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Abstract

BACKGROUND:

Stress urinary incontinence is prevalent among women and the incidence increases with age.

OBJECTIVE:

To explore the effect of intelligent pelvic floor muscle rehabilitation on elderly female patients with incontinence.

METHODS:

A total of 209 patients with urinary incontinence who were treated with pelvic floor muscle rehabilitation at Peking University International Hospital from September 2020 to January 2022 were selected by convenient sampling. All subjects were divided into the 50–60 year old patient group ( $n=$ 51) and over 60 years old patient group according to age ( $n=$ 158). The subjects of different age group were divided into an experimental group and a control group. The patients in the control group received routine nursing and health education, and the patients in the observation group received a combination of mobile application use and smart dumbbells. Based on this, we constructed an intervention model for intelligent, continuous pelvic floor rehabilitation. After 7 and 12 weeks, pelvic floor muscle function knowledge and exercise compliance in the two groups were evaluated. The improvement of urinary incontinence symptoms, pelvic floor muscle strength grades and quality-of-life scales were evaluated.

RESULTS:

The results showed that pelvic floor knowledge and exercise compliance in the experimental group were better than in the control group at 7 and 12 weeks after intervention ( $P<$ 0.05). There was no significant difference in pelvic floor muscle strength and quality of life between the two groups at 7 weeks after intervention ( $P>$ 0.05). However, there was a significant difference in pelvic floor muscle strength and quality of life between the two groups at 12 weeks after intervention ( $P<$ 0.05). There was no significant difference between different age groups.

CONCLUSION:

The intelligent pelvic floor rehabilitation model that combines a mobile application with smart dumbbells can maintain and strengthen the clinical treatment effect for elderly patients with urinary incontinence.

Keywords

Intelligent app pelvic floor muscle training exercise older female urinary incontinence

1. Introduction

Stress urinary incontinence (SUI) is an involuntary leakage of urine caused by excessive pressure on the bladder and urethra due to coughing, sneezing, laughing or exercising [1]. It is a common disease affecting about 200 million people around the world [2]. It is prevalent among women and the incidence increases with age. Urinary incontinence in Chinese women is as high as 18.9% [3]. Among them, women over the age of 60 account for 53% of the cases [4]. Although this condition is rarely life-threatening, SUI can severely affect an individual’s physical, psychological and social well-being, as well as quality of life [5]. Interventions may include non-surgical options (e.g. lifestyle changes, pelvic floor muscle training, medication) and surgical options to support the urethra or increase bladder capacity [6, 7, 8]. However, a non-surgical approach is the first-line treatment for SUI. It comprises pelvic floor muscle treatment (PFMT) based on Kegel exercises. Compliance with pelvic floor muscle training among elderly patients is poor due to a lack of knowledge for pelvic floor rehabilitation, dull and monotonous exercises, forgetfulness, a lack of daily supervision and guidance, etc., thus diminishing the rehabilitation effect. Tools available through the application of information technology can not only create a better medical service model for patients but also improve the work efficiency of medical staff [9, 10, 11]. This study aims to combine a mobile phone application (app) with smart dumbbells to construct a mobile intelligent pelvic floor rehabilitation model. With pelvic floor muscle training as the core, the app provides health information, pelvic floor muscle training guidance, real-time and dynamic supervision and reminders. The system automatically records the exercise contraction and relaxation time and intensity, automatically generates test scores and curves and gives feedback reports on results, improving pelvic floor rehabilitation knowledge, exercise compliance, pelvic floor muscle strength and quality of life in elderly patients with SUI.

2. Materials and methods

2.1 General information

This study was approved by the ethics committee of the Peking University International Hospital (approval number: 2021-046 (BMR)), and all patients signed an informed consent form. Using the method of convenient sampling, 209 female patients diagnosed with urinary incontinence in the outpatient department of the Peking University International Hospital from September 2020 to January 2022 were collected.

Inclusion criteria: (1) age $\geqslant$ 50 years old; (2) the ICI-Q-SF score met the criteria for urinary incontinence; (3) a doctor recommendation for non-surgical treatment methods such as pelvic floor muscle exercise; (4) patient and family agreement and acceptance to this study with no communication barriers. Exclusion criteria: (1) a history of SUI surgery; (2) pelvic surgery performed within the prior three months; (3) a urinary tract infection or acute reproductive tract infection occurrence within the prior two weeks; (4) a chronic consumptive disease and acute exacerbation of mental illness. The patients who met the inclusion criteria were divided into an experimental group and a control group according to the random number table generated by the computer. All subjects were divided into the 50–60 year old patient group and over 60 years old patient group according to age.

