Adherence and uncertainty during rehabilitation for urinary incontinence: Validation of a scale

We sought to create an Italian version of Mishel's Uncertainty in Illness Scale, dedicated to people undergoing conservative rehabilitation for urinary incontinence, for studying uncertainty as a determinant of therapeutic adherence. Urinary incontinence has a high prevalence worldwide, ranging from 25% to 45%. Incontinence is often treatable with conservative interventions but demands a long and intensive commitment from the patient. Results are not immediate, and relapses are possible. These patients can experience uncertainty and difficulty complying with rehabilitation programs, hence the importance of the therapeutic relationship with a healthcare professional. Mishel's theory of uncertainty can be used to measure uncertainty and the effects of such a relationship, but no instrument currently exists for this purpose. Prospective observational study enrolling all male and female adult patients admitted to a nurse-led outpatient pelvic clinic for non-neurogenic urinary incontinence, excluding puerpera. A scale named MUIS-PF (pelvic floor) was created, based on previous versions of Mishel's scale, and administered during the first consultation and at the end of the rehabilitation program. Internal consistency was assessed, and exploratory factor analysis was conducted. A total of 109 patients enrolled (54 M, 55 F) aged 64 ± 5 years, medial initial leakage 245 grams/day, IQR [90; 370]. Seventy-nine percent obtained continence; there were no dropouts during the study. Internal consistency of the MUIS-PF was high (93%), and structure analysis yielded a clear separation of the factors. Patient uncertainty decreased significantly at the end of the program compared to the first consultation (p < 0.001). The MUIS-PF is valid and reliable. Utilizing the correct approach, the nurse could significantly reduce the uncertainty of persons with incontinence by listening, giving clear information and searching for the best solution for their continence issues.