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A longitudinal randomized controlled trial (RCT) was conducted to evaluate the effectiveness of physiotherapeutic pelvic floor muscle exercise (PFME) therapy supplemented with a health education program to promote long-term adherence among women with stress, mixed, and urge urinary incontinence (UI). Women (n = 129) were evaluated by their general practitioner (GP) and randomized in either the control group (PFME therapy alone) or one of the three experimental groups (PFME therapy with one of the three health education program versions). Therapy consisted of 9–18 individual 30 min sessions with a specialized physiotherapist, over 14–22 weeks. Outcome measures were weekly frequency of wet episodes and adherence behavior. Women were assessed up to 1 year after therapy. The health education program had no additional impact to individual contact during PFME therapy on treatment outcome, nor on adherence. However, the individual physiotherapeutic treatment protocol was very effective in reducing weekly frequency of wet episodes from 23 to 8 times a week immediately after therapy, and effects were maintained during the 1-year follow-up period. Adherence was very high; most women followed the behavioral advice on average 6 days/week at posttest and still 4–5 days 1 year after therapy. Results were not different between incontinence types. Women who had relatively frequent wet episodes before and 1 year after therapy had higher adherence levels compared to women who had fewer weekly losses. Results suggest that a standardized protocol checklist for physiotherapists covering all treatment aspects of PFME therapy, may optimize long-term treatment outcome and adherence behavior among patients, and outshines the addition of a health education program. Neurourol. Urodynam. 22:284–295, 2003. © 2003 Wiley-Liss, Inc.

Studies that have examined correlations between psychosocial factors and survival in cancer patients do not permit any definitive conclusions. To the authors' knowledge, to date no study has examined the relation between medical as well as quality of life variables and survival in head and neck carcinoma patients. The current study focused on the complex interactions among psychosocial, medical, behavioral, and demographic variables as they relate to prognosis in these patients. A total of 133 consecutive head and neck carcinoma patients were included in a prospective study at pretreatment. In addition to clinical variables, psychosocial and physical functioning was assessed by means of a self-report questionnaire. During the observation period 57 patients died whereas 76 were still alive at 6 years after treatment. Results of the multivariate survival analysis indicated that patients without head and neck metastasis had a better prognosis than patients with positive cervical lymph nodes. Pretreatment smoking showed a negative correlation with overall survival. Patients who were more physically self-efficacious (i.e., higher perceived physical abilities) were more likely to survive and less likely to develop a recurrence. In addition, patients who expressed intense psychosocial complaints prior to treatment had a better prognosis than had those who did not express such negative feelings. The current findings linking physical self-efficacy and prognosis are promising, but clinical trials are necessary to examine the direct and indirect mediational pathways of the variables that underlie physical efficacy and influence survival and recurrence. Also, the negative correlation between pretreatment smoking and survival suggests a need for increased efforts to address smoking in newly diagnosed patients. Cancer 1998;83:2567-2579. © 1998 American Cancer Society.