This study aimed to evaluate both the clinical effectiveness and patient satisfaction regarding a hybrid care rehabilitation model designed for female patients experiencing stress and mixed urinary incontinence (MUI) within Spanish public hospital settings. Specifically, the study assessed three stages of rehabilitation: individual in-person rehabilitation, group in-person rehabilitation, and individual asynchronous remote rehabilitation via a telerehabilitation platform. The objective was to assess the efficacy of this combined approach in improving patient outcomes and satisfaction levels.

Data were collected over one year of healthcare practice involving patients with stress and mixed urinary incontinence. Patients underwent a six-month treatment regimen consisting of six individual face-to-face sessions followed by five group sessions and two months of telerehabilitation. Throughout the treatment period, the completion of exercises was recorded on the telerehabilitation platform. Additionally, at the conclusion of the rehabilitation program, patients were surveyed to gauge their satisfaction and experience with the platform. Furthermore, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) was administered to assess the evolution of patients' condition over the course of the study. Conservative treatments included pelvic floor self-knowledge, CORE pressure management, re-education of urinary and dietary habits, neuromodulation of the tibialis posterior for mixed incontinence, and progressive pelvic floor muscle training.

The study comprised a cohort of 19 patients, with a mean age of 52 ± 12 years, all of whom were female, predominantly aged between 35 to 64 years. Approximately 91.5% of the patients participated in at least one remote session.
Patients exhibited significant engagement in therapy, completing an average of 264 exercises and 32 sessions. The session adherence rate of 55%, calculated as the ratio of sessions completed to sessions assigned.
The evaluation of clinical outcomes through the ICIQ-SF questionnaire revealed an improvement in 13 patients, representing an increase of 24%. While 1 patient reported a 10% worsening of their condition, the remaining 5 patients did not answer the last questionnaire.
In terms of satisfaction, the surveys indicated high ratings for therapist engagement (4.6/5.0), usability (4.3/5.0), perceived benefits (3.9/5.0), perceived safety (4.2/5.0), and product recommendation (4.3/5.0). The overall satisfaction was calculated as the average of these five ratings, resulting in a score of 4.3 out of 5.0.

The results highlight the effectiveness of the mixed care model in addressing female stress and mixed urinary incontinence in Spanish public hospital settings. The active engagement and high satisfaction levels among patients underscore the potential of this model in addressing the complex needs associated with pelvic floor dysfunctions.

In conclusion, the implementation of a mixed care model for female stress and mixed urinary incontinence in Spanish public hospitals demonstrates promising outcomes. This model provides a comprehensive approach to addressing the multifaceted challenges of pelvic floor dysfunctions, potentially improving patient outcomes and satisfaction levels. Further research and implementation of similar models are warranted to enhance the management of pelvic floor disorders in healthcare settings.

Kamali S, Özengin N, Topçuoglu MA. The effect of e-pelvic floor muscle training on symptoms in women with stress urinary incontinence: a randomized controlled trial. Women Health. 2023 Jul 3;63(6):473-483
Xu X, Guo P, Xu P, Chen DD, Chen W, Wang H, Jin Y, Wang X, Zhang W, Xie F, Mao M, Zhao R, Feng S. Effectiveness of web-based interventions for women with urinary incontinence: protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2024 Mar 29;14(3):e081731.
Astasio-Picado Á, García-Cano M. Neuromodulation of the Posterior Tibial Nerve for the Control of Urinary Incontinence. Medicina (Kaunas). 2022 Mar 17;58(3):442