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Technical Update No. 433: eHealth Solutions for Urinary Incontinence among Women

Published:October 20, 2022DOI:https://doi.org/10.1016/j.jogc.2022.10.005

      Abstract

      Objective

      The purpose of this technical update is to establish the state of the science regarding emerging and novel electronic health (eHealth) and mobile health (mHealth) solutions for urinary incontinence among women.

      Target population

      Women over 18 years with urinary incontinence.

      Options

      Websites and mobile health applications are useful in the conservative care of urinary incontinence. Relevant care providers should be familiar with such tools, particularly those that use motivational principles for behaviour change, which can be used as adjunct tools for urinary incontinence care. Telemedicine is an effect mode to provide services for the conservative care of urinary incontinence.

      Outcomes

      Use of eHealth and mHealth solutions has potentially significant health outcomes for patients, providers, and global health systems. Broader use of telemedicine, in and of itself, could improve care access and reduce costs incurred by patients and the health care system.

      Benefits, Harms, and Costs

      Evidence for the efficacy of eHealth and mHealth technologies and applications for urinary incontinence ranges from weak to strong. However, the research landscape for many of these novel solutions is developing rapidly. Furthermore, these options have minimal or no harm and confer an established cost benefit and care access benefit.

      Evidence

      The Cochrane Library, Medline, EMBASE, CENTRAL databases (from January 2014 to April 2019) were searched to find articles related to conservative care of urinary incontinence in women (over 18 years) and studies on eHealth and mHealth interventions for urinary incontinence. Articles were appraised, and the collective evidence was graded.

      Validation methods

      The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).

      Intended audience

      Relevant primary care providers and medical specialists, including physicians, nurses, midwives, and pelvic health physiotherapists.

      Keywords

      ABBREVIATIONS:

      eHealth (electronic health), ICIQ-LUTSqol (International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms Quality of Life module), ICIQ-UI SF (International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form), mHealth (mobile health), OAB (overactive bladder), PFDI (Pelvic Floor Distress Inventory), PFMT (pelvic floor muscle training), SUI (stress urinary incontinence), UI (urinary incontinence), UUI (urge urinary incontinence)
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      References

        • Bo K.
        • Frawley H.C.
        • Haylen B.T.
        • et al.
        An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.
        Neurourol Urodyn. 2017; 36: 221-244
        • Dufour S.
        • Wu M.
        • No
        397 - Conservative care of urinary incontinence in women.
        J Obstet Gynaecol Can. 2020; 42: 510-522
        • Deslauriers S.
        • Raymond M.H.
        • Laliberte M.
        • et al.
        Access to publicly funded outpatient physiotherapy services in Quebec: waiting lists and management strategies.
        Disabil Rehabil. 2017; 39: 2648-2656
        • Moossdorff-Steinhauser H.F.A.
        • Berghmans B.C.M.
        • Spaanderman M.E.A.
        • et al.
        Urinary incontinence during pregnancy: prevalence, experience of bother, beliefs, and help-seeking behavior.
        Int Urogynecol J. 2021; 32: 695-701
        • Eysenbach G.
        What is e-health?.
        J Med Internet Res. 2001; 3: E20
      1. eHealth WHOGOf. mHealth: new horizons for health through mobile technologies: second global survey on eHealth. Geneva, Switzerland: World Health Organization; 2011. Available at: https://apps.who.int/iris/handle/10665/44607. Accessed on October 29, 2019.

