Internet‐based treatment of stress urinary incontinence: 1‐ and 2‐year results of a randomized controlled trial with a focus on pelvic floor muscle training
Authors: Sjöström Malin , Umefjord Göran , Stenlund Hans , Carlbring Per , Andersson Gerhard , Samuelsson Eva 
Published: February 2015

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

The present study was a randomized controlled trial with online recruitment of 250 community‐dwelling women aged 18–70 years with SUI ≥ one time/week. Diagnosis was based on validated self‐assessed questionnaires, 2‐day bladder diary and telephone interview with a urotherapist. Consecutive computer‐generated block randomization was carried out 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 Global Impression of Improvement, health‐specific quality of life (EQ‐visual analogue scale [EQ‐VAS]), 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 (QoL) after 1 and 2 years, respectively. No significant differences were found between the groups. The mean (sd) changes in symptom score were 3.7 (3.3) for the internet group and 3.2 (3.4) for the postal group (P = 0.47) after 1 year, and 3.6 (3.5) for the internet group and 3.4 (3.3) for the postal group (P = 0.79) after 2 years. The mean changes (sd) in condition‐specific QoL were 5.5 (6.5) for the internet group and 4.7 the for postal group (6.5) (P = 0.55) after 1 year, and 6.4 (6.0) for the internet group and 4.8 (7.6) for the postal group (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 degree of improvement (39.2% [29/74] vs 23.8% [19/80], P = 0.03). Health‐specific QoL improved significantly in the internet group after 2 years (mean change in EQ‐VAS, 3.8 [11.4], P = 0.005). We found no other significant improvements in this measure. At 1 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 QoL at 1 and 2 years after treatment.