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Self-Management of Urinary Incontinence Using eHealth: clinically relevant improvement, treatment effect and factors associated with success
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
2018 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)Alternativ tittel
Självbehandling av urininkontinens med hjälp av eHälsa : kliniskt relevant förbättring, behandlingseffekt och framgångsfaktorer (svensk)
Abstract [en]

Background: Urinary incontinence is common among women, with prevalence most often reported to be between 25% and 45%. The most common type is stress urinary incontinence (SUI), defined as leakage upon exertion. First-line treatment includes pelvic floor muscle training (PFMT) and lifestyle advice. eHealth, the use of information and communication technology for health, can lower barriers to seeking help, save time and provide easily accessible care. In other conditions, the use of mobile technology has been argued to improve adherence to, and serve as a support for, self-management leading to improved symptom control.

Aim: To evaluate self-management of urinary incontinence via eHealth with respect to clinically relevant improvement, treatment effect and factors associated with success. This thesis focuses on self-management of SUI via the mobile app Tät®.

Methods: This thesis is based on four papers (I-IV) with data from three different studies (1-3). Studies 1 and 2 were randomised controlled trials, to which adult, community-dwelling women with at least weekly SUI were recruited via the website of the research project. In study 3, we studied the use of the Tät® app once it had been made freely available after study 2. All users with urinary incontinence that were 18 years of age or older were included. All interventions were developed within the research project, focused on PFMT and included lifestyle advice

In study 1, participants were randomised to either internet-based or brochurebased SUI management. Data from both groups were analysed for correlation with the Patient Global Impression of Improvement (PGI-I) questionnaire and the changes in validated symptom (ICIQ-UI SF) questionnaire and in the quality of life (ICIQ-LUTSqol) questionnaire. We then determined a minimal important difference (MID) for non-face-to-face treatment of SUI. (Paper I)

In study 2, participants were randomised to three months of self-management with the Tät® app or to control group (waiting list). The primary outcomes were ICIQ-UI SF and ICIQ-LUTSqol. These were analysed according to intention to treat using a linear mixed model. (Paper II) Data from the participants that were randomised to app management were analysed using logistic regression to identify factors associated with success. Success was defined as participants stating that they were much/very much better according to PGI-I. (Paper III)

In study 3, users were asked to participate by completing questionnaires upon download of the app and three months thereafter. Background factors, PFMT iv frequency and app usage were analysed using logistic regression to identify factors associated with three outcomes: completion of three months of selfmanagement, improvement (according to PGI-I) and success (defined as described above). (Paper IV)

Results: We found that the symptom and quality of life scores capture a clinically relevant improvement. The MIDs were determined to be a reduction of 2.52 points for ICIQ-UI SF and 3.71 points for ICIQ-LUTSqol. (Paper I)

The Tät® app had a positive effect on symptoms with a mean ICIQ-UI SF reduction of 3.9 points (95% CI 3.0 -4.7), and improved quality of life with a mean ICIQ-LUTSqol reduction of 4.8 points (95% CI 3.4-6.2). These scores differed significantly from the control group and were well above the MIDs, and therefore clinically relevant improvements. Women in the intervention groups also had a greater decrease in incontinence episode frequency, and significantly reduced their pad use compared to the control group. In terms of patient satisfaction, 97% found the app to be “good” or “very good”. (Paper II)

After three months of self-management with Tät®, 34 out of 61 participants (56%) stated that they were much or very much better. Three factors were associated with successful management: high expectations on treatment, weight control and self-assessed improvement in pelvic floor muscle strength. (Paper III)

Once the app was freely available, 1 861 of 13 257 users (14%) completed the three-month follow-up. Four factors predicted completion: age, higher educational level, stress-type incontinence episodes and language. Together these factors accounted for 2.7% of the variability (Nagelkerke R2). Among the users that completed self-management, 68% improved and 29% were successful according to the PGI-I. Stress-type leakage and language were also associated with improvement. At least weekly PFMT and app usage predicted both improvement and successful self-management. (Paper IV)