2.2 Methods

2.2.1 Data collection methods

The researcher explained the purpose and content of the study to the subjects, signed the informed consent form after obtaining the patients’ consent, and distributed questionnaires to the patients, which included the general information questionnaire, pelvic floor rehabilitation knowledge awareness questionnaire, pelvic floor muscle strength measurement and evaluation and urinary incontinence quality-of-life scale. At 7 and 12 weeks of intervention, the awareness questionnaire of pelvic floor rehabilitation knowledge and urinary incontinence quality-of-life scale were issued. Additionally, a pelvic floor muscle exercise diary was collected and pelvic floor muscle strength was measured in the clinic; the results were evaluated and recorded. Specific data collection methods were: (1) The fixed person in charge of the two groups established health files, including basic data, informed consent, knowledge awareness questionnaires, scoring scales and the pelvic floor muscle training implementation process. (2) Both groups of patients received the same pelvic floor-related knowledge training, including the concept of SUI, its harm to the body, the causes of the disease, the understanding of the pelvic floor muscle group, the factors affecting the muscle group, the correct lifestyle and the methods of pelvic floor muscle training. The control group was given the paper version of the publicity and education materials, and the experimental group was given voice guidance through the mobile phone app. (3) The training time of both groups was two times a day, 20 minutes each time. (4) Both groups of patients made appointments for 7- and 12-week follow-ups for a pelvic floor treatment evaluation at the hospital. The patients’ pelvic floor class I muscle fibres and class II muscle fibres were evaluated for muscle strength, and the patients’ awareness of pelvic floor rehabilitation knowledge, exercise compliance, quality of life and programme implementation were recorded by questionnaire.

2.2.2 Intervention methods

The control group was given routine nursing and home rehabilitation guidance by professional nurses trained in urinary incontinence maintenance. The following intervention methods were implemented: (1) The nurses distributed the pelvic floor function rehabilitation instruction manual [12], ensured the understanding of pelvic floor muscles and taught patients the methods of pelvic floor muscle exercise. (2) The patients recorded their own bladder diary information, including the amount of water consumed, number of urination instances during the day and night, the length of pelvic floor contraction exercises, etc.

The experimental group was guided by the smart app for pelvic floor rehabilitation, which had been developed by the preliminary team. The rehabilitation knowledge guidance and exercise contents in the app were consistent with those in the control group; it contained references to guidelines for the diagnosis and treatment of female SUI [3]. A continuous pelvic floor rehabilitation mode was constructed by the smart app and vaginal dumbbells (see Fig. 1). Method (see Fig. 2). Specific contents of the app included the following: (1) Patients could obtain knowledge of pelvic floor muscles at any time through the app master lecture hall, and the information was presented in the form of text, pictures and videos; (2) Home training was provided to: (a) deliver exercise reminders every day; (b) allow patients to choose from four levels of pelvic floor muscle rehabilitation training courses with increasing difficulty according to their own needs, and carry out pelvic floor muscle contraction and relaxation exercises through animated voice guidance; (c) automatically generate exercise data, including the time of each contraction and relaxation and total duration; (d) prompt the patient to adjust the irregular contraction and relaxation of muscle movements after connecting the vaginal dumbbells to ensure the optimal effect; (3) Patients could establish a WeChat group to have questions answered during exercise in one-hour sessions at a fixed time every day; this encouraged patients to share exercise experiences and increased their enthusiasm for exercise; (4) Weekly telephone follow-ups that provided psychological support helped the patients adjust according to the exercise performance of the research object and correct non-standard actions, and the importance of adhering to pelvic floor exercise and changing bad living habits was emphasised.

2.3 Observation indicators

Both groups of patients used the following indicators at the 7 ${}^{\text{th}}$ and 12 ${}^{\text{th}}$ week interventions: (1) A pelvic

Figure 1.

