveying and auditing physiotherapists who provided antenatal education at public hospitals in 2012 in Western Australia. Phase 2 surveyed pregnant women about their knowledge; confidence in and beliefs about pelvic floor muscle function and exercises; attendance at antenatal education; self-reported urinary incontinence; and usage of the Internet for pregnancy-related information. Subsequently in Phase 2, a pilot randomised controlled trial of primiparae women was conducted to evaluate the effect of providing a novel web-based pelvic floor muscle education programme delivered in addition to usual antenatal care on knowledge, confidence in and beliefs about engaging in and adhering to a pelvic floor muscle exercise programme.

Results: Antenatal education facilitated by physiotherapists (n=31) was provided at 25 (83.3%) hospitals. While all classes provided information about pelvic floor muscle function, there was a wide variation in pelvic floor muscle exercise prescription. Of the pregnant women surveyed (n = 633), English speaking respondents (82%) were significantly more knowledgeable about pelvic floor muscles; significantly more likely to practise pelvic floor muscle exercises; significantly more likely to attend antenatal education compared to respondents who spoke languages other than English (18%). A total of 49% of respondents reported urinary incontinence. Fewer than 50% of primiparae women in Western Australia attended antenatal education.

Participants (n=70) enrolled in the RCT were randomised into two groups. There were 47 (67.1 %) participants who provided full follow-up data (n = 25 intervention; n = 22 control). Participants in the intervention group had significantly increased knowledge about pelvic floor muscles and significantly increased belief about engaging in pelvic floor muscle exercises at follow-up compared to the control group. Intervention group participants also showed significantly increased adherence to a pelvic floor muscle exercise programme compared to the control group [Odds ratio 19.1; 95% Confidence Interval (1.8, 196), p =.013].

Conclusions: Surveying physiotherapists and pregnant women identified that large numbers of primiparae women do not attend antenatal education. Furthermore, these women reported low levels of engagement in pelvic floor muscle exercises and a high frequency of urinary incontinence. Providing web-based antenatal education was a feasible and effective method of increasing knowledge, confidence in and adherence to pelvic floor muscle exercises. Future research should evaluate this promising intervention as a means of providing more pregnant women with education about pelvic floor muscles and pelvic floor muscle exercises.

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