Hypothesis / aims of study
Urinary incontinence (UI) affects up to 50% of older women, impacting physical and emotional health. Clinical practice guidelines recommend pelvic floor muscle (PFM) training (PFMT) as the first-line treatment, yet most go untreated due to a lack of financial and human resources (1). Healthcare systems need innovative solutions to expand scalable treatment access. Mobile PFMT applications (app) have proven effective in extending treatment to young or middle-aged women with UI, but neither the apps nor the PFMT programs are designed specifically for older women (2). This feasibility study aimed to evaluate the acceptability and effectiveness of an app designed to overcome age-related usability barriers and improve adherence to PFMT in older women with UI.
Study design, materials and methods
This is a pre–post cohort study including women age ≥60 with stress or predominant stress UI, ≥3 leakages/week (7-day bladder diary), and a confirmed PFM contractility capacity. Those with urgency UI and conditions likely to bias the intervention (neurological, medications, previous treatments, etc.) were excluded. Participants completed baseline assessments, the app’s PFMT program, and a post-treatment reassessment.
The app was designed to address key factors known to influence acceptance of new technologies among older women, per the MOLD-US framework synthesizing usability knowledge on aging- and disease-related barriers (cognition, physical ability, perception, motivation) (3). Development included an ergonomic interface and design choices (age-appropriate buttons, icons, text, sound, color schemes). The app delivers a structured 12-week PFMT program in three 4-week phases, in which exercises progress in difficulty. Supporting adherence, the app provides educational content (weekly videos on UI-health literacy and self-management) and behavioral support (motivational videos) to sustain long-term engagement. The app documents weekly exercises adherence and educational material usage in addition to daily symptoms.
Acceptability was assessed through adherence rates to the app’s PFMT program according to predefined targets (dropout <20%, exercise adherence >80%, video viewing >80%) and participant ratings on the Mobile Application Rating Scale (uMARS), user version. Effectiveness was evaluated based on changes in daily leakages (7-day bladder diary), the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF), the International Consultation on Incontinence Questionnaire–Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol), and PFM function using the PERFECT scheme.
Wilcoxon signed-rank test (p<0.05) was used for the statistical analysis.
Results
Twelve participants commenced the program, one patient’s data was unsusable due to difficulties with home Wi-Fi connection; 11/12 (92%) were included in the analysis (age, mean ±SD: 70.5 ±5.7 years). The app was well accepted, with adherence exceeding all predefined targets. uMARS ratings indicated high app quality (mean ±SD: 4.35/5 ±0.31). Significant reductions in daily leakage episodes were observed, along with improvements in ICIQ-UI SF and ICIQ-LUTSqol and in PFM function, particularly in endurance, repetitions, and fast contractions. For leakage/day and ICIQ-UI SF, changes exceeded the minimal clinically important difference. (Table 1).
Interpretation of results
Ninety-two percent of participants demonstrated high adherence to the app’s PFMT and video viewings. High uMARS scores and adherence rates suggest the app successfully addressed age-related usability barriers. Significant reductions in daily leakage episodes, combined with statistical improvements in UI symptoms and UI-related QoL scores, suggest that a digitally delivered PFMT program may be effective in this population. Improvements in PFM function further support the app’s effectiveness, despite the small sample size.