OBJECTIVES: To evaluate the long-term effects of two non-face-to-face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT).
SUBJECTS AND METHODS: Randomised controlled trial with online recruitment of 250 community-dwelling women aged 18-70 years with SUI ≥1/week. Diagnosis based on validated self-assessed questionnaires, 2-day bladder diary, and telephone interview with a urotherapist. Consecutive computer-generated block-randomisation with allocation by an independent administrator to 3 months of treatment with either an Internet-based treatment programme (n=124) or a programme sent by post (n=126). Both interventions focused mainly on PFMT; the Internet group received continuous e-mail support from a urotherapist, whereas the postal group trained on their own. Follow-up was performed after 1 and 2 years via self-assessed postal questionnaires. The primary outcomes were symptom severity (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 were the Patient's Global Impression of Improvement, health-specific quality of life (EQ-Visual Analogue Scale), use of incontinence aids, and satisfaction with treatment. There was no face-to-face contact with the participants at any time. Analysis was based on intention-to-treat.
RESULTS: We lost 32.4% (81/250) of participants to follow-up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (p< 0.001) improvements with large effect sizes (>0.8) for symptoms and condition-specific quality of life after 1 and 2 years, respectively. No significant differences were found between the groups. The mean changes (SD) in symptom score were 3.7 (3.3) for Internet and 3.2 (3.4) for postal (p=0.47) after 1 year, and 3.6 (3.5) for Internet and 3.4 (3.3) for postal (p=0.79) after 2 years. The mean changes (SD) of condition-specific quality of life were 5.5 (6.5) for Internet and 4.7 for postal (6.5) (p=0.55) after 1 year, and 6.4 (6.0) for Internet and 4.8 (7.6) for postal (p=0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (Internet 31.9% (28/88), postal 33.8% (27/80) p=0.82), but after 2 years significantly more participants in the Internet group reported this level of improvement (39.2% (29/74) vs. 23.8% (19/80), p=0.03). Health-specific quality of life improved significantly in the Internet group after 2 years (mean change EQ-VAS 3.8 (11.4), p=0.005). We found no other significant improvements in this measure. One year after treatment, 69.8% (60/86) of participants in the Internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the treatment result. After 2 years, the proportions were 64.9% (48/74) and 58.2% (46/79), respectively.
CONCLUSION: Non-face-to-face treatment of SUI with PFMT provides significant and clinically relevant improvements in symptoms and condition-specific quality of life 1 and 2 years after treatment.
Written by:
Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Are you the author?
Department of Public Health and Clinical Medicine, Unit of Clinical research center - Östersund, Umeå University, Sweden.
Reference: BJU Int. 2015 Feb 14. Epub ahead of print.
doi: 10.1111/bju.13091
PubMed Abstract
PMID: 25683075