Factors Influencing Pelvic Floor Muscle Exercise Engagement Among Patients Post-Radical Prostatectomy: A Prospective Correlational Study

Abstract

What factors influence pelvic floor muscle exercise (PFME) intention and engagement among men post-radical prostatectomy (RP), and how do demographic and medical characteristics moderate these relationships? Post-RP urinary incontinence (UI) affects up to 69% of patients, significantly impacting their quality of life. PFME is recommended to manage UI, but many patients fail to achieve the required frequency and intensity, leading to suboptimal outcomes. This study seeks to identify factors influencing PFME intention and engagement, using the Reasoned Action Approach (RAA), to fill the gaps in PFME research and practice. The literature highlights that experiential attitude, instrumental attitude, injunctive norm, autonomy, capacity and perceived UI influence PFME engagement. Previous studies have not fully explored the role of these determinants specifically among men post-RP. Additionally, the moderating effects of demographic and medical factors, such as education level and time since surgery, on these relationships remain underexamined. This gap underscores the need for targeted, evidence-based interventions to optimise UI management post-RP. This study utilised a correlational design with data collected at two points: baseline and a four-week follow-up. A total of 108 men with prostate cancer (PC) post-RP from two large hospitals in Amman, Jordan, participated. After obtaining IRB approval, we recruited patients during their follow-up visits, achieving a recruitment rate of 93.1%. Written informed consent was obtained from all participants. Data were collected through anonymous, printed questionnaires administered in private rooms at the hospitals. PFME engagement, RAA determinants and demographics were measured. A follow-up survey was completed by 107 participants, yielding a retention rate of 99.1%. Statistical analysis included hierarchical regression and moderation analyses. In the final model, PFME intention (β = 0.33, p < 0.001) and perceived UI (β = −0.08, p < 0.001) were significant predictors of PFME engagement. Follow-up regression showed that PFME intention predicted engagement less effectively (B = 0.51, p < 0.001), and perceived UI predicted engagement more strongly (B = −0.22, p < 0.001) when participants were 6 months or longer post-RP. Interactions between months since RP and intention (B = −0.60, p < 0.001) and perceived UI (B = −0.11, p < 0.017) significantly impacted PFME engagement. The study suggests that the RAA framework can effectively predict PFME engagement in men post-RP, guiding the development of tailored interventions to enhance PFME engagement, ultimately improving urinary incontinence outcomes. This research also has the potential to impact the research community by offering insights into behavioural determinants and enhancing the effectiveness of post-radical prostatectomy rehabilitation strategies.