Women with urinary incontinence (UI) may consider using digital technologies (DT) to guide pelvic floor muscle training (PFMT) as an avenue to help manage their symptoms.  Digital technologies that deliver PFMT programmes are readily available yet there is uncertainty around their scientific validity, appropriateness, cultural relevance or if they are specific to meet the need of women at different stages of their lives.

The aim of this review was to provide a narrative synthesis on digital technologies used for PFMT to manage UI in women across the life course.

This scoping review was conducted in accordance with the Joanna Briggs Institute methodological framework (1) and the PRISMA_ScR (Figure 1). A protocol was prospectively registered with the Open Science Framework (2). Following an initial search in PubMed, a systematic search of seven electronic databases (AMED, CINAHL, Embase, Medline, SPORTDiscus, Scopus, PsychINFO) was conducted to identify relevant literature (inception to December 2021). Key search concepts related to i) DT (e.g., smart/cell phone, app, telemedicine, mobile health); ii) urinary incontinence; iii) pelvic floor muscle training or exercise and iv) key life stages (e.g., pregnancy, menopause). Hand searching of reference lists of included articles, as well as citation tracking (e.g., Web of Science, last 5 years), was utilised to identify additional articles that may have been eligible for screening and inclusion.
Studies were eligible if they focused on women, with or without UI, who had engaged with DT for PFMT; reported on outcomes relating to the use of PFMT DT for managing UI; or explored users’ experiences of DT for PFMT. Identified studies were screened for eligibility by five of the authors. Data relating to: (a) the evidence base for, and features of DT; (b) PFMT, using the Consensus on Exercise Reporting Template (CERT-PFMT); (c) outcomes of DT for PFMT (e.g., UI symptoms, quality of life, adherence, satisfaction); (d) stage of life and culture; and (e) the experiences (facilitators and barriers) of women and healthcare providers; were extracted and synthesised by two or more independent reviewers.

Eighty-nine papers were included (45 primary, 44 supplementary) involving studies from 14 countries. Publications in this area have increased rapidly since the 2010's with most protocols registered since 2019 (Figure 2). Twenty-eight types of DT were used, including mobile apps, with or without a portable vaginal biofeedback or accelerometer-based device, 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, 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.

It is evident that the medium of DT for the conservative management of UI is prevalent and continually expanding, with rapid growth apparent particularly over the last 10 years. In terms of the evidence-based dimension it is encouraging that the DT in over half of the papers in this review were developed based on evidential research and/or testing. The means of achieving this varied across studies, but most adopted an iterative process of continuous testing, implementation and refinement. However, adaptation to stage of life, other than pregnancy or postpartum, or any specific cultural characteristics were mostly lacking from the papers that were reviewed.

DT are a growing 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.

Peters, M., et al. "Chapter 11: Scoping reviews. The Joanna Briggs Institute." (2020).
Woodley, ., et al. " J Soc Res Methodol 8.1 (2017): 19-32.

Continence 7S1 (2023) 100741
DOI: 10.1016/j.cont.2023.100741