While randomized trials have demonstrated the efficacy of group-based pelvic floor muscle training (PFMT) for the treatment of urinary incontinence (UI) in older women under controlled conditions (1,2), effectiveness in real-world clinical practice remains unclear. This pragmatic study aimed to evaluate the effectiveness of a group-based PFMT for the treatment of UI in older women within public healthcare settings.

This pre-post study was conducted in routine clinical practice. Two regional public healthcare centres recruited patients aged ≥60 with stress or mixed UI (≥3 leakage episodes/week), from their waitlists. 

A trained local pelvic floor physiotherapist confirmed patients’ ability to perform a correct pelvic floor muscle (PFM) contraction through vaginal digital assessment. Successful patients completed a 12-week group-based PFMT program: weekly 1-hour sessions (6–8 per group), including education and progressive supervised exercises, and a structured home exercise program 5 days per week.

Data from three implementation cycles at each of the two centres were included. Effectiveness outcomes were collected at baseline and post intervention: the number of weekly UI episodes (7-day bladder diary) (3), symptom severity (ICIQ-UI SF), and UI-specific quality of life (ICIQ-LUTSqol). Post-intervention outcomes also included Patient Global Impression of Improvement (PGI-I), perceived percentage of improvement, attendance at the 12 supervised group sessions (number attended), exercise adherence to prescribed 240 exercises (number completed), need for additional treatment, and adverse events.

Descriptive statistics were used to summarize patient characteristics and outcomes. Mean differences with 95% confidence intervals were estimated using linear mixed models, with random effects accounting for correlation within individuals and within centres.

There were 38 women at baseline (see Table 1). Two withdrew during the study, leaving 36 for post-intervention analysis.

Participants attended a mean of 10.9/12 sessions (SD 1.05; 90.5%) and completed a mean of 197.2/240 prescribed exercises (SD 34.1; 82.2%).

Significant improvements were observed across all effectiveness outcomes. Weekly UI episodes decreased significantly (mean difference −8.02; 95% CI −11.19 to −4.84; p<0.001). Both symptom severity (ICIQ-UI SF: −7.00; 95% CI −9.62 to −4.38; p<0.001) and quality of life (ICIQ-LUTSqol: −7.80; 95% CI −10.55 to −5.06; p<0.001) improved significantly. See Table 2.

Patients reported a mean perceived improvement of 72.0% (SD 25.1). On the PGI-I, 47.2% of patients reported being “very much better”, 30.6% “much better”, 19.4% “a little better”, and 2.8% reported no change. Additionally, 88.6% reported no need for additional treatment following the intervention. No adverse events were reported.

These findings suggest group-based PFMT in clinical settings can produce statistically meaningful reductions in UI episodes and improve symptom severity and quality of life in older women. 

High adherence to both supervised sessions and home exercises, combined with strong patient-reported improvement (PGI-I) and the high proportion reporting no need for additional treatment, supports the clinical relevance and acceptability of this intervention. The absence of adverse events suggests that the intervention is safe.

These findings confirm results from previous randomized controlled trials (1) and extend the evidence to real-world clinical practice, demonstrating that group-based PFMT can be effectively implemented in regional healthcare centres. Qualitative evaluation exploring patients’, healthcare providers’, and managers’ experiences with the intervention will be reported in a separate manuscript.

Group-based PFMT delivered in regional healthcare centres is an effective, safe, and scalable intervention for managing UI in older women, supporting integration into public healthcare systems to improve access to conservative continence care.

Group-Based vs Individual Pelvic Floor Muscle Training to Treat Urinary Incontinence in Older Women: A Randomized Clinical Trial. JAMA Intern Med. 2020 Oct 1;180(10):1284-1293. doi: 10.1001/jamainternmed.2020.2993. PMID: 32744599; PMCID: PMC7400216.
Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev. 2024 Dec 20;12(12):CD009508. doi: 10.1002/14651858.CD009508.pub2. PMID: 39704322; PMCID: PMC11660230.
Reliability assessment of the bladder diary for urinary incontinence in older women. J Gerontol A Biol Sci Med Sci. 2001 Jan;56(1):M32-5. doi: 10.1093/gerona/56.1.m32. PMID: 11193230.