Effects of Action Observation and Metaphorical Imagery in Pelvic Floor Muscle Training for Geriatric Urinary Incontinence

Investigation of the Effects of Pelvic Floor Muscle Training Applied Via Action Observation Method Accompanied by Metaphorical Imagery on Urinary Incontinence in Geriatric Women

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.

Inclusion Criteria:

• 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)
• Able to walk independently without the use of any walking aids (assistive devices)
• Having signed the informed consent form

Exclusion Criteria:

• 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
• Presence of neurological, orthopedic, psychiatric, hematological, or cardiovascular conditions that would preclude participation in exercise
• Body mass index (BMI) ≥ 25 kg/m²
• Hearing or visual impairments that would negatively affect participation
• Presence of hematuria, urethral and/or bladder fistula, or a history of pelvic surgery