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Burgio K, Echt K, Markland A, Enemchukwu E, Williams B. A mobile telehealth program for behavioral treatment of urinary incontinence in women Veterans: Qualitative evaluation of MyHealth eBladder. J Women Aging 2024:1-17. [PMID: 39331496 DOI: 10.1080/08952841.2024.2401716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 08/16/2024] [Accepted: 08/30/2024] [Indexed: 09/29/2024]
Abstract
Women Veterans constitute a distinctive cohort whose exposure to military service can contribute to development of bladder conditions, such as urinary incontinence (UI), as they age. Behavioral therapies are recommended as first-line treatment for incontinence, yet many VA Medical Centers do not have staff trained to administer them. The purpose of this research study was to conduct a qualitative program evaluation of MyHealtheBladder, a mobile telehealth version of an evidence-based eight-week behavioral treatment program designed for women Veterans with incontinence. MyHealtheBladder uses mobile telehealth technology to teach pelvic floor muscle exercises, bladder control strategies, fluid management, risk factor reduction, and self-monitoring. Eighteen women Veterans who completed a pilot study of MyHealtheBladder participated in semi-structured telephone interviews exploring their experience with the program. A directed content analysis was conducted of the transcribed interview data. Participants described ease of accessing MyHealtheBladder using smart phones and other mobile devices, emphasizing the flexibility of using the program at home, work, or while traveling. Most participants described program content as understandable, relevant, and easy to follow. They discussed how the program increased knowledge of UI, promoted consistency in practicing behavioral therapy, strengthened pelvic floor muscles, reduced urine leakage, and improved psychosocial wellbeing. Suggestions for improvement included more interaction with staff, more individualized tailoring of content to UI type, incorporating in-person clinic visits, and including supplementary material. Participants uniformly endorsed the program and recommended it for other women Veterans, as well as for those in active duty to prevent or treat UI earlier in the life course.
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Affiliation(s)
- Kathryn Burgio
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, USA, and Atlanta, GA, USA
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Katharina Echt
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, USA, and Atlanta, GA, USA
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Alayne Markland
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, USA, and Atlanta, GA, USA
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Ekene Enemchukwu
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Beverly Williams
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL, USA, and Atlanta, GA, USA
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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Yang X, Sayer L, Bassett S, Woodward S. Group-based pelvic floor muscle training for pregnant women: A randomized controlled feasibility study. J Adv Nurs 2024. [PMID: 39140698 DOI: 10.1111/jan.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/05/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024]
Abstract
AIM This study aims to test the feasibility and acceptability of a group-based pelvic floor muscle training for pregnant women in China and facilitate women's adherence to the pelvic floor muscle training programme. BACKGROUND Urinary incontinence is a prevalent health problem in women worldwide, especially in pregnant women. Supervised pelvic floor muscle training is recommended as the first-line conservative treatment for urinary incontinence. However, the implementation and effectiveness of pelvic floor muscle training are limited by insufficient human resources and low adherence. Group-based interventions may improve people's adherence to interventions by facilitating peer support. However, it has been investigated in a limited number of maternity studies. DESIGN Feasibility testing randomized controlled trial, accompanied by a mixed methods process evaluation. METHODS This study was guided by the Medical Research Council framework for complex interventions and the Behaviour Change Wheel guide to developing interventions. A three-phase, mixed-methods design was used in this study. This study reported the feasibility of the group-based pelvic floor muscle training programme. Semi-structured reviews were conducted following the intervention to explore the acceptability of the programme. RESULTS The study included 48 pregnant women with a recruitment rate of 52.17%. The adherence rate to the training programme was 66.67%. The intervention was positively valued, in particular the support promoting participants' adherence, but additional changes need to be made to the programme for a future trial. CONCLUSIONS Group-based pelvic floor muscle training programme provides a possible way of delivering pelvic floor muscle training with limited health professionals in China. The study showed promising results concerning the acceptability and feasibility of the intervention, which were well perceived by both pregnant women and the midwife. IMPLICATIONS FOR PATIENT CARE Group-based pelvic floor muscle training may have the potential of reducing the prevalence of urinary incontinence in pregnant women with insufficient healthcare professionals. IMPACT This study assessed the feasibility of delivering group-based pelvic floor muscle training in pregnant women in China. The group-based pelvic floor muscle training is acceptable to both pregnant women and the midwife, but integrating online and face-to-face sessions need to be considered. The findings of this study provided evidence for delivering group-based pelvic floor muscle training to pregnant women in China. REPORTING METHOD The study has adhered to CONSORT guidelines (Table S1) and TIDier checklist (Table S2). PATIENT AND PUBLIC CONTRIBUTION The patient and public have been invited as stakeholders during the development of the intervention. They worked with healthcare professionals to co-design the group-based pelvic floor muscle training programme. REGISTRATION The trial was registered on ClinicalTrials.gov (NCT05242809) under the title 'Development and Feasibility Testing of a Group-based PFMT Programme for Antenatal Women in Nanjing City in China'.
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Affiliation(s)
- Xiaowei Yang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Department of Clinical Teaching and Research, Nanjing Vocational Health College, Nanjing, China
| | - Lynn Sayer
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sam Bassett
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sue Woodward
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Karhu E, Gurland B, Barten J, Miller L, Yi G, Shen S, Neshatian L. Telehealth is effective for pelvic health physical therapy. Neurogastroenterol Motil 2024; 36:e14844. [PMID: 38873829 DOI: 10.1111/nmo.14844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/30/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Telehealth utilization, largely spurred by the COVID-19 pandemic, has become popular due to convenience and access. We assessed the effectiveness of telehealth for delivering pelvic health physical therapy (PHPT) in patients with pelvic floor disorders (PFD). METHODS In this IRB approved, cross-sectional study, 812 patients who underwent PHPT treatment by telehealth or in combination with in-person visits were surveyed. Post intervention effectiveness was analyzed using Patient Global Impression of Change (PGIC) and short form Pelvic Floor Impact Questionnaire (PFIQ-7). RESULTS One hundred and forty-one patients, 80% female, mean (SD) age of 52 (17) completed the study. The mean number of encounters was 4.55 (4.25) with 2.81 (2.08) telehealth visits. A total of 42 (30%) patients reported no change/worse, 27 (19%) minimal, and 72 (51%) moderate/much improvement of symptoms consistent with a lower PFIQ-7 scores. Patients who reported improvement were significantly younger (p < 0.002). Age was the only independent factor that could predict response to PHPT. Patients <50 years old reported significantly more symptom improvement (p < 0.02), symptom resolution (p < 0.002), meeting personal goals (p < 0.0001), improved muscle strength, coordination, and relaxation (p < 0.05), greater satisfaction with bowel movements, and less negative impact of bowel on quality of life (p < 0.005) than older patients. Regardless of age, 89 (64%) patients preferred hybrid telehealth visits. CONCLUSION & INFERENCES Utilizing telehealth alone or in a hybrid format combined with in-person visits for PHPT appears to be preferred by patients and associated with subjective report of improvement of symptoms. However, efficacy of telehealth interventions in older adults warrants further studies.
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Affiliation(s)
- Elisa Karhu
- Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Brooke Gurland
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Gloria Yi
- Stanford Health Care, Stanford, California, USA
| | - Sa Shen
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
| | - Leila Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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Karaahmet AY, Bilgiç FŞ, Kızılkaya Beji N. The effect of telehealth on incontinence severity given to women with urinary incontinence: A systematic review and meta-analysis of randomized controlled trials. Actas Urol Esp 2024; 48:384-391. [PMID: 38360107 DOI: 10.1016/j.acuroe.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Although urinary incontinence does not cause mortality, it is a global health problem that adversely affects the quality of life and health of women. OBJECTIVE The aim of this study was to conduct a systematic review and meta-analysis of the studies investigating the effect of telehealth given to women with urinary incontinence (UI) on the severity of incontinence. METHODS The literature review for this systematic review was conducted between August-Semptember 2023 using four electronic databases. Y-based articles were scanned using MeSH-based keywords. Randomized Controlled Trials conducted over the last decade were included in the screening. RESULTS The analysis included six studies involving 826 women with UI. After telehealth intervention, there was a significant difference in UI symptom severity (MD: -2.14 95% CI: -2.67 to -1.62, Z=8.03, p<0.00001) and quality of life (SMD: -2.14 95% CI: -2.67 to -1.62, Z=8.03, p<0.00001) compared to the control groups. It had no effect on sexuality (MD: -4.65 95% CI: -9.60 to 0.30, Z=1.84, p=0.07), and anxiety (SMD: -0.15, 95% CI: -0.38 to 0.08, Z=1.27, p=0.21). CONCLUSION In this analysis, it was found that telehealth interventions performed on women with UI increased the quality of life while reducing the severity of incontinence in women, but had no effect on sexuality, and anxiety.
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Affiliation(s)
- A Y Karaahmet
- Departamento de Partería, Facultad de Ciencias de la Salud, Universidad de Haliç, Estambul, Turkey
| | - F Ş Bilgiç
- Departamento de Partería, Facultad de Ciencias de la Salud, Universidad de Haliç, Estambul, Turkey.
| | - N Kızılkaya Beji
- Facultad de Ciencias de la Salud, Universidad de Biruni, Estambul, Turkey
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Buck J, Fromings Hill J, Collins R, Booth J, Fleming J. Effectiveness of non-pharmacological interventions delivered at home for urinary and faecal incontinence with homebound older people: systematic review of randomised controlled trials. Age Ageing 2024; 53:afae126. [PMID: 38941119 PMCID: PMC11212545 DOI: 10.1093/ageing/afae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Incontinence is a common, distressing condition, most prevalent in older people. There is an unmet need for effective interventions to support continence. This review focuses on non-pharmacological interventions to reduce incontinence among homebound older people. Aim: to identify interventions with potential to be delivered by care workers, nurses or family members in a person's home. METHODS Multiple databases were searched until 15 September 2023 for randomised controlled trials reporting home-based interventions for incontinence for older people (≥65 years) living at home. Two reviewers independently screened titles, abstracts and papers against inclusion criteria, then assessed for the Risk of Bias (RoB2). A third reviewer resolved the discrepancies. Primary data were extracted and synthesised. RESULTS A full-text review of 81 papers identified seven eligible papers (1996-2022, all USA), including n = 636 participants (561 women and 75 men). Two studies focusing on multicomponent behavioural interventions showed benefit, as did one study of transcutaneous tibial nerve stimulation self-administered through electrode-embedded socks. Three, which included cognitively impaired people, reported improvement with toileting assistance programmes, but the effects were not all significant. Results were inconclusive from a study examining the effects of fluid intake adjustments. Interventions were delivered by nurses, three in collaboration with family caregivers. No faecal incontinence interventions met the criteria. CONCLUSION There is scant evidence for continence supporting interventions delivered in older people's own homes. With an ageing population often reliant on family or social care workers well-placed to support continence promotion and policy drives for services to support older people remaining at home, this evidence gap needs addressing.
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Affiliation(s)
- Jackie Buck
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Julia Fromings Hill
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Rachael Collins
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Joanne Booth
- Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jane Fleming
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
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Mantilla Toloza SC, Villareal Cogollo AF, Peña García KM. Pelvic floor training to prevent stress urinary incontinence: A systematic review. Actas Urol Esp 2024; 48:319-327. [PMID: 38556125 DOI: 10.1016/j.acuroe.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/15/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is a common disorder in women that has a negative impact on quality of life. Pregnancy and childbirth are considered important risk factors that directly affect the pelvic floor during pregnancy and labour, increasing the risk of pelvic floor dysfunction, with prevalence rates of SUI in the postpartum period ranging from 30 to 47% during the first 12 months. OBJECTIVE To determine the effectiveness of pelvic floor muscle training (PFMT) in the prevention of SUI in women during the antenatal and postnatal period by reviewing and evaluating the available scientific literature. METHODS This is a systematic review, using only randomised controlled trials. We searched the databases Pubmed, Scopus, Cochrane and PEDro. We reviewed 7 prospective studies in English and Portuguese, which included 1,401 pregnant women of legal age who underwent PFMT to prevent SUI. RESULTS The results allowed us to establish that PFMT is used for pelvic floor muscles and that this intervention, applied with the appropriate methodology, can prevent or cure SUI. CONCLUSIONS The application of PFMT in an early stage of pregnancy has positive effects on the continence capacity after delivery.
