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      Self‐management of stress urinary incontinence via a mobile app: two‐year follow‐up of a randomized controlled trial

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          Abstract

          Introduction

          We investigated the long‐term effects of using a mobile app to treat stress urinary incontinence with a focus on pelvic floor muscle training.

          Material and methods

          A previous randomized controlled trial of 123 women aged 27–72 years found that three months of self‐managing stress urinary incontinence with support from the Tät ® app was effective. We followed up the women in the app group ( = 62) two years after the initial trial with the same primary outcomes for symptom severity (International Consultation on Incontinence Questionnaire Short Form) and condition‐specific quality of life (ICIQ‐Lower Urinary Tract Symptom Quality of Life) and compared the scores with those at baseline.

          Results

          Of the 62 women, 61 and 46 (75.4%), respectively, participated in three‐month and two‐year follow‐ups. Baseline data did not differ between responders and non‐responders at follow‐up. The mean decreases in International Consultation on Incontinence Questionnaire Short Form and ICIQ‐Lower Urinary Tract Symptom Quality of Life scores after two years were 3.1 (95% confidence interval 2.0–4.2) and 4.0 (95% confidence interval 2.1–5.9), respectively. Of the 46 women, four (8.7%) rated themselves as very much better, nine (19.6%) as much better, and 16 (34.8%) as a little better. The use of incontinence protection products decreased significantly ( =  0.04), and the proportion of women who felt they could contract their pelvic muscles correctly increased from 14/46 (30.4%) at baseline to 31/46 (67.4%) at follow‐up ( < 0.001).

          Conclusions

          Self‐management of stress urinary incontinence with support from the Tät ® app had significant and clinically relevant long‐term effects and may serve as first‐line treatment.

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          Most cited references21

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          ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence.

          To develop and evaluate the International Consultation on Incontinence Questionnaire (ICIQ), a new questionnaire to assess urinary incontinence and its impact on quality of life (QoL). A developmental version of the questionnaire was produced following systematic literature review and views of an expert committee and patients. Several studies were undertaken to evaluate the psychometric properties of the questionnaire, including content, construct and convergent validity, reliability and sensitivity to change. The ICIQ was easily completed, with low levels of missing data (mean 1.6%). It was able to discriminate among different groups of individuals, indicating good construct validity. Convergent validity was acceptable, with most items demonstrating 'moderate' to 'strong' agreement with other questionnaires. Reliability was good, with 'moderate' to 'very good' stability in test-retest analysis and a Cronbach's alpha of 0.95. Items identified statistically significant reductions in symptoms from baseline following surgical and conservative treatment. Item reduction techniques were used to determine the final version and scoring scheme, which also demonstrated good psychometric properties. The final ICIQ comprises three scored items and an unscored self-diagnostic item. It allows the assessment of the prevalence, frequency, and perceived cause of urinary incontinence, and its impact on everyday life. The ICIQ is a brief and robust questionnaire that will be of use in outcomes and epidemiological research as well as routine clinical practice. Copyright 2004 Wiley-Liss, Inc.
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            Validation of two global impression questionnaires for incontinence.

            The purpose of this study was to assess the construct validity of two global assessment questions, the Patient Global Impression of Severity and of Improvement, in female patients with stress urinary incontinence. This was a secondary analysis of data from two double-blind, placebo-controlled studies that evaluated duloxetine for the treatment of predominant stress urinary incontinence in the United States (n = 1133 patients). Assessment variables included incontinence episode frequency, the Incontinence Quality of Life Questionnaire results, fixed volume (400 mL) stress pad test results, and the Patient Global Impression of Improvement and of Severity question results. Spearman correlation coefficients were 0.36, 0.20, and -0.50 among the Patient Global Impression of Severity question and incontinence episode frequency, stress pad test, and Incontinence Quality of Life Questionnaire results, respectively (all P <.0001). Mean incontinence episode frequency and median stress pad test results increased and mean Incontinence Quality of Life Questionnaire results decreased with increasing Patient Global Impression of Severity question severity levels. Similarly, significant (P <.0001) correlations were observed between the Patient Global Impression of Improvement question response categories and the three independent measures of improvement in stress urinary incontinence (0.49, 0.33, and -0.43 with incontinence episode frequency, stress pad test, and Incontinence Quality of Life Questionnaire results, respectively). As with the Patient Global Impression of Severity question, differences in mean changes for Incontinence Quality of Life Questionnaire and median percent changes for incontinence episode frequency and stress pad test among the Patient Global Impression of Improvement question response categories were highly significant (P <.0001). These relationships indicate appropriate and significant associations between the Patient Global Impression of Severity and of Improvement questions and the three independent measures of stress urinary incontinence severity and improvement, respectively. The Patient Global Impression of Severity and of Improvement question responses were correlated significantly with incontinence episode frequency, stress pad test, and Incontinence Quality of Life Questionnaire measures, which established the construct validity of these two global assessment questions for baseline severity and treatment response, respectively.
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              A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trøndelag.

              The aim was to assess the prevalence of any urinary leakage in an unselected female population in Norway, and to estimate the prevalence of significant incontinence. The EPINCONT Study is part of a large survey (HUNT 2) performed in a county in Norway during 1995-97. Everyone aged 20 years or more was invited. 27,936 (80%) of 34,755 community-dwelling women answered a questionnaire. A validated severity index was used to assess severity. Twenty-five percent of the participating women had urinary leakage. Nearly 7% had significant incontinence, defined as moderate or severe incontinence that was experienced as bothersome. The prevalence of incontinence increased with increasing age. Half of the incontinence was of stress type, 11% had urge and 36% mixed incontinence. Urinary leakage is highly prevalent. Seven percent have significant incontinence and should be regarded as potential patients.
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                Author and article information

                Contributors
                victoria.hoffman@regionjh.se
                Journal
                Acta Obstet Gynecol Scand
                Acta Obstet Gynecol Scand
                10.1111/(ISSN)1600-0412
                AOGS
                Acta Obstetricia et Gynecologica Scandinavica
                John Wiley and Sons Inc. (Hoboken )
                0001-6349
                1600-0412
                21 August 2017
                October 2017
                : 96
                : 10 ( doiID: 10.1111/aogs.2017.96.issue-10 )
                : 1180-1187
                Affiliations
                [ 1 ] Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
                [ 2 ] Unit of Research, Education and Development – Östersund Umeå University Umeå Sweden
                Author notes
                [*] [* ] Correspondence

                Victoria Hoffman, Department of Internal Medicine, Östersunds Hospital, Kyrkgatan 16, 831 83 Östersund, Sweden.

                E‐mail: victoria.hoffman@ 123456regionjh.se

                Author information
                http://orcid.org/0000-0001-8271-184X
                http://orcid.org/0000-0002-8549-0007
                Article
                AOGS13192
                10.1111/aogs.13192
                5638068
                28718223
                d625f9a4-89f9-4dee-83f9-2d7dff976e8b
                © 2017 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 08 March 2017
                : 08 July 2017
                Page count
                Figures: 3, Tables: 3, Pages: 8, Words: 5059
                Funding
                Funded by: Swedish Research Council for Health, Working Life and Welfare
                Funded by: Region Jämtland Härjedalen
                Funded by: Västerbotten County Council
                Funded by: VisareNorr, Northern County Councils, Sweden
                Categories
                Original Research Article
                Urology
                Custom metadata
                2.0
                aogs13192
                October 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.1 mode:remove_FC converted:12.10.2017

                Obstetrics & Gynecology
                mobile applications,pelvic floor muscle training,self‐management,stress urinary incontinence,women

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