Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training
Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training
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DOI：
10.1111/j.1464-410x.2012.11713.x
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发表时间：
2013-08-01
影响因子：
4.5
通讯作者：
Samuelsson, Eva
中科院分区：
文献类型：
--
作者：
Sjostrom, Malin;Umefjord, Goran;Samuelsson, Eva
目的比较非面对面接触的压力性尿失禁(SUI)的两种治疗方案：一种是基于互联网的，一种是邮寄的。病人与方法2009-2011年在瑞典进行的随机对照试验。计算机生成的区块--随机化，由独立管理员分配。这项研究涵盖了250名居住在社区的女性，年龄在18-70岁之间，SUI和Gt；=1次/周。这些妇女接受了3个月的网上招聘：(1)基于互联网的治疗方案(124名妇女)，包括电子邮件支助和认知行为治疗任务；(2)邮寄的治疗方案(126人)。两个方案主要集中于盆底肌肉训练。主要结果：症状评分(国际大小便失禁问卷简写，ICIQ-UISF)和特定条件的生活质量(ICIQ-下尿路症状生活质量，ICIQ-LUTSQoL)。次要结果：(I)患者对改善的总体印象，(Ii)大小便失禁辅助设备，(Iii)患者满意度，(Iv)特定于健康的生活质量(EQ5D-视觉模拟评分)，以及(V)大小便失禁发作频率。4个月后通过自评邮寄问卷进行随访。结果总共有12%(30名女性)失访。意向处理分析显示，两种干预措施都有非常显著的改善(P<；0.001)，且效应大(P>；0.8)，但两组之间的主要结果没有显著差异。症状评分的平均变化(SD)分别为：互联网3.4(3.4)，邮政2.9(3.1)(P=0.27)。条件相关生活质量的平均变化(SD)分别为：互联网4.8(6.1)，邮政4.6(6.7)(P=0.52)。与邮政组相比，互联网组更多的参与者感觉自己有很大或非常大的改善(40.9%(43/105)比26.5%(30/113，P=0.01))，报告减少了失禁辅助器具的使用(59.5%(47/79)比41.4%(34/82)，治疗方案满意率分别为84.8%(89/105)和62.9%(71/113)，P<；总体上，69.8%的参与者报告完全无渗漏或渗漏次数减少50%。结论就主要结果而言，两组之间的治疗效果相似，而对于次要结果，基于互联网的治疗更有效。基于互联网的治疗是一种新的、有前途的治疗方法。
ObjectiveTo compare two treatment programmes for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post.Patients and MethodsRandomised, controlled trial conducted in Sweden 2009-2011. Computer-generated block-randomisation, allocation by independent administrator. No 'blinding'.The study included 250 community-dwelling women aged 18-70 years, with SUI >= 1 time/week. Consecutive online recruitment.The women had 3 months of either; (i) An Internet-based treatment programme (124 women), including e-mail support and cognitive behavioural therapy assignments or (ii) A treatment programme sent by post (126). Both programmes focused mainly on pelvic floor muscle training.Primary outcomes: symptom-score (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: (i) Patient Global Impression of Improvement, (ii) Incontinence aids, (iii) Patient satisfaction, (iv) Health-specific QoL (EQ5D-Visual Analogue Scale), and (v) Incontinence episode frequency. Follow-up after 4 months via self-assessed postal questionnaires.ResultsIn all, 12% (30 women) were lost to follow-up. Intention-to-treat analysis showed highly significant improvements (P < 0.001) with large effect sizes (>0.8) with both interventions, but there were no significant differences between groups in primary outcomes. The mean (SD) changes in symptom-score were: Internet 3.4 (3.4), Postal 2.9 (3.1) (P = 0.27). The mean (SD) changes in condition-specific QoL were: Internet 4.8 (6.1), Postal 4.6 (6.7) (P = 0.52).Compared with the postal-group, more participants in the Internet-group perceived they were much or very much improved (40.9% (43/105) vs 26.5% (30/113), P = 0.01), reported reduced usage of incontinence aids (59.5% (47/79) vs 41.4% (34/82), P = 0.02) and were satisfied with the treatment programme (84.8% (89/105) vs 62.9% (71/113), P < 0.001).Health-specific QoL improved in the Internet-group (mean change 3.7 (10.9), P = 0.001), but not in the postal-group (1.9 (13.0), P = 0.13).Overall, 69.8% (120/172) of participants reported complete lack of leakage or reduced number of leakage episodes by >50%.ConclusionsConcerning primary outcomes, treatment effects were similar between groups whereas for secondary outcomes the Internet-based treatment was more effective.Internet-based treatment for SUI is a new, promising treatment alternative.