Effect of pelvic floor muscle training using mobile health applications for stress urinary incontinence in women: a systematic review

Abstract

Background Pelvic floor muscle training (PFMT) is the first-line treatment for urinary incontinence, but adherence to PFMT is generally poor. Currently, a number of novel strategies exist to facilitate adherence of PFMT. We sought to determine effectiveness of mHealth app-based PFMT for treating stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI) in women. The primary objective was to assess the effects of mHealth app-based PFMT and usual treatment on severity of the symptom, the quality of life (QoL) of users and the patient’s global impression of improvement. The secondary objective was to assess how mHealth app use affects adherence of PFMT. Methods All randomized controlled trials and quasi-randomized controlled trials aimed at evaluating the effects of mHealth app-based PFMT in women with SUI or stress-predominant MUI were included. Twelve electronic databases, namely the Cochrane Library, PubMed, CINAHL, Embase, Web of science, OVID, SciELO, REHABDATA, PEDro database, Chinese CNKI and Wanfang and the Open Grey databases were used as search sources. The protocol was registered in PROSPERO (CRD 42020183515). This systematic review was developed following the PRISMA 2020 Checklist. The Cochrane Handbook for Systematic Reviews of Interventions for Randomized Controlled Trials was used to assess risk of bias in included studies. Two authors extracted the data into a standardized spreadsheet. Results Six studies that met the eligibility criteria were included. The full sample included 439 patients with treatment via mHealth app and 442 controls of usual treatment. ICIQ-UI SF, ICIQ-VS, and QUID scores decreased after follow-up in the mHealth app and control groups in six studies. ICIQ-LUTS QoL scores decreased after follow-up in the mHealth app and control groups in three studies. In only one study, ICIQ-VS QoL scores decreased after 1 month and 2 months of follow-up in the mHealth app group, but increased abruptly after 3 months of follow-up. EQ5D-VAS scores increased in both groups in one study. The percentage of PGI-I increased in the mHealth app group in three studies after follow-up. After follow-up in three studies, BPMSES scores and self-reported adherence scores increased in the mHealth app group relative to the initial time point, but in one study, at 6 months compared with 3 months of follow-up, adherence scores decreased slightly in the mHealth app group. Conclusions This systematic review determined that mHealth app-based PFMT showed promise from the perspective of improving both outcomes and exercise adherence.

An umbrella review of effectiveness and efficacy trials for app-based health interventions

“…The number of RCT studies included in a review ranged from two to 36. Out of the 48 included reviews, 35 15 – 49 conducted data pooling and meta-analyses whereas 13 reviews 50 – 62 provided a narrative synthesis without meta-analysis. Median follow-up periods ranged from 1 to 10 months, with no respective information reported in six reviews 15 , 31 – 33 , 50 , 53 .…”

Pelvic Floor Muscle Training Using the Perifit Device for the Treatment of Urinary Incontinence: A Pragmatic Trial Using Real-World Data

“… 13 A recent systematic review of mobile app-based programs found variable success rates for mobile app-based training, reporting improvement in UI symptoms in 40% to 66% of women at ∼4 months, increasing to 92% of women at 2 years of follow-up. 23 In the current analysis, the “short-term” and “long-term” improvement timepoints corresponded to training durations averaging 41 days (or about 6 weeks) and 125 days (or about 4 months), respectively. The timing of the reduction in UI symptoms achieved with the Perifit device is therefore in line with previous reports of both clinic- and home-based treatment plans.…”

“… 13 , 14 Despite its demonstrated effectiveness, exercise adherence is low. 23 Additionally, patients report substantial barriers to accessing pelvic floor physical therapy, including cost, time constraints, and issues organizing travel to and from appointments. 28 Home-based solutions may therefore play a role in expanding access to care.…”

Effectiveness of web-based interventions for women with urinary incontinence: protocol for a systematic review and meta-analysis of randomised controlled trials

“…WBIs have drawn great attention from the medical and hygiene fields due to their advantages of high accessibility and efficiency 17 25 26. Recently, some researchers have attempted to use WBIs to manage UI for women, but the effectiveness of WBIs among this crowd has remained inconclusive,27–31 and even the existing relevant systematic reviews failed to arrive at a consensus on this matter,21–24 32 which impedes clinical decision-making and limits the widespread application of WBIs. Accordingly, this paper presents a protocol for a systematic review and meta-analyses that will summarise the related evidence by systematically reviewing previous RCTs regarding the effectiveness of WBIs in women with UI.…”