Digital physical therapy intervention to treat female urinary incontinence: a semi-experimental study
DOI:
https://doi.org/10.33233/fb.v24i5.5448Keywords:
urinary incontinence, pelvic floor muscle training, digital physiotherapy, telehealthAbstract
Background: Urinary incontinence affects 15-40% Brazilians in rural areas, indicating the necessity of treatment for people in remote regions. Digital technology could be an option, but the evidence-based digital health intervention remains untapped. Objective: To assess whether a group intervention by synchronous video call reduces the severity of female urinary incontinence symptoms and to assess woman’s perception on this modality. Methods: Incontinent women who had digital access were invited to this semi-experimental study. An 8-week protocol was conducted through video calls once a week. Lifestyle counseling and exercises were performed. Pre- and post-evaluations were done exclusively by phone call. Results: 48 women were enrolled in the study and 40 concluded the protocol. They were 56.5 years (±12.0) and most of them had mixed urinary incontinence. The impact on quality of life and the severity of urinary incontinence symptoms was significantly improved and most of the participants were completely satisfied with the intervention. A large effect size was observed (Glass’s delta = 0.83) Conclusion: Our findings support a digital group approach for the treatment of female urinary incontinence as an alternative to be further explored. Combining digital service with group assistance brought satisfaction and clinical results for the participants and it can be promising for public health services.
References
Mostafaei H, Sadeghi‐Bazargani H, Hajebrahimi S, Salehi‐Pourmehr H, Ghojazadeh M, Onur R, et al. Prevalence of female urinary incontinence in the developing world: A systematic review and meta‐analysis—A Report from the Developing World Committee of the International Continence Society and Iranian Research Center for Evidence Based Medicine. Neurourol Urodyn [Internet]. 2020 Apr 3;39(4):1063–86. Available from: https://onlinelibrary.wiley.com/doi/10.1002/nau.24342
Guedes TSR, Guedes MBOG, de Oliveira HKM, Soares RL, da Cunha VL, Lopes JM, et al. Urinary Incontinence in Physically Active Older Women of Northeast Brazil. Int J Environ Res Public Health [Internet]. 2021 May 30;18(11):5878. Available from: https://www.mdpi.com/1660-4601/18/11/5878
Ting HY, Cesar JA. Urinary incontinence among pregnant women in Southern Brazil: A population-based cross-sectional survey. Spradley FT, editor. PLoS One [Internet]. 2020 Jun 8;15(6):e0234338. Available from: https://dx.plos.org/10.1371/journal.pone.0234338
Oriá MOB, Mitchell EM, Vasconcelos CTM, de Oliveira TDA, Lopes LG, de Menezes PR, et al. Prevalence of lower urinary tract symptoms and social determinants in primary care users in Brazil. Int Urogynecol J [Internet]. 2018 Dec 24;29(12):1825–32. Available from: http://link.springer.com/10.1007/s00192-018-3635-1
Magnani PS, Bettiol H, da Silva AAM, Barbieri MA, de Carvalho Cavalli R, Brito LGO. Urinary incontinence between 12 and 24 months postpartum: a cross-sectional study nested in a Brazilian cohort from two cities with different socioeconomic characteristics. Int Urogynecol J [Internet]. 2019 Jun 26;30(6):1003–11. Available from: http://link.springer.com/10.1007/s00192-019-03907-y
Paiva LL, Rodrigues MP, Bessel T. Prevalência de incontinência urinária em idosos no brasil nos últimos 10 anos: uma revisão sistemática. Estud Interdiscip sobre o Envelhec [Internet]. 2019 Oct 28;24. Available from: https://seer.ufrgs.br/RevEnvelhecer/article/view/97762
Weschenfelder AJ, Strelow C, de Arruda GT, Froelich MA, Foletto Pivetta HM, Braz M. Prevalência de incontinência urinária e seu impacto sobre a qualidade de vida de idosos: estudo comparativo entre meio urbano e meio rural. Rev Kairos Gerontol. 2016;19(3):67–77.