        • Barnes K.L.
        • Dunivan G.
        • Jaramillo-Huff A.
        • et al.
        Evaluation of smartphone pelvic floor exercise applications using standardized scoring system.
        Female Pelvic Med Reconstr Surg. 2019; 25: 328-335
        • Powell A.C.
        • Landman A.B.
        • Bates D.W.
        In search of a few good apps.
        JAMA. 2014; 311: 1851-1852
        • Bernard S.
        • Boucher S.
        • McLean L.
        • et al.
        Mobile technologies for the conservative self-management of urinary incontinence: a systematic scoping review.
        Int Urogynecol J. 2020; 31: 1163-1174
        • Wessels N.J.
        • Hulshof L.
        • Loohuis A.M.M.
        • et al.
        User experiences and preferences regarding an app for the treatment of urinary incontinence in adult women: qualitative study.
        JMIR Mhealth Uhealth. 2020; 8e17114
        • Nystrom E.
        • Asklund I.
        • Sjostrom M.
        • et al.
        Treatment of stress urinary incontinence with a mobile app: factors associated with success.
        Int Urogynecol J. 2018; 29: 1325-1333
        • Asklund I.
        • Nystrom E.
        • Sjostrom M.
        • et al.
        Mobile app for treatment of stress urinary incontinence: a randomized controlled trial.
        Neurourol Urodyn. 2017; 36: 1369-1376
        • Czyrnyj C.S.
        • Berube M.E.
        • Brooks K.
        • et al.
        Reliability and validity of a mobile home pelvic floor muscle trainer: the Elvie trainer.
        Neurourol Urodyn. 2020; 39: 1717-1731
        • Barbato K.A.
        • Wiebe J.W.
        • Cline T.W.
        • et al.
        Web-based treatment for women with stress urinary incontinence.
        Urol Nurs. 2014; 34: 252-257
        • Novara G.
        • Checcucci E.
        • Crestani A.
        • et al.
        Telehealth in urology: a systematic review of the literature. How much can telemedicine be useful during and after the COVID-19 pandemic?.
        Eur Urol. 2020; 78: 786-811
        • Asklund I.
        • Samuelsson E.
        • Hamberg K.
        • et al.
        User experience of an app-based treatment for stress urinary incontinence: qualitative interview study.
        J Med Internet Res. 2019; 21e11296
        • Hoffman V.
        • Soderstrom L.
        • Samuelsson E.
        Self-management of stress urinary incontinence via a mobile app: two-year follow-up of a randomized controlled trial.
        Acta Obstet Gynecol Scand. 2017; 96: 1180-1187
        • Mendiola M.F.
        • Kalnicki M.
        • Lindenauer S.
        Valuable features in mobile health apps for patients and consumers: content analysis of apps and user ratings.
        JMIR Mhealth Uhealth. 2015; 3: e40
        • Payne H.E.
        • Lister C.
        • West J.H.
        • et al.
        Behavioral functionality of mobile apps in health interventions: a systematic review of the literature.
        JMIR Mhealth Uhealth. 2015; 3e20
        • Bjork A.B.
        • Sjostrom M.
        • Johansson E.E.
        • et al.
        Women's experiences of internet-based or postal treatment for stress urinary incontinence.
        Qual Health Res. 2014; 24: 484-493
        • Duenas-Garcia OF
        • Kandadai P.
        • Flynn M.K.
        • et al.
        Patient-focused websites related to stress urinary incontinence and pelvic organ prolapse: a DISCERN quality analysis.
        Int Urogynecol J. 2015; 26: 875-880
        • Mazloomdoost D.
        • Kanter G.
        • Chan R.C.
        • et al.
        Social networking and Internet use among pelvic floor patients: a multicenter survey.
        Am J Obstet Gynecol. 2016; 215 (e1–10): 654
        • Dufour S.
        • Fedorkow D.
        • Kun J.
        • et al.
        Exploring the impact of a mobile health solution for postpartum pelvic floor muscle training: pilot randomized controlled feasibility study.
        JMIR Mhealth Uhealth. 2019; 7e12587
        • Firet L.
        • de Bree C.
        • Verhoeks C.M.
        • et al.
        Mixed feelings: general practitioners' attitudes towards eHealth for stress urinary incontinence - a qualitative study.
        BMC Fam Pract. 2019; 20: 21
        • Shakir N.
        • Yi Y.
        • Davenport M.
        • et al.
        096 Improved prediction of transobturator sling outcomes utilizing a validated internet-based nomogram.
        J Sex Med. 2019; 16: S49-50
        • Sjostrom M.
        • Lindholm L.
        • Samuelsson E.
        Mobile app for treatment of stress urinary incontinence: a cost-effectiveness analysis.
        J Med Internet Res. 2017; 19: e154
        • Sjostrom M.
        • Umefjord G.
        • Lindholm L.
        • et al.
        Cost-effectiveness of an Internet-based treatment program for stress urinary incontinence.
        Neurourol Urodyn. 2015; 34: 244-250
        • Tincello D.G.
        • Armstrong N.
        • Hilton P.
        • et al.
        Surgery for recurrent stress urinary incontinence: the views of surgeons and women.
        Int Urogynecol J. 2018; 29: 45-54
        • Wadensten T.
        • Nystrom E.
        • Franzen K.
        • et al.
        A mobile app for self-management of urgency and mixed urinary incontinence in women: randomized controlled trial.
        J Med Internet Res. 2021; 23e19439
        • Wang X.
        • Xu X.
        • Luo J.
        • et al.
        Effect of app-based audio guidance pelvic floor muscle training on treatment of stress urinary incontinence in primiparas: a randomized controlled trial.
        Int J Nurs Stud. 2020; 104103527
      2. Coggins JH, Thomson H, Cartwright R. Self-reported changes in pelvic floor training frequency and incontinence symptoms with the intravaginal Elvie device. Paper presented at: International Continence Society 47th Annual Meeting; Septermber 12-September 15, 2017; Florence, Italy. Abstract available at: https://www.ics.org/2017/abstract/213. Accessed on March 25, 2019.