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Affiliation(s)
- S C Mantilla Toloza
- Departamento de Fisioterapia, Facultad de Salud, Universidad de Pamplona, Pamplona, Colombia.
| | - A F Villareal Cogollo
- Departamento de Fisioterapia, Facultad de Salud, Universidad de Pamplona, Pamplona, Colombia
| | - K M Peña García
- Departamento de Fisioterapia, Facultad de Salud, Universidad de Pamplona, Pamplona, Colombia
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Wadensten T, Nyström E, Sjöström M, Lindam A, Samuelsson E. APP-based treatment of urgency and mixed urinary incontinence in women: factors associated with long-term satisfaction. Arch Gynecol Obstet 2024; 309:2193-2202. [PMID: 38141064 PMCID: PMC11018664 DOI: 10.1007/s00404-023-07303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE App-based treatment of urgency (UUI) and mixed (MUI) urinary incontinence has proved to be effective. To further improve treatment, it will be beneficial to analyze baseline and treatment-related factors that are associated with satisfaction. METHODS A secondary analysis was conducted of data from a randomized controlled trial (RCT) assessing an app for UUI or MUI treatment, encompassing 98 women for whom there was long-term treatment satisfaction data. All participants completed a short-term (15 weeks) and a long-term (15 months) follow-up questionnaire after being given access to treatment. The outcome was a 3-item question on current treatment satisfaction at the long-term follow-up. Factors potentially associated with the outcome were analyzed using the chi-square test, Student's t test or logistic regression. RESULTS At the long-term follow-up, 58% of the women were satisfied with the treatment. The most important baseline variable associated with satisfaction was incontinence-related quality of life (International Consultation on Incontinence Questionnaire (ICIQ) - Lower Urinary Tract Symptoms Quality of Life Module) (OR 0.91, 95% CI 0.58-0.97). Short-term follow-up variables associated with long-term treatment satisfaction were improvement in the ability to endure urgency (OR 4.33, 95% CI 1.43-13.12), and confidence in pelvic floor contraction ability (OR 2.67, 95% CI 1.04-6.82). CONCLUSION App-based treatment for UUI and MUI may be an alternative first-line treatment that is satisfactory to many women over the long-term. Furthermore, short-term treatment that focuses on improving the ability to endure urgency, and confidence in pelvic floor contraction ability, can also be recommended for long-term satisfaction.
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Affiliation(s)
- Towe Wadensten
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Emma Nyström
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
- Unit of Research, Education, and Development, Östersund Hospital, Östersund, Sweden
| | - Malin Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Anna Lindam
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
- Unit of Research, Education, and Development, Östersund Hospital, Östersund, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
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Firet L, Teunissen TAM, Kool RB, Akkermans RP, Lagro-Janssen ALM, van der Vaart H, Assendelft WJJ. The relation between usage of an eHealth intervention for stress urinary incontinence and treatment outcomes: an observational study. BMC PRIMARY CARE 2024; 25:89. [PMID: 38493288 PMCID: PMC10943843 DOI: 10.1186/s12875-024-02325-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Stress urinary incontinence (SUI), though a prevalent condition among women, is undertreated in primary care. EHealth with pelvic floor muscle training is an evidence-based alternative to care-as-usual. It is unknown, however, how eHealth usage is related to treatment outcome, and this knowledge is required for general practitioners to implement eHealth in their practice. This study examines the relation between usage of eHealth for SUI and treatment outcomes by examining log data. Baseline factors were also explored for associations with treatment success. METHOD In this pre-post study, women with SUI participated in "Baasoverjeblaas.nl", a web-based intervention translated from the Swedish internet intervention "Tät®-treatment of stress urinary incontinence". Usage was based on log data and divided into three user groups (low, intermediate and high). Online questionnaires were sent before, after treatment and at six-months follow-up. The relation between usage and the primary outcome - treatment success (PGI-) - was studied with a binomial logistic regression analysis. Changes in the secondary outcomes - symptom severity (ICIQ-UI SF) and quality of life (ICIQ-LUTSqol) - were studied per user group with linear mixed model analysis. RESULTS Included were 515 users with a mean age of 50.5 years (12.0 SD). The majority were low users (n = 295, 57.3%). Treatment success (PGI-I) was reached by one in four women and was more likely in high and intermediate users than in low users (OR 13.2, 95% CI 6.1-28.5, p < 0.001 and OR 2.92, 95% CI 1.35-6.34, p = 0.007, respectively). Symptom severity decreased and quality of life improved significantly over time, especially among high users. The women's expected ability to train their pelvic floor muscles and the frequency of pelvic floor muscle exercises at baseline were associated with treatment success. CONCLUSION This study shows that usage of eHealth for SUI is related to all treatment outcomes. High users are more likely to have treatment success. Treatment success is more likely in women with higher expectations and pelvic floor muscle training at baseline. These findings indicate that general practitioners can select patients that would be more likely to benefit from eHealth treatment, and they can enhance treatment effect by stimulating eHealth usage. TRIAL REGISTRATION Landelijk Trial Register NL6570; https://onderzoekmetmensen.nl/nl/trial/25463 .
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Affiliation(s)
- Lotte Firet
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands.
| | - Theodora Alberta Maria Teunissen
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands
| | - Rudolf Bertijn Kool
- Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands
| | - Reinier Peter Akkermans
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands
- Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands
| | - Antoinette Leonarda Maria Lagro-Janssen
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands
| | - Huub van der Vaart
- Department of Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem Jan Jozef Assendelft
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands
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Chen KY, Jones MK, Zillioux JM, Rapp DE. Pilot Study of a Novel Online Comprehensive Pelvic Floor Program for Urinary Incontinence in Women. Int Urogynecol J 2024; 35:415-421. [PMID: 38175280 DOI: 10.1007/s00192-023-05695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) is common in women and has a vast impact on quality of life (QOL), financial health, and work disability. Robust evidence demonstrates the efficacy of comprehensive conservative therapy (pelvic floor muscle training [PFMT], and behavioral and dietary modification) in the treatment of UI. However, numerous barriers impede access to this care, including limited specialized therapists, financial barriers, and scheduling obstacles. To address these barriers, we developed a novel comprehensive online pelvic floor program (oPFP). METHODS We performed a prospective study assessing continence and QOL outcomes in women with stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed urinary incontinence (MUI) treated with oPFP between May 2019 and November 2022. Outcomes were assessed at baseline and following completion of the 2-month program using the validated International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms, Urgency Perception Scale (UPS), Incontinence Impact Questionnaire (IIQ-7) questionnaires, and 24-h bladder diary. Data were analyzed using linear, Poisson mixed models, or generalized estimating equations. RESULTS Twenty-eight women (2 SUI, 3 UUI, 23 MUI) were enrolled and 19 (2 SUI, 2 UUI, 15 MUI) completed the study. Following oPFP, participants showed significantly improved SUI domain scores (3.04 ± 0.19 vs 1.81 ± 0.23, p < 0.001), UPS reason score (2.52 ± 0.18 vs 2.05 ± 0.14, p = 0.003), IIQ-7 sum scores (5.16 ± 0.88 vs 3.07 ± 0.70, p = 0.038), and daily incontinence episodes (2.96 ± 0.60 vs 1.06 ± 0.29, p < 0.001). Mean patient-reported improvement was 5.4 ± 2.5 (ten-point Likert scale). Of respondents, 89% reported program satisfaction, ease of use, and would recommend the program to others. CONCLUSION The oPFP results in significant improvements to a variety of UI and QOL measures. This program provides an important UI treatment option and gives women greater access to effective conservative therapy.
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Affiliation(s)
- Katherina Y Chen
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Marieke K Jones
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | - David E Rapp
- Department of Urology, University of Virginia, Charlottesville, VA, USA
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Ghaderi F, Kharaji G, Hajebrahimi S, Pashazadeh F, Berghmans B, Salehi Pourmehr H. Physiotherapy in Patients with Stress Urinary Incontinence: A Systematic Review and Meta-analysis. UROLOGY RESEARCH & PRACTICE 2023; 49:293-306. [PMID: 37877877 PMCID: PMC10646808 DOI: 10.5152/tud.2023.23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/04/2023] [Indexed: 10/26/2023]
Abstract
Physiotherapy is the most commonly used treatment for stress urinary incontinence including pelvic floor muscle training, biofeedback, and electrical stimulation. This systematic review evaluated the effects of physiotherapy in patients with stress urinary incontinence compared with no treatment, placebo, sham, surgery, or other inactive control treatments. MEDLINE (via PubMed), The Cochrane Library (CENTRAL), Embase, Scopus, Web of Science, PEDro, and Trip Database were explored using applicable vocabularies for all English and Persian language investigations released from inception to January 2021. On one side, trials including physiotherapy of pelvic floor muscle training, biofeedback, and electrical stimulation and on the other, either no treatment, placebo, sham, surgery, or other inactive control treatments were included. Studies were assessed for appropriateness and methodological excellence. Two authors extracted data. Disagreements were resolved by a third opinion. Data were processed as described in the Joanna Briggs Institute Handbook. Twenty-nine trials with 2601 participants were found, but only 16 were included because of data heterogeneity. The results showed that physiotherapy interventions are better than no treatment in terms of urine leakage, but no difference was found for urinary incontinence severity. Also, physiotherapy showed favorable results over comparison groups for International Consultation on Incontinence Questionnaire, pad test, pelvic floor muscle function, and improvement outcomes. This systematic review supports the widespread use of pelvic physiotherapy as the first-line treatment for adult patients with stress urinary incontinence.
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Affiliation(s)
- Fariba Ghaderi
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghazal Kharaji
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Faculty of Medicine, Tabriz, Iran
| | - Fariba Pashazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Faculty of Medicine, Tabriz, Iran
| | - Bary Berghmans
- Pelvic Care Unit Maastricht, CAPHRI, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Hanieh Salehi Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Papanikolaou DT, Lampropoulou S, Giannitsas K, Skoura A, Fousekis K, Billis E. Pelvic floor muscle training: Novel versus traditional remote rehabilitation methods. A systematic review and meta-analysis on their effectiveness for women with urinary incontinence. Neurourol Urodyn 2023; 42:856-874. [PMID: 36808744 DOI: 10.1002/nau.25150] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To investigate the effectiveness of supervised remote rehabilitation programs comprising novel methods of pelvic floor muscle (PFM) training for women with urinary incontinence (UI). DESIGN A systematic review and meta-analysis including randomized controlled trials (RCTs), involving novel supervised PFM rehabilitation programs as intervention groups (e.g., mobile applications programs, web-based programs, vaginal devices) versus more traditional PFM exercise groups (acting as control); both sets of groups being offered remotely. METHODS Data have been searched and retrieved from the electronic databases of Medline, PUBMED, and PEDro using relevant key words and MeSH terms. All included study data were handled as reported in the Cochrane Handbook for Systematic Reviews of Interventions and the evaluation of their quality was undertaken utilizing the Cochrane risk-of-bias tool 2 (RoB2) for RCTs. The included RCTs, involved adult women with stress UI (SUI) or mixed urinary incontinence, where SUI were the most predominant symptoms. Exclusion criteria involved pregnant women or up to 6-month postpartum, systemic diseases and malignancies, major gynecological surgeries or gynecological problems, neurological dysfunction or mental impairments. The searched outcomes included subjective and objective improvements of SUI and exercise adherence in PFM exercises. Meta-analysis was conducted and included studies pulled by the same outcome measure. RESULTS The systematic review included 8 RCTs with 977 participants. Novel rehabilitation programs included mobile applications (1 study), web-based programs (1 study) and vaginal devices (6 studies) versus more traditional remote PFM training, involving home-based PFM exercise programs (8 studies). Estimated quality with Cochrane's RoB2, presented the 80% of the included studies as "some concerns" and the 20% as "high risk." Meta-analysis included 3 studies with no heterogeneity (I2 = 0) across them. Weak-evidenced results presented home PFM training equally effective with novel PFM training methods (mean difference: 0.13, 95% confidence interval: -0.47, 0.73), with small total effect size (0.43). CONCLUSIONS Novel PFM rehabilitation programs presented as effective (but not superior) to traditional ones in women with SUI, both offered remotely. However, individual parameters of novel remote rehabilitation including supervision by the health professional, remains in question and larger RCTs are required. Connection between devices and applications in combination with real-time synchronous communication between patient and clinician during treatment is challenged for further research across novel rehabilitation programs.
