This clinical trial investigates the effects of a 12-week Pelvic Floor Muscle Training (PFMT) program applied via Action Observation Therapy (AOT) with metaphorical imagery on urinary incontinence, quality of life, and treatment adherence in geriatric women. The study will be conducted between June 2025 and June 2026 in nursing homes in Istanbul, targeting women aged 65 and older who are diagnosed with stress or stress-predominant mixed urinary incontinence, possess normal cognitive function (Standardized Mini Mental Test score ≥ 24), and walk independently. Eligible participants will be divided into groups, where both will undergo a progressive exercise regimen involving twice-weekly 45-50 minute group sessions that advance from supine positions to standing and jumping movements. However, the AOT study group will uniquely perform these exercises while observing and imagining projected metaphor-themed visuals to enhance motor learning and motivation. Efficacy will be evaluated pre- and post-intervention using various standardized tools, including the Pelvic Floor Distress Inventory-20, a 24-hour pad test, the Incontinence Severity Index, the Movement Imagery Questionnaire-3, and the Incontinence Quality of Life Scale, to comprehensively assess improvements in incontinence severity, functional status, and overall well-being.
Diagnosed with stress or stress-predominant mixed urinary incontinence by a physician
Women aged 65 years and older
Literate in Turkish to understand, interpret, and answer the questionnaires
Scoring 24 or higher on the Mini-Mental State Examination (MMSE)
Received pelvic floor muscle training within the past 6 months
Presence of fecal incontinence
Current genitourinary infection or use of medication for urinary incontinence
History of urinary incontinence surgery or presence of symptomatic pelvic organ prolapse
Parallel
Pelvic Floor Muscle Training program
Other interventionParticipants will engage in a 12-week Pelvic Floor Muscle Training (PFMT) program. The exercises will be conducted twice a week in group sessions lasting 45-50 minutes each. These sessions will be supervised by a physiotherapist and performed in small groups of five participants.
Pelvic Floor Muscle Training via Action Observation Therapy
Other interventionParticipants will be enrolled in a Pelvic Floor Muscle Training (PFMT) program using the action observation method accompanied by metaphorical imagery. This program will be administered over 12 weeks, consisting of twice-weekly group sessions lasting 45-50 minutes each. The exercise content is identical for both groups. However, during the sessions for this specific group, metaphor-themed visuals will be projected onto a screen, and participants will be given the instruction: 'Perform the movement by imagining it as shown in the visual.' To enhance physical participation and motivation, verbal cues and positive reinforcement will be provided by the physiotherapist. The exercises and the corresponding metaphors will be updated on a weekly basis. All sessions will be supervised by a physiotherapist in small groups of five participants.
Mini-Mental State Examination
Pelvic Floor Distress Inventory
The Incontinence Severity Index
Movement Imagery Questionnaire-3
Geriatric Self-Efficacy Index for Urinary Incontinence
Incontinence Quality of Life Questionnaire
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