Dziekaniak AC, Meucci RD, Cesar JA. Incontinência urinária entre idosos residentes em área rural de município do sul do Brasil. Geriatr Gerontol Aging [Internet]. 2019 Mar;13(1):4–10. Available from: http://www.ggaging.com/details/508/pt-BR/incontinencia-urinaria-entre-idosos-residentes-em-area-rural-de-municipio-do-sul-do-brasil
Tavares DMS, Santos LL, Dias FA, Pollyana, Ferreira C dos S, Feliciano EA de O, et al. Comparação das características sociodemográficas de saúde e qualidade de vida de idosos rurais segundo sexo. Revista Enfermagem e Atenção à Saúde. 2013;2(1):32–46.
Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare [Internet]. 2020 Jun 20;26(5):309–13. doi: 10.1177/1357633X20916567
WHO. Global Strategy on Digital Health 2020-2025. Geneva; 2021.
Abrams P, Andersson K-E, Apostolidis A, Birder L, Bliss D, Brubaker L, et al. 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol Urodyn [Internet]. 2018 Sep;37(7):2271–2. doi: 10.1002/nau.23551
Paiva LL, Ferla L, Darski C, Catarino BM, Ramos JGL. Pelvic floor muscle training in groups versus individual or home treatment of women with urinary incontinence: systematic review and meta-analysis. Int Urogynecol J [Internet]. 2017 Mar 9;28(3):351–9. doi: 10.1007/s00192-016-3133-2
Lamb S, Pepper J, Lall R, Jørstad-Stein E, Clark M, Hill L, et al. Group treatments for sensitive health care problems: a randomised controlled trial of group versus individual physiotherapy sessions for female urinary incontinence. BMC Womens Health [Internet]. 2009 Dec 14;9(1):26. Available from: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-9-26
Figueiredo VB, Nascimento SL, Martínez RFL, Lima CTS, Ferreira CHJ, Driusso P. Effects of individual pelvic floor muscle training vs individual training progressing to group training vs group training alone in women with stress urinary incontinence: A randomized clinical trial. Neurourol Urodyn [Internet]. 2020 Jun 30;39(5):1447–55. Available from: https://onlinelibrary.wiley.com/doi/10.1002/nau.24370
Brennen R, Frawley HC, Martin J, Haines TP. Group-based pelvic floor muscle training for all women during pregnancy is more cost-effective than postnatal training for women with urinary incontinence: cost-effectiveness analysis of a systematic review. J Physiother [Internet]. 2021 Apr;67(2):105–14. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1836955321000217
da Mata KRU, Costa RCM, Carbone É dos SM, Gimenez MM, Bortolini MAT, Castro RA, et al. Telehealth in the rehabilitation of female pelvic floor dysfunction: a systematic literature review. Int Urogynecol J [Internet]. 2021 Feb 11;32(2):249–59. Available from: http://link.springer.com/10.1007/s00192-020-04588-8
Huang Z, Wu S, Yu T, Hu A. Efficacy of telemedicine for urinary incontinence in women: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J [Internet]. 2020 Aug 31;31(8):1507–13. Available from: https://link.springer.com/10.1007/s00192-020-04340-2
Bernard S, McLean L, Boucher S, Hébert LJ, Plante M, Grégoire J, et al. An in-home rehabilitation program for the treatment of urinary incontinence symptoms in endometrial cancer survivors: a single-case experimental design study. Int Urogynecol J [Internet]. 2021 Nov 25;32(11):2947–57. Available from: https://link.springer.com/10.1007/s00192-021-04981-x
Santiago M, Cardoso-Teixeira P, Pereira S, Firmino-Machado J, Moreira S. A Hybrid-Telerehabilitation Versus a Conventional Program for Urinary Incontinence: a Randomized Trial during COVID-19 Pandemic. Int Urogynecol J [Internet]. 2022 May 21; Available from: https://link.springer.com/10.1007/s00192-022-05108-6
Des Jarlais DC, Lyles C, Crepaz N. Improving the Reporting Quality of Nonrandomized Evaluations of Behavioral and Public Health Interventions: The TREND Statement. Am J Public Health [Internet]. 2004 Mar;94(3):361–6. Available from: http://ajph.aphapublications.org/doi/10.2105/AJPH.94.3.361
COFFITO. Teleconsulta, Telemonitoramento e teleconsultoria. Resolução N 516, 20 março 2020.