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Affiliation(s)
- Dimitra Tania Papanikolaou
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Sofia Lampropoulou
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | | | - Anastasia Skoura
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Konstantinos Fousekis
- Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Evdokia Billis
- Laboratory of Clinical Physiotherapy and Research, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
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Cross D, Waheed N, Krake M, Gahreman D. Effectiveness of supervised Kegel exercises using bio-feedback versus unsupervised Kegel exercises on stress urinary incontinence: a quasi-experimental study. Int Urogynecol J 2023; 34:913-920. [PMID: 35802177 PMCID: PMC9266083 DOI: 10.1007/s00192-022-05281-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate and compare the efficacy of supervised Kegel exercises with bio-feedback on stress urinary incontinence (SUI) and pelvic floor muscle strength (PFMS) compared with unsupervised Kegel exercises. METHOD Matched-group quasi-experimental study of 29 female participants divided into two groups (supervised and non-supervised) was conducted over 12 weeks. Baseline measurements of PFMS were undertaken by a women's health physiotherapist and a Kegel exercise regime bespoke designed for each participant. The supervised group visited the physiotherapist monthly for bio-feedback training (BT); the unsupervised group continued at home with their individualised Kegel exercises. Data were collected via a perineometer (Peritron™) and self-reporting responses to questionnaires. All participants received a final PFMS measurement on completion of the study. RESULTS Overall Incontinence Severity index (ISI) score was significantly lower in the supervised group post-intervention. Wilcoxon signed-rank tests indicated that supervised Kegel exercises significantly reduced frequency (p= 0.002) and severity (p= 0.020) of overall ISI. Analysis of PFMS were not significantly different, despite an increase in maximum voluntary contraction or pelvic floor muscle strength (PFMS) (p= 0.032) in the supervised group. Of the questionnaires, results of Wilcoxon signed-rank tests indicated that "total bother" was significantly reduced (p= 0.005) in the supervised group. The correlation analysis between PFMS and ISI did not reveal any significant results. CONCLUSIONS The study confirmed that supervised BT is more effective in reducing SUI than unsupervised Kegel exercises, and that this reduction in ISI score did not correlate with the improvement in PFMS.
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Affiliation(s)
- Donelle Cross
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, 0909, Australia.
- College of Nursing and Health Sciences, Flinders University, Bedford Park, 5042, Australia.
| | - Nasreena Waheed
- College of Nursing and Health Sciences, Flinders University, Bedford Park, 5042, Australia
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, 0909, Australia
| | | | - Daniel Gahreman
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, 0909, Australia
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Dufour S, Clancy A, Wu M. Technical Update No. 433: eHealth Solutions for Urinary Incontinence Among Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:150-159.e1. [PMID: 36273716 DOI: 10.1016/j.jogc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this technical update is to establish the state of the science regarding emerging and novel electronic health (eHealth) and mobile health (mHealth) solutions for urinary incontinence among women. TARGET POPULATION Women over 18 years with urinary incontinence. OPTIONS Websites and mobile health applications are useful in the conservative care of urinary incontinence. Relevant care providers should be familiar with such tools, particularly those that use motivational principles for behaviour change, which can be used as adjunct tools for urinary incontinence care. Telemedicine is an effect mode to provide services for the conservative care of urinary incontinence. OUTCOMES Use of eHealth and mHealth solutions has potentially significant health outcomes for patients, providers, and global health systems. Broader use of telemedicine, in and of itself, could improve care access and reduce costs incurred by patients and the health care system. BENEFITS, HARMS, AND COSTS Evidence for the efficacy of eHealth and mHealth technologies and applications for urinary incontinence ranges from weak to strong. However, the research landscape for many of these novel solutions is developing rapidly. Furthermore, these options have minimal or no harm and confer an established cost benefit and care access benefit. EVIDENCE The Cochrane Library, Medline, EMBASE, CENTRAL databases (from January 2014 to April 2019) were searched to find articles related to conservative care of urinary incontinence in women (over 18 years) and studies on eHealth and mHealth interventions for urinary incontinence. Articles were appraised, and the collective evidence was graded. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Relevant primary care providers and medical specialists, including physicians, nurses, midwives, and pelvic health physiotherapists. SUMMARY STATEMENTS RECOMMENDATIONS.
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Dufour S, Clancy A, Wu M. Mise à jour technique N o433 : Cybersanté et incontinence urinaire chez la femme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:160-171.e1. [PMID: 36925223 DOI: 10.1016/j.jogc.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Hou Y, Feng S, Tong B, Lu S, Jin Y. Effect of pelvic floor muscle training using mobile health applications for stress urinary incontinence in women: a systematic review. BMC Womens Health 2022; 22:400. [PMID: 36192744 PMCID: PMC9531466 DOI: 10.1186/s12905-022-01985-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is the first-line treatment for urinary incontinence, but adherence to PFMT is generally poor. Currently, a number of novel strategies exist to facilitate adherence of PFMT. We sought to determine effectiveness of mHealth app-based PFMT for treating stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI) in women. The primary objective was to assess the effects of mHealth app-based PFMT and usual treatment on severity of the symptom, the quality of life (QoL) of users and the patient's global impression of improvement. The secondary objective was to assess how mHealth app use affects adherence of PFMT. METHODS All randomized controlled trials and quasi-randomized controlled trials aimed at evaluating the effects of mHealth app-based PFMT in women with SUI or stress-predominant MUI were included. Twelve electronic databases, namely the Cochrane Library, PubMed, CINAHL, Embase, Web of science, OVID, SciELO, REHABDATA, PEDro database, Chinese CNKI and Wanfang and the Open Grey databases were used as search sources. The protocol was registered in PROSPERO (CRD 42020183515). This systematic review was developed following the PRISMA 2020 Checklist. The Cochrane Handbook for Systematic Reviews of Interventions for Randomized Controlled Trials was used to assess risk of bias in included studies. Two authors extracted the data into a standardized spreadsheet. RESULTS Six studies that met the eligibility criteria were included. The full sample included 439 patients with treatment via mHealth app and 442 controls of usual treatment. ICIQ-UI SF, ICIQ-VS, and QUID scores decreased after follow-up in the mHealth app and control groups in six studies. ICIQ-LUTS QoL scores decreased after follow-up in the mHealth app and control groups in three studies. In only one study, ICIQ-VS QoL scores decreased after 1 month and 2 months of follow-up in the mHealth app group, but increased abruptly after 3 months of follow-up. EQ5D-VAS scores increased in both groups in one study. The percentage of PGI-I increased in the mHealth app group in three studies after follow-up. After follow-up in three studies, BPMSES scores and self-reported adherence scores increased in the mHealth app group relative to the initial time point, but in one study, at 6 months compared with 3 months of follow-up, adherence scores decreased slightly in the mHealth app group. CONCLUSIONS This systematic review determined that mHealth app-based PFMT showed promise from the perspective of improving both outcomes and exercise adherence.
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Affiliation(s)
- Yuqing Hou
- grid.431048.a0000 0004 1757 7762Gynecology Department, Women’s Hospital School of Medicine Zhejiang University, No. 1 Xueshi Road, Hangzhou, 310006 Zhejiang Province China
| | - Suwen Feng
- grid.431048.a0000 0004 1757 7762Gynecology Department, Women’s Hospital School of Medicine Zhejiang University, No. 1 Xueshi Road, Hangzhou, 310006 Zhejiang Province China
| | - Baoqin Tong
- grid.431048.a0000 0004 1757 7762Gynecology Department, Women’s Hospital School of Medicine Zhejiang University, No. 1 Xueshi Road, Hangzhou, 310006 Zhejiang Province China
| | - Shuping Lu
- grid.431048.a0000 0004 1757 7762Gynecology Department, Women’s Hospital School of Medicine Zhejiang University, No. 1 Xueshi Road, Hangzhou, 310006 Zhejiang Province China
| | - Ying Jin
- grid.431048.a0000 0004 1757 7762Gynecology Department, Women’s Hospital School of Medicine Zhejiang University, No. 1 Xueshi Road, Hangzhou, 310006 Zhejiang Province China
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Guo P, Jin Y, Xiang Z, Chen DD, Xu P, Wang X, Zhang W, Mao M, Zheng Q, Feng S. Web-based interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e061151. [PMID: 35768118 PMCID: PMC9244690 DOI: 10.1136/bmjopen-2022-061151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/19/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is one of the most prevalent diseases during pregnancy, which is closely associated with many short-term and long-term maternal and neonatal complications and can incur heavy financial burden on both families and society. Web-based interventions have been used to manage GDM because of the advantages of high accessibility and flexibility, but their effectiveness has remained inconclusive. This systematic review and meta-analysis aims to comprehensively investigate the multidimensional effectiveness of web-based interventions for pregnant women with GDM, thereby aiding implementation decisions in clinical settings. METHODS AND ANALYSIS This systematic review protocol strictly adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Six electronic databases (PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, CINAHL and PsycINFO) will be comprehensively searched from their inception to 26 January 2022 to identify randomised controlled trials and controlled clinical trials regarding the efficacy of web-based interventions for pregnant women with GDM on glycaemic control, behavioural outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service utilisation and costs. Two reviewers will independently conduct the study selection, data extraction and quality assessment. The methodological quality of included studies will be assessed using the Effective Public Health Practice Project assessment tool. The overall meta-analyses for each of the interested outcomes will be performed if the outcome data are sufficient and provides similar effect measures, as well as subgroup analyses for glycaemic control indicators based on the different types of intervention format, interactivity and technology. We will conduct a qualitative synthesis for studies that cannot be quantitatively synthesised. ETHICS AND DISSEMINATION Ethics approval is not required for this review as no human participants will be involved. The results will be disseminated via a peer-reviewed journal or an academic conference. PROSPERO REGISTRATION NUMBER CRD42022296625.
