Dr. Caldwell discusses study of an online program for incontinence


"The reason we did this study was that in Australia, there are usually very long waiting times to be seen in the continence service," says Patrina H. Y. Caldwell, BMed, FRACP, PhD.

In this video, Patrina H. Y. Caldwell, BMed, FRACP, PhD, highlights the background of the study, “A Randomized Controlled Trial of a Web-Based Management Support System for Children With Urinary Incontinence: The eADVICE Trial.” Caldwell is an associate professor in the discipline of child and adolescent health at the University of Sydney in Australia.

Video Transcript:

The eADVICE trial is a randomized controlled trial that compares using an online program with standard care when patients who are referred to a tertiary pediatric continence service are awaiting their clinic appointment. The reason we did this study was that in Australia, there are usually very long waiting times to be seen in the continence service. The wait ranges between 6 months to over 12 months. In my particular institution, at the start of the study, the waiting time was closer to 2 years. So, we had a lot of very distressed parents and referring doctors and patients who wanted to be seen sooner than that. And how this idea of this study came up was that parents would eventually see me in my clinic and say, "It was a really long wait, and it was very frustrating. But we found when we rang your secretary, she gave us some basic advice, and it helped a bit." And I thought, “that's strange, because my secretary is not medically trained.” So, I spoke to her and said, "What did you do?" and she said, "I didn't do very much. I just, encouraged them to go to the toilet regularly, and drink, and treat their constipation." Because she's been used to typing up my letters for me, she knew basic urotherapy without realizing that was what she was doing. She was just giving general, helpful advice, not as a health professional, but when parents expressed distress to her. I was surprised that parents then came back and said they found it really helpful. So, that was the impetus of needing to do something. Then follow that with watching “Social Network” on a plane trip 1 day, and I said, maybe we can do something using the internet or using artificial intelligence to provide some help for them. That was the reason why we began the study.

Basically, we looked at when patients were referred to the clinic, instead of just waiting, could the provision of a personalized online resource help them improve in their continence. The 2 arms of the randomized controlled trial was that 1 arm was given an opportunity to access the program, and the control arm just had to wait. Now, in both arms, they also could go and see anybody else they wanted to while they're waiting [or] could keep being treated by their doctor. There was no difference in the 2 arms except that the first arm had the opportunity to use the program. Now, there are a few people that didn't use it, even though they were given the opportunity, and we factored that in, too. Of those who used it, they can go back into the program every 2 weeks if they wish and get further information. So, I was simulating what would happen if they came to clinic. The program asked questions that we would generally ask when we see patients for the first time. It goes through an algorithm and gives them an evidence-based treatment advice, usually very general advice, and patients can choose to follow it or not. Then, if they choose to come back for a follow-up appointment, it actually asked them "did you do what you were told to do, and what happened?" Then, based on whether they did or didn't do it and what the results were, their program recalibrates and gives them further advice. They were allowed to do that for up to 6 months, and then the program was shut off and the password didn't work anymore, and the control arm had access to the program. We had to do this wait list control, otherwise, no one would join it. The people who are in the control arm were comforted by the fact that in 6 months, they will still have access to this program, whereas otherwise, they would have to wait 12 to 24 months to be seen. We had reasonable recruitment as a result of that.

This transcription has been edited for clarity.

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