Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year

Abstract

Introduction and hypothesisThe objective was to determine predictors of long-term success in women with stress urinary incontinence (SUI) treated with a 3-month pelvic floor muscle training (PFMT) program delivered via the Internet or a brochure.MethodsWe included 169 women with SUI ≥1 time/week who completed the 1-year follow-up (n = 169, mean age 50.3, SD 10.1 years). Three outcome variables defined success after 1 year: Patient Global Impression of Improvement (PGI-I), International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), and sufficient treatment. Using logistic regression, we analyzed data from the baseline, and from the 4-month and 1-year follow-ups, for potential predictors of success.ResultsOf the participants, 77 % (129 out of 169) were successful in ≥1 of the outcomes, 23 % (37 out of 160) were successful in all 3. Participants with successful short-term results were more likely to succeed in the corresponding outcome at 1 year than those without successful short-term results (adjusted odds ratios [ORs]: PGI 5.15, 95 % confidence interval [CI] 2.40–11.03), ICIQ-UI SF 6.85 (95 % CI 2.83–16.58), and sufficient treatment 3.78 (95 % CI 1.58–9.08). Increasing age predicted success in PGI-I and sufficient treatment (adjusted OR 1.06, 95 % CI 1.02–1.10, and 1.08, 95 % CI, 1.03–1.13 respectively). Compared with not training regularly, regular PFMT at 1 year predicted success for PGI and sufficient treatment (adjusted OR 2.32, 95 % CI 1.04–5.20, and 2.99, 95 % CI 1.23–7.27 respectively).ConclusionThe long-term success of a non-face-to-face treatment program for SUI with a focus on PFMT can be predicted by successful short-term results, increasing age, and the performance of regular PFMT after 1 year.

Treatment of stress urinary incontinence with a mobile app: factors associated with success

“…Another possible explanation is self-efficacy. Self-assessed ability to carry out PFMT predicts long-term success [ 15 ], but has not been evaluated in other studies of predictors. The benefit of high educational level found in other studies [ 14 ] and the influence of expectations for treatment found in our study could both be surrogate measures of self-efficacy.…”

“…In line with these results, poor contraction at baseline predicted success in one other study of PFMT and bladder training [ 25 ]. From other reports, we know that short-term results predict long-term outcomes [ 15 , 26 ]. The participants in our study received the app-based treatment without any physical examination or face-to-face care.…”

“…In several studies, less severe SUI symptoms, treatment naivety, or previous good treatment results predicted success [ 14 , 15 , 21 , 22 , 27 ]. These factors are most likely to co-vary with the ability to train pelvic floor muscle strength and attitudes to treatment, as they could indicate lower rates of birth injuries to the pelvic floor, for example, or no previous treatment failures that could potentially lower the adherence to the next treatment.…”

“…The seven possible answers ranged from “very much better” to “very much worse.” In these analyses, the participants who rated themselves to be much or very much better were considered to have had a successful treatment at 3-month follow-up. This definition was chosen to ensure a comprehensive and patient-centered definition of success, and also because it is a validated questionnaire [ 13 ], and the definition has been used in previous studies [ 14 , 15 ].…”

What was hot at the ICS meeting 2015

“…Samuelsson et al presented a smartphone application as an easily accessible, cost effective treatment for stress urinary incontinence (SUI) and they were awarded joint winner of the Conservative Management Award. Given that many are still smartphone illiterate and 40% perform pelvic floor exercises incorrectly this application can provide an adjunct to, rather than replace, individualized pelvic floor training with digital palpation (Abstracts 16, 521, 526).…”