Conclusion: Self-management for urinary incontinence via a mobile app has clinically relevant effects on symptoms and quality of life. This is particularly the case for women with high expectations on app self-management and for those who used the app and exercised their pelvic floor at least weekly. Furthermore, beyond the study setting once the app was freely available, the majority of users’ symptoms improved if users completed three months of training.

sted, utgiver, år, opplag, sider
Umeå: Umeå Universitet , 2018. , s. 66
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2002
Emneord [en]
Urinary incontinence, pelvic floor muscle training, eHealth, self-management, quality of life, randomised controlled trial
HSV kategori
Forskningsprogram
allmänmedicin
Identifikatorer
URN: urn:nbn:se:umu:diva-154542ISBN: 978-91-7601-994-8 (tryckt)OAI: oai:DiVA.org:umu-154542DiVA, id: diva2:1272467
Disputas
2019-01-11, Hörsalen Snäckan, Östersunds sjukhus, Östersund, 13:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2018-12-21 Laget: 2018-12-19 Sist oppdatert: 2019-01-10bibliografisk kontrollert
Delarbeid
1. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence
Åpne denne publikasjonen i ny fane eller vindu >>ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence
2015 (engelsk)Inngår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 34, nr 8, s. 747-751Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

AIMS: To determine whether changes in questionnaire scores on symptoms and condition-specific quality of life reflect clinically relevant improvements in women with stress urinary incontinence (SUI).

METHODS: We retrospectively analyzed questionnaires collected during a randomized controlled trial in women with SUI, that received pelvic floor muscle training (PFMT) in two different formats. We included 218 women that answered validated self-assessment questionnaires at baseline and at a 4-month follow-up. We registered changes on two questionnaires, the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol). We compared these score changes to responses from the Patient Global Impression of Improvement (PGI-I) questionnaire. Differences were analyzed with the Spearman rho and one-way-ANOVA. The minimum important difference (MID) was the mean change in score for women that experienced a small improvement.

RESULTS: The PGI-I correlated significantly to both the ICIQ-UI SF (r = 0.547, P < 0.0001) and ICIQ-LUTSqol (r = 0.520, P < 0.0001). Thus, larger reductions in symptoms or quality of life scores were associated with greater impressions of improvement. The changes in ICIQ-UI SF and ICIQ-LUTSqol scores were significant across all PGI-I groups from "no change" to "very much improved" (P < 0.05). The MIDs were 2.52 (SD 2.56) for ICIQ-UI SF and 3.71 (SD 4.95) for ICIQ-LUTSqol.

CONCLUSIONS: The change in ICIQ-UI SF and ICIQ-LUTSqol scores after PFMT reflected clinically relevant improvements in women with SUI. The MIDs established for this population may facilitate future research, treatment evaluations, and comparisons between studies. 

sted, utgiver, år, opplag, sider
Wiley-Blackwell, 2015
Emneord
ICIQ-LUTSqol, ICIQ-UI SF, minimum important difference, pelvic floor muscle training, PGI-I, stress urinary incontinence
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-99024 (URN)10.1002/nau.22657 (DOI)000362963200008 ()25154378 (PubMedID)
Merknad

Article first published online: 2014-08-22

Tilgjengelig fra: 2015-02-02 Laget: 2015-02-02 Sist oppdatert: 2018-12-19bibliografisk kontrollert
2. Mobile app for treatment of stress urinary incontinence: a randomized controlled trial
Åpne denne publikasjonen i ny fane eller vindu >>Mobile app for treatment of stress urinary incontinence: a randomized controlled trial
Vise andre…
2017 (engelsk)Inngår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 36, nr 5, s. 1369-1376Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

AIMS: To evaluate the effect of a mobile app treatment for stress urinary incontinence (SUI) in women.

METHODS: Randomized controlled trial, conducted 2013-2014 in Sweden. Community-dwelling adult women with ≥1 SUI episode/week recruited through our website and randomized to app treatment (n = 62) or control group (postponed treatment, n = 61). One participant from each group was lost to follow-up. Intervention was the mobile app Tät(®) with a treatment program focused on pelvic floor muscle training (PFMT), and information about SUI and lifestyle factors. Primary outcomes, 3 months after randomization: symptom severity (International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form [ICIQ-UI SF]); and condition-specific quality of life (ICIQ Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]).

RESULTS: One hundred and twenty-three women were included (mean age 44.7), with moderate/severe SUI (97.5%, 120/123), mean ICIQ-UI SF score 11.1 (SD 2.8) and mean ICIQ-LUTSqol score 34.4 (SD 6.1) at baseline. At follow-up, the app group reported improvements in symptom severity (mean ICIQ-UI SF score reduction: 3.9, 95% confidence interval 3.0-4.7) and condition-specific quality of life (mean ICIQ-LUTSqol score reduction: 4.8, 3.4-6.2) and the groups were significantly different (mean ICIQ-UI SF score difference: -3.2, -4.3to -2.1; mean ICIQ-LUTSqol score difference: -4.6, -7.8 to -1.4). In the app group, 98.4% (60/61) performed PFMT at follow-up, and 41.0% (25/61) performed it daily.

CONCLUSIONS: The mobile app treatment was effective for women with SUI and yielded clinically relevant improvements. This app may increase access to first-line treatment and adherence to PFMT.

sted, utgiver, år, opplag, sider
John Wiley & Sons, 2017
Emneord
mobile applications, pelvic floor muscle training, randomized controlled trial, self-management, stress urinary incontinence
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-127492 (URN)10.1002/nau.23116 (DOI)000404361100020 ()27611958 (PubMedID)
Tilgjengelig fra: 2016-11-14 Laget: 2016-11-14 Sist oppdatert: 2018-12-19bibliografisk kontrollert
3. Treatment of stress urinary incontinence with a mobile app: factors associated with success
Åpne denne publikasjonen i ny fane eller vindu >>Treatment of stress urinary incontinence with a mobile app: factors associated with success
Vise andre…
2018 (engelsk)Inngår i: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 29, nr 9, s. 1325-1333Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Introduction and hypothesis: Stress urinary incontinence is common among women. First-line treatment includes pelvic floor muscle training (PFMT) and lifestyle advice, which can be provided via a mobile app. The efficacy of app-based treatment has been demonstrated in a randomized controlled trial (RCT). In this study, we aimed to analyze factors associated with successful treatment.

Methods: Secondary analysis of data from the RCT. At baseline and 3-month follow-up, participants (n = 61) answered questions about symptoms, quality of life, background, and PFMT. Success was defined as rating the condition as much or very much better according to the validated Patient Global Impression of Improvement questionnaire. Factors possibly associated with success were analyzed with univariate logistic regression; if p < 0.20, the factor was entered into a multivariate model that was adjusted for age. Variables were then removed stepwise.

Results: At follow-up, 34 out of 61 (56%) of participants stated that their condition was much or very much better. Three factors were significantly associated with success: higher expectations for treatment (odds ratio [OR] 11.38, 95% confidence interval [CI] 2.02-64.19), weight control (OR 0.44 per kg gained, 95% CI 0.25-0.79), and self-rated improvement of pelvic floor muscle strength (OR 35.54, 95% CI 4.96-254.61). Together, these factors accounted for 61.4% (Nagelkerke R-2) of the variability in success.

Conclusion: These results indicate that app-based treatment effects are better in women who are interested in and have high expectations of such treatment. Also, the findings underline the importance of strengthening the pelvic floor muscles and offering lifestyle advice.

sted, utgiver, år, opplag, sider
Springer, 2018
Emneord
Mobile applications, Pelvic floor muscle training, Stress urinary incontinence, Self-management
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-152224 (URN)10.1007/s00192-017-3514-1 (DOI)000443429400014 ()29222718 (PubMedID)
Tilgjengelig fra: 2018-10-16 Laget: 2018-10-16 Sist oppdatert: 2018-12-19bibliografisk kontrollert
4. Self-Management of Incontinence Using a Mobile App: Factors Associated with Completion and Improvement
Åpne denne publikasjonen i ny fane eller vindu >>Self-Management of Incontinence Using a Mobile App: Factors Associated with Completion and Improvement
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
HSV kategori
Forskningsprogram
allmänmedicin
Identifikatorer
urn:nbn:se:umu:diva-154486 (URN)
Tilgjengelig fra: 2018-12-19 Laget: 2018-12-19 Sist oppdatert: 2018-12-19

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