The use of an app with a PFMT programme among pregnant and postnatal women for preventive use and treatment of urinary incontinence.

Asklund I1, Samuelsson E1

Research Type

Clinical

Abstract Category

E-Health

Abstract 549
Pelvic Floor Muscle Assessment and Treatment
Scientific Podium Short Oral Session 30
Friday 6th September 2019
12:37 - 12:45
Hall G1
Stress Urinary Incontinence Conservative Treatment Pelvic Floor Prevention Female
1.Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
Presenter
I

Ina Asklund

Links

Abstract

Hypothesis / aims of study
Pregnancy and delivery are significant risk factors for developing urinary incontinence and they are particularly associated with stress urinary incontinence (SUI) (1). A UI prevalence of 58% has been reported during the second and third trimester of pregnancy, and during the three months following childbirth the prevalence of UI is approximately 30% (2). 

A Cochrane review focusing on antenatal and postnatal pelvic floor muscle training (PFMT) concludes that PFMT for continent pregnant women can prevent the onset of UI (2). In the same review, however, there was uncertainty about the treatment effect for those who were already incontinent both prenatal and postnatal. 

We have developed a mobile app intended for women with SUI that contains a self-management programme based on PFMT and lifestyle advice. The PFMT programme includes different types of pelvic floor muscle contractions and instructions on how to find the right muscles. In the app the user can set reminders for training and follow training statistics. We evaluated the efficacy of the app-based programme in a randomised controlled trial (RCT) and found that women using the app experienced fewer incontinence symptoms, fewer leakage episodes and a better quality of life compared to the control group (3). 

The app is now freely available on Google play and Appstore and we are interested in its use by pregnant and postnatal women since they were not included in our previous RCT. The aim of this study was to investigate the use of the app during pregnancy and the postnatal period, and the characteristics of the users.
Study design, materials and methods
This is a descriptive study of the pregnant and postnatal users of the app. We included pregnant and postnatal participants between 18 and 69 years old, who had downloaded the app and answered the inclusion questionnaire between the dates of 16 January 2018 and 15 November 2018 (10 months of inclusion). 

A short questionnaire appeared when the app was downloaded with information about the study. It was optional to answer the questionnaire and the responses were sent anonymously to our research database. The information provided by the questionnaire included: age, gender, country, place of residence, education, reason for downloading the app, pregnancy, delivery during the last three months, and incontinence symptoms according to the validated questionnaire ICIQ-UI SF.  

Participants were defined as incontinent if their answers to the first two questions on the ICIQ-UI SF indicated both that they experienced urinary leakage and also had some amount of leakage.
Results
This study included 10,588 participants, of which 4,729 (45%) were pregnant and 5,859 (55%) were postnatal. 66 participants answered that they were both pregnant and postnatal and they were assigned to the pregnant group. The study population constitutes 42% of the total amount of participants (n=25,276) who answered the inclusion questionnaire. 

The proportion of pregnant participants that were incontinent was 47%, and 55% of the postnatal participants were incontinent. For baseline characteristics, see Table 1.
Interpretation of results
A large proportion of the total number of users of the app were either pregnant or postnatal (42%). Among the pregnant and postnatal population about half of the participants experienced incontinence. The mean ICIQ-UI SF score of those with incontinence was around 6 - 7 which is in accordance with other studies on incontinent pregnant women.

The use of the app during the period of one year corresponds to use by approximately one tenth of all pregnant women in Sweden (115,000 – 120,000 births per year) during pregnancy and/or the postpartum period.
Concluding message
The app appears to be a popular tool for PFMT self-management since it is widely used by pregnant and postnatal women in Sweden both for preventive use and treatment of urinary incontinence. In follow-up studies we will investigate how many participants continue to use the app for the recommended three months and how their incontinence symptoms change over that time.
Figure 1 Table 1. Baseline characteristics of the participants
References
  1. Milsom I, Altman D, Cartwright R, Lapitan M, Nelson R, Sjöström S, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence: 6th International Consultation on Incontinence, Tokyo, September 2016 6th Edition Vol 1. Vol. 1. 6th Edition ed. Bristol (UK)2017.
  2. Woodley SJ, Boyle R, Cody JD, Morkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. The Cochrane database of systematic reviews. 2017;12:Cd007471.
  3. Asklund I, Nyström E, Sjöström M, Umefjord G, Stenlund H, Samuelsson E. Mobile app for treatment of stress urinary incontinence: A randomized controlled trial. Neurourol Urodyn. 2017 Jun;36(5):1369-1376. doi: 10.1002/nau.23116. Epub 2016 Sep 9. PMID: 27611958
Disclosures
Funding This study was funded by grants from the Kamprad Family Foundation for Entrepreneurship, Research, and Charity, and the Region Jämtland Härjedalen. Clinical Trial No Subjects Human Ethics Committee the Regional Ethical Review Board, Umeå University, Umeå, Sweden Helsinki Yes Informed Consent Yes