Self-management of incontinence using a free mobile app: factors associated with improvement

Emma Nyström, Lars Söderström, Eva Samuelsson, Emma Nyström, Lars Söderström, Eva Samuelsson

Abstract

Background: Pelvic floor muscle training (PFMT) is first-line treatment for urinary incontinence (UI) in women. Self-management via a mobile app is a new cost-effective method for PFMT delivery. This study analyzes factors associated with improvement among app users.

Methods: A pragmatic observational study in a community setting. Upon downloading the app Tät®, users answered questions regarding their age, education, residence, and UI symptoms. After 3 months, users answered follow-up questions regarding symptoms and frequency of training and app usage, and the validated Patient Global Impression of Improvement (PGI-I) questionnaire. Only non-pregnant, non-postpartum adult women with UI who answered the PGI-I questionnaire were included. Multivariate logistic regression was used to analyze possible associations between these factors with any improvement and with great improvement according to the PGI-I. The models were adjusted for age.

Results: The study included 2,153 participants who had completed self-management, that is, 11.5% of eligible women who completed the baseline questionnaire. Of these participants, 65.6% reported improvement of UI. Any improvement was associated with age, frequency of PFMT, and app use, accounting for 27.9% of variability (Nagelkerke R2). Lower incontinence severity, frequency of PFMT, and app use were associated with great improvement.

Conclusion: Self-management of urinary incontinence is easily accessible to many women and improvement rates are comparable with other forms of PFMT. Demographic factors and incontinence severity showed no or incongruent association, whereas regular PFMT and app use predicted any and great improvement. App use showed an additional effect beyond frequency of training.

Keywords: Mobile applications; Pelvic floor muscle training; Predictors; Self-management; Urinary incontinence.

Conflict of interest statement

No competing financial interests exist.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram of the study
Fig. 2
Fig. 2
Patient Global Impression of Improvement (PGI-I) at follow-up after 3 months of self-management and definition of the outcome variables

