{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T11:54:11Z","timestamp":1791633251359,"version":"4.3.4"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Initial treatment for urinary incontinence (UI) includes behavioral treatment. However, access to care may be limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the effectiveness of 2 remote modalities for UI behavioral treatments and to assess the effect of a booster video visit for treatment nonresponders.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This sequential, multiple assignment randomized clinical trial was conducted in 3 southeastern US Department of Veterans Affairs health care systems from April 2020 through September 2023. Participants were nonpregnant women veterans with UI who had access to email.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n \n Remote interventions included (1) a mobile health UI app (MyHealth\n e<\/jats:italic>\n Bladder) with daily sessions delivered for 8 weeks or (2) a single video visit through VA Video Connect delivered by trained UI health care professionals and (3) a randomized booster video visit for women without UI symptom improvement at 8 weeks.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was change in UI symptoms at 12 weeks as measured by the International Consultation on Incontinence Questionnaire\u2013Urinary Incontinence Short Form (ICIQ-UI SF; score range, 0-21, with higher scores indicating more severe UI) with a minimal clinically important difference of 2.52 defining response status at 8 weeks. The results of the sequential addition of a video booster visit for nonresponders in both randomization groups were also investigated. Primary analyses were assessed using intention-to-treat and per-protocol analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 286 women veterans randomized (147 to UI app; 139 to video visit), 244 (85%) received an intervention. Their mean (SD) age was 53.2 (11.3) years (range, 23-83 years). At 12 weeks, ICIQ-UI SF scores for the UI app group decreased \u22123.6 (95% CI, \u22124.4 to \u22122.8) points compared with \u22122.3 (95% CI, \u22123.1 to \u22121.5) points for the video visit group (\n P<\/jats:italic>\n \u2009=\u2009.02). In the UI app nonresponder group at 8 weeks (n\u2009=\u200929 [20%]) with the booster video visit (n\u2009=\u200912), ICIQ-UI SF scores changed \u22121.0 (95% CI, \u22122.4 to 0.4) points vs \u22121.2 (95% CI, \u22121.3 to 3.7) points for 10 UI app nonresponders who continued UI app treatment (\n P<\/jats:italic>\n \u2009=\u2009.10). In the video visit nonresponder group (n\u2009=\u200961 [44%]) with the booster video visit (n\u2009=\u200923), ICIQ-UI SF scores changed \u22120.9 (95% CI, \u22122.1 to 0.3) points vs \u22120.3 (95% CI, \u22121.9 to 1.2) points in 30 video visit nonresponders who continued treatment (\n P<\/jats:italic>\n \u2009=\u2009.58). The change in ICIQ-UI SF scores for the UI app reached the MCID threshold (2.52 points) in 4 weeks (\u22122.9 [95% CI, \u22123.8 to \u22122.0] points), whereas the video visit group did not reach this threshold until 24 weeks (\u22123.4 [95% CI,\u22124.2 to \u22122.5] points).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This randomized clinical trial comparing 2 remote delivery modalities of behavioral UI treatment with randomized booster visits among women veterans found that UI symptoms improved earlier for the UI app intervention compared with the video visit intervention, without reaching a meaningful clinical between-group difference at 12 weeks. The addition of a booster video visit did not further improve UI symptoms. Further research could extend these modalities to broaden access to behavioral UI treatment.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04237753<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.32111","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T15:00:36Z","timestamp":1758034836000},"page":"e2532111","source":"Crossref","is-referenced-by-count":8,"title":["Remote Access to Urinary Incontinence Treatments for Women Veterans"],"prefix":"10.1001","volume":"8","author":[{"given":"Alayne D.","family":"Markland","sequence":"first","affiliation":[{"name":"Birmingham\/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia"},{"name":"Department of Medicine, University of Alabama at Birmingham, Birmingham"},{"name":"Now with Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen M.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Durham VA Health Care System, Durham, North Carolina"},{"name":"Department of Medicine, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Mark","family":"Beasley","sequence":"additional","affiliation":[{"name":"Birmingham\/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia"},{"name":"Department of Medicine, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily Malone","family":"Boyd","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Zubkoff","sequence":"additional","affiliation":[{"name":"Birmingham\/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia"},{"name":"Department of Medicine, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula A.