Remote Access to Urinary Incontinence Treatments for Women Veterans: The PRACTICAL Randomized Clinical Trial

Area of Science:

• Urology
• Digital Health
• Behavioral Medicine

Background:

• Behavioral treatment is a first-line therapy for urinary incontinence (UI).
• Access to in-person care for UI behavioral treatment can be limited for some populations, such as women veterans.

Purpose of the Study:

• To compare the effectiveness of two remote behavioral treatments for UI: a mobile health app and video visits.
• To assess if a booster video visit improves outcomes for nonresponders to initial remote treatment.

Main Methods:

• A sequential, multiple assignment randomized clinical trial involving women veterans with UI.
• Participants were randomized to either a mobile health UI app (MyHealtheBladder) or a single video visit.
• A subset of nonresponders received a randomized booster video visit.

Main Results:

• The UI app group showed a statistically significant greater decrease in UI symptoms at 12 weeks compared to the video visit group.
• The UI app intervention reached the minimal clinically important difference threshold for symptom improvement in 4 weeks, while the video visit group took 24 weeks.
• Booster video visits did not lead to further improvements in UI symptoms for nonresponders in either group.

Conclusions:

• A mobile health app may offer a more rapid improvement in UI symptoms compared to video visits for women veterans.
• Booster video visits were not effective in improving UI symptoms for nonresponders.
• Remote delivery of behavioral UI treatment shows promise for expanding access to care.