Clinical efficacy of a patient-centered smartphone-based platform for self-management of IC/BPS

Background: We have previously developed and validated an algorithm-driven, interactive text messaging platform that addresses the biopsychosocial domains of interstitial cystitis/bladder pain syndrome (IC/BPS).


Objective:
To determine the clinical efficacy of a patient-centered, algorithm-driven, interactive text messaging platform for promoting self-efficacy in women with IC/BPS.


Methods:
Adult women with IC/BPS interested in conservative management interacted with the platform for six weeks. Through the platform, patients received videos on patient education, behavioral modification, one of three evidence-based, self-selected treatment modules (cognitive behavioral therapy, pelvic floor physical therapy, and guided mindfulness practices), and weekly supportive messages. Patients reporting severe symptom-bother were offered a callback by a study clinician.

Validated questionnaire data on self-efficacy (Pain Self Efficacy Scale) (primary outcome), symptom bother (Interstitial Cystitis Problem Index), symptom severity (Interstitial Cystitis Symptom Index), anxiety and depression (Hospital Anxiety and Depression Scale), and physician-patient communication satisfaction (Health Care Climate Questionnaire) were compared at baseline and completion of the study.


Results:
A total of 52 patients, median age (range) 40.9 (19-80 years), participated in the study. Commonest concomitant conditions were anxiety (67%) and depression (32%). Engagement rate with the platform was 76.9% and accuracy was 97.9%. Six patients (11.5%) were lost to follow up with median (range) time of attrition being 4 (3-5) weeks. Treatment modules selected included pelvic floor physical therapy (50%), cognitive behavioral therapy (34%), and guided mindfulness (15%). Mean baseline scores indicated IC/BPS symptoms of moderate severity (11.9 ± 3.8) and bother (10.4 ± 3.8). Following interaction with the platform, significant improvement in scores for pain self-efficacy (p < .001), IC/BPS symptom severity (p < .001), IC/BPS symptom bother (p < .001), and anxiety (p < .001) were noted. Physician-patient communication satisfaction also increased (p < .001), indicating greater satisfaction with quality of communication with the healthcare team. Changes in scores for pain self-efficacy, urinary symptom severity, bother from urinary symptoms, and satisfaction with provider communication were significantly greater for patients with higher than lower rate of engagement (all p < .05). Five patients (9.6%) requested a callback from a clinician. No study participant had any unscheduled contact with the healthcare system for IC/BPS during the study period. Narrative feedback demonstrated appreciation for the platform even though all patients were aware that text messages were automated.


Conclusion:
A smartphone-based platform improved self-efficacy in managing symptoms of IC/BPS and satisfaction with communication with the healthcare team. This intervention also provided short-term improvement in IC/BPS symptom severity, symptom bother, and anxiety. The platform has the potential for reducing healthcare utilization. Long-term studies to assess the sustainability of improvements are required.