References

    1. Milsom I, Altman D, Cartwright R, Lapitan MC, Nelson R, Sjöström S, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP), and anal incontinence (AI) In: Abrams P, Cardozo L, Wagg A, Wein A, et al., editors. Incontinence. 6. Bristol: ICI-ICS; 2017. pp. 4–142.
    1. Dumoulin C, Adewuyi T, Booth J, Bradley C, Burgio K, Hagen S, et al. Adult conservative management. In: Abrams P, Cardozo L, Wagg A, Wein A, et al., editors. Incontinence. 6. Bristol: ICI-ICS; 2017. pp. 1445–1628.
    1. 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.
    1. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017;318:1592–1604. doi: 10.1001/jama.2017.12137.
    1. Novara G, Checcucci E, Crestani A, Abrate A, Esperto F, Pavan N, et al. 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(6):786–811. doi: 10.1016/j.eururo.2020.06.025.
    1. Asklund I, Nyström E, Sjöström M, Umefjord G, Stenlund H, Samuelsson E. Mobile app for treatment of stress urinary incontinence: a randomized controlled trial. Neurourol Urodyn. 2017;36:1369–1376. doi: 10.1002/nau.23116.
    1. 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. doi: 10.1111/aogs.13192.
    1. Sjöström M, Lindholm L, Samuelsson E. Mobile app for treatment of stress urinary incontinence: a cost-effectiveness analysis. J Med Internet Res. 2017;19:e154. doi: 10.2196/jmir.7383.
    1. Barnes KL, Dunivan G, Jaramillo-Huff A, Krantz T, Thompson J, Jeppson P. Evaluation of smartphone pelvic floor exercise applications using standardized scoring system. Female Pelvic Med Reconstr Surg. 2019;25:328–335. doi: 10.1097/SPV.0000000000000563.
    1. Lindh A, Sjöström M, Stenlund H, Samuelsson E. Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year. Int Urogynecol J. 2016;27:1857–1865. doi: 10.1007/s00192-016-3050-4.
    1. Weinberger MW, Goodman BM, Carnes M. Long-term efficacy of nonsurgical urinary incontinence treatment in elderly women. J Gerontol A Biol Sci Med Sci. 1999;54:M117–M121. doi: 10.1093/gerona/54.3.M117.
    1. Burgio KL, Goode PS, Locher JL, Richter HE, Roth DL, Wright KC, et al. Predictors of outcome in the behavioral treatment of urinary incontinence in women. Obstet Gynecol. 2003;102:940–947.
    1. Schaffer J, Nager CW, Xiang F, Borello-France D, Bradley CS, Wu JM, et al. Predictors of success and satisfaction of nonsurgical therapy for stress urinary incontinence. Obstet Gynecol. 2012;120:91–97. doi: 10.1097/AOG.0b013e31825a6de7.
    1. Hendriks EJ, Kessels AG, de Vet HC, Bernards AT, de Bie RA. Prognostic indicators of poor short-term outcome of physiotherapy intervention in women with stress urinary incontinence. Neurourol Urodyn. 2010;29:336–343.
    1. Cammu H, Van Nylen M, Blockeel C, Kaufman L, Amy JJ. Who will benefit from pelvic floor muscle training for stress urinary incontinence? Am J Obstet Gynecol. 2004;191:1152–1157. doi: 10.1016/j.ajog.2004.05.012.
    1. Dumoulin C, Hay-Smith J, Frawley H, McClurg D, Alewijnse D, Bo K, et al. 2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 state-of-the-science seminar. Neurourol Urodyn. 2015;34:600–605. doi: 10.1002/nau.22796.
    1. Nyström E, Asklund I, Sjöström M, Stenlund H, Samuelsson E. Treatment of stress urinary incontinence with a mobile app: factors associated with success. Int Urogynecol J. 2018;29:1325–1333. doi: 10.1007/s00192-017-3514-1.
    1. Rygh P, Asklund I, Samuelsson E. Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study. BMJ Open. 2021;11:e040819. doi: 10.1136/bmjopen-2020-040819.
    1. Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23:322–330. doi: 10.1002/nau.20041.
    1. Yalcin I, Bump RC. Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol. 2003;189:98–101. doi: 10.1067/mob.2003.379.
    1. Milne JL, Moore KN. Factors impacting self-care for urinary incontinence. Urol Nurs. 2006;26:41–51.
    1. Xu D, Wang X, Li J, Wang K. The mediating effect of 'bothersome' urinary incontinence on help-seeking intentions among community-dwelling women. J Adv Nurs. 2015;71:315–325. doi: 10.1111/jan.12514.
    1. Björk AB, Sjöström M, Johansson EE, Samuelsson E, Umefjord G. Women's experiences of internet-based or postal treatment for stress urinary incontinence. Qual Health Res. 2014;24:484–493. doi: 10.1177/1049732314524486.
    1. Asklund I, Samuelsson E, Hamberg K, Umefjord G, Sjöström M. User experience of an app-based treatment for stress urinary incontinence: qualitative interview study. J Med Internet Res. 2019;21:e11296. doi: 10.2196/11296.
    1. Richter HE, Burgio KL, Chai TC, Kraus SR, Xu Y, Nyberg L, et al. Predictors of outcomes in the treatment of urge urinary incontinence in women. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:489–497. doi: 10.1007/s00192-009-0805-1.
    1. Labrie J, Lagro-Janssen AL, Fischer K, Berghmans LC, van der Vaart CH. Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence. Int Urogynecol J. 2015;26:329–334. doi: 10.1007/s00192-014-2473-z.
    1. Obloza A, Teo R, Marriott E, Parker G, Tincello D. Association of baseline severity of lower urinary tract symptoms with the success conservative therapy for urinary incontinence in women. Int Urogynecol J. 2019;30:705–710. doi: 10.1007/s00192-018-3778-0.
    1. Carroll JK, Moorhead A, Bond R, LeBlanc WG, Petrella RJ, Fiscella K. Who uses mobile phone health apps and does use matter? A secondary data analytics approach. J Med Internet Res. 2017;19:e125. doi: 10.2196/jmir.5604.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe