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Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training.

https://arctichealth.org/en/permalink/ahliterature270264
Source
BJU Int. 2015 Dec;116(6):955-64
Publication Type
Article
Date
Dec-2015
Author
Malin Sjöström
Göran Umefjord
Hans Stenlund
Per Carlbring
Gerhard Andersson
Eva Samuelsson
Source
BJU Int. 2015 Dec;116(6):955-64
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Exercise Therapy - methods
Female
Follow-Up Studies
Humans
Internet
Middle Aged
Pelvic Floor - physiopathology
Sweden
Telemedicine - methods
Treatment Outcome
Urinary Incontinence, Stress - epidemiology - physiopathology - therapy
Young Adult
Abstract
To evaluate the long-term effects of two non-face-to-face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT).
The present study was a randomized controlled trial with online recruitment of 250 community-dwelling women aged 18-70 years with SUI = one time/week. Diagnosis was based on validated self-assessed questionnaires, 2-day bladder diary and telephone interview with a urotherapist. Consecutive computer-generated block randomization was carried out with allocation by an independent administrator to 3 months of treatment with either an internet-based treatment programme (n = 124) or a programme sent by post (n = 126). Both interventions focused mainly on PFMT. The internet group received continuous e-mail support from a urotherapist, whereas the postal group trained on their own. Follow-up was performed after 1 and 2 years via self-assessed postal questionnaires. The primary outcomes were symptom severity (International Consultation on Incontinence Questionnaire Short Form [ICIQ-UI SF]) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]). Secondary outcomes were the Patient Global Impression of Improvement, health-specific quality of life (EQ-visual analogue scale [EQ-VAS]), use of incontinence aids, and satisfaction with treatment. There was no face-to-face contact with the participants at any time. Analysis was based on intention-to-treat.
We lost 32.4% (81/250) of participants to follow-up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (P 0.8) for symptoms and condition-specific quality of life (QoL) after 1 and 2 years, respectively. No significant differences were found between the groups. The mean (sd) changes in symptom score were 3.7 (3.3) for the internet group and 3.2 (3.4) for the postal group (P = 0.47) after 1 year, and 3.6 (3.5) for the internet group and 3.4 (3.3) for the postal group (P = 0.79) after 2 years. The mean changes (sd) in condition-specific QoL were 5.5 (6.5) for the internet group and 4.7 the for postal group (6.5) (P = 0.55) after 1 year, and 6.4 (6.0) for the internet group and 4.8 (7.6) for the postal group (P = 0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (internet, 31.9% [28/88]; postal, 33.8% [27/80], P = 0.82), but after 2 years significantly more participants in the internet group reported this degree of improvement (39.2% [29/74] vs 23.8% [19/80], P = 0.03). Health-specific QoL improved significantly in the internet group after 2 years (mean change in EQ-VAS, 3.8 [11.4], P = 0.005). We found no other significant improvements in this measure. At 1 year after treatment, 69.8% (60/86) of participants in the internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the treatment result. After 2 years, the proportions were 64.9% (48/74) and 58.2% (46/79), respectively.
Non-face-to-face treatment of SUI with PFMT provides significant and clinically relevant improvements in symptoms and condition-specific QoL at 1 and 2 years after treatment.
Notes
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PubMed ID
25683075 View in PubMed
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Treatment of stress urinary incontinence with a mobile app: factors associated with success.

https://arctichealth.org/en/permalink/ahliterature297755
Source
Int Urogynecol J. 2018 09; 29(9):1325-1333
Publication Type
Journal Article
Date
09-2018
Author
Emma Nyström
Ina Asklund
Malin Sjöström
Hans Stenlund
Eva Samuelsson
Author Affiliation
Department of Public Health and Clinical Medicine, Unit of Research, Education and Development-Östersund, Umeå University, Umeå, Sweden. emma.nystrom@regionjh.se.
Source
Int Urogynecol J. 2018 09; 29(9):1325-1333
Date
09-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Exercise Therapy - methods
Female
Follow-Up Studies
Humans
Middle Aged
Mobile Applications - statistics & numerical data
Pelvic Floor
Pregnancy
Quality of Life
Self Care - methods
Sweden
Telemedicine - statistics & numerical data
Treatment Outcome
Urinary Incontinence, Stress - psychology - therapy
Abstract
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.
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?
Notes
CommentIn: Int Urogynecol J. 2018 Apr;29(4):613 PMID 29508042
CommentIn: Int Urogynecol J. 2018 Jun;29(6):925 PMID 29594320
PubMed ID
29222718 View in PubMed
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Women's experiences of internet-based or postal treatment for stress urinary incontinence.

https://arctichealth.org/en/permalink/ahliterature264939
Source
Qual Health Res. 2014 Apr;24(4):484-93
Publication Type
Article
Date
Apr-2014
Author
Anna-Bell Björk
Malin Sjöström
Eva E Johansson
Eva Samuelsson
Göran Umefjord
Source
Qual Health Res. 2014 Apr;24(4):484-93
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Female
Humans
Internet
Pelvic Floor
Postal Service
Sweden
Urinary Incontinence, Stress - psychology - therapy
Abstract
Stress urinary incontinence is common and sometimes embarrassing. New, simple, and easily accessible treatments are needed. We telephone interviewed 21 women who participated in a randomized controlled study comparing two treatment programs based on instructions for pelvic floor muscle training. One program was Internet-based and included email support by a urotherapist; the other was sent by post. There was no face-to-face contact in either program. Our main aim was to explore the women's experiences of the Internet-based treatment. Grounded theory analysis revealed three categories: hidden but present, at a distance but close, and by myself but not alone. These were incorporated in a core category: acknowledged but not exposed. The leakage was often a well-hidden secret, but the study treatments lowered the barrier for seeking care. In the Internet group, a supportive patient-provider relationship developed despite the lack of face-to-face contact. Internet-based treatment programs can increase access to care and empower women.
PubMed ID
24598777 View in PubMed
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