rehabilitation teaching and research unit best practice in rehabilitation jean hay-smith, sarah dean...

Rehabilitation Teaching and Research UnitBest Practice in Rehabilitation

Jean Hay-Smith, Sarah Dean

Overcoming inertia:Narratives from women embarking on conservative management of urinary

incontinence


Rx

CNS or PT

N=6

Patient

N=6

Pseudonym Referral HP Symptoms Duration of symptoms (causal event )

Catherine Neurology CNS UUI Many years (part of her neurological condition)

Janice GP PT SUI, rectal fullness and incomplete emptying.

18 years (following child birth)

Deborah GP PT SUI 5 years (following child birth)

Bernice GP PT SUI 5 years (following hysterectomy)

Heather GP CNS UUI, nocturia Many years (Previous vaginal repair)

Ruby GP CNS UUI, nocturia Many years (Previous colposuspension and TVT


Making sense of it all

Past experience

and meaning

Going on

and looking ahead

The relationship with, and experience of, others

The (supervised) treatment period


PFMT

Reluctance to exerciseApathy about exercise

Doubts about exercise efficacy

Passivity

default to not doing PFMT


Motivation

Capability and opportunity

Skills, confidence, emotional support and encouragement

Ask, then offer.Readiness rule.


Ask, then offer• What do you think caused the bladder

problem?• What kind of treatment do you want?• What are the most important results you

want from treatment?• Ask permission to share information• Selectively offer information (rather than

‘educate’)


• How do you really feel about doing PFMT?• How ready are you to do PFMT?• If 0 was not ready and 10 was ready, what

score would you give yourself?• You gave yourself a score of x? Why are you

at x not [a lower number]?• You gave yourself a score of x. What would

have to happen for you to move up to [a higher number]?

0 10


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rehabilitation teaching and research unit best practice in rehabilitation jean hay-smith, sarah dean...

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