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
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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 ( I nternational C onsultation on I ncontinence Q uestionnaire S hort F orm [ ICIQ ‐ UI SF ]) and condition‐specific quality of life ( ICIQ ‐ L ower U rinary T ract S ymptoms Q uality of L ife [ ICIQ ‐ LUTS qol]). Secondary outcomes were the P atient G lobal I mpression of I mprovement, 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 ( Q o L ) 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 Q o L 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 Q o L 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 Q o L at 1 and 2 years after treatment.
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Across several studies, telehealth programs for pelvic floor muscle training outperformed traditional written or physician-led instruction, and in one trial they matched supervised pelvic floor physical therapy.
“Overall, telehealth interventions aimed at pelvic floor muscle strengthening had benefits over traditional models (written information and physician teaching) in multiple studies and were non-inferior to supervised pelvic floor physical therapy in one study.”
From Evidence for the Appropriate Use of Telemedicine in Female Pelvic Medicine and Reconstructive Surgery (2021) · cites this paper as [13]
Smartphone and internet-based programs may boost adherence to pelvic floor muscle training relative to written or verbal instructions, and better adherence may improve urinary incontinence outcomes.
“Studies have already suggested that smartphone app and internet-based interventions may improve compliance with pelvic floor muscle strengthening programs compared with traditional written or verbal instruction and this increase in compliance may result in improved outcomes for patients with urinary incontinence.”
From Evidence for the Appropriate Use of Telemedicine in Female Pelvic Medicine and Reconstructive Surgery (2021) · cites this paper as [13]
Stress urinary incontinence treatment with a focus on pelvic floor muscle training provided via the internet is associated with marked improvements in symptoms and quality of life, in both the short and the long term.
“SUI treatment with a focus on PFMT provided via the internet is associated with marked improvements in symptoms and quality of life, in both the short and the long term 11, 12.”
From Self‐management of stress urinary incontinence via a mobile app: two‐year follow‐up of a randomized controlled trial (2017) · cites this paper as [11]
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- Authors
- Sjöström, M., Umefjord, G., Stenlund, H., Carlbring, P., Andersson, G., & Samuelsson, E.
- Affiliations
- Umeå University (SE)
- Stockholm University (SE)
- Linköping University (SE)
- Corresponding author
- Sjöström, Malin
- Venue
- BJU International
- Publisher
- Wiley
- Published
- 2015-06-03
- Volume
- 116
- Issue
- 6
- Pages
- 955-964
- ISSN
- 1464-4096 (ISSN-L)
- 1464-410X
- PMC
- PMC4690161
- OpenAlex
- W2071292560
- Cited by
- 84
- References
- 38
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 17 · 2023: 5 · 2022: 11 · 2021: 7 · 2020: 9 · 2019: 8 · 2018: 3 · 2017: 11 · 2016: 2 · 2015: 2 · 2014: 1
- FWCI
- 5.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of Urology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- Funders
- Forskningsrådet för Arbetsliv och Socialvetenskap
- Västerbotten Läns Landsting
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- stress urinary incontinence, pelvic floor muscle training, online therapy, long-term outcomes, quality of life, symptom severity, women, medication adherence, loss to follow-up, incontinence aids, treatment satisfaction, telemedicine, community-dwelling adults, ICIQ-SF
- MeSH terms
- Adolescent, Adult, Aged, Exercise Therapy, Female, Follow-Up Studies, Humans, Middle Aged, Sweden, Urinary Incontinence, Stress, Treatment Outcome, Telemedicine, Pelvic Floor, Internet, Young Adult
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