Flowchart of intelligent pelvic floor rehabilitation mode.

floor rehabilitation knowledge awareness questionnaire was given. The self-developed questionnaire used in this study assessed for the patients’ knowledge and understanding of SUI disease, related lifestyle and other health information and pelvic floor muscle rehabilitation exercises. The content validity index was 0.910. Cronbach’s coefficient of the questionnaire was 0.866; (2) To ensure pelvic floor muscle exercise compliance, patients recorded the frequency, intensity and duration of daily exercise in a pelvic floor muscle exercise diary, and compliance was determined according to the pelvic floor muscle exercise diary and telephone inquiries. The standard exercise frequency was two times a day, 20 minutes each time, for a total of 40 minutes a day, making the total weekly exercise time more than 280 minutes. Patients were considered to be in good compliance when they achieved 50% of their total weekly exercise time (i.e. 140 minutes) [13]; (3) Patients were scheduled to come to the hospital for pelvic floor muscle strength measurement and evaluation at 7 and 12 weeks. In this study, biofeedback electrical stimulation (biofeedback electrical stimulator, model UROSTYM, produced by Canadian Laborie Medical Technologies Co., Ltd.) was used in the gynaecological outpatient department of Peking University International Hospital to evaluate pelvic floor muscle strength (including class I muscle fibres and class II muscle fibres) using a frequency of 50 Hz and a pulse width of 250 us; (4) The Chinese version of the Urinary Incontinence Quality of Life Scale translated by Woodley et al. [14]. The Chinese version of the I-QOL included behavioural limitations, psychological impacts and social barriers, with a total of three dimensions and 22 items. Likert 5 grades were used for all scores, with one to five points assigned from ‘completely like this’ to ‘never like this’, and finally all the scores were accumulated. The higher the score, the better the quality of life. Cronbach’s coefficients of the scales overall were 0.93.

Figure 2.

Intelligent APP operation method.

2.4 Statistical methods

The SPSS 26.0 software was used for statistical analysis. If the measurement data were normally distributed, they were described by the mean $\pm$ standard deviation ( $x\pm s$ ), and the independent sample $t$ -test was used for comparative analysis between the two groups. If the distribution was not normal, the median and interquartile range was used for statistical description, and the rank-sum test in the non-parametric test was used for comparative analysis between the two groups. Counting data were described by frequency and percentage, the chi-square test or Fisher’s exact probability method were used for comparison between the groups and paired chi-square analysis was used to compare dichotomous variables at different time points. A $P$ value of $<$ 0.05 indicated that the difference was statistically significant.

3. Results

3.1 Comparison of general data between the two groups

First, we analyzed and compared the general data of the patients. A total of 209 patients were included in this study (over 60 years old patient group: 158; 50–60 year old patient group: 51). There was no significant difference between the two groups in age, Body Mass Index (BMI), mode of delivery, ICI-Q-SF score and other factors ( $P>$ 0.05). There was no significant difference between different age groups. The two groups were comparable (Tables 1 and 2).

Table 1
General data of the research subjects over 60 years old group

Indicator		Subject ( $n=$ 158)		Experimental group ( $n=$ 81)		Control group ( $n=$ 77)		$t/Z$	$P$
Age		63.47	(60.71)	63.46	(60.70)	63.49	(60.71)	$-$ 0.22	0.83
Education level	Junior high school and below	89	(56.33)	45	(55.56)	44	(57.14)	0.04	0.98
	Senior high School	52	(32.91)	27	(33.33)	25	(32.47)
	College and above	17	(10.76)	9	(11.11)	8	(10.39)
BMI		24.04 $\pm$ 1.84		24.02 $\pm$ 1.83		24.05 $\pm$ 1.85		$-$ 0.09	0.93
Mode of delivery	Vaginal delivery	139	(87.97)	72	(88.89)	67	(87.01)	0.08	0.78
	Cesarean section	19	(12.03)	9	(11.11)	10	(12.99)
ICI-Q-SF score		9	(7,11.75)	10	(8,12)	8	(7,10)	$-$ 2.77	0.01
Knowledge awareness score		3	(2,4)	3	(3,4)	3	(2,4)	$-$ 1.10	0.27
Urine pad experiment		7.55	(6.525,8.5)	7.4	(6.65,8.3)	7.8	(6.625,8.6)	$-$ 0.94	0.35
Pelvic floor fast	Level 0–1	30	(18.99)	16	(19.75)	14	(18.18)	0.05	0.82
muscle strength	Level 2–3	128	(81.01)	65	(80.25)	63	(81.82)
	Level 4–5	0	(0.00)	0	(0.00)	0	(0.00)
Pelvic floor slow	Level 0–1	63	(39.87)	34	(41.98)	29	(37.66)	0.30	0.58
muscle strength	Level 2–3	95	(60.13)	47	(58.02)	48	(62.34)
	Level 4–5	0	(0.00)	0	(0.00)	0	(0.00)