Associação Brasileira de Fisioterapia em Saúde da Mulher. Recomendações da ABRAFISM sobre fisioterapia em uroginecologia e coloproctologia em tempos de COVID-19; 2020.
Associação Brasileira de Fisioterapia em Saúde da Mulher. Recomendação geral abrafism fisioterapia por meio digital/teleconsulta e telemonitoramento na fisioterapia em saúde da mulher e uro- proctologia. 2020.
Tamanini JTN, Dambros M, D’Ancona CAL, Palma PCR, Rodrigues Netto Jr N. Validação para o português do “International Consultation on Incontinence Questionnaire - Short Form” (ICIQ-SF). Rev Saude Publica [Internet]. 2004 Jun;38(3):438–44. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102004000300015&lng=pt&tlng=pt
Lim R, Liong ML, Lim KK, Leong WS, Yuen KH. The Minimum Clinically Important Difference of the International Consultation on Incontinence Questionnaires (ICIQ-UI SF and ICIQ-LUTSqol). Urology [Internet]. 2019 Nov;133:91–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0090429519307125
Hui E, Lee PSC, Woo J. Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomized controlled trial. J Telemed Telecare [Internet]. 2006 Oct 1;12(7):343–7. Available from: http://journals.sagepub.com/doi/10.1258/135763306778682413
Ferreira CHJ, Driusso P, Haddad JM, Pereira SB, Fernandes ACNL, Porto D, et al. A guide to physiotherapy in urogynecology for patient care during the COVID-19 pandemic. Int Urogynecol J [Internet]. 2021 Jan 28;32(1):203–10. Available from: https://link.springer.com/10.1007/s00192-020-04542-8
Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol [Internet]. 2013;4. Available from: http://journal.frontiersin.org/article/10.3389/fpsyg.2013.00863/abstract
Klovning A, Avery K, Sandvik H, Hunskaar S. Comparison of two questionnaires for assessing the severity of urinary incontinence: The ICIQ-UI SF versus the incontinence severity index. Neurourol Urodyn [Internet]. 2009 Jun;28(5):411–5. Available from: https://onlinelibrary.wiley.com/doi/10.1002/nau.20674
Sawilowsky SS. New Effect Size Rules of Thumb. J Mod Appl Stat Methods [Internet]. 2009 Nov 1;8(2):597–9. Available from: http://digitalcommons.wayne.edu/jmasm/vol8/iss2/26
Bernard S, Boucher S, McLean L, Moffet H. Mobile technologies for the conservative self-management of urinary incontinence: a systematic scoping review. Int Urogynecol J [Internet]. 2020 Jun 2;31(6):1163–74. Available from: http://link.springer.com/10.1007/s00192-019-04012-w
Aquino EML, Silveira IH, Pescarini JM, Aquino R, Souza-Filho JA de, Rocha A dos S, et al. Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil. Cienc Saude Colet [Internet]. 2020 Jun;25(suppl 1):2423–46. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232020006702423&tlng=pt
Hay-Smith EJC, Herderschee R, Dumoulin C, Herbison GP. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev [Internet]. 2011 Dec 7; Available from: https://doi.wiley.com/10.1002/14651858.CD009508
Paquette J, McDermott CD, Acquaviva B, Faghani N, Lovatsis D. Real-World Effectiveness of Pelvic Floor Muscle Training for Women With Urinary Tract Symptoms and/or Prolapse. J Obstet Gynaecol Canada [Internet]. 2021 Nov;43(11):1247-1253.e1. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1701216321004163
Frawley HC, McClurg D, Mahfooza A, Hay-Smith J, Dumoulin C. Health professionals’ and patients’ perspectives on pelvic floor muscle training adherence- 2011 ICS State-of-the-Science Seminar research paper IV of IV. Neurourol Urodyn [Internet]. 2015 Sep;34(7):632–9. Available from: https://onlinelibrary.wiley.com/doi/10.1002/nau.22774
HCPA. Produção assistencial HCPA [Internet]. [cited 2022 nov 10]. Available from: https://www.hcpa.edu.br/institucional/institucional-apresentacao/institucional-apresentacao-principais-numeros
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