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Affiliation(s)
- Pingping Guo
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yin Jin
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenzhen Xiang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Dan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Xu
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojuan Wang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minna Mao
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Zheng
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suwen Feng
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Sun B, Liu Y, Su T, Sun Y, Liu Z. Electroacupuncture for stress-related urinary incontinence in elderly women: data analysis from two randomised controlled studies. BMJ Support Palliat Care 2022; 12:e164-e170. [PMID: 31919102 PMCID: PMC9120373 DOI: 10.1136/bmjspcare-2019-002034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the efficacy of electroacupuncture (EA) in elderly and non-elderly women with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI). METHODS This study was a secondary analysis of two randomised controlled trials involving 252 women with SUI and 132 women with stress-predominant MUI who were treated with the same EA regimen. Elderly women were defined as those aged >60 years. The main outcome measure was the proportion of patients with ≥50% decrease in the mean 72-hour urinary incontinence episode frequency (IEF) from baseline to week 6. Overall, 1004 women were recruited in the SUI and MUI trials. In the EA group, those with urge-predominant or balanced MUI at baseline were excluded from the current study, resulting in a sample size of 384. RESULTS Out of 384 patients with SUI or stress-predominant MUI who were treated with EA, 371 completed the study. After 6-week treatment, the proportion of women who achieved ≥50% decrease in mean 72-hour IEF from baseline was 57.3% (51/89) in the elderly group and 60.70% (173/285) in the non-elderly group; the between-group difference was not significant (3.11%, 95% CI -9.83% to 16.05%; p=0.637). Similar outcomes were observed at weeks 4, 16 and 28. Both groups showed reduction in the 72 -hour IEF, amount of urine leakage (assessed by 1-hour pad test) and International Consultation on Incontinence Questionnaire-Short Form score from baseline with no significant between-group difference. No obvious EA-related adverse events were observed during the study. CONCLUSION EA may be an effective and safe alternative treatment for SUI or stress-predominant MUI in both elderly and non-elderly women. Age may not affect the treatment outcomes of acupuncture. TRIAL REGISTRATION NUMER NCT01784172, NCT02047032.
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Affiliation(s)
- Biyun Sun
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Tongsheng Su
- Shanxi Province Hospital of Traditional Chinese Medicine, Xian, Shanxi, China
| | - Yuanjie Sun
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Loohuis AMM, Van Der Worp H, Wessels NJ, Dekker JH, Slieker-Ten Hove MCP, Berger MY, Vermeulen KM, Blanker MH. Cost-effectiveness of an app-based treatment for urinary incontinence in comparison with care-as-usual in Dutch general practice: a pragmatic randomised controlled trial over 12 months. BJOG 2022; 129:1538-1545. [PMID: 35460163 PMCID: PMC9545277 DOI: 10.1111/1471-0528.17191] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
Objective To assess the cost‐effectiveness of app‐based treatment for female stress, urgency or mixed urinary incontinence (UI) compared with care‐as‐usual in Dutch primary care. Design A pragmatic, randomised controlled, superiority trial. Setting Primary care in the Netherlands from 2015 to 2018, follow‐up at 12 months. Population Women with ≥2 UI‐episodes per week, access to mobile apps, wanting treatment. Methods The standalone app included conservative management for UI with motivation aids (e.g. reminders). Care‐as‐usual delivered according to the Dutch GP guideline for UI. Main outcome measures Costs and cost‐effectiveness and ‐utility were assessed from a societal perspective, based on incontinence impact adjusted life years (IIALYs), quality adjusted life years (QALYs) and medical, non‐medical and productivity costs. Information on costs was obtained with the iMCQ and iPCQ questionnaires (medical consumption and productivity cost questionnaires). Results In all, 262 women were andomised equally to app or care‐as‐usual; 89 (68%) and 83 (63%) attended follow‐up, respectively. Costs were lower for app‐based treatment with € −161 (95% confidence interval [CI −180 to −151) per year. Cost‐effectiveness showed small mean differences in effect for IIALY (0.04) and QALY (−0.03) and thus larger incremental cost‐effectiveness ratios (ICER: −€3696) and incremental cost‐utility ratios (ICUR: €6379). Conclusion App‐based treatment is a cost‐effective alternative to care‐as‐usual for women with UI in Dutch primary care. Tweetable abstract App‐treatment for female urinary incontinence cost‐effective compared to care‐as‐usual in general practice after 12 months. App‐treatment for female urinary incontinence cost‐effective compared to care‐as‐usual in general practice after 12 months. Linked article: See related article at https://doi.org/10.1111/1471‐0528.16875.
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Affiliation(s)
- Anne M M Loohuis
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Van Der Worp
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Nienke J Wessels
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Janny H Dekker
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Wadensten T, Nyström E, Nord A, Lindam A, Sjöström M, Samuelsson E. App-based self-management of urgency and mixed urinary incontinence in women: One-year follow-up. Neurourol Urodyn 2022; 41:945-954. [PMID: 35266189 PMCID: PMC9313824 DOI: 10.1002/nau.24898] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/22/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate the long-term effect of the Tät®II app for treatment of urgency (UUI) and mixed urinary incontinence (MUI). METHODS Long-term follow-up of a randomized controlled trial, including 123 women ≥18 years old with UUI or MUI, without red-flag symptoms, and ≥2 leakages per week. All participants, regardless of group, had received the intervention, a treatment app, at the long-term follow-up. Long-term data were collected through web-based questionnaires 15 months after participants received the intervention. The app included pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, an exercise log, reminders, reinforcement messages, and tailored advice. The primary outcome was a change in incontinence symptoms (International Consultation on Incontinence Questionnaire [ICIQ]-Urinary Incontinence Short Form [ICIQ-UI SF]), from baseline to follow-up. Other outcomes were urgency symptoms (ICIQ-Overactive Bladder Module (ICIQ-OAB)), quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life Module [ICIQ-LUTSqol]), and improvement (Patient's Global Impression of Improvement [PGI-I]). RESULTS Of the 123 women, 102 (83%) completed the long-term follow-up. The ICIQ-UI SF mean score improved from 11.5 to 7.6 (mean difference 4.0, 95% CI 3.2-4.7). The ICIQ-OAB improved from 6.7 to 5.5 (mean difference 1.3, 95% CI 0.9-1.6) and the ICIQ-LUTSqol improved from 38.0 to 30.9 (mean difference 7.1, 95% CI 5.7-8.5). Of the 102 women, 74 (73%) reported improvement. CONCLUSIONS Self-management with the Tät®II app for UUI and MUI had a significant effect across all outcome measures also long-term and might serve as an alternative first-line treatment for these conditions.
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Affiliation(s)
- Towe Wadensten
- Family Medicine, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Emma Nyström
- Family Medicine, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
- Department of Public Health and Clinical Medicine, Umeå UniversityUnit of Research, Education, and Development, Östersund HospitalUmeåSweden
| | - Anneli Nord
- Family Medicine, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Anna Lindam
- Family Medicine, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Malin Sjöström
- Family Medicine, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Eva Samuelsson
- Family Medicine, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
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McKinney JL, Datar M, Pan L, Goss T, Keyser LE, Pulliam SJ. Retrospective claims analysis of physical therapy utilization among women with stress or mixed urinary incontinence. Neurourol Urodyn 2022; 41:918-925. [PMID: 35353916 PMCID: PMC9311701 DOI: 10.1002/nau.24913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/07/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe the characteristics of women with stress or mixed urinary incontinence (SUI/MUI) receiving physical therapy (PT) services, including referral patterns and PT utilization. METHODS Female patients with claims associated with an SUI or MUI diagnosis (International Classification of Disease-Clinical Modification [ICD-9-CM]: 625.6, 788.33, or ICD-10-CM: N39.3, N39.46) between July 01, 2014 and June 30, 2016 were identified in International business machines (IBM)'s MarketScan Research Database. Inclusion criteria included the absence of pregnancy claims and ≥80% medical and pharmacy enrollment pre- and postindex. First SUI/MUI diagnosis claim determined index. Patients were followed for 2 years, and associated UI-associated PT encounters were identified. Descriptive statistics were calculated for patients with at least one PT visit during the postindex period. RESULTS In a cohort of 103,813 women with incident SUI or MUI diagnosis, 2.6% (2792/103,813) had at least one PT visit in the 2 years following their diagnosis. Mean age at index PT encounter was 50.55 years. A total of 52.36% (1462/2792) women had one to four PT visits; 21.2% (592/2792) had >8 PT visits. In subanalysis of the PT cohort (1345/2792), women who received PT only had the lowest average 2-year postindex total medical cost (mean: $12,671; SD: $16,346), compared with PT plus medications (mean: $27,394; SD: $64,481), and PT plus surgery (mean: $33,656; SD: $26,245), respectively. Over 40% had their first PT visit ≥3 months after their index date. CONCLUSIONS The percentage of women with a PT visit associated with an incident SUI or MUI diagnosis was low (2.6%), and 30% of this group completed three or more PT visits. This suggests poor adherence to clinical guidelines regarding supervised treatment of UI in women. IMPACT STATEMENT Our study suggests underutilization of PT among insured women with SUI and MUI in the 2 years following diagnosis. Interventions to improve this gap in first-line care may represent an opportunity for an increased role for PTs in the care of women with UI.
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Affiliation(s)
- Jessica L. McKinney
- Physical Therapy, School of Rehabilitation SciencesAndrews UniversityBerrien SpringsMichiganUSA
- Renovia Inc.BostonMassachusettsUSA
| | - Manasi Datar
- Boston Healthcare AssociatesBostonMassachusettsUSA
| | - Li‐Chen Pan
- Boston Healthcare AssociatesBostonMassachusettsUSA
| | - Thomas Goss
- Boston Healthcare AssociatesBostonMassachusettsUSA
| | - Laura E. Keyser
- Physical Therapy, School of Rehabilitation SciencesAndrews UniversityBerrien SpringsMichiganUSA
- Renovia Inc.BostonMassachusettsUSA
| | - Samantha J. Pulliam
- Renovia Inc.BostonMassachusettsUSA
- Obstetrics and GynecologyTufts UniversityBostonMassachusettsUSA
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Ekersund J, Samuelsson E, Lindholm L, Sjöström M. A mobile app for the treatment of female mixed and urgency incontinence: a cost-effectiveness analysis in Sweden. Int Urogynecol J 2022; 33:1273-1282. [PMID: 35278093 PMCID: PMC9119896 DOI: 10.1007/s00192-022-05137-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Introduction and hypothesis
A previous randomized controlled trial (RCT) demonstrated that the app Tät II, for self-management of mixed urinary incontinence (MUI) and urgency urinary incontinence (UUI), yielded significant, clinically relevant improvements in symptom severity and quality of life (QoL) compared with a control group. We aimed to assess the cost-effectiveness of Tät II.
Methods
A cost–utility analysis with a 1-year societal perspective was carried out, comparing Tät II with an information app. Data were collected alongside an RCT: 122 community-dwelling women aged ≥18 years with MUI or UUI ≥2 times/week were randomized to 3 months of Tät II treatment focused on pelvic floor muscle training (PFMT) and bladder training (BT; n = 60), or to an information app (n = 62). Self-assessed data from validated questionnaires were collected at baseline and at 3-month and 1-year follow-ups. Costs for assessment, treatment delivery, incontinence aids, laundry, and time for PFMT and BT were included. We calculated quality-adjusted life-years (QALYs) using the International Consultation on Incontinence Modular Questionnaire Lower Urinary Tract Symptoms Quality of Life. The incremental cost-effectiveness ratio (ICER) between the groups was our primary outcome. Sensitivity analyses were performed.
Results
The mean age was 58.3 (SD = 9.6) years. Annual overall costs were €738.42 in the treatment group and €605.82 in the control group; annual QALY gains were 0.0152 and 0.0037 respectively. The base case ICER was €11,770.52; ICERs in the sensitivity analyses ranged from €−9,303.78 to €22,307.67.
Conclusions
The app Tät II is a cost-effective treatment method for women with MUI and UUI.
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Affiliation(s)
- J Ekersund
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden
| | - E Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden
| | - L Lindholm
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden
| | - M Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden.
