A Mobile App for Self-management of Urgency and Mixed Urinary Incontinence in Women: Randomized Controlled Trial

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://ichgcp.net/clinical-trials-registry/NCT03097549.

Keywords: eHealth; mHealth; mixed urinary incontinence; mobile app; self-management; smartphone app; urgency urinary incontinence; urinary incontinence; women.

Conflict of interest statement

Conflicts of Interest: The logos Tät and Tät.nu are registered as trademark by The Swedish Patent and Registration office for E Samuelsson at Umeå University. None of the researchers have any financial interest in the programs.

©Towe Wadensten, Emma Nyström, Karin Franzén, Anna Lindam, Elisabet Wasteson, Eva Samuelsson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.04.2021.

Figures

Figure 1

Screenshots from the treatment app (Tät II). Upper-left corner: main (home) screen; upper-right corner: active view of an exercise in the bladder training program; lower-left corner: textual description of another bladder training exercise; lower-right corner: information from the lifestyle section. Text has been translated from Swedish to English for illustration purposes.

Figure 2

Trial profile.

Figure 3

Patient’s Global Impression of Improvement responses reported by the participants at follow-up. Comparison between the treatment group (n=60) and the information group (n=63). *P<.001 (Mann-Whitney U test). Two participants were lost to follow-up in the treatment group and imputed as “no change” for this analysis.