        • Lindh A.
        • Sjostrom M.
        • Stenlund H.
        • et al.
        Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year.
        Int Urogynecol J. 2016; 27: 1857-1865
        • Sjostrom M.
        • Umefjord G.
        • Stenlund H.
        • et al.
        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.
        BJU Int. 2015; 116: 955-964
        • Carrion Perez F.
        • Rodriguez Moreno M.S.
        • Carnerero Cordoba L.
        • et al.
        [Telerehabilitation to treat stress urinary incontinence. Pilot study].
        Med Clin (Barc). 2015; 144 ([in Spanish]): 445-448
        • Khanijow K.D.
        • Leri D.
        • Arya L.A.
        • et al.
        A mobile application patient decision aid for treatment of overactive bladder.
        Female Pelvic Med Reconstr Surg. 2021; 27: 365-370
        • Clancy A.A.
        • Hickling D.
        • Didomizio L.
        • et al.
        Patient-targeted websites on overactive bladder: what are our patients reading?.
        Neurourol Urodyn. 2018; 37: 832-841
        • Koo K.
        • Shee K.
        • Yap R.L.
        Readability analysis of online health information about overactive bladder.
        Neurourol Urodyn. 2017; 36: 1782-1787
        • Andrade A.D.
        • Anam R.
        • Karanam C.
        • et al.
        An overactive bladder online self-management program with embedded avatars: a randomized controlled trial of efficacy.
        Urology. 2015; 85: 561-567
        • Mateu Arrom L.
        • Peri Cusi L.
        • Franco de Castro A.
        • et al.
        Development and feasibility assessment of a 3 day electronic bladder diary as an app for smart-phone.
        Neurourol Urodyn. 2018; 37: 1717-1723
        • Mateu Arrom L.
        • Peri Cusi L.
        • Lopez-Fando L.
        • et al.
        Validation of a 3 day electronic bladder diary as an app for smart-phone.
        Neurourol Urodyn. 2019; 38: 764-769
        • Pepper J.
        • Zhang A.
        • Li R.
        • et al.
        Usage results of a mobile app for managing urinary incontinence.
        J Urol. 2015; 193: 1292-1297
        • Yu P.
        • Hailey D.
        • Fleming R.
        • et al.
        An exploration of the effects of introducing a telemonitoring system for continence assessment in a nursing home.
        J Clin Nurs. 2014; 23: 3069-3076
        • Lisonkova S.
        • Geoffrion R.
        • Sanaee M.
        • et al.
        Regional variation and temporal trends in surgery for pelvic organ prolapse in Canada, 2004-2014.
        J Obstet Gynaecol Can. 2020; 42: 846-852 e5
        • Johnson 2nd, T.M.
        • Kincade J.E.
        • Bernard S.L.
        • et al.
        The association of urinary incontinence with poor self-rated health.
        J Am Geriatr Soc. 1998; 46: 693-699
        • da Mata K.R.U.
        • Costa R.C.M.
        • Carbone E.
        • et al.
        Telehealth in the rehabilitation of female pelvic floor dysfunction: a systematic literature review.
        Int Urogynecol J. 2021; 32: 249-259
        • Murugesu S.
        • Galazis N.
        • Jones B.P.
        • et al.
        Evaluating the use of telemedicine in gynaecological practice: a systematic review.
        BMJ Open. 2020; 10e039457
        • Hui E.
        • Lee P.S.
        • Woo J.
        Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomized controlled trial.
        J Telemed Telecare. 2006; 12: 343-347
        • Goode P.S.
        • Markland A.D.
        • Echt K.V.
        • et al.
        A mobile telehealth program for behavioral treatment of urinary incontinence in women veterans: development and pilot evaluation of MyHealtheBladder.
        Neurourol Urodyn. 2020; 39: 432-439
        • Jones G.
        • Brennan V.
        • Jacques R.
        • et al.
        Evaluating the impact of a 'virtual clinic' on patient experience, personal and provider costs of care in urinary incontinence: a randomised controlled trial.
        PLoS One. 2018; 13e0189174
        • Schimpf M.O.
        • Fenner D.E.
        • Smith T.M.
        • et al.
        Patient satisfaction with nurse-led telephone follow-up in an ambulatory setting.
        Female Pelvic Med Reconstr Surg. 2016; 22: 430-432
      3. Caldwell L, Papermaster AE, Halder GE, et al. Evidence-based pelvic floor disorder care pathways optimize shared decision making between patients and surgeons [e-pub ahead of print]. Int Urogynecol J. doi:10.1007/s00192-021-05021-4.