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Moreira TDC, Constant HM, Gomes Faria A, Matzenbacher AMF, Balardin GU, Matturro L, Silva MSD, Umpierre RN, Rodrigues ÁS, Cabral FC, Pagano CGM. Tradução, adaptação transcultural e validação de questionário de satisfação em telemedicina. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)2837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: A telemedicina facilita o acesso ao cuidado para os pacientes. Essa tecnologia tem apresentado bons resultados clínicos e de satisfação dos usuários. A satisfação é um dos principais indicadores de qualidade dos serviços, e sua avaliação permite mudanças na qualidade da prestação de cuidados, identifica problemas e viabiliza a melhor gestão e os melhores comportamentos dos profissionais de saúde. Do aumento do uso da telemedicina no mundo emergiu a necessidade de entendimento da qualidade desse serviço. Objetivo: Traduzir, adaptar culturalmente e validar um questionário para avaliação da satisfação de pacientes atendidos por telemedicina. Métodos: A versão adaptada após a avaliação por um comitê de juízes foi utilizada em pré-teste com 30 pacientes atendidos no projeto TeleOftalmo. Os resultados do pré-teste foram avaliados a fim de se obter uma versão adequada do instrumento. Além disso, o instrumento foi aplicado em uma amostra de 141 pacientes atendidos via telemedicina. Análises de consistência interna e de validação de constructo foram realizadas. Resultados: O coeficiente de validade de conteúdo (CVC) global foi 0,942, demonstrando clareza, pertinência e relevância das questões. O instrumento apresentou consistência interna com alfa de Cronbach estandardizado de 0,6, considerado aceitável. A análise fatorial exploratória apresentou critério de Kaiser-Meyer-Olkin de adequação de amostragem de 0,56 e o teste de esfericidade de Bartlett apresentou valor de 0,001. Conclusões: A versão brasileira do Questionário de Avaliação da Satisfação de Pacientes Atendidos via Telemedicina (QAS-Tele) é um instrumento fácil e viável para a avaliação da satisfação dos pacientes atendidos por telemedicina.
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Evidence for the Appropriate Use of Telemedicine in Female Pelvic Medicine and Reconstructive Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2021; 16:97-104. [PMID: 34745407 PMCID: PMC8563823 DOI: 10.1007/s11884-021-00635-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/20/2022]
Abstract
Purpose of Review To summarize the available literature regarding telehealth interventions in the management of pelvic floor disorders. Recent Findings Most Female Pelvic Medicine and Reconstructive Surgery (FPMRS) patients own and feel comfortable operating the technology required to participate in telehealth interventions and would be willing to interact remotely with their providers. Telehealth may be an appropriate and effective tool for patient education about bladder and pelvic physiology and pathophysiology, remote pelvic floor muscle strengthening when in-person physical therapy is not accessible, overactive bladder follow-up and medication management, and for postoperative care following uncomplicated incontinence and prolapse surgery. Summary There is a growing body of literature specific to FPMRS supporting various telehealth interventions that could reasonably be expected to improve access to sub-specialty care while maintaining or improving healthcare quality and reducing costs to the patient and the healthcare system.
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Åström Y, Asklund I, Lindam A, Sjöström M. Quality of life in women with urinary incontinence seeking care using e-health. BMC WOMENS HEALTH 2021; 21:337. [PMID: 34544393 PMCID: PMC8454026 DOI: 10.1186/s12905-021-01477-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
Background Quality of life (QoL) in women with urinary incontinence (UI) is mainly affected by UI severity, but it is also affected by the UI subtype, comorbidities, age, and socioeconomic status. e-Health is a new method for providing UI treatment. This study aimed to identify factors with the highest impact on QoL in women that turned to e-health for UI self-management. Methods We analysed data from three randomized controlled trials (RCTs) that evaluated e-health treatments for UI. We included baseline data for 373 women with stress urinary incontinence (SUI) and 123 women with urgency/mixed UI (UUI/MUI). All participants were recruited online, with no face-to-face contact. Participants completed two questionnaires: the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF, range: 0–21 points), for assessing UI severity, and the ICIQ Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol, range: 19–76 points), for assessing condition-specific quality of life (QoL). To identify factors that impacted QoL, we constructed a linear regression model. Results The mean ICIQ-LUTSqol score was 34.9 (SD 7.6). UI severity significantly affected QoL; the adjusted mean ICIQ-LUTSqol score increased by 1.5 points for each 1.0-point increase in the overall ICIQ-UI SF score (p < 0.001). The UI type also significantly affected QoL; the adjusted mean ICIQ-LUTSqol score was 2.5 points higher in women with UUI/MUI compared to those with SUI (p < 0.001). Conclusions We found that women that turned to e-health for UI self-management advice had a reduced QoL, as shown previously among women seeking UI care through conventional avenues, and that the severity of leakage had a greater impact on QoL than the type of UI. Condition-specific factors impacted the QoL slightly less among women that turned to e-health, compared to women that sought help in ordinary care. Thus, e-health might have reached a new group of women in need of UI treatment.
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Affiliation(s)
- Ylva Åström
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden
| | - Ina Asklund
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development - Östersund, Umeå University, 905 81, Umeå, Sweden
| | - Anna Lindam
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development - Östersund, Umeå University, 905 81, Umeå, Sweden
| | - Malin Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden.
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Loohuis AMM, Van Der Worp H, Wessels NJ, Dekker JH, Slieker-Ten Hove MCP, Berger MY, Vermeulen KM, Blanker MH. One year effectiveness of an app-based treatment for urinary incontinence in comparison to care as usual in Dutch general practice: A pragmatic randomised controlled trial over 12 months. BJOG 2021; 129:1474-1480. [PMID: 34437756 PMCID: PMC9544358 DOI: 10.1111/1471-0528.16875] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 12/04/2022]
Abstract
Objective To assess the long‐term effectiveness of app‐based treatment for female stress, urgency or mixed urinary incontinence (UI) compared with care‐as‐usual in primary care. Design A pragmatic, randomised controlled, superiority trial. Setting Primary care in the Netherlands from 2015 to 2018, follow up at 12 months. Population Women with two or more UI episodes per week and access to mobile apps, wanting treatment. A total of 262 women were randomised equally to app or care‐as‐usual; 89 (68%) and 83 (63%) attended 1 year follow up. Interventions The standalone app included conservative management for UI with motivation aids (e.g. reminders). Care‐as‐usual was delivered according to the Dutch GP guideline for UI. Main outcome measures Effectiveness assessed by the change in symptom severity score (ICIQ‐UI‐SF) and the change in quality of life (ICIQ‐LUTSqol) with linear regression on an intention‐to‐treat basis. Results Clinically relevant improvement of UI severity for both app (−2.17 ± 2.81) and care‐as‐usual (−3.43 ± 3.6) groups, with a non‐significant mean difference of 0.903 (−0.66 to 1.871). Conclusion App‐based treatment is a viable alternative to care‐as‐usual for UI in primary care in terms of effectiveness after 1 year. Tweetable abstract App‐based treatment for female urinary incontinence is a viable alternative to care‐as‐usual after 12 months. App‐based treatment for female urinary incontinence is a viable alternative to care‐as‐usual after 12 months. Linked article: See related article at https://doi.org/10.1111/1471‐0528.17191.
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Affiliation(s)
- Anne M M Loohuis
- University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care medicine, FA21, PO Box 196, 9700AD, Groningen, The Netherlands
| | - Henk Van Der Worp
- University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care medicine, FA21, PO Box 196, 9700AD, Groningen, The Netherlands
| | - Nienke J Wessels
- University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care medicine, FA21, PO Box 196, 9700AD, Groningen, The Netherlands
| | - Janny H Dekker
- University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care medicine, FA21, PO Box 196, 9700AD, Groningen, The Netherlands
| | | | - Marjolein Y Berger
- University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care medicine, FA21, PO Box 196, 9700AD, Groningen, The Netherlands
| | - Karin M Vermeulen
- University of Groningen, University Medical Centre Groningen, Department of Epidemiology, FA21, PO Box 196, 9700AD, Groningen, The Netherlands
| | - Marco H Blanker
- University of Groningen, University Medical Centre Groningen, Department of General Practice and Elderly Care medicine, FA21, PO Box 196, 9700AD, Groningen, The Netherlands
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Wadensten T, Nyström E, Franzén K, Lindam A, Wasteson E, Samuelsson E. A Mobile App for Self-management of Urgency and Mixed Urinary Incontinence in Women: Randomized Controlled Trial. J Med Internet Res 2021; 23:e19439. [PMID: 33818395 PMCID: PMC8056293 DOI: 10.2196/19439] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/10/2020] [Accepted: 01/31/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Many women experience urgency (UUI) and mixed (MUI) urinary incontinence but commonly hesitate to seek care. Treatment access and self-management for these conditions can be supported through eHealth approaches. OBJECTIVE This study aimed to investigate the efficacy of the mobile app Tät II for self-management of UUI and MUI in women. METHODS This randomized controlled trial included women ≥18 years old with UUI or MUI and ≥2 leakages per week. Those with red-flag symptoms were excluded. Participants were recruited via analog and digital advertisements and screened for initial selection through a web-based questionnaire. Data were collected using another questionnaire and a 2-day bladder diary. A telephone interview confirmed the symptom diagnosis. Participants were randomized (1:1) to receive access to a treatment app (including pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, tailored advice, exercise log, reinforcement messages, and reminders) or an information app (control group), with no external treatment guidance provided. The primary outcome was incontinence symptoms at the 15-week follow-up, measured using the International Consultation on Incontinence Questionnaire (ICIQ)-Urinary Incontinence Short Form (ICIQ-UI SF). Urgency symptoms were assessed using the ICIQ-Overactive Bladder Module (ICIQ-OAB) and quality of life using the ICIQ-Lower Urinary Tract Symptoms Quality of Life Module (ICIQ-LUTSqol). Incontinence episode frequency (IEF) was calculated per bladder diary entries. Improvement was measured using the Patient's Global Impression of Improvement. All outcomes were self-reported. Cure was defined as no leakages per the bladder diary. Intention-to-treat analysis was performed. RESULTS Between April 2017 and March 2018, 123 women (mean age 58.3, SD 9.6 years) were randomized to the treatment (n=60, 2 lost to follow-up) or information (n=63) group. Of these, 35 (28%) women had UUI, and 88 (72%) had MUI. Mean ICIQ-UI SF score at follow-up was lower in the treatment group than in the information group (estimated difference -3.1, 95% CI -4.8 to -1.3). The estimated between-group difference was -1.8 (95% CI -2.8 to -0.99) for mean ICIQ-OAB score and -6.3 (95% CI -10.5 to -2.1) for the mean ICIQ-LUTSqol score at follow-up. IEF reduction from baseline to follow-up was greater in the treatment group (-10.5, IQR -17.5 to -3.5) than in the information group (P<.001). Improvement was reported by 87% (52/60) of treatment group participants and by 30% (19/63) of information group participants. The cure rate was 32% in the treatment group, and 6% in the information group (odds ratio 5.4, 95% CI 1.9-15.6; P=.002). About 67% (40/60) of the treatment group participants used the app more than thrice a week. CONCLUSIONS The treatment app was effective for improving urgency and mixed incontinence in women. When self-management is appropriate, this app may be a good alternative to pharmacological treatment or other conservative management, thus increasing access to care. TRIAL REGISTRATION ClinicalTrials.gov NCT03097549; https://clinicaltrials.gov/ct2/show/NCT03097549.
