The eContinence Project: Development, Evaluation, and Implementation of Treatment Programmes for Urinary Incontinence via Internet/Smartphone/PC Tablet Applications
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Abstract
Background
Urinary incontinence (UI) may severely affect quality of life and costs for society are high. Its prevalence and severity increase with age and comorbidity. UI is twice as prevalent among women as among men; approximately one-fourth of women have UI. First-line treatments for UI are lifestyle advice, pelvic floor muscle training (PFMT) for stress urinary incontinence (SUI) and bladder training for urgency urinary incontinence (UUI). Embarrassment may prevent those in need from seeking help; in addition, access to care varies and treatment is often not optimal. Almost 95% of the Swedish population has access to the Internet, and 63% of the adult population owns a smartphone. Our research group has developed an Internet-based treatment programme based on PFMT for SUI in women. The effect of the Internet programme was evaluated in a randomized controlled trial (RCT, Clinical Trials NCT01032265), and compared with the effect of a treatment programme sent by post. Briefly, improvement of symptom severity and quality of life was highly significant and similar with both programmes. Women receiving Internet-based treatment reported greater subjective improvements, larger reductions in the use of incontinence aids, and greater satisfaction with the treatment programme. The non face-to-face approach seemed to lower the barrier for seeking care and the participants felt supported, acknowledged and empowered. We have also developed a mobile application for women with SUI, currently under evaluation in an ongoing RCT. We now plan to implement the existing Internet programme in different clinical settings and to develop treatment programmes for other types of UI.
Objective
The overall aim of the project is to develop and evaluate easily accessible treatment programmes for urinary incontinence via Internet/Smartphone/PC tablet applications
Methods
We have started the development of a diagnostic and treatment programme for UUI and MUI (mixed urinary incontinence). The use of a new platform will allow us to individually tailor actions depending on each individual’s preferences, symptoms, and needs. Support for self-assessment and diagnosis are implemented. Different treatment programmes such as PFMT, bladder training and other behavioural therapies are included. We are aiming to recruit approximately 110 adult women (≥18 years old) that experience ≥1 episode of MUI or UUI per week. Diagnosis will be based on questionnaires, a bladder diary, a telephone interview, and a clinical assessment if necessary. The participants will be randomized to a treatment group or to a postponed treatment group. Outcomes are symptom severity, condition-specific quality of life, incontinence episode frequency, use of incontinence aids, health economic measures, and patient satisfaction (4 months, 1 year). The trial will be registered at Clinical Trials and reported according to CONSORT guidelines. An overview of the eContinence Project and a detailed study protocol will be presented at the conference.
Conclusions
Treatment via Internet/smartphone/pc tablet has the potential to increase access to care and to empower women with urinary incontinence to take an active role in their treatment.
Urinary incontinence (UI) may severely affect quality of life and costs for society are high. Its prevalence and severity increase with age and comorbidity. UI is twice as prevalent among women as among men; approximately one-fourth of women have UI. First-line treatments for UI are lifestyle advice, pelvic floor muscle training (PFMT) for stress urinary incontinence (SUI) and bladder training for urgency urinary incontinence (UUI). Embarrassment may prevent those in need from seeking help; in addition, access to care varies and treatment is often not optimal. Almost 95% of the Swedish population has access to the Internet, and 63% of the adult population owns a smartphone. Our research group has developed an Internet-based treatment programme based on PFMT for SUI in women. The effect of the Internet programme was evaluated in a randomized controlled trial (RCT, Clinical Trials NCT01032265), and compared with the effect of a treatment programme sent by post. Briefly, improvement of symptom severity and quality of life was highly significant and similar with both programmes. Women receiving Internet-based treatment reported greater subjective improvements, larger reductions in the use of incontinence aids, and greater satisfaction with the treatment programme. The non face-to-face approach seemed to lower the barrier for seeking care and the participants felt supported, acknowledged and empowered. We have also developed a mobile application for women with SUI, currently under evaluation in an ongoing RCT. We now plan to implement the existing Internet programme in different clinical settings and to develop treatment programmes for other types of UI.
Objective
The overall aim of the project is to develop and evaluate easily accessible treatment programmes for urinary incontinence via Internet/Smartphone/PC tablet applications
Methods
We have started the development of a diagnostic and treatment programme for UUI and MUI (mixed urinary incontinence). The use of a new platform will allow us to individually tailor actions depending on each individual’s preferences, symptoms, and needs. Support for self-assessment and diagnosis are implemented. Different treatment programmes such as PFMT, bladder training and other behavioural therapies are included. We are aiming to recruit approximately 110 adult women (≥18 years old) that experience ≥1 episode of MUI or UUI per week. Diagnosis will be based on questionnaires, a bladder diary, a telephone interview, and a clinical assessment if necessary. The participants will be randomized to a treatment group or to a postponed treatment group. Outcomes are symptom severity, condition-specific quality of life, incontinence episode frequency, use of incontinence aids, health economic measures, and patient satisfaction (4 months, 1 year). The trial will be registered at Clinical Trials and reported according to CONSORT guidelines. An overview of the eContinence Project and a detailed study protocol will be presented at the conference.
Conclusions
Treatment via Internet/smartphone/pc tablet has the potential to increase access to care and to empower women with urinary incontinence to take an active role in their treatment.
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