        • Firet L.
        • Teunissen D.
        • Verhoeks C.
        • et al.
        Expectations regarding eHealth among women with stress urinary incontinence.
        Int Urogynecol J. 2019; 30: 1955-1963
        • Bugge C.
        • Dembinsky M.
        • Kearney R.
        • et al.
        Does self-management of vaginal pessaries improve care for women with pelvic organ prolapse?.
        BMJ. 2021; 372: n310
        • Nemeth Z.
        • Nagy S.
        • Ott J.
        The cube pessary: an underestimated treatment option for pelvic organ prolapse? Subjective 1-year outcomes.
        Int Urogynecol J. 2013; 24: 1695-1701
        • Holubyeva A.
        • Rimpel K.
        • Blakey-Cheung S.
        • et al.
        Rates of pessary self-care and the characteristics of patients who perform it.
        Female Pelvic Med Reconstr Surg. 2021; 27: 214-216
        • Grimes C.L.
        • Balk E.M.
        • Crisp C.C.
        • et al.
        A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence.
        Int Urogynecol J. 2020; 31: 1063-1089
        • Tates K.
        • Antheunis M.L.
        • Kanters S.
        • et al.
        The effect of screen-to-screen versus face-to-face consultation on doctor-patient communication: an experimental study with simulated patients.
        J Med Internet Res. 2017; 19: e421
      4. International Urogynecologic Association (IUGA). Your pelvic floor leaflets. Available at: https://www.yourpelvicfloor.org/leaflets/. Accessed on January 21, 2022.

      5. American Urogynecologic Association (AUGS). Voices for pelvic floor disorders fact sheets and downloads. Available at: https://www.voicesforpfd.org/resources/fact-sheets-and-downloads/. Accessed on January 21, 2022.

        • Thompson J.C.
        • Cichowski S.B.
        • Rogers R.G.
        • et al.
        Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial.
        Int Urogynecol J. 2019; 30: 1639-1646
        • Giusto L.L.
        • Derisavifard S.
        • Zahner P.M.
        • et al.
        Telemedicine follow-up is safe and efficacious for synthetic midurethral slings: a randomized, multi-institutional control trial.
        Int Urogynecol J. 2022; 33: 1007-1015