Adherence and continuance intention of biofeedback-assisted pelvic floor muscle training: a theory-driven study among women with pelvic floor disorders

BACKGROUND: Adherence to pelvic floor muscle training (PFMT) remains a major challenge in the conservative management of pelvic floor disorders in women. Although biofeedback-assisted PFMT facilitates motor learning, sustained engagement may be influenced by a range of behavioral and experiential factors. This study investigated clinical and behavioral determinants of engagement with PFMT technologies and examined changes in manometry-derived pelvic floor muscle performance during a supervised biofeedback-assisted PFMT. METHODS: This prospective observational study examined outpatient care for women with pelvic floor disorder. Participants completed six PFMT sessions with manometer-based biofeedback. Based on baseline Pelvic Floor Distress Inventory-20 (PFDI-20) scores, participants were stratified into low- and high-symptom groups. Changes in muscle performance were evaluated using repeated-measures analysis of variance. Adherence determinants were examined using partial least squares structural equation modeling (PLS-SEM). RESULTS: Participants with lower baseline symptoms showed higher program adherence. Significant improvements in contraction and peak pressure occurred over time (p < .01), with comparable benefits across symptom groups. Perceived usefulness emerged as the strongest predictor of sustained engagement, followed by self-efficacy, confirmation, and early engagement. Satisfaction and perceived ease of use did not directly predict continuance. Privacy and comfort concerns negatively influenced satisfaction, indirectly reducing continuance intention. Higher baseline quality of life impairment correlated with lower adherence. CONCLUSIONS: Biofeedback-assisted PFMT enhances pelvic floor muscle performance across varying symptom severities; however, sustained engagement is primarily driven by perceived functional benefit rather than satisfaction alone. These findings highlight the need to integrate behavioral, experiential, and functional considerations in PFMT interventions. TRIAL REGISTRATION: The Institutional Review Board of National Cheng Kung University Hospital, Tainan, Taiwan, thoroughly reviewed and approved the procedures and consent form (Reference Number AER112385 Registration number NCT07243028 at ClinicalTrials.gov).