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JU INSIGHT A Randomized Controlled Trial of a Web-Based Management Support System for Children With Urinary Incontinence
By: Patrina H. Y. Caldwell, B Med, FRACP, PhD, The Children’s Hospital at Westmead, Sydney, Australia, Discipline of Child and Adolescent Health, University of Sydney, Australia; Deborah Richards, PhD, School of Computing, Macquarie University, Sydney, Australia; Sana Hamilton, MPH, The Children’s Hospital at Westmead, Sydney, Australia; Amy Von Huben, MBiostats, School of Public Health, University of Sydney, Australia, Menzies Centre for Health Policy and Economics, The University of Sydney, Australia; Armando Teixeira-Pinto, PhD, School of Public Health, University of Sydney, Australia; Martin Howell, PhD, School of Public Health, University of Sydney, Australia, Menzies Centre for Health Policy and Economics, The University of Sydney, Australia; Kirsten Howard, PhD, School of Public Health, University of Sydney, Australia, Menzies Centre for Health Policy and Economics, The University of Sydney, Australia; Jonathan C. Craig, PhD, College of Medicine and Public Health, Flinders University, Adelaide, Australia; Chris Seton, FRACP, The Children’s Hospital at Westmead, Sydney, Australia; Karen Waters, PhD, The Children’s Hospital at Westmead, Sydney, Australia, Discipline of Child and Adolescent Health, University of Sydney, Australia; Aniruddh Deshpande, PhD, The Children’s Hospital at Westmead, Sydney, Australia, Discipline of Child and Adolescent Health, University of Sydney, Australia, School of Medicine and Public Health, University of Newcastle, Australia; Karen M. Scott, PhD, Discipline of Child and Adolescent Health, University of Sydney, Australia | Posted on: 18 Mar 2024
Caldwell PHY, Richards D, Hamilton S, et al. A randomized controlled trial of a web-based management support system for children with urinary incontinence: the eADVICE trial. J Urol. 2024;211(3):364-375.
Study Need and Importance
Long waiting times for specialist urology outpatient clinics for children are frustrating for parents and health practitioners, and can result in deterioration in health and quality of life for children. There is a need to develop effective eHealth solutions utilizing the waiting time for clinics with long waiting times.
What We Found
Electronic Advice and Diagnosis Via the Internet following Computerized Evaluation (eADVICE) is a web-based eHealth program which used an embodied conversational agent to engage with the child regarding their incontinence (Figure). This randomized controlled trial which compared 6 months’ access to eADVICE with standard care at the time of referral to a tertiary continence clinic found that eADVICE improved all clinical outcomes including doubling the proportion who were dry at 6 months, improved quality of life of children using the program, but did not reduce clinic appointment requests by parents.
Limitations
A limitation of the study was the loss of participants during the study, particularly those who were wetting less frequently at baseline, had not previously tried first-line therapy, were referred to clinics with shorter waiting times, or were in the treatment group. These patients were more likely to have had their incontinence resolved in a shorter time period and thus had less incentive to remain within the trial.
Interpretation for Patient Care
The improved clinical outcomes with eADVICE use without a commensurate reduction in requests for specialist appointments suggest that there are factors other than a child’s health status that influence parental decisions to seek specialist care.
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