BMI, Body Mass Index.

Table 2

General data of the research subjects 50–60 year old group

Indicator		Subject ( $n=$ 51)		Experimental group ( $n=$ 20)		Control group ( $n=$ 31)		$t/Z$	$P$
Age		53.70	(50.59)	53.65	(50.59)	53.74	(50.59)	$-$ 0.24	0.87
Education level	Junior high school and below	31	(60.78)	10	(50.00)	21	(67.74)	0.03	0.99
	Senior high School	14	(27.45)	7	(35.00)	7	(22.58)
	College and above	6	(11.76)	3	(15.00)	3	(9.68)
BMI		24.34 $\pm$ 1.44		24.19 $\pm$ 1.37		25.01 $\pm$ 1.36		$-$ 0.11	0.95
Mode of delivery	Vaginal delivery	43	(84.31)	17	(85.00)	26	(83.87)	0.09	0.77
	Cesarean section	8	(15.69)	3	(15.00)	5	(16.13)
ICI-Q-SF score		9	(7,11.76)	10	(8,11)	8	(7,10)	$-$ 2.78	0.02
Knowledge awareness score		3	(2,4)	3	(3,4)	3	(2,4)	$-$ 1.11	0.28
Urine pad experiment		7.45	(6.425,8.5)	7.3	(6.64,8.4)	7.7	(6.625,8.5)	$-$ 0.95	0.36
Pelvic floor fast	Level 0–1	9	(17.65)	4	(20.00)	5	(16.13)	0.06	0.81
muscle strength	Level 2–3	42	(82.35)	16	(80.00)	26	(83.87)
	Level 4–5	0	(0.00)	0	(0.00)	0	(0.00)
Pelvic floor slow	Level 0–1	20	(39.22)	8	(40.00)	12	(38.71)	0.32	0.56
muscle strength	Level 2–3	31	(60.78)	12	(60.00)	19	(61.29)
	Level 4–5	0	(0.00)	0	(0.00)	0	(0.00)

BMI, Body Mass Index.

Table 3

Comparison of different indexes in different treatment periods in over 60 years old group

Time point	Items			Experimental group ( $n=$ 81)	Control group ( $n=$ 77)	$P$
Before	Knowledge awareness			3(3,4)	3(2,4)	0.274
intervention	Pelvic floor	Class I muscle	Level 0–1	34	29	0.583
	muscle strength	fibers	Level 2–3	47	48
			Level 4–5	0	0
		Class II muscle	Level 0–1	16	14	0.818
		fibers	Level 2–3	65	63
			Level 4–5	0	0
	Life quality			59.66(53.4,67.04)	59.66(50.85,65.9)	0.478
After 7 weeks	Knowledge awareness			5(5,6)	5(4,5)	0.001
	Compliance	Good		65(80.25)	32(41.56)	0.032
		Poor		16(19.75)	45(58.44)
	Pelvic floor	Class I muscle	Level 0–1	4	4	0.536
	muscle strength	fibers	Level 2–3	67	62
			Level 4–5	10	11
		Class II muscle	Level 0–1	10	12	0.613
		fibers	Level 2–3	69	63
			Level 4–5	2	2
	Life quality			69.56(66.60,72.54)	68.18(61.36,73.575)	$<$ 0.001
After 12 weeks	Knowledge awareness			8(7,9)	6(5,6)	$<$ 0.001
	Compliance	Good		72(88.89)	43(55.84)	0.004
		Poor		9(11.11)	34(44.16)
	Pelvic floor	Class I muscle	Level 0–1	5	7	$<$ 0.001
	muscle strength	fibers	Level 2–3	31	57
			Level 4–5	45	13
		Class II muscle	Level 0–1	3	2	0.001
		fiberss	Level 2–3	12	34
			Level 4–5	66	41
	Life quality			84.09(81.81,86.36)	75.57(67.8725,81.81)	$<$ 0.001

