Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study.
Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study.
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DOI：
10.1136/bmjopen-2020-040819
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发表时间：
2021-01-04
期刊：
影响因子：
2.9
通讯作者：
Samuelsson E
中科院分区：
文献类型：
--
作者：
Rygh P;Asklund I;Samuelsson E
基于app的压力性尿失禁（SUI）治疗的疗效已在一项随机对照试验（RCT）中得到证实。在这项研究中，我们调查了用户特征和免费提供的同一应用程序的有效性，并将这些结果与RCT进行比较。前瞻性队列研究。在17个月的时间里，24602名18岁以上的非怀孕、非产后妇女下载了这款应用程序，并匿名回答了一份问卷。其中，2672例（11%）对3个月随访做出了应答。三个月的应用程序Tät的使用，包含信息，骨盆底肌肉训练计划和生活方式建议。症状严重程度变化（国际尿失禁咨询-尿失禁简表（ICIQ-UI SF））和主观改善（患者总体改善印象（PGI-I））。在受访者中，88%居住在瑞典，75%（18 384/24 602）的人失禁，平均年龄为45.5岁（SD 14.1）。根据症状，UI类型为SUI（53%）、紧急UI（12%）、混合UI（31%）和未定义UI（4%）。基线时平均ICIQ-UI SF评分为8.2（SD 4.0）。随访时ICIQ-UI SF评分平均降低1.31（95% CI：1.19至1.44），基线时尿失禁更严重的患者降低幅度更大（重度/极重度3.23（95% CI：2.85 - 3.61）、中度1.41（95% CI：1.24 - 1.59）和轻度0.24（95% CI 0.06 - 0.42）。当对结果进行加权以匹配RCT中的严重程度分布时，ICIQ-UI SF评分降低为2.2，而RCT中为3.9。关于PGI-I，65%的患者出现改善，而RCT中为92%。即使在真实的世界中，应用程序Tät也能有效地进行UI的自我管理。虽然尿失禁症状的减少低于RCT，但三分之二的使用者得到改善。基于应用程序的治疗覆盖了许多妇女，而不需要普通医疗服务的资源。
The efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT). In this study, we investigate the user characteristics and the effectiveness of the same app when freely available, and compare these results with the RCT. Prospective cohort study. During a 17-month period, 24 602 non-pregnant, non-postpartum women older than 18 years downloaded the app and responded anonymously to a questionnaire. Of these, 2672 (11%) responded to the 3-month follow-up. Three months’ use of the app Tät, containing information, a pelvic floor muscle training programme and lifestyle advice. Change in symptom severity (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)) and subjective improvement (Patient Global Impression of Improvement (PGI-I)). Of the respondents, 88% lived in Sweden and 75% (18 384/24 602) were incontinent with a mean age of 45.5 (SD 14.1) years. The UI types, based on symptoms, were SUI (53%), urgency UI (12%), mixed UI (31%) and undefined (4%). The mean ICIQ-UI SF score was 8.2 (SD 4.0) at baseline. The mean ICIQ-UI SF score reduction at follow-up was 1.31 (95% CI: 1.19 to 1.44) with a larger reduction in those with more severe incontinence at baseline (severe/very severe 3.23 (95% CI: 2.85 to 3.61), moderate 1.41 (95% CI: 1.24 to 1.59) and slight 0.24 (95% CI 0.06 to 0.42). When the results were weighted to match the distribution of severity in the RCT, the ICIQ-UI SF score reduction was 2.2 compared with 3.9 in the RCT. Regarding PGI-I, 65% experienced improvement compared with 92% in the RCT. The app Tät was effective for self-management of UI even in the real world. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.
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