The WOMEN-UP Solution, a Patient-Centered Innovative e-Health Tool for Pelvic Floor Muscle Training: Qualitative and Usability Study during Early-Stage Development

Abstract

e-Health may enhance self-management of pelvic floor muscle training (PFMT) to treat stress urinary incontinence (SUI). It is crucial to involve patients in planning, developing and monitoring the optimal e-Health solution. This research aims to describe patient-centered innovation in an early developmental stage of the WOMEN-UP solution. We conducted a qualitative study through a self-developed questionnaire in 22 women with SUI, to define system requirements from a patient’s perspective. The first prototype of the WOMEN-UP solution was developed. It was tested by 9 patients in a usability study (think-aloud protocol and retrospective interviews). Patient preferences regarding the possible use of an e-Health solution with serious games for PFMT were: (1) to receive feedback about PFMT; (2) convenient home-use; (3) increasing motivation; (4) available in medical centers. Identified usability aids (31) reassured our design-development plan, which considered the biofeedback and serious games as key factors. Patient’s perspective detected some unexpected issues related to the calibration and serious games, involving a change in the ongoing development to get an improved WOMEN-UP solution; the value of patient-centered innovation during the development of an e-Health solution for PFMT (WOMEN-UP solution). To identify patients’ unmet needs, we proposed a longitudinal approach for the future eHealth-related patient-centered innovations.

Virtual medicine in urology: Is it here to stay?

“…video visits, phone calls, applications/internetbased treatments) have been largely effective in urology. [5][6][7] From the patient perspective, Locke et al conducted a survey of patients who received telemedicine consults in urology, and found that almost half had no preference for in-office versus telephone visits. 8 Other studies have found that some patients preferred telemedicine, owing to spending less time waiting to see practitioners, travelling to appointments, and eliminating the need to find transportation to attend appointments.…”

“…22 One emerging area of virtual care is the use of app-based treatments for patient guidance and self-management. [5][6][7] For certain patients, these can be used effectively for management, such as in the case of stress urinary incontinence. 5-7…”

Digital Technologies for Women’s Pelvic Floor Muscle Training to Manage Urinary Incontinence Across Their Life Course: Scoping Review (Preprint)

“…Just over 40% (12/28, 43%) of these were solely mobile apps, 4% (1/28) trialed a smartphone-based messaging system, 11% (3/28) were internet-based programs, and 7% (2/28) were dedicated to videoconferencing. A total of 32% (9/28) of the technologies involved the use of a portable vaginal biofeedback or accelerometer-based device [36][37][38]43,44,48,49,53,54,62,67,71,76] that provided real-time feedback transmitted via Bluetooth to a mobile app or, in one instance, to a computer application [43]. In addition to the vaginal device, electromyographic data were integrated from surface electrodes attached to the abdominal muscles [37,38] or PFMs [36].…”

“…A total of 21% (6/28) of the DTs incorporated gamification [36][37][38]48,57,67], which, with 1 exception [57], was used in conjunction with biofeedback. Descriptions of gamification included "serious games" [37,38], games or activities (eg, weight lifting room and flying arena) [67], and gaming and virtual reality mediated by a comic character [11,57] or a cyclist [36] with built-in scoring systems.…”

“…Confirmation of a voluntary PFM contraction was undertaken in just under half (19/41, 46%) of the studies and was either not included in the study design in 41% (17/41) of the studies or not indicated or appropriate (5/41, 12%). Confirmation was obtained through digital assessment [39,57,61,69], which was also used to teach a correct contraction or relaxation of the PFM [52,67]; biofeedback or the digital device [36][37][38]43,44,49,62]; or a combination of both [42,47,51,59,71,76]. Digital assessment was undertaken by a specialized HCP, although it was not indicated who performed this procedure in 7% (3/41) of the studies [51,57,71].…”