3.2 Comparison between before intervention and after treatment

Before the intervention, there was no significant difference in the knowledge awareness rate between the experimental group and the control group ( $P>$ 0.05). At the 7th and 12th week of intervention, the scores of knowledge awareness in the experimental group were significantly higher than those in the control group. The difference was statistically significant ( $P<$ 0.01). With the extension of intervention time, the compliance of patients in both groups increased. However, the compliance of the experimental group was significantly higher than that of the study group. After 12 weeks, there was significant difference in compliance between the two groups ( $P<$ 0.05). Before the intervention and at the 7th week of the intervention, the pelvic floor muscle tension of class I muscle fibers and class II muscle fibers was mainly grade 2–3. At the 12th week of intervention, the pelvic floor muscle tension of class I muscle fiber and class II muscle fiber was mainly 4–5. The difference was statistically significant ( $P<$ 0.01). There was no significant difference in the scores of quality of life between the experimental group and the control group before and at the 7th week of intervention ( $P>$ 0.05). At the 12th week of intervention, the scores of the experimental group and the control group increased. But the score of the experimental group was significantly higher than that of the control group. There was a significant difference between the two groups ( $P<$ 0.01). There was no significant difference between the different age groups (Tables 3 and 4).

Table 4
Comparison of different indexes in different treatment periods in 50–60 year old group

Time point	Items			Experimental group ( $n=$ 20)	Control group ( $n=$ 31)	$P$
Before	Knowledge awareness			3(3,4)	3(2,4)	0.213
intervention	Pelvic floor	Class I muscle	Level 0–1	8	12	0.591
	muscle strength	fibers	Level 2–3	12	19
			Level 4–5	0	0
		Class II muscle	Level 0–1	4	6	0.716
		fibers	Level 2–3	16	25
			Level 4–5	0	0
	Life quality			59.66(52.4,66.04)	59.66(50.85,65.7)	0.454
After 7 weeks	Knowledge awareness			5(5,6)	5(4,5)	0.001
	Compliance	Good		16(80.00)	13(41.93)	0.031
		Poor		4(20.00)	18(58.07)
	Pelvic floor	Class I muscle	Level 0–1	1	1	0.537
	muscle strength	fibers	Level 2–3	16	25
			Level 4–5	3	5
		Class II muscle	Level 0–1	3	5	0.633
		fibers	Level 2–3	17	25
			Level 4–5	0	1
	Life quality			69.56(66.60,72.54)	67.12(61.36,73.575)	$<$ 0.001
After 12 weeks	Knowledge awareness			8(7,9)	6(5,6)	$<$ 0.001
	Compliance	Good		18(90.00)	18(58.06)	0.003
		Poor		2(10.00)	13(41.94)
	Pelvic floor	Class I muscle	Level 0–1	1	3	$<$ 0.001
	muscle strength	fibers	Level 2–3	8	23
			Level 4–5	11	5
		Class II muscle	Level 0–1	1	1	0.001
		fibers	Level 2–3	3	14
			Level 4–5	16	16
	Life quality			84.12(81.81,86.34)	75.52(67.8715,81.71)	$<$ 0.001

4. Discussion

SUI is more common in postmenopausal women and elderly women, mainly caused by pelvic floor tissue relaxation. The main causes of pelvic floor tissue relaxation are pregnancy and vaginal delivery injury, and the decrease of estrogen level after menopause. In addition, age, pelvic organ prolapse, obesity, genetics and other factors may also cause SUI [15]. The treatment of SUI can be divided into conservative treatment and surgical treatment. Behavioral therapy and pelvic floor rehabilitation are the first choice for the initial treatment of urinary incontinence. The literature on treatment of SUI is summarized in Table 5.

