Table 4.
Clinical studies evaluating applications of telehealth in the management of patients with any kind of urinary incontinence.
| Reference | Study design | Cases | Studied intervention | Methods | Endpoint | Results |
|---|---|---|---|---|---|---|
| Hui (2006) [12] | Randomized controlled trial | 31 | Telemedicine continence program to manage incontinence in older women | At baseline, both groups were assessed face-to-face for pelvic floor muscle strength, instrumental biofeedback, and verbal feedback by vaginal palpation. During the intervention period, identical behavioral training was administered via telemedicine or in outpatients service | Participants were asked to rate the severity of their existing bladder problem | Participants in both treatment groups experienced significant improvement in their symptoms (namely, a reduction in the number of daily incontinence episodes and voiding frequency, while the volume of urine at each micturition increased). Pelvic floor muscle strength as measured by the Oxford Score also improved. Clients’ perceptions of their symptoms showed significant improvement in both groups following intervention. Overall, no significant difference in treatment outcomes, in terms of both subjective and objective data, was observed in the two treatment groups |
| 27 | Conventional outpatient continence service to manage incontinence in older women | Objective measures included the number of incontinent episodes, voiding frequency, and voided volume, as documented in a 3-d voiding diary, and pelvic floor muscle strength by digital assessment using the Oxford Scale | Self-reported satisfaction with the use of videoconferencing as a mode of care delivery was also high (100% were satisfied or highly satisfied) | |||
| Yu (2014) [23] | Prospective series | 31 | Introducing a telemonitoring system for continence assessment in a nursing home | Care staff were trained in the use of a telemonitoring system for continence assessment. Voiding events for each older person were recorded using the system during a 72-h urinary continence assessment, and the data were used to prepare an individualized care plan. After 2 wk of using the new care plan, a second assessment was carried out for each older person, using the telemonitoring system | To explore the effects of introducing a telemonitoring and care planning system for urinary continence assessment in a nursing home and adherence by care staff to urinary continence care plans | The volume of urine voided into the continence aids was significantly reduced; the number of actual and successful toilet visits was significantly increased |
| Increased adherence to urinary continence care plans by staff | ||||||
| Schimpf (2016) [32] | Prospective series | 87 | Nurse telephone follow-up under physician direction to assess symptom improvement and patient satisfaction | Nurse telephone follow-up for prescribed medication follow-up after physical therapy symptom assessment, and efficacy of recommended bowel regime | To assess symptom improvement and patient satisfaction of nurse telephone follow-up under physician direction | The most common diagnoses were overactive bladder and mixed urinary incontinence. Satisfaction rates and the level of convenience for patients were high. Women indicated ease of speaking over the telephone about their condition and confidence in the treatment plan. Satisfaction with telephone follow-up did not differ significantly based on age or diagnosis |
| Jones (2018) [38] | Randomized controlled trial | 98 | Telephone consultation (virtual clinic) in the care of women with urinary incontinence | Both groups completed a validated, web-based interactive, patient-reported outcome measure (ePAQ-Pelvic Floor), in advance of their appointment followed by either a telephone consultation or a face-to-face consultation | The primary outcome was the mean “short-term outcome scale” score on the PEQ. Secondary outcome measures included the other domains of the PEQ (communications, emotions and barriers), CSQ, SF-12, personal, societal, and NHS costs | The primary outcome showed a nonsignificant difference between the two study arms. No significant differences were also observed on the CSQ and SF-12. However, the intervention group showed significantly higher PEQ domain scores for communications, emotions, and barriers (including following adjustment for age and parity). The virtual clinic also reduced consultation time (10.94 vs 25.9 min) and consultation costs (£31.75 vs £72.17) significantly compared with usual care. Standard care was more cost effective due to greater clinic reattendances in this group, but the difference was minimal (£38.04) |
| 97 | Standard consultation in the care of women with urinary incontinence | |||||
| Lee (2019) [49] | Cross sectional | 200 | A survey regarding women’s willingness to use technology to communicate with providers | Women completed a survey regarding what technology they owned, how they utilized it, and their willingness to use technology to communicate with providers | To assess the willingness of women with pelvic floor disorders to adopt nontraditional mobile communication methods with health care providers | After controlling for education and travel distance to clinic, older women remained significantly less likely to express willingness to use various technologies:
|
| Davis (2020) [51] | Prospective series | Three caregiver/care-recipient dyads were enrolled, who completed the study | Development and feasibility of a 6-wk evidence-based, educational/skill-building program delivered via a tablet personal computer, aimed at developing informal caregiver UI knowledge | Data were collected at baseline (T0; face to face), 3 wk (T1; mailing), and 6 wk (T2; face to face) after baseline. As part of the feasibility analysis, weekly logs of prompted voiding, module viewing, and telephone visits were also maintained | To explore the feasibility of an innovative, technology-delivered, prompted-voiding, and skill-building intervention to support the informal caregivers of functionally limited older adults with UI. Second, to assess the acceptability and usefulness of the intervention, and its impact on informal caregiver and care-recipient outcomes | The tablet-facilitated intervention was feasible and acceptable to informal caregivers, and showed promise for improving both caregiver and care recipient outcomes |
| Goode (2020) [52] | Prospective series | 29 | An evidence‐based 8‐wk behavioral mHealth program, MyHealtheBladder, with input from women veterans, behavioral medicine and health education experts, and clinical providers treating UI | The program was story based and included pelvic floor muscle exercises, bladder control strategies, fluid management, risk factor reduction, and self‐monitoring | Change in UI frequency and volume, and impact on the quality of life as measured by the validated ICIQ-SF | Reductions in ICIQ‐SF scores from a mean of 12.6 ± 3.9 at baseline to 10.4 ± 4.11 at 5 wk, to 8.7 ± 4.0 at the end of the 8‐wk intervention. Changes exceeded the minimal clinically important difference for the ICIQ‐SF |
CI = confidence interval; CSQ = Client Satisfaction Questionnaire; ICIQ-SF = International Consultation on Incontinence Questionnaire‐Short Form; NHS = National Health Service; OR = odds ratio; PEQ = Patient Experience Questionnaire; SF-12 = Short-Form 12; UI = urinary incontinence.