Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study

Pontus Rygh, Ina Asklund, Eva Samuelsson, Pontus Rygh, Ina Asklund, Eva Samuelsson

Abstract

Objectives: The efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT). In this study, we investigate the user characteristics and the effectiveness of the same app when freely available, and compare these results with the RCT.

Design: Prospective cohort study.

Participants: During a 17-month period, 24 602 non-pregnant, non-postpartum women older than 18 years downloaded the app and responded anonymously to a questionnaire. Of these, 2672 (11%) responded to the 3-month follow-up.

Intervention: Three months' use of the app Tät, containing information, a pelvic floor muscle training programme and lifestyle advice.

Main outcome measures: Change in symptom severity (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)) and subjective improvement (Patient Global Impression of Improvement (PGI-I)).

Results: Of the respondents, 88% lived in Sweden and 75% (18 384/24 602) were incontinent with a mean age of 45.5 (SD 14.1) years. The UI types, based on symptoms, were SUI (53%), urgency UI (12%), mixed UI (31%) and undefined (4%). The mean ICIQ-UI SF score was 8.2 (SD 4.0) at baseline. The mean ICIQ-UI SF score reduction at follow-up was 1.31 (95% CI: 1.19 to 1.44) with a larger reduction in those with more severe incontinence at baseline (severe/very severe 3.23 (95% CI: 2.85 to 3.61), moderate 1.41 (95% CI: 1.24 to 1.59) and slight 0.24 (95% CI 0.06 to 0.42). When the results were weighted to match the distribution of severity in the RCT, the ICIQ-UI SF score reduction was 2.2 compared with 3.9 in the RCT. Regarding PGI-I, 65% experienced improvement compared with 92% in the RCT.

Conclusions: The app Tät was effective for self-management of UI even in the real world. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.

Keywords: gynaecology; urinary incontinences; urogynaecology; urology.

Conflict of interest statement

Competing interests: The name Tät and the logo Tät.nu are registered as trademarks by The Swedish Patent and Registration office for ES at Umeå University.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Screenshots from the Tät app.
Figure 2
Figure 2
Flowchart of users of the freely available Tät app, at baseline and follow-up. PGI-I, Patient Global Impression of Improvement.
Figure 3
Figure 3
Patient Global Impression of Improvement: How is your urinary leakage now compared with before downloading the app? Users with slight, moderate, severe or very severe incontinence at baseline.

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Source: PubMed

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