Table 5
Literature summary

Article title	Authors	Main conclusion
Electroacupuncture for stress-related urinary incontinence in elderly women: data analysis from two randomised controlled studies [27]	Biyun Sun, Yan Liu, Tongsheng Su, Yuanjie Sun, Zhishun Liu	Electroacupuncture may be an effective and safe alternative treatment for SUI in both elderly and non-elderly women.
Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises [28]	Daria Chmielewska, Magdalena Stania, Katarzyna Kucab-Klich, Edward Bç ¤szczak, Krystyna Kwaæ¸˜a, Agnieszka Smykla, Dominika Hudziak, Patrycja Dolibog	Pilates and sEMG-assisted biofeedback training could promote SUI.
Effectiveness of pelvic floor muscle and abdominal training in women with stress urinary incontinence [29]	Burcu Kucukkaya, Hatice Kahyaoglu Sut	Pelvic floor muscle and abdominal training could promote SUI.
Management of stress urinary incontinence in spinal cord injured female patients with a mid-urethral tape - a single center experience [30]	Vasileios I Sakalis, Michael S Floyd Jr, Philippa Caygill, Chloe Price, Ben Hartwell, Peter J Guy 1, Melissa C Davies	Mid-urethral tapes are effective in the management of SUI.
Pulsed Magnetic Stimulation for Stress Urinary Incontinence and Its Impact on Sexuality and Health [31]	Pablo González-Isaza 1, Rafael Sánchez-Borrego, Félix Lugo Salcedo, Nuria Rodríguez, Diana Vélez Rizo, Irene Fusco, Silvia Callarelli	Pulsed Magnetic Stimulation could promote SUI.

4.1 Awareness of patients’ pelvic floor rehabilitation knowledge

At present, the use of apps has been widely explored in the prevention of early postpartum SUI. For the first time, this innovative study combined the use of a mobile phone app with smart vaginal dumbbell training, achieving good results in elderly female patients. The results of the study showed that there was a statistically significant difference among elderly patients in the understanding of pelvic floor rehabilitation before and after the intervention ( $P<$ 0.05). Hence, compared with the traditional health education model, the information-based health education model provided by the app can improve the understanding of pelvic floor rehabilitation knowledge in elderly patients for the following reasons. (1) The health knowledge contained in the app is presented in the form of text, pictures and animation videos, which is more vivid and interesting than the traditional printed and oral propaganda methods, and the information can be read at any time, repeatedly and cyclically, improving the elderly patients’ interest and confidence in learning [16]. (2) The app has a learning and training reminder function; it automatically delivers information and reminds elderly patients to participate in learning and training. It also reduces the teaching burden of medical staff and enhances the quality of education. Wang et al. [17] built a patient pelvic floor rehabilitation information management platform that significantly improved patients’ participation in pelvic floor function assessment and improved patients’ understanding of pelvic floor rehabilitation, which is consistent with the results of this study.

4.2 Compliance with pelvic floor muscle training in elderly patients

The results of this study showed that the difference in compliance before and after intervention was statistically significant ( $P<$ 0.05). It shows that the information-based pelvic floor muscle training provided by the app can improve exercise compliance in elderly patients for the following reasons: (1) The app has the function of reminding and urging patients to exercise and participate in rehabilitation training. (2) The system automatically generates exercise curves from data such as the contraction and relaxation time and intensity during each training session, and it generates a comprehensive score that is provided to the patient in the form of a training diary, which greatly improves the compliance and long-term adherence of home rehabilitation training and promotes a sense of obligation in female patients with SUI; this is consistent with related research results by Asklund et al. [18] and Loohuis et al. [19]. (3) After connecting the vaginal dumbbells, the app will prompt the patient to adjust the irregular contraction and relaxation of the muscles to ensure the optimal training effect.

4.3 Pelvic floor muscle strength of patients

The results of pelvic floor muscle strength in this study showed that there was no significant difference in the pelvic floor muscle strength of class I and class II muscle fibres before intervention and at the 7th week of intervention ( $P>$ 0.05); at the 12th week of intervention, the difference was statistically significant ( $P<$ 0.05). This shows the effectiveness and superiority of the smart app guidance. This may be due to the fact that the app provides the elderly with knowledge related to the pelvic floor and lays a cognitive foundation. More than 94% of patients believe that the functions and training modes of the smart app are simple and easy to understand [20]. The smart app can automatically generate relevant training data for patient information feedback, and at the same time, it has a certain supervision function. Therefore, patients can improve the quality of pelvic floor health behaviour management through targeted app guidance, effectively improving pelvic floor muscle strength [21].

