One year effectiveness of an app-based treatment for urinary incontinence in comparison to care as usual in Dutch general practice: A pragmatic randomised controlled trial over 12 months

Abstract

Objective: To assess the long-term effectiveness of app-based treatment for female stress, urgency or mixed urinary incontinence (UI) compared with care-as-usual in primary care.

Design: A pragmatic, randomised controlled, superiority trial.

Setting: Primary care in the Netherlands from 2015 to 2018, follow up at 12 months.

Population: Women with two or more UI episodes per week and access to mobile apps, wanting treatment. A total of 262 women were randomised equally to app or care-as-usual; 89 (68%) and 83 (63%) attended 1 year follow up.

Interventions: The standalone app included conservative management for UI with motivation aids (e.g. reminders). Care-as-usual was delivered according to the Dutch GP guideline for UI.

Main outcome measures: Effectiveness assessed by the change in symptom severity score (ICIQ-UI-SF) and the change in quality of life (ICIQ-LUTSqol) with linear regression on an intention-to-treat basis.

Results: Clinically relevant improvement of UI severity for both app (-2.17 ± 2.81) and care-as-usual (-3.43 ± 3.6) groups, with a non-significant mean difference of 0.903 (-0.66 to 1.871).

Conclusion: App-based treatment is a viable alternative to care-as-usual for UI in primary care in terms of effectiveness after 1 year.

Tweetable abstract: App-based treatment for female urinary incontinence is a viable alternative to care-as-usual after 12 months.

Keywords: app; eHealth; effectiveness; general practice; long term; pragmatic; primary care; self-management; urinary incontinence.