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Affiliation(s)
- Towe Wadensten
- Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Emma Nyström
- Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Karin Franzén
- Women's Clinic, Örebro University Hospital, Örebro, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anna Lindam
- Unit of Research, Education, and Development, Östersund Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Elisabet Wasteson
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Eva Samuelsson
- Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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[COVID-19 in urology : Influence of the pandemic on telemedicine, education and surgery]. Urologe A 2021; 60:301-305. [PMID: 33533961 PMCID: PMC7856848 DOI: 10.1007/s00120-021-01451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/12/2022]
Abstract
Die COVID-19-Pandemie („coronavirus disease 2019“) hat weltweit zu wirtschaftlichen und klinischen Katastrophen geführt. In den Hochphasen mit hohen Infektionsraten verlagerte sich der klinische Alltag in den Notfallbereich und betrifft alle Fachbereiche und somit auch die Urologie. Es ist ein schmaler Grat zwischen Verschiebung einer Operation, um das Risiko einer möglichen Infektion der Patienten zu minimieren und gleichzeitig das Ergebnis der Behandlung nicht negativ zu beeinflussen. Im ambulanten Sektor konnte durch die forcierte Integration der Telemedizin die Routine kompensiert werden. Auch die Ausbildung der Urologieanwärter kann bis zu einem gewissen Punkt durch die Telemedizin aufrechterhalten werden, die operative Ausbildung fällt zunächst allerdings zurück. Das tatsächliche Ausmaß der Pandemie in der Urologie bleibt noch abzuwarten und kann erst nach Stabilisierung der Infektionswellen mit den zu erwarteten Impfstoffen erfasst werden.
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Bertuit J, Barrau M, Huet S, Rejano-Campo M. Intérêt des applications mobiles et internet dans la prise en charge de l’incontinence urinaire d’effort chez la femme. Prog Urol 2020; 30:1022-1037. [DOI: 10.1016/j.purol.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/04/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
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da Mata KRU, Costa RCM, Carbone ÉDSM, Gimenez MM, Bortolini MAT, Castro RA, Fitz FF. Telehealth in the rehabilitation of female pelvic floor dysfunction: a systematic literature review. Int Urogynecol J 2020; 32:249-259. [PMID: 33175229 PMCID: PMC7657071 DOI: 10.1007/s00192-020-04588-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/23/2020] [Indexed: 01/14/2023]
Abstract
Introduction and hypothesis The pandemic caused by coronavirus disease 2019 (COVID-19) increased the awareness and efforts to provide care from distance using information technologies. We reviewed the literature about the practice and effectiveness of the rehabilitation of the female pelvic floor dysfunction via telehealth regarding symptomatology and quality of life and function of pelvic floor muscles (PFM). Methods A bibliographic review was carried out in May 2020 in the databases: Embase, Medline/PubMed, LILACS and PEDro. A total of 705 articles were reviewed after the removal of duplicates. The methodological quality of the articles was evaluated by the PEDro scale. Two authors performed data extraction into a standardized spreadsheet. Results Four studies were included, two being randomized controlled trials. Among the RCTs, only one compared telehealth with face-to-face treatment; the second one compared telehealth with postal treatment. The other two studies are follow-up and cost analysis reports on telehealth versus postal evaluation. Data showed that women who received the intervention remotely presented significant improvement in their symptoms, such as reducing the number of incontinence episodes and voiding frequency, improving PFM strength and improving quality of life compared to women who had the face-to-face treatment. Conclusions Telehealth promoted a significant improvement in urinary symptoms, PFM function and quality of life. Telehealth is still emerging, and more studies are needed to draw more conclusions. The recommendations of the governmental authorities, physical therapy councils and corresponding associations of each country also need to be considered. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-020-04588-8.
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Affiliation(s)
| | | | - Ébe Dos Santos Monteiro Carbone
- Centro Universitário São Camilo, São Paulo, SP, Brazil.,Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, São Paulo, SP, CED 04024-002, Brazil
| | - Márcia Maria Gimenez
- Centro Universitário São Camilo, São Paulo, SP, Brazil.,Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, São Paulo, SP, CED 04024-002, Brazil
| | - Maria Augusta Tezelli Bortolini
- Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, São Paulo, SP, CED 04024-002, Brazil
| | - Rodrigo Aquino Castro
- Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, São Paulo, SP, CED 04024-002, Brazil
| | - Fátima Faní Fitz
- Centro Universitário São Camilo, São Paulo, SP, Brazil. .,Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 - Vila Clementino, São Paulo, SP, CED 04024-002, Brazil.
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31
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Wu C, Newman DK, Palmer MH. Unsupervised behavioral and pelvic floor muscle training programs for storage lower urinary tract symptoms in women: a systematic review. Int Urogynecol J 2020; 31:2485-2497. [DOI: 10.1007/s00192-020-04498-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022]
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Novara G, Checcucci E, Crestani A, Abrate A, Esperto F, Pavan N, De Nunzio C, Galfano A, Giannarini G, Gregori A, Liguori G, Bartoletti R, Porpiglia F, Scarpa RM, Simonato A, Trombetta C, Tubaro A, Ficarra V. Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic? Eur Urol 2020; 78:786-811. [PMID: 32616405 PMCID: PMC7301090 DOI: 10.1016/j.eururo.2020.06.025] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Context Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse. Objective To perform a systematic review of the literature and evaluate all the available studies on urological applications of telehealth. Evidence acquisition After registration on PROSPERO, we searched PubMed and Scopus databases to collect any kind of studies evaluating any telehealth interventions in any urological conditions. The National Toxicology Program/Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies was used to estimate the risk of bias. A narrative synthesis was performed. Evidence synthesis We identified 45 studies (11 concerning prostate cancer [PCa], three hematuria management, six urinary stones, 14 urinary incontinence [UI], five urinary tract infections [UTIs], and six other conditions), including 12 randomized controlled trials. The available literature indicates that telemedicine has been implemented successfully in several common clinical scenarios, including the decision-making process following a diagnosis of nonmetastatic PCa, follow-up care of patients with localized PCa after curative treatments, initial diagnosis of hematuria, management diagnosis and follow-up care of uncomplicated urinary stones and uncomplicated UTIs, and initial evaluation, behavioral therapies, and pelvic floor muscle training in UI patients, as well as follow-up care after surgical treatments of stress urinary incontinence or pelvic organ prolapse. The methodological quality of most of the reports was good. Conclusions Telehealth has been implemented successfully in selected patients with PCa, UI, pelvic organ prolapse, uncomplicated urinary stones, and UTIs. Many urological conditions are suitable for telehealth, but more studies are needed on other highly prevalent urological malignant and benign conditions. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine. More robust data on long-term efficacy, safety, and health economics are necessary. Patient summary The diffusion of coronavirus disease 2019 (COVID-19) infections has recently increased the interest in telehealth, which is the adoption of telecommunication to deliver any health care activity. The available literature indicates that telemedicine has been adopted successfully in selected patients with several common clinical urological conditions, including prostate cancer, uncomplicated urinary stones, uncomplicated urinary infections, urinary incontinence, or pelvic organ prolapse. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine, but more robust data on long-term efficacy, safety, and costs are necessary.
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Affiliation(s)
- Giacomo Novara
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Italy.
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alberto Abrate
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre, "Santa Maria della Misericordia" Hospital, Udine, Italy
| | | | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, Urologic Unit, University of Pisa, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Alchiede Simonato
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Urology Unit, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
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Byambasuren O, Beller E, Hoffmann T, Glasziou P. mHealth App Prescription in Australian General Practice: Pre-Post Study. JMIR Mhealth Uhealth 2020; 8:e16497. [PMID: 32478660 PMCID: PMC7296416 DOI: 10.2196/16497] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/21/2020] [Accepted: 03/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Evidence of effectiveness of mobile health (mHealth) apps as well as their usability as non-drug interventions in primary care are emerging around the globe. Objective This study aimed to explore the feasibility of mHealth app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation intervention to increase app prescription. Methods A single-group, before-and-after study was conducted in Australian general practice. GPs were given prescription pads for 6 mHealth apps and reported the number of prescriptions dispensed for 4 months. After the reporting of month 2, a 2-minute video of one of the apps was randomly selected and sent to each GP. Data were collected through a prestudy questionnaire, monthly electronic reporting, and end-of-study interviews. The primary outcome was the number of app prescriptions (total, monthly, per GP, and per GP per fortnight). Secondary outcomes included confidence in prescribing apps (0-5 scale), the impact of the intervention video on subsequent prescription numbers, and acceptability of the interventions. Results Of 40 GPs recruited, 39 commenced, and 36 completed the study. In total, 1324 app prescriptions were dispensed over 4 months. The median number of apps prescribed per GP was 30 (range 6-111 apps). The median number of apps prescribed per GP per fortnight increased from the pre-study level of 1.7 to 4.1. Confidence about prescribing apps doubled from a mean of 2 (not so confident) to 4 (very confident). App videos did not affect subsequent prescription rates substantially. Post-study interviews revealed that the intervention was highly acceptable. Conclusions mHealth app prescription in general practice is feasible, and our implementation intervention was effective in increasing app prescription. GPs need more tailored education and training on the value of mHealth apps and knowledge of prescribable apps to be able to successfully change their prescribing habits to include apps. The future of sustainable and scalable app prescription requires a trustworthy electronic app repository of prescribable mHealth apps for GPs.
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Affiliation(s)
| | - Elaine Beller
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
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Hansson Vikström N, Wasteson E, Lindam A, Samuelsson E. Anxiety and depression in women with urinary incontinence using E-health. Int Urogynecol J 2020; 32:103-109. [PMID: 32095954 PMCID: PMC7788012 DOI: 10.1007/s00192-020-04227-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Previous studies have found high prevalence rates of anxiety and depression in women with urinary incontinence (UI). This study investigates the prevalence in women who had turned to eHealth for treatment of UI and identifies possible factors associated with depression. METHODS We analyzed data from two randomized controlled trials evaluating eHealth treatment for UI, including 373 women with stress UI (SUI), urgency UI (UUI), or mixed UI (MUI). We used the Hospital Anxiety and Depression Scale (HADS) and defined a score of ≥8 as depression or anxiety. The ICIQ-UI-SF questionnaire was used to score incontinence severity. Logistic regression was used to determine factors associated with depression and anxiety. RESULTS Women with UUI or MUI were older than women with SUI, mean age 58.3 vs 48.6 years (p = <0.001). Four out of five participating women had a university education. The prevalence of anxiety and depression in women with SUI was 12.4% and 3.2% respectively. In women with MUI/UUI, 13.8% had anxiety and 10.6% had depression. In multivariate analyses, the odds ratio of having depression was 4.2 (95% CI = 1.4-12.3) for women with MUI/UUI compared with SUI when controlling for other risk factors. CONCLUSION The odds of depression in women with MUI/UUI were increased compared with SUI. The prevalence of anxiety and depression was considerably lower than reported in large cross-sectional surveys. Socioeconomic differences may partly explain this finding, as the use of eHealth still is more common among highly educated women.
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Affiliation(s)
| | - Elisabet Wasteson
- Department of Psychology and Social work, Mid Sweden University, Östersund, Sweden
| | - Anna Lindam
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Goode PS, Markland AD, Echt KV, Slay L, Barnacastle S, Hale G, Wright MK, Lane TR, Burgio KL. A mobile telehealth program for behavioral treatment of urinary incontinence in women veterans: Development and pilot evaluation of MyHealtheBladder. Neurourol Urodyn 2019; 39:432-439. [PMID: 31774200 DOI: 10.1002/nau.24226] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/05/2019] [Indexed: 12/31/2022]
Abstract
AIM To develop and pilot test an interactive mobile telehealth program (mHealth) for behavioral treatment of women veterans with urinary incontinence (UI). METHODS We developed an evidence-based 8-week behavioral mHealth program, MyHealtheBladder, with input from women veterans, behavioral medicine and health education experts, and clinical providers treating UI in the VA system. The program was story-based and included pelvic floor muscle exercises, bladder control strategies, fluid management, risk factor reduction, and self-monitoring. Participants were women veterans seeking outpatient treatment for UI occurring at least twice weekly. The primary efficacy estimate was the change in UI frequency, volume and impact on the quality of life as measured by the validated International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF; range: 0-21, 2.5 points for minimal clinically important difference [MCID]). RESULTS We enrolled 29 women veterans (ages 29-77 years; mean = 54.4 ± 10.4), including 15 (52%) African-American women, 13 (45%) women with high school education, and 16 (55%) with a college degree. Twenty of 29 women (69%) completed all 8 weeks of the intervention with a 97% adherence rate to the daily sessions among completers. We found reductions in ICIQ-SF scores from a mean 12.6 ± 3.9 at baseline to 10.4 ± 4.11 at 5 weeks, to 8.7 ± 4.0 at the end of the 8-week intervention. CONCLUSIONS Women veterans using an 8-week behavioral mHealth program for the treatment of UI had symptom improvements that exceeded the MCID for the ICIQ-SF. Our next step involves comparing the effectiveness of MyHealtheBladder to usual care in a larger clinical trial.
