Mobile Phone Apps for Pelvic Floor Dysfunction: An Assessment of Tools for Patient Utilization

Objectives: Pelvic floor disorders (PFD), including stress incontinence (SUI), overactive bladder, nocturia (OAB), recurrent UTIs, painful bladder syndrome (PBS), defecatory dysfunction, accidental bowel leakage (ABL), pelvic organ prolapse (POP), and sexual dysfunction affect many women. Although these disorders have effective treatment strategies, many women don’t discuss symptoms with providers. The rise in phone applications (apps) for healthcare information suggests an opportunity to access care. The objective of this study is to systematically evaluate content and function of apps for patients with PFD.

Methods: Apps were independently screened by two researchers using PFD-related search terms. Included apps were available on the official Apple store (free or paid), run on iOS, available in English, and targeted at patients with PFD. Apps were excluded if they required developer invitation, partnered with pre-purchased devices, or were non-functional. The primary outcome was the quality of app function based on a validated APPLICATIONS scoring system assessing app comprehensiveness, cost, literature use, inter-device compatibility, media use, special features, navigation ease, and presentation, where 0 represents low functionality and 16 high (Chyjek et al, PMID 260005520). Secondary outcomes include whether the app was developed with professional medical involvement, iTunes rating, and number of ratings. Further specific app functions evaluated include presence/characteristics of a voiding or bowel diary, diet tracker, pain/symptom tracking, exercise tracking, medication tracking, graphing functions, social functions, reminders, disease information, and decision support. Data is reported with descriptive statistics (medians (ranges) and n (percentages)).

Results: 840 apps were identified. 83 apps met inclusion criteria (Figure 1). Based on subject, defecatory dysfunction (29) had the most apps followed by OAB (28), SUI (27), recurrent UTIs (8), PBS (7), sexual dysfunction (4), POP (2), ABL (1), and nocturia (0). The median APPLICATIONS score was 7 (3-12). Most apps (78%) were developed without professional medical involvement. The median iTunes rating was 4.2 (0-5) with a median of 5 ratings (with 61% having less than 10 ratings). Most apps were free, while the remainder ranged from $1.99 to $4.99. No app had all assessed features. 25 apps (30%) included a voiding diary, 33 (40%) had a bowel movement diary, 27 (33%) included exercise tracking and 44 (53%) had a reminder system. The 3 apps with highest APPLICATIONS score (where applicable) affiliated with each condition are shown (Figure 2).

Conclusions: We systematically evaluated the characteristics of apps for patients seeking information and self-management of PFD. Most apps had reasonable, but not high, functionality based on APPLICATIONS score. Current apps provide varying degrees of overall utility, with limited disease information and decision support. Further collaboration with medical providers in app development would support better integration of clinician and patient needs in PFD education and treatment.