Research Progress on Compliance of Pelvic Floor Muscle Training in Patients with Urinary Incontinence

This study describes the status quo and related factors of compliance with pelvic floor muscle training at home and abroad, and introduces in detail the current scale of compliance with pelvic floor muscle training at home and abroad, so as to provide a reliable and scientific method for clinical medical staff to objectively evaluate pelvic floor muscle training of patients with urinary incontinence, and also provide a basis for how to improve compliance with pelvic floor muscle training.


Introduction
The International Continence Society (ICS) defines urinary incontinence (UI) as: It is a phenomenon that can be objectively verified and any involuntary leakage of urine [1] [2] [3], which brings inconvenience to social activities and troubles in personal hygiene [4]. Urinary incontinence can be divided into stress incontinence, urge incontinence and mixed incontinence [5] [6]. Stress urinary incontinence is commonly seen in women with postpartum abdominal pressure increase, surgical destruction of urethral and bladder normal anatomical support, urethral and bladder dysfunction, etc. [7] [8] [9]. Urgent urinary incontinence is mainly caused by acute cystitis, acute urethritis, urinary calculus, bladder hyperactivity and other factors [10]. Mixed urinary incontinence means that symptoms of stress and urge urinary incontinence exist at the same time or cannot be simply attributed to these two types of urinary incontinence, such as uncons-

Compliance Status of Pelvic Floor Muscle Training
Heidi [26] investigated the willingness of 169 parturient women to participate in the program of pelvic floor muscle training to prevent urinary incontinence, and the results showed that only 31% of parturient women agreed to participate and 15% of parturient women did not want to participate. Beyar et al. [27] studied the pelvic floor muscle training of 208 women with urinary incontinence for up to 5 years, and conducted a survey in the form of questionnaire. The results showed that only 132 people completed the questionnaire, among which 55 (41.6%) reported compliance, 75 (56.8%) stopped training, and 2 (1.5%) underwent surgery. Takaoka [28] recruited 116 women for a pelvic floor muscle training program in a maternity clinic in Japan, and 89 women completed the program. Under the guidance and training of the researchers, only 36 (31%) women were highly adherent to the pelvic floor muscle training. Bayat et al. [29] studied the cognition of 200 pregnant women in the third trimester of pregnancy on pelvic floor muscle training by using semi-structured interview. 175 (87.5%) believed that urinary incontinence during pregnancy was normal, 54 (27%) were familiar with pelvic floor muscle training methods, and 25 (32.05%) had consulted obstetricians for urinary incontinence problems. Twenty-one (10.5%) performed pelvic floor exercises prior to pregnancy, 14 (66.6%) continued their exercises during pregnancy, and seven (33.4%) discontinued their exercises. Several studies have shown that pelvic floor muscle training is effective in the treatment of patients with urinary incontinence, but you need to keep training for long enough to get the desired results. The survey found that the number of patients who often complied with the requirements of health care providers for standardized training was small, and the number of patients who persisted in training was small.

Research in Other Countries
According to foreign literature [ [38] found that 86 women with stress, emergency, or mixed urinary incon-   [41] adopted individualized cross-theoretical model visit nursing form to promote behavioral change of incontinence puerperas, assess whether puerperas are willing to adopt new behaviors, and provide individualized guidance, which significantly improved the compliance of pelvic floor muscle training for puerperas.

Intervention Study on Improving Compliance of Rehabilitation Training for Foreign Patients with Urinary Incontinence
Asklund [42] used mobile phone APP to remind female patients with urinary incontinence to complete pelvic floor muscle training, and the close contact with mobile phone could reduce the embarrassment of female patients. App features such as reminders and visual charts are more conducive to supporting and motivating women with urinary incontinence to complete pelvic floor muscle training. Sacomori [43] used a conference format, organized by rehabilitation therapists, in which incontinence patients participated in meetings on the knowledge of pelvic floor muscle training, as well as educational methods through the distribution of home pelvic floor muscle training manuals, and the whole process was unsupervised. A subsequent assessment found improved training compliance.
In the study of Hoff [44], patients with urinary incontinence were instructed by rehabilitation therapists to conduct pelvic floor muscle training for a period of 6 months, including personal strength training and daily family training, and the training compliance was significant.

Factors Influencing the Compliance of Pelvic Floor Muscle Training
Scholars [45]- [52] believe that the degree of attention to disease, education, age, severity of urinary incontinence, memory, cognitive deficiency, behavioral support and lack of professional supervision all affect the compliance of patients  The influence of disease severity on the compliance of pelvic floor muscle training for urinary incontinence, Alewijnse et al. [48] showed that the frequency of urinary incontinence attacks during and after treatment was related to the compliance of pelvic floor muscle training during follow-up, and the more severe the patient's condition, the higher the compliance of pelvic floor muscle training.
Borello France et al. [49] investigated 146 incontinence patients who only received behavioral intervention and analyzed the influencing factors of exercise compliance during the supervised treatment period, 3 months and 12 months later, and found that many female incontinence patients reduced the frequency of pelvic floor muscle training over time. The influence of insufficient cognition on the compliance of pelvic floor muscle training, Pelaez et al. [50] believed that because incontinence patients did not know enough about pelvic floor muscle training and did not know enough about the importance of pelvic floor muscle training, most patients could not correctly grasp the pelvic floor muscle training methods, so that the training compliance was low. Behavior support in the effect of pelvic floor muscle training compliance, ying white [51] and so on through the theory of behavior change intervention in 100 patients with urinary incontinence, according to the behavior of the patients with urinary incontinence change requirements, provide targeted in the process of behavior change the behavior of the support, help patients to change or establish healthy behavior, found that in the control group patients with pelvic floor muscle training compliance is low. Lack of professional supervision and the effect of pelvic floor muscle training compliance, Lanhong Xia [52] Gongqie Chu studied 65 examples patients, such as hospital found that most patients with pelvic floor muscle training on their own that occupy the home, because of the lack of the supervi-