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Affiliation(s)
- Patricia S Goode
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alayne D Markland
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Katharina V Echt
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Medicine, Emory University, Atlanta, Georgia
| | - Laurie Slay
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Susan Barnacastle
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Galen Hale
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - M Kate Wright
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - T Renea Lane
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama
| | - Kathryn L Burgio
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Charette M, Bérubé M, Brooks K, O'Neil J, Brosseau L, McLean L. How well do published randomized controlled trials on pelvic floor muscle training interventions for urinary incontinence describe the details of the intervention? A review. Neurourol Urodyn 2019; 39:35-44. [DOI: 10.1002/nau.24208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/15/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
| | - Marie‐Ève Bérubé
- School of Rehabilitation Sciences, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
| | - Kaylee Brooks
- School of Rehabilitation Sciences, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
| | - Jennifer O'Neil
- School of Rehabilitation Sciences, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
- Bruyère Research Institute Ottawa Ontario Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
- Bruyère Research Institute Ottawa Ontario Canada
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Wang B, Ruan Y, Zhou T, Wang L, Li H, Peng D, Reed-Maldonado AB, Sanford MT, Lee YC, Zhou J, Wang HS, Banie L, Wang G, Liu J, Lin G, Lue TF. The effects of microenergy acoustic pulses on an animal model of obesity-associated stress urinary incontinence. Part 1: Functional and histologic studies. Neurourol Urodyn 2019; 38:2130-2139. [PMID: 31483063 DOI: 10.1002/nau.24160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/23/2019] [Indexed: 01/04/2023]
Abstract
AIM Obesity is a strong independent risk factor for urinary incontinence. Effective therapeutic approaches for obesity-associated stress urinary incontinence (OA-SUI) are lacking as the mechanisms remain unclear. The aim of our study is to explore the impacts of microenergy acoustic pulse (MAP) therapy on urethral and pelvic floor muscle structure and function in female lean and fatty rats. METHODS A total 24 Zucker fatty (ZF) and 24 Zucker lean (ZL) female 24-week-old rats were grouped into four groups: ZL control, ZLMAP, ZF control, and ZFMAP. For MAP treatment, 500 pulses were delivered at an energy level of 0.033 mJ/mm 2 and a frequency of 3 Hz and were applied twice a week for 4 weeks. After a 1-week washout, all rats underwent conscious cystometry and leak-point pressure (LPP) measurements followed by ex vivo organ-bath assay and histological study. RESULTS ZF rats had lower LPP as compared to ZL rats, and MAP treatment significantly improved LPP in ZF rats (P < .05). Impaired muscle contractile activity (MCA) in organ-bath study was noted in ZF rats. MAP treatment significantly increased MCA in ZF rats (P < .05) and also increased the thickness of the striated muscle layer and the number of neuromuscular junctions (NMJs). In situ, MAP activated muscle satellite cells significantly (P < .05). CONCLUSIONS Obesity impairs the function of both the urethral sphincter and the pelvic floor and leads to atrophy and distortion of the striated muscle in obese female rats. These issues contribute to OA-SUI. MAP improves continence by stimulating muscle regeneration and nerve innervation as well as by activating satellite cells.
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Affiliation(s)
- Bohan Wang
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California.,Department of Urology, The Second Hospital, Zhejiang University, Hangzhou, China
| | - Yajun Ruan
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California.,Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Tie Zhou
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California.,Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lin Wang
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Huixi Li
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Dongyi Peng
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Amanda B Reed-Maldonado
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Melissa T Sanford
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Yung-Chin Lee
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Jun Zhou
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Hsun Shuan Wang
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Lia Banie
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Guifang Wang
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guiting Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
| | - Tom F Lue
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, California
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Verhoeks C, Teunissen D, van der Stelt-Steenbergen A, Lagro-Janssen A. Women's expectations and experiences regarding e-health treatment: A systematic review. Health Informatics J 2019; 25:771-787. [PMID: 28764600 PMCID: PMC6769287 DOI: 10.1177/1460458217720394] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is a gap in knowledge of women's perceptions of e-health treatment. This review aims to investigate women's expectations and experiences regarding e-health. A search was conducted in MEDLINE, EMBASE, CINAHL and PsycInfo in March 2016. We included articles published between 2000 and March 2016, reporting on e-health interventions. The initial search yielded 2987 articles. Eventually, 16 articles reporting on 16 studies were included. Barriers to e-health treatment were lower for women than barriers to face-to-face treatment, such as feelings of shame and time constraints. Women were able to develop an online therapeutic relationship. As reduced feelings of obligation and lack of motivation were women's greatest challenges in completing e-health treatment, they expressed a wish for more support during e-health treatment, preferably blended care. e-Health lowers the threshold for women to seek healthcare. Combining e-health interventions with face-to-face sessions may enhance women's motivation to complete treatment.
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Bokne K, Sjöström M, Samuelsson E. Self-management of stress urinary incontinence: effectiveness of two treatment programmes focused on pelvic floor muscle training, one booklet and one Internet-based. Scand J Prim Health Care 2019; 37:380-387. [PMID: 31317808 PMCID: PMC6713123 DOI: 10.1080/02813432.2019.1640921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objectives: In a previous study, self-management of stress urinary incontinence (SUI), via an Internet-based programme or a booklet improved symptoms and quality of life. We wanted to evaluate the effectiveness of these programmes when implemented for free use, as well as to characterize the users. Design: Pragmatic prospective cohort study. Setting and subjects: Information about the Internet programme and the booklet was provided at www.tät.nu and by nurse midwives. Both programmes included a three-month pelvic floor muscle training (PFMT) programme. Questionnaires were used at the start and after three months. Main outcome measures: Characteristics of the participants regarding age and education. Reductions in symptom severity was measured using the validated ICIQ-UI SF. Results: 109 women using the booklet, and 166 women using the Internet-based programme responded to the pre-treatment questionnaire. Of these, 53 (48.6%) in the booklet group and 27 (16.3%) in the Internet group responded to the follow-up. The mean age of booklet users was higher, 59.4 years vs. 54.5 years (p = .005). The proportion of women with post-secondary education was high, 59% in the booklet group and 67% in the Internet group. The mean reduction in the symptom score was 2.6 points (SD 3.4) in the booklet group, and 3.4 (SD 2.9) in the Internet group. These reductions were significant within both groups, with no difference between the groups, and in the same order of magnitude as in the previous randomised controlled study. Conclusion: Two self-management programmes for SUI, one provided as a booklet and one as an Internet-based programme, also rendered clinically relevant improvements when made freely available. KEY POINTS Female stress urinary incontinence can be treated using self-management programmes focused on pelvic floor muscle training. This study evaluates the effect of two different programmes, one provided as a booklet and one Internet-based, when made freely available to the public. •Both programmes rendered clinically relevant improvements, in the same order of magnitude as in the previous randomised controlled study. •Self-management of stress urinary incontinence should be recommended to women that request treatment.
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Affiliation(s)
- Kajsa Bokne
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden;
| | - Malin Sjöström
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development – Östersund, Umeå University, Umeå, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden;
- CONTACT Eva Samuelsson Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87 Umeå, Sweden
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Firet L, Teunissen TAM, van der Vaart H, Assendelft WJJ, Notten KJB, Kool RB, Lagro-Janssen ALM. An Electronic Health Intervention for Dutch Women With Stress Urinary Incontinence: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e13164. [PMID: 31298222 PMCID: PMC6657453 DOI: 10.2196/13164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/20/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common problem with a great potential influence on quality of life. Although SUI can be treated effectively with pelvic floor muscle training (PFMT), only a minority of women with this complaint seek help. An internet-based electronic health (eHealth) intervention could make care more accessible. The Swedish eHealth intervention Tät-treatment of Stress Urinary Incontinence offers PFMT and has shown to be effective in reducing symptoms in women with SUI. This intervention might be helpful for Dutch women too, but its adoption needs to be studied as the Netherlands differs from Sweden in terms of geographical characteristics and health care organization. OBJECTIVE The objective of this protocol is to investigate the barriers and facilitators to the adoption of an eHealth intervention for Dutch women with SUI and the effects of this intervention. METHODS We are conducting an explanatory sequential mixed methods study among 800 Dutch women with SUI who participate in the translated version of Tät-treatment of Stress Urinary Incontinence. This eHealth intervention takes 3 months. A pre-post study is conducted using surveys, which are sent at baseline (T0), 3 weeks after baseline (T1), posttreatment (T2), and 3 months posttreatment (T3). After the intervention, semistructured interviews will be held with 15 to 20 participants. The primary outcomes are barriers and facilitators to using the Tät-treatment of Stress Urinary Incontinence. This will also be analyzed among groups that differ in age and severity of incontinence. A thematic content analysis of the qualitative data will be performed. The secondary outcomes are: (1) effect on symptoms of urinary incontinence, (2) effect on quality of life, and (3) factors that are potentially associated with success. Effects will be analyzed by a mixed model analysis. Logistic regression analysis will be used to study what patient-related factors are associated with success. RESULTS Enrollment started in July 2018 and will be finished by December 2019. Data analysis will start in March 2020. CONCLUSIONS An eHealth intervention for Dutch women with SUI is promising because it can make treatment more accessible. The strength of this study is that it explores the possibilities for an internet-based-only treatment for women with SUI by using both quantitative and qualitative research methodologies. The study elaborates on existing results by using a previously tested and effective eHealth program. Insight into the barriers and facilitators to using this program can enhance the implementation of the intervention in the Dutch health care system. TRIAL REGISTRATION Netherlands Trial Registry (NTR) NTR6956; https://www.trialregister.nl/trial/6570. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13164.
