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Influence of nurse-patient therapeutic relationship on uncertainty during rehabilitation for urinary incontinence: validation of the novel MUIS-Pelvic Floor scale.
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  • Stefano Terzoni,
  • Paolo Ferrara,
  • Giancarlo Celeri Bellotti,
  • Cristina Mora,
  • Sara Alessandrini,
  • Pietro Marconi,
  • Eva Wallace,
  • Anne Destrebecq
Stefano Terzoni
ASST Santi Paolo e Carlo

Corresponding Author:[email protected]

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Paolo Ferrara
ASST Santi Paolo e Carlo
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Giancarlo Celeri Bellotti
ASST Santi Paolo e Carlo
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Cristina Mora
ASST Santi Paolo e Carlo
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Sara Alessandrini
Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico
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Pietro Marconi
IRCCS University Hospital of Bologna S Orsola-Malpighi Polyclinic
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Eva Wallace
Dún Laoghaire
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Anne Destrebecq
Università degli Studi di Milano
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Abstract

Rationale, aims and objectives: Urinary incontinence has a high prevalence worldwide, ranging from 25 to 45%. Incontinence is often treatable with conservative interventions, which however demand a long and intensive commitment from the patient. Results are not immediate and relapses are possible; patients can experience uncertainty and difficulty to comply with rehabilitation programs, hence the importance of therapeutic relationship with a healthcare professional. Mishel’s theory of uncertainty can be used to measure uncertainty and the effects of such relationship, but no instrument currently exist to this purpose. We sought to create an Italian version of the MUIS (Mishel’s Uncertainty in Illness Scale) dedicated to people undergoing conservative rehabilitation for urinary incontinence. Method: a prospective observational study enrolling all male and female adult patients admitted to a nurse-led outpatient pelvic clinic for non-neurogenic urinary incontinence, exluding 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 an exploratory factor analysis was conducted. Results: 109 patients enrolled (54 M, 55 F) aged 64±5 years, medial initial leakage 245 grams/day, IQR[90;370]. Seventy-nine percent of the patients obtained continence; there were no dropouts during the study. Internal consistency of the MUIS-PF was high (93%) and structure analysis yielded clear separation of the factors. Patients uncertainty decreased significantly at the end of the program, compared to the first consultation (p<0.001). Conclusions: The MUIS-PF is valid and reliable. Utilising the correct approach the nurse could significantly reduce the uncertainty of persons with incontinence during the process, by listening, giving clear information and searching for the best solution for their continence issues. Future studies could focus on specific features of programs run by professionals other than nurses.