Evaluation Tool for Compliance of Urinary Incontinence Rehabilitation Training
In 2004, Chen [53] developed a self-efficacy scale for pelvic floor muscle training, which quantified the frequency, time and self-score of pelvic floor muscle training. The scale has 17 items and consists of two dimensions: confidence in pelvic floor muscle exercise and its efficacy, and confidence in overcoming obstacles to pelvic floor muscle exercise. Each item was scored on a 5-point scale, with a total score of 85 points. The higher the score, the higher the patient's self-efficacy level is and the greater the self-confidence is. A score between 34 and 68 is considered as poor self-efficacy; a score between 34 and 68 is considered as average self-efficacy; and a score between 68 and 68 is considered as good self-efficacy. Cronbach showed that Sα was 0.95, which showed good internal consistency and high correlation validity of criteria. Studies have pointed out that the self-efficacy mediation will directly or indirectly affect the training compliance, but this scale did not quantify the training compliance of patients.
In 2013, Sacomori [54] developed a self-efficacy table for pelvic floor muscle training, which used graded scoring to evaluate the self-efficacy of pelvic floor muscle training and the compliance of women's pelvic floor muscle training. It is composed of 17 items, each item is 10 grades, each item score is 0 -100 points, all items are positive points, the total score is 0 -1700 points, the higher the total score, the better the self-efficacy of pelvic floor muscle training. Cronbach showed that Sα was 0.923. Although the scale also has 17 items, there are 4 items that mention continuous practice and focus more on the study and measurement of compliance, which is different from the contents of the scale developed by Chen.In 2016, Porta [55] modified Morisky's medication compliance questionnaire by replacing the word "taking medication" in each of the four questions of Morisky's questionnaire with "performing pelvic floor muscle training" in the original questionnaire to measure the adherence to pelvic floor muscle training in 70 patients with urinary incontinence. The question is: 1) Have you ever forgotten to do your pelvic floor muscle exercises? 2) Do you do pelvic floor exercises on schedule? 3) Do you stop doing pelvic floor exercises when you feel better? 4) Do you stop doing pelvic floor muscle exercises when you feel worse? Since this questionnaire has not been tested for reliability and validity after improvement, and the items are too few, patient compliance cannot be accurately measured.
Compliance of urinary incontinence rehabilitation training: 1) Pelvis floor muscle exercise (PFMT), which believes that the pubococcygeus muscle can be effectively treated by active self-contraction and anal relaxation through the synergism of intestinal tract, urinary tract and reproductive tract; 2) The traditional anal movement, contraction of the anus this health care method in our country Open Journal of Urology has a long history of more than two thousand years. It is mainly used for the daily maintenance of room health care and life prolongation, and then used in the treatment of diseases such as spermatorrhea and enuresis. Its specific exercise method is: in shrink, relax anus while, cooperate deep inhale, slow exhale, maintain calm, concentrate idea at umbilical and umbilical lower part; 3) Whole Postural Rebuilding Movement (GPR). The theoretical basis of GPR is the muscle chain theory, which believes that human muscles can form muscle chains through muscle overlap and mutual connection between aponeurosis. The distribution of tension in the muscle chain enables the muscle to resist gravity, maintain posture stability, and keep the body upright; 4) Yoga, as a time-honored ancient Indian physical strengthening technique, attaches great importance to the unity of body and mind. It is a sport with obvious physical and psychological interaction. Yoga adjusts the nervous and endocrine systems through asanas, breathing exercises and consciousness meditation, so as to maintain balance inside and outside the body; 5) Interrupt urination training. Interrupt urination method is a method to relieve urinary incontinence by instructing patients to consciously contract pelvic floor muscles during urination to interrupt urination. Through the urination interruption method training, patients with urinary incontinence can enhance the self-control of urination, in laughter, cough and other abdominal pressure suddenly increased before the conscious contraction of pelvic floor muscles, to reduce incontinence. Successful interruption of urination in patients can, on the one hand, help patients correctly contract the pelvic floor muscles; on the other hand, it can improve the muscle strength of urethral sphincter in the continuous control and interruption of urination training, and gradually make patients close to normal urination.

Summary
To sum up, the incidence of urinary incontinence is high at home and abroad, which seriously affects the quality of life of patients. Pelvic floor muscle training is an important measure for the treatment of urinary incontinence, and compliance is an important factor for the treatment effect. However, studies have found that patients with urinary incontinence have poor compliance with pelvic floor muscle training. The compliance of pelvic floor muscle training is affected by many factors, including the degree of attention to disease, education, age, severity of urinary incontinence, memory, cognitive deficiency, behavioral support, lack of professional supervision, etc. Correct pelvic floor muscle training method can effectively promote the recovery of pelvic floor function. There are many ways to improve the compliance of pelvic floor muscle training for patients with urinary incontinence at home and abroad, such as improving patients' sense of self-efficacy, adopting the way of meeting, professional guidance, cross-theoretical model individualized visit nursing form, modern information tools, etc., but there is no unified method or model. Now about incontinence patients of pelvic floor muscle training compliance evaluation tool is the use of self-made questionnaires or scales, self-efficacy evaluation, improvement of oth-Open Journal of Urology er compliance questionnaires to evaluate compliance, and failing to report its self-evaluation of the reliability and validity, has not yet found the scientific, objective and has good reliability and validity of evaluation tools. In order to obtain a good training effect, effectively improve the urine control ability of patients with urinary incontinence, and improve the quality of life of patients, how to accurately measure compliance and how to improve the compliance of patients with urinary incontinence rehabilitation training is worth exploring and studying.