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Affiliation(s)
- Lotte Firet
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Theodora Alberta Maria Teunissen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Huub van der Vaart
- Department of Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Willem Jan Jozef Assendelft
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rudolf Bertijn Kool
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Mobile technologies for the conservative self-management of urinary incontinence: a systematic scoping review. Int Urogynecol J 2019; 31:1163-1174. [DOI: 10.1007/s00192-019-04012-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/30/2019] [Indexed: 01/15/2023]
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Dumoulin C, Cacciari LP, Hay‐Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018; 10:CD005654. [PMID: 30288727 PMCID: PMC6516955 DOI: 10.1002/14651858.cd005654.pub4] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI).This is an update of a Cochrane Review first published in 2001 and last updated in 2014. OBJECTIVES To assess the effects of PFMT for women with urinary incontinence (UI) in comparison to no treatment, placebo or sham treatments, or other inactive control treatments; and summarise the findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register (searched 12 February 2018), which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings, and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in women with SUI, UUI or MUI (based on symptoms, signs or urodynamics). One arm of the trial included PFMT. Another arm was a no treatment, placebo, sham or other inactive control treatment arm. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials for eligibility and risk of bias. We extracted and cross-checked data. A third review author resolved disagreements. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. We subgrouped trials by diagnosis of UI. We undertook formal meta-analysis when appropriate. MAIN RESULTS The review included 31 trials (10 of which were new for this update) involving 1817 women from 14 countries. Overall, trials were of small-to-moderate size, with follow-ups generally less than 12 months and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration, study populations and outcome measures. There was only one study of women with MUI and only one study with UUI alone, with no data on cure, cure or improvement, or number of episodes of UI for these subgroups.Symptomatic cure of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were eight times more likely to report cure (56% versus 6%; risk ratio (RR) 8.38, 95% confidence interval (CI) 3.68 to 19.07; 4 trials, 165 women; high-quality evidence). For women with any type of UI, PFMT groups were five times more likely to report cure (35% versus 6%; RR 5.34, 95% CI 2.78 to 10.26; 3 trials, 290 women; moderate-quality evidence).Symptomatic cure or improvement of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were six times more likely to report cure or improvement (74% versus 11%; RR 6.33, 95% CI 3.88 to 10.33; 3 trials, 242 women; moderate-quality evidence). For women with any type of UI, PFMT groups were two times more likely to report cure or improvement than women in the control groups (67% versus 29%; RR 2.39, 95% CI 1.64 to 3.47; 2 trials, 166 women; moderate-quality evidence).UI-specific symptoms and quality of life (QoL) at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT group were more likely to report significant improvement in UI symptoms (7 trials, 376 women; moderate-quality evidence), and to report significant improvement in UI QoL (6 trials, 348 women; low-quality evidence). For any type of UI, women in the PFMT group were more likely to report significant improvement in UI symptoms (1 trial, 121 women; moderate-quality evidence) and to report significant improvement in UI QoL (4 trials, 258 women; moderate-quality evidence). Finally, for women with mixed UI treated with PFMT, there was one small trial (12 women) reporting better QoL.Leakage episodes in 24 hours at the end of treatment: PFMT reduced leakage episodes by one in women with SUI (mean difference (MD) 1.23 lower, 95% CI 1.78 lower to 0.68 lower; 7 trials, 432 women; moderate-quality evidence) and in women with all types of UI (MD 1.00 lower, 95% CI 1.37 lower to 0.64 lower; 4 trials, 349 women; moderate-quality evidence).Leakage on short clinic-based pad tests at the end of treatment: women with SUI in the PFMT groups lost significantly less urine in short (up to one hour) pad tests. The comparison showed considerable heterogeneity but the findings still favoured PFMT when using a random-effects model (MD 9.71 g lower, 95% CI 18.92 lower to 0.50 lower; 4 trials, 185 women; moderate-quality evidence). For women with all types of UI, PFMT groups also reported less urine loss on short pad tests than controls (MD 3.72 g lower, 95% CI 5.46 lower to 1.98 lower; 2 trials, 146 women; moderate-quality evidence).Women in the PFMT group were also more satisfied with treatment and their sexual outcomes were better. Adverse events were rare and, in the two trials that did report any, they were minor. The findings of the review were largely supported by the 'Summary of findings' tables, but most of the evidence was downgraded to moderate on methodological grounds. The exception was 'participant-perceived cure' in women with SUI, which was rated as high quality. AUTHORS' CONCLUSIONS Based on the data available, we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI. It may reduce the number of leakage episodes, the quantity of leakage on the short pad tests in the clinic and symptoms on UI-specific symptom questionnaires. The authors of the one economic evaluation identified for the Brief Economic Commentary reported that the cost-effectiveness of PFMT looks promising. The findings of the review suggest that PFMT could be included in first-line conservative management programmes for women with UI. The long-term effectiveness and cost-effectiveness of PFMT needs to be further researched.
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Affiliation(s)
- Chantale Dumoulin
- University of MontrealSchool of Rehabilitation, Faculty of MedicineC.P.6128 Succ. Centre‐villeMontrealQCCanadaH3C 3J7
| | - Licia P Cacciari
- University of MontrealSchool of Rehabilitation, Faculty of MedicineC.P.6128 Succ. Centre‐villeMontrealQCCanadaH3C 3J7
| | - E Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineWellingtonNew Zealand
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Vaughan CP, Markland AD, Smith PP, Burgio KL, Kuchel GA. Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: A Translational Research Agenda for a Complex Geriatric Syndrome. J Am Geriatr Soc 2018; 66:773-782. [PMID: 29205261 PMCID: PMC5906179 DOI: 10.1111/jgs.15157] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its ninth Bedside-to-Bench research conference, entitled "Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome," October 16 to 18, 2016, in Bethesda, Maryland. As part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm disturbance, and urinary incontinence-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these conditions. The conference provided a forum for discussing current epidemiology, basic science, and clinical and translational research on urinary incontinence in older adults; for identifying gaps in knowledge; and for developing a research agenda to inform future investigative efforts. The conference also promoted networking involving emerging researchers and thought leaders in the field of incontinence, aging, and other fields of research, as well as National Institutes of Health program personnel.
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Affiliation(s)
- Camille P Vaughan
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Phillip P Smith
- Division of Urology, University of Connecticut Health Center, Farmington, Connecticut
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| | - Kathryn L Burgio
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize and evaluate the most recent literature on the epidemiology, etiology, and treatment of lower urinary tract symptoms (LUTS) in women. RECENT FINDINGS Several authors have studied characteristics of populations of women with LUTS and addressed care-seeking behavior for these conditions. Multiple investigators also sought greater understanding of the urinary microbiome and its relationship to LUTS in women. Evidence for the treatment of overactive bladder and stress urinary incontinence is being synthesized and innovative treatments are being rigorously studied. SUMMARY Investigations and high quality research continue to shed light on the epidemiology, diagnosis, and management of LUTS in women.
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Loohuis AMM, Wessels NJ, Jellema P, Vermeulen KM, Slieker-Ten Hove MC, van Gemert-Pijnen JEWC, Berger MY, Dekker JH, Blanker MH. The impact of a mobile application-based treatment for urinary incontinence in adult women: Design of a mixed-methods randomized controlled trial in a primary care setting. Neurourol Urodyn 2018; 37:2167-2176. [PMID: 29392749 DOI: 10.1002/nau.23507] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 11/29/2017] [Accepted: 12/25/2017] [Indexed: 02/06/2023]
Abstract
AIMS We aim to assess whether a purpose-developed mobile application (app) is non-inferior regarding effectiveness and cost-effective when used to treat women with urinary incontinence (UI), as compared to care as usual in Dutch primary care. Additionally, we will explore the expectations and experiences of patients and care providers regarding app usage. METHODS A mixed-methods study will be performed, combining a pragmatic, randomized-controlled, non-inferiority trial with an extensive process evaluation. Women aged ≥18 years, suffering from UI ≥ 2 times per week and with access to a smartphone or tablet are eligible to participate. The primary outcome will be the change in UI symptom scores at 4 months after randomization, as assessed by the International Consultation on Incontinence Modular Questionnaire UI Short Form. Secondary outcomes will be the change in UI symptom scores at 12 months, as well as the patient-reported global impression of improvement, quality of life, change in sexual functioning, UI episodes per day, and costs at 4 and 12 months. In parallel, we will perform an extensive process evaluation to assess the expectations and experiences of patients and care providers regarding app usage, making use of interviews, focus group sessions, and log data analysis. CONCLUSION This study will assess both the effectiveness and cost-effectiveness of app-based treatment for UI. The combination with the process evaluation, which will be performed in parallel, should also give valuable insights into the contextual factors that influence the effectiveness of such a treatment.
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Affiliation(s)
- Anne M M Loohuis
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Nienke J Wessels
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Petra Jellema
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Julia E W C van Gemert-Pijnen
- Department Psychology, Health, Technology, University of Twente, Centre eHealth Research & Wellbeing, Enschede, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Janny H Dekker
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marco H Blanker
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Andersson G, Rozental A, Shafran R, Carlbring P. Long-term effects of internet-supported cognitive behaviour therapy. Expert Rev Neurother 2017; 18:21-28. [PMID: 29094622 DOI: 10.1080/14737175.2018.1400381] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer. Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8-15 weeks). The pre-to follow-up effect size was Hedge's g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects. Expert commentary: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.
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Affiliation(s)
- Gerhard Andersson
- a Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.,b Department of Clinical Neuroscience, Psychiatry Section , Karolinska Institutet , Stockholm , Sweden
| | - Alexander Rozental
- c Department of Clinical Psychology , Stockholm University , Stockholm , Sweden.,d UCL Institute of Child Health , University College London , London , England
| | - Roz Shafran
- d UCL Institute of Child Health , University College London , London , England
| | - Per Carlbring
- c Department of Clinical Psychology , Stockholm University , Stockholm , Sweden.,d UCL Institute of Child Health , University College London , London , England
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Telephysiotherapy: time to get online. J Physiother 2017; 63:193-195. [PMID: 28939309 DOI: 10.1016/j.jphys.2017.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 12/14/2022] Open
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Hoffman V, Söderström L, Samuelsson E. Self-management of stress urinary incontinence via a mobile app: two-year follow-up of a randomized controlled trial. Acta Obstet Gynecol Scand 2017; 96:1180-1187. [PMID: 28718223 PMCID: PMC5638068 DOI: 10.1111/aogs.13192] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/08/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We investigated the long-term effects of using a mobile app to treat stress urinary incontinence with a focus on pelvic floor muscle training. MATERIAL AND METHODS A previous randomized controlled trial of 123 women aged 27-72 years found that three months of self-managing stress urinary incontinence with support from the Tät® app was effective. We followed up the women in the app group (n = 62) two years after the initial trial with the same primary outcomes for symptom severity (International Consultation on Incontinence Questionnaire Short Form) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptom Quality of Life) and compared the scores with those at baseline. RESULTS Of the 62 women, 61 and 46 (75.4%), respectively, participated in three-month and two-year follow-ups. Baseline data did not differ between responders and non-responders at follow-up. The mean decreases in International Consultation on Incontinence Questionnaire Short Form and ICIQ-Lower Urinary Tract Symptom Quality of Life scores after two years were 3.1 (95% confidence interval 2.0-4.2) and 4.0 (95% confidence interval 2.1-5.9), respectively. Of the 46 women, four (8.7%) rated themselves as very much better, nine (19.6%) as much better, and 16 (34.8%) as a little better. The use of incontinence protection products decreased significantly (p = 0.04), and the proportion of women who felt they could contract their pelvic muscles correctly increased from 14/46 (30.4%) at baseline to 31/46 (67.4%) at follow-up (p < 0.001). CONCLUSIONS Self-management of stress urinary incontinence with support from the Tät® app had significant and clinically relevant long-term effects and may serve as first-line treatment.
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Affiliation(s)
- Victoria Hoffman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Söderström
- Unit of Research, Education and Development - Östersund, Umeå University, Umeå, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Abstract
Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.
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Affiliation(s)
- Yoshitaka Aoki
- Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Heidi W Brown
- Departments of Obstetrics and Gynecology &Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Linda Brubaker
- Department of Reproductive Medicine, University of California San Diego, San Diego, California, USA
| | - Jean Nicolas Cornu
- Department of Urology, Charles Nicolle Hospital, University of Rouen Normandy, Rouen, France
| | - J Oliver Daly
- Department of Obstetrics and Gynaecology, Western Health, Victoria, Australia
| | - Rufus Cartwright
- Department of Urogynaecology, St Mary's Hospital, London, UK
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK
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Arnouk A, De E, Rehfuss A, Cappadocia C, Dickson S, Lian F. Physical, Complementary, and Alternative Medicine in the Treatment of Pelvic Floor Disorders. Curr Urol Rep 2017; 18:47. [DOI: 10.1007/s11934-017-0694-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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