Self-management of incontinence using a free mobile app: factors associated with improvement

Emma Nyström,Eva Samuelsson,Lars Söderström

doi:10.1007/s00192-021-04755-5

Abstract

BackgroundPelvic floor muscle training (PFMT) is first-line treatment for urinary incontinence (UI) in women. Self-management via a mobile app is a new cost-effective method for PFMT delivery. This study analyzes factors associated with improvement among app users.MethodsA pragmatic observational study in a community setting. Upon downloading the app Tät®, users answered questions regarding their age, education, residence, and UI symptoms. After 3 months, users answered follow-up questions regarding symptoms and frequency of training and app usage, and the validated Patient Global Impression of Improvement (PGI-I) questionnaire. Only non-pregnant, non-postpartum adult women with UI who answered the PGI-I questionnaire were included. Multivariate logistic regression was used to analyze possible associations between these factors with any improvement and with great improvement according to the PGI-I. The models were adjusted for age.ResultsThe study included 2,153 participants who had completed self-management, that is, 11.5% of eligible women who completed the baseline questionnaire. Of these participants, 65.6% reported improvement of UI. Any improvement was associated with age, frequency of PFMT, and app use, accounting for 27.9% of variability (Nagelkerke R2). Lower incontinence severity, frequency of PFMT, and app use were associated with great improvement.ConclusionSelf-management of urinary incontinence is easily accessible to many women and improvement rates are comparable with other forms of PFMT. Demographic factors and incontinence severity showed no or incongruent association, whereas regular PFMT and app use predicted any and great improvement. App use showed an additional effect beyond frequency of training.

Highlights

Urinary incontinence is common among women, with reported prevalence rates most frequently ranging from 25 to 45% [1]
A total of 2,153 women with urinary incontinence submitted the baseline and follow-up questionnaire, including a response to the Patient Global Impression of Improvement (PGI-I) question via the app Tät®. These women were included in this study and amounted to 11.5% of all eligible women who had downloaded the app for self-management and completed the baseline questionnaire (Fig. 1)
There could be other reasons, for example, it is likely that weekly training of good quality is better than daily training of poor quality, and that the frequency of training alone is an insufficient measure of adherence. These results show that a free mobile app can reach many women with urinary incontinence and that improvement rates are comparable with other forms of Pelvic floor muscle training (PFMT) [3] if 3 months of active self-management is completed

Summary

Introduction

Urinary incontinence is common among women, with reported prevalence rates most frequently ranging from 25 to 45% [1]. For all types of urinary incontinence among women, the first-line treatment includes pelvic floor muscle training (PFMT) and lifestyle advice [2]. One method of providing unsupervised PFMT safely and effectively is via eHealth, such as a mobile app [5]. Pelvic floor muscle training (PFMT) is first-line treatment for urinary incontinence (UI) in women. Selfmanagement via a mobile app is a new cost-effective method for PFMT delivery. This study analyzes factors associated with improvement among app users. Upon downloading the app Tät®, users answered questions regarding their age, education, residence, and UI symptoms. After 3 months, users answered follow-up questions regarding symptoms and frequency of training and app usage, and the validated Patient Global Impression of Improvement (PGI-I) questionnaire.

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