Innovative treatment modalities for urinary incontinence: a European survey identifying experience and attitude of healthcare providers

Int Urogynecol J (2017) 28:1725–1731 DOI 10.1007/s00192-017-3339-y ORIGINAL ARTICLE Innovative treatment modalities for urinary incontinence: a European survey identifying experience and attitude of healthcare providers Arnoud W. Kastelein 1 & Maarten F. A. Dicker 1 & Brent C. Opmeer 2 & Sonia S. Angles 3 & Kaisa E. Raatikainen 4 & Joan F. Alonso 5 & Diana Tăut 6 & Olavi Airaksinen 7 & Linda D. Cardozo 8 & Jan-Paul W. R. Roovers 1 & on behalf of the WOMEN-UP consortium Received: 3 February 2017 / Accepted: 4 April 2017 / Published online: 21 April 2017 # The Author(s) 2017. This article is an open access publication Abstract Introduction and hypothesis Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25% to 51%. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI). A European research consortium is investigating an innovative system based on information and communication technology for the conservative treatment of women with SUI. When introducing a new intervention, implementation barriers arise and need to be identified. Therefore, we investigated healthcare providers’ experience with and attitude towards innovative care options. * Arnoud W. Kastelein 1 Department of Obstetrics and Gynaecology, Academic Medical Centre, Room F4-240, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands 2 Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands 3 Department of Obstetrics and Gynaecology, Hospital Clinic, Barcelona, Spain 4 Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland 5 Department of Automatic Control, Biomedical Engineering Research Centre, Universitat Politècnica de Catalunya, Barcelona, Spain 6 Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania 7 Department of Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland 8 Department of Obstetrics and Gynaecology, King’s College Hospital, London, UK Methods We performed an online survey to assess (1) the characteristics and practice of healthcare providers, (2) current protocols for SUI, (3) current use of biofeedback, and (4) knowledge about serious gaming. The survey was sent to members of professional societies in Europe (EUGA), UK (BSUG) and The Netherlands (DPFS). Results Of 341 questionnaires analyzed (response rate between 18% and 30%), 64% of the respondents had access to a protocol for the treatment of SUI, and 31% used biofeedback when treating patients with SUI. However, 92% considered that biofeedback has a clear or probable added value, and 97% of those who did not use biofeedback would change their practice if research evidence supported its use. Finally, 89% of respondents indicated that they had no experience of serious gaming, but 92% considered that it could be useful. Conclusions Although inexperienced, European urogynecologists and physical therapists welcome innovative treatment options for the conservative treatment of SUI such as portable wireless biofeedback and serious gaming. Scientific evidence is considered a prerequisite to incorporate such innovations into clinical practice. Keywords Urinary incontinence . Serious gaming . Biofeedback . Pelvic floor muscle training Introduction Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25% to 51% [1]. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI) [2], a condition that has a major impact on the quality of life [3]. Pelvic floor muscle training (PFMT) is an 1726 effective treatment for women with mild or moderate SUI [4] and is recommended as part of first-line conservative management programs for women with SUI [5]. However, because the efficacy of PFMT is directly related to adherence, poor compliance can significantly reduce the cure rates with this treatment [6, 7]. Healthcare providers try to support adherence with more frequent patient visits, which has been proven to be effective but makes the intervention more costly [8–11]. A European research group, the WOMEN-UP consortium, collaborates on an innovative intervention to expose women with SUI to the benefits of pelvic floor physiotherapy, optimize adherence and reduce costs. This novel intervention involves a wireless vaginal biofeedback device and an abdominal belt, both with surface electromyography sensors, connected via Bluetooth to a smartphone with access to ‘serious games’. Both vaginal and abdominal biofeedback are obtained, enabling patients to improve their training technique. Exercise performance and results can be monitored by patients and their therapists through an online web portal with twoway messaging functionality. In serious gaming, interactive training games are used for a primary purposes other than pure entertainment, that is to improve knowledge, skill or attitude with the added value of fun and competition [12, 13]. Serious games have been successfully used in, for instance, rehabilitation programs [14] and for promoting health behavior [15]. In the WOMEN-UP project, serious games will be employed to make PFMT more appealing and thereby possibly improve adherence. In these serious games, contracting and relaxing the pelvic floor operates a game on a smartphone via a Bluetooth biofeedback signal. In addition, to evaluate this innovative approach in terms of clinical and cost effectiveness, professionals’ attitudes towards pelvic physiotherapy, biofeedback and serious gaming need to be known. Implementation of new treatment modalities can be hampered by multiple factors, including healthcare providers’ attitudes towards and knowledge of the innovative technology. It is important to identify, assess and tackle these factors in a timely manner to optimize the intervention and facilitate its application in practice. For example, sufficient knowledge of PFMT, biofeedback and serious gaming, and their therapeutic value seem essential. The lack of scientific evidence and the absence of a standardized protocol describing the treatment leave healthcare providers hesitant to use new treatment modalities. Therefore, as a first step, the current protocol and data on experience with and attitudes towards biofeedback combined with serious gaming need to be collected and described for the different European countries. It is also important to understand the attitudes of those who do not use biofeedback, and the conditions under which they would be willing to use such a treatment modality. Suggestions and criticisms should be taken into account and acted upon to minimize the risk of problems during subsequent implementation. Int Urogynecol J (2017) 28:1725–1731 Therefore, the aim of this research was to investigate whether and when this innovative solution for the conservative treatment of urinary incontinence would fit in professionals’ daily practice by performing a Europe-wide survey. Materials and methods We designed a surv (...truncated)