JMIR Publications

ABSTRACT

Background:

Pelvic floor muscle training (PFMT) is recommended as first line conservative management for urinary incontinence (UI). Women with pelvic floor muscle dysfunction, specifically UI, may consider digital technologies (DT) as an avenue to manage their symptoms. While DT that deliver PFMT programmes are readily available, uncertainty exists around whether they are scientifically valid, effective, appropriate, culturally relevant, and meet the needs of women at specific stages of life.

Objective:

The purpose of this scoping review was to provide a narrative synthesis and explore the extent, nature and range of existing literature and evidence of DT for managing UI in women across the life course.

Methods:

This scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. A systematic search of seven electronic databases was conducted, and primary quantitative and qualitative research, and grey literature publications were considered. Studies were eligible if they: i) focused on women, with or without UI, who had engaged with DT for PFMT; ii) evaluated the effectiveness of PFMT DT for the management of UI; or iii) explored women’s or healthcare providers’ experiences of DT for PFMT. Identified studies were screened for eligibility and data were extracted and synthesised.

Results:

Ninety-one papers were included (47 primary, 44 supplementary) involving studies from 14 countries. Twenty-nine types of DT were used, including mobile apps, with or without a portable vaginal biofeedback or accelerometer-based device, electromyographic biofeedback systems, a smartphone messaging system, internet-based programmes and videoconferencing. Approximately half of the studies provide evidence for or testing of the DT and a similar proportion of PFMT programmes were drawn from and/or adapted from a known evidence-base. Although PFMT parameters and compliance with programmes varied, the majority of studies that reported on UI symptoms, showed improved outcomes (23/25 studies), and women were generally satisfied with this treatment approach. With respect to stage of life, pregnancy and the postpartum period were the most common focus, with more evidence required for women of various age ranges (e.g., adolescent and older women), including their cultural context which is a factor that is rarely considered. Women’s perceptions and experiences are often taken into account in the development of DT, with the qualitative data highlighting factors that are usually both facilitators and barriers.

Conclusions:

DT are a growing and mostly effective mechanism for delivering PFMT, evidenced by the recent increase in publications. This review has highlighted the heterogeneity in types of DT, PFMT protocols, the lack of cultural adaptations for most of the DT reviewed, and a paucity in the consideration of the changing needs of women across the life course.