4.4 Quality of life of patients

The results of this study showed that in terms of quality of life, the pairwise comparison of the quality-of-life total scores at different time points indicated there was no significant difference between the two groups at 7 weeks ( $P>$ 0.05) compared with before intervention, and at 12 weeks, the difference between the two groups was statistically significant ( $P<$ 0.05). The results showed that the longer the intervention time, the more significant the improvement in the patients’ quality of life. The main reasons are: (1) Continuous app education can effectively improve the cognitive level of patients with urinary incontinence, and patients can actively adjust their emotions; negative psychology, such as low self-esteem, anxiety and depression, can significantly improve, promoting satisfactory pelvic floor muscle training. The conclusions of the study are consistent with Jia Jing’s research [22]. (2) The quality of life of patients with urinary incontinence is related to the type and severity of urinary incontinence; the more severe, the greater the impact on quality of life. In this study, with the prolongation of the intervention time, the urine leakage of the two groups of patients decreased significantly, so their quality of life also improved. We constructed a new intervention model for the treatment of SUI, which will provide an important reference for subsequent clinical work.

Based on the findings of this study, the use of the smart app improves the knowledge and awareness of elderly female patients with SUI, improves the compliance and clinical efficacy of pelvic floor rehabilitation training, and we speculate that artificial intelligence (AI) may also have a positive effect on the treatment of patients. A large number of studies have found that AI is of great help in the treatment of human diseases, such as urinary tract infection, pulmonary emphysema, prostate cancer, neonatal sepsis [23, 24, 25, 26]. Therefore, AI intelligent therapy will be the direction of our future efforts.

4.5 Limitations

However, at this stage, intelligent applications and vaginal dumbbells still have many functions to be improved, such as real-time information exchange, pelvic floor related Q & A and other functions related to the hospital information system to realize information sharing. It is necessary to conduct a controlled trial design to further verify the impact of the smart app based intelligent continuous rehabilitation model intervention on elderly women with SUI. It is also important to extend the follow-up time to observe the long-term efficacy. And the sample size of this study is small, and the age range is 61–65 years old, so it is impossible to divide into different subgroups for comparison. In the follow-up study, the sample size and age range will be expanded and the age will be divided into different subgroups for comparison.

5. Conclusion

This study built an intelligent, continuous rehabilitation model based on the smart app, which included knowledge lectures, regular exercise reminders, personalised training courses, automatic exercise data generation, queries and statistics. Use of this model helped improve patient compliance with pelvic floor muscle rehabilitation. The use of the smart app improved knowledge and awareness among elderly female patients with SUI and also improved the compliance of pelvic floor rehabilitation training. Future use of this app can consolidate and strengthen the clinical efficacy of urinary incontinence treatment and play a positive role in maintaining pelvic floor muscle function, improving the long-term treatment effect of SUI.

Ethics statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of Peking University International Hospital (approval number: 2021-046 (BMR)).

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Competing interests

None of the authors have any personal, financial, commercial, or academic conflicts of interest.

Funding

Not applicable.

Author contributions

Mao WJ and Jiang MZ conceived the study, Chen WD participated in its design and coordination, and Du J and Xiao Q helped draft the manuscript. All authors read and approved the final manuscript.

Footnotes

Acknowledgments

Not applicable.

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The effect of using mobile phone applications for intelligent pelvic floor rehabilitation on elderly female patients with stress urinary incontinence

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Materials and methods

2.1 General information

2.2 Methods

2.2.1 Data collection methods

2.2.2 Intervention methods

2.3 Observation indicators

3. Results

3.1 Comparison of general data between the two groups

Table 1 General data of the research subjects over 60 years old group

Table 4 Comparison of different indexes in different treatment periods in 50–60 year old group

Table 5 Literature summary

4.2 Compliance with pelvic floor muscle training in elderly patients

4.3 Pelvic floor muscle strength of patients

4.4 Quality of life of patients

4.5 Limitations

5. Conclusion

Ethics statement

Availability of data and materials

Competing interests

Funding

Author contributions

Footnotes

Acknowledgments

References

Table 1
General data of the research subjects over 60 years old group

Table 4
Comparison of different indexes in different treatment periods in 50–60 year old group

Table 5
Literature summary