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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 Prim 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Firet L, Teunissen TAM, Kool RB, Notten KJB, Lagro-Janssen ALM, van der Vaart H, Assendelft WJJ. Usage of an eHealth intervention for women with stress urinary incontinence: a mixed-methods study (Preprint). J Med Internet Res 2022; 24:e38255. [DOI: 10.2196/38255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/07/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
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Firet L, Teunissen TAM, Kool RB, van Doorn L, Aourag M, Lagro-Janssen ALM, Assendelft WJJ. Women's adoption of a web-based intervention for stress urinary incontinence: a qualitative study. BMC Health Serv Res 2021; 21:574. [PMID: 34118900 PMCID: PMC8199839 DOI: 10.1186/s12913-021-06585-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/21/2021] [Indexed: 02/01/2023] Open
Abstract
Background Stress urinary incontinence (SUI) is common among women and affects their quality of life. Pelvic floor muscle training is an effective conservative therapy, but only a minority of women seek help. E-health with pelvic floor muscle training is effective and increases access to care. To implement an e-Health intervention in a sustainable way, however, we need to understand what determines adoption. The aim is to investigate the barriers and facilitators to adopting an e-Health intervention among Dutch women with stress urinary incontinence. Methods Semi-structured telephonic interviews were carried out among participants of the Dutch e-Health intervention for women with stress urinary incontinence. Women were purposively sampled. The ‘Fit between Individuals, Task and Technology’ (FITT) framework was used for both the data collection and data analysis, to gain a more in-depth insight into the adoption of the intervention. Results Twenty women were interviewed, mean age 51 years and mostly highly educated. The adoption of e-Health for women with SUI mainly depends on the interaction between users and e-Health, and users and pelvic floor muscle training exercises. Facilitators for the adoption were the preference for an accessible self-management intervention, having a strong sense of self-discipline and having the ability to schedule the exercises routinely. Women needed to possess self-efficacy to do this intervention independently. Barriers to the adoption of e-Health were personal circumstances restricting time for scheduling pelvic floor muscle training and lacking skills to perform the exercises correctly. Despite guidance by technical features several women remained uncertain about their performance of the exercises and, therefore, wanted additional contact with a professional. Conclusions For stress urinary incontinence e-Health is an appropriate option for a target audience. Use of the FITT framework clearly demonstrates the conditions for optimal adoption. For a subgroup it was a suitable alternative for medical care in person. For others it identified the need for further support by a health care professional. This support could be provided by improvements of technical features and incorporating modes for digital communication. The additional value of integration of the e-Health intervention in primary care might be a logical next step. Trial registration The study was prospectively registered in the Netherlands Trial Registry (NTR) NTR6956. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06585-z.
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Affiliation(s)
- Lotte Firet
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands.
| | - Theodora Alberta Maria Teunissen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Rudolf Bertijn Kool
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lukas van Doorn
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Manal Aourag
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Antoinette Leonarda Maria Lagro-Janssen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
| | - Willem Jan Jozef Assendelft
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Postbox 9101, 6500, Nijmegen, HB, Netherlands
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Firet L, Teunissen TAM, Kool RB, van Doorn L, Aourag M, Lagro-Janssen ALM, Assendelft WJJ. Women’s Adoption of a Web-Based Intervention for Stress Urinary Incontinence: a Qualitative Study (Preprint). JMIR Rehabil Assist Technol 2020. [DOI: 10.2196/20727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Firet L, de Bree C, Verhoeks CM, Teunissen DAM, Lagro-Janssen ALM. Mixed feelings: general practitioners' attitudes towards eHealth for stress urinary incontinence - a qualitative study. BMC Fam Pract 2019; 20:21. [PMID: 30684962 PMCID: PMC6347743 DOI: 10.1186/s12875-019-0907-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/15/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is the most prevalent subtype of urinary incontinence and is a bothering condition in women. Only a minority of those with SUI consult a general practitioner (GP). EHealth with pelvic floor muscle training (PFMT) is effective in reducing incontinence symptoms and might increase access to care. The role of the GP regarding such an eHealth intervention is unknown. The aim of the study is to gain insight into the attitudes towards a PFMT internet-based, eHealth, intervention for SUI. METHODS A qualitative study was conducted. Data were collected through semi-structured interviews among purposively sampled GPs. Audio records were fully transcribed, and analysed thematically. RESULTS Thirteen GPs were interviewed, nine females and four males. Three themes emerged: appraisal of eHealth as a welcome new tool, mixed feelings about a supportive role, and eHealth is no cure-all. GPs welcomed eHealth for SUI as matching their preferences for PFMT and having advantages for patients. With eHealth as stand-alone therapy GPs were concerned about the lack of feedback, and the loss of motivation to adhere to the intervention. Therefore, GPs considered personal support important. The GP's decision to recommend eHealth was strongly influenced by a woman's motivation and her age. GPs' treatment preferences for elderly are different from those for young women with SUI; both PFMT and eHealth are perceived less suitable for older women. CONCLUSION EHealth with PFMT fits into the GPs' routine practice of SUI and adds value to it. Although there is evidence that eHealth as a stand-alone intervention is effective, GPs consider personal support important to supplement the perceived shortcomings. Probably GPs are not aware of, or convinced of the existing evidence. Training should address this issue and should also focus on common misunderstandings about regular care for women with SUI, such as the idea that PFMT is not suitable for the elderly. Improving GPs' knowledge that eHealth can be a stand-alone therapy for SUI facilitates the implementation in daily care.
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Affiliation(s)
- Lotte Firet
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands.
| | - Chrissy de Bree
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Carmen M Verhoeks
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Doreth A M Teunissen
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
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Firet L, Koekkoek WAC, Savelkoul C, Harringhuizen AW, Tjan DHT. [The acutely ill oncological patient: admit to ICU or not?]. Ned Tijdschr Geneeskd 2017; 161:D991. [PMID: 28831936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
- 5-10% of all oncological patients will be admitted to ICU at some point.- Medical oncological patients are usually admitted due to respiratory insufficiency or sepsis.- Mortality among medical-oncological ICU patients has decreased to an average of 40%, with a wide spread per tumour type.- The main prognostic factors for ICU survival are: clinical condition, severity of the acute condition, tumour type, and some specific oncological conditions.- This article describes directive ICU admission criteria, subdivided into three categories of medical oncological patients. Although not validated, these criteria give guidance to clinicians in deciding whether ICU admission is a responsible course of action.- In patients with an uncertain prognosis an ICU trial can be useful.- ICU admission criteria are largely based on expert opinion, as sufficient scientific evidence is lacking. A multidisciplinary decision process is therefore important.- Ideally, decision-making about ICU treatment should take place at an early stage in primary health care or outpatient clinic; this is called Advance Care Planning.
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Affiliation(s)
- L Firet
- Ziekenhuis Gelderse Vallei, Ede
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