Trial registration number: http://www.clinicaltrials.gov (ID: NCT01032265)
Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training
Version of Record online: 25 JAN 2013
© 2013 BJU International
Volume 112, Issue 3, pages 362–372, August 2013
How to Cite
Sjöström, M., Umefjord, G., Stenlund, H., Carlbring, P., Andersson, G. and Samuelsson, E. (2013), Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training. BJU International, 112: 362–372. doi: 10.1111/j.1464-410X.2012.11713.x
- Issue online: 4 JUL 2013
- Version of Record online: 25 JAN 2013
- The Swedish Council for Working Life and Social Research
- The Swedish Society of Medicine
- Jämtland County Council
- Västerbotten County Council (ALF)
- Visare Norr, Northern County Councils, Sweden
- stress urinary incontinence;
- randomised controlled study;
- pelvic floor muscle training;
- cognitive behavioural therapy
What's known on the subject? and What does the study add?
- Stress urinary incontinence (SUI) affects 10‒35% of women, and it is sometimes very distressful. Pelvic floor exercises are the first line of treatment, but access barriers or embarrassment may prevent women from seeking help. There is a need for new, simple, and effective ways to deliver treatment.
- Management of SUI without face-to-face contact is possible, and Internet-based treatment is a new, promising treatment alternative.
- To compare two treatment programmes for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post.
Patients and Methods
- Randomised, 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.
- In 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%.
- Concerning 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.