Rygh Pontus, Asklund Ina, Samuelsson Eva
Department of Public Health and Clinical Medicine, Umeå University Faculty of Medicine, Umea, Sweden
Department of Public Health and Clinical Medicine, Umeå University Faculty of Medicine, Umea, Sweden.
BMJ Open. 2021 Jan 4;11(1):e040819. doi: 10.1136/bmjopen-2020-040819.
The efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT). In this study, we investigate the user characteristics and the effectiveness of the same app when freely available, and compare these results with the RCT.
Prospective cohort study.
During a 17-month period, 24 602 non-pregnant, non-postpartum women older than 18 years downloaded the app and responded anonymously to a questionnaire. Of these, 2672 (11%) responded to the 3-month follow-up.
Three months' use of the app Tät, containing information, a pelvic floor muscle training programme and lifestyle advice.
Change in symptom severity (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)) and subjective improvement (Patient Global Impression of Improvement (PGI-I)).
Of the respondents, 88% lived in Sweden and 75% (18 384/24 602) were incontinent with a mean age of 45.5 (SD 14.1) years. The UI types, based on symptoms, were SUI (53%), urgency UI (12%), mixed UI (31%) and undefined (4%). The mean ICIQ-UI SF score was 8.2 (SD 4.0) at baseline. The mean ICIQ-UI SF score reduction at follow-up was 1.31 (95% CI: 1.19 to 1.44) with a larger reduction in those with more severe incontinence at baseline (severe/very severe 3.23 (95% CI: 2.85 to 3.61), moderate 1.41 (95% CI: 1.24 to 1.59) and slight 0.24 (95% CI 0.06 to 0.42). When the results were weighted to match the distribution of severity in the RCT, the ICIQ-UI SF score reduction was 2.2 compared with 3.9 in the RCT. Regarding PGI-I, 65% experienced improvement compared with 92% in the RCT.
The app Tät was effective for self-management of UI even in the real world. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.
基于应用程序的压力性尿失禁（SUI）治疗效果已在一项随机对照试验（RCT）中得到证实。在本研究中，我们调查了该应用程序免费提供时的用户特征和效果，并将这些结果与RCT进行比较。
前瞻性队列研究。
在17个月期间，24602名18岁以上的非孕、非产后女性下载了该应用程序，并匿名回答了一份问卷。其中，2672人（11%）回复了3个月的随访。
使用应用程序Tät三个月，其中包含信息、盆底肌肉训练计划和生活方式建议。
症状严重程度的变化（国际尿失禁咨询委员会尿失禁简表（ICIQ-UI SF））和主观改善情况（患者整体改善印象（PGI-I））。
在受访者中，88%居住在瑞典，75%（18384/24602）有尿失禁，平均年龄为45.5（标准差14.1）岁。根据症状，尿失禁类型为压力性尿失禁（53%）、急迫性尿失禁（12%）、混合性尿失禁（31%）和未明确类型（4%）。基线时ICIQ-UI SF平均评分为8.2（标准差4.0）。随访时ICIQ-UI SF平均评分降低1.31（95%置信区间：1.19至1.44），基线时失禁程度越严重的患者降低幅度越大（重度/极重度为3.23（95%置信区间：2.85至3.61），中度为1.41（95%置信区间：1.24至1.59），轻度为0.24（95%置信区间0.06至0.42）。当对结果进行加权以匹配RCT中的严重程度分布时，ICIQ-UI SF评分降低为2.2，而RCT中为3.9。关于PGI-I，65%的患者有改善，而RCT中为92%。
即使在现实世界中，应用程序Tät对尿失禁的自我管理也是有效的。尽管失禁症状的减轻程度低于RCT，但三分之二的用户有改善。基于应用程序的治疗可以惠及许多女性，而无需普通医疗服务的资源。