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Atlanta VA Health Care System, Atlanta, Georgia"},{"name":"Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn L.","family":"Burgio","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille P.","family":"Vaughan","sequence":"additional","affiliation":[{"name":"Birmingham\/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia"},{"name":"Department of Medicine, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"zoi250904r1","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1007\/s11606-022-07585-3","article-title":"Women veterans\u2019 healthcare needs, utilization, and preferences in Veterans Affairs primary care settings.","volume":"37","author":"Sheahan","year":"2022","journal-title":"J Gen Intern Med"},{"issue":"12","key":"zoi250904r2","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1007\/s11606-017-4152-5","article-title":"An evidence map of the women veterans\u2019 health research literature (2008-2015).","volume":"32","author":"Danan","year":"2017","journal-title":"J Gen Intern Med"},{"issue":"1","key":"zoi250904r3","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/JU.0000000000003985","article-title":"The AUA\/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder.","volume":"212","author":"Cameron","year":"2024","journal-title":"J Urol"},{"issue":"6","key":"zoi250904r4","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1097\/JU.0000000000003435","article-title":"Updates to surgical treatment of female stress urinary incontinence (SUI): AUA\/SUFU guideline (2023).","volume":"209","author":"Kobashi","year":"2023","journal-title":"J Urol"},{"issue":"1","key":"zoi250904r5","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.eururo.2022.01.045","article-title":"European Association of Urology Guidelines on the diagnosis and management of female non-neurogenic lower urinary tract symptoms. part 1: diagnostics, overactive bladder, stress urinary incontinence, and mixed urinary incontinence.","volume":"82","author":"Nambiar","year":"2022","journal-title":"Eur Urol"},{"issue":"4","key":"zoi250904r6","doi-asserted-by":"publisher","first-page":"83","DOI":"10.5489\/cuaj.8751","article-title":"2024 Canadian Urological Association guideline: female stress urinary incontinence.","volume":"18","author":"Carlson","year":"2024","journal-title":"Can Urol Assoc J"},{"issue":"9","key":"zoi250904r7","doi-asserted-by":"publisher","first-page":"2900","DOI":"10.1007\/s11606-020-06196-0","article-title":"Quality of care for women with urinary incontinence in the Veterans Health Administration.","volume":"36","author":"Tcheung","year":"2021","journal-title":"J Gen Intern Med"},{"issue":"4","key":"zoi250904r8","doi-asserted-by":"publisher","first-page":"S15","DOI":"10.1097\/MLR.0000000000000296","article-title":"Travel time and attrition from VHA care among women veterans: how far is too far?","volume":"53","author":"Friedman","year":"2015","journal-title":"Med Care"},{"issue":"12","key":"zoi250904r9","doi-asserted-by":"publisher","first-page":"3089","DOI":"10.1007\/s11606-022-07452-1","article-title":"Home telehealth in the Veterans Health Administration: trends and correlates of length of enrollment from 2010 to 2017.","volume":"37","author":"Gray","year":"2022","journal-title":"J Gen Intern Med"},{"issue":"7","key":"zoi250904r10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.24921","article-title":"Primary care telehealth initiation and engagement among veterans at high risk, 2019-2022.","volume":"7","author":"Schuttner","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"6","key":"zoi250904r12","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1089\/jwh.2023.0781","article-title":"Gender differences in adoption and frequency of virtual primary care among men and women veterans.","volume":"33","author":"Ferguson","year":"2024","journal-title":"J Womens Health (Larchmt)"},{"key":"zoi250904r13","doi-asserted-by":"publisher","DOI":"10.2196\/68314","article-title":"Experiences receiving and delivering virtual health care for women: qualitative evidence synthesis.","volume":"27","author":"Goldstein","year":"2025","journal-title":"J Med Internet Res"},{"issue":"1","key":"zoi250904r14","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1002\/nau.24226","article-title":"A mobile telehealth program for behavioral treatment of urinary incontinence in women veterans: development and pilot evaluation of MyHealtheBladder.","volume":"39","author":"Goode","year":"2020","journal-title":"Neurourol Urodyn"},{"key":"zoi250904r15","doi-asserted-by":"publisher","DOI":"10.2196\/44929","article-title":"Digital technologies for women\u2019s pelvic floor muscle training to manage urinary incontinence across their life course: scoping review.","volume":"11","author":"Woodley","year":"2023","journal-title":"JMIR Mhealth Uhealth"},{"issue":"1","key":"zoi250904r16","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.urology.2007.11.163","article-title":"Urologic disease burden in the United States: veteran users of Department of Veterans Affairs healthcare.","volume":"72","author":"Anger","year":"2008","journal-title":"Urology"},{"issue":"10","key":"zoi250904r17","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1002\/2327-6924.12490","article-title":"Critical questions: advancing the health of female Veterans.","volume":"29","author":"Muirhead","year":"2017","journal-title":"J Am Assoc Nurse Pract"},{"issue":"4","key":"zoi250904r18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.6372","article-title":"An evidence map of the women veterans\u2019 health literature, 2016 to 2023: a systematic review.","volume":"8","author":"Goldstein","year":"2025","journal-title":"JAMA Netw Open"},{"key":"zoi250904r19","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2023.107328","article-title":"Optimizing remote access to urinary incontinence treatments for women veterans (PRACTICAL): Study protocol for a pragmatic clinical trial comparing two virtual care options.","volume":"133","author":"Markland","year":"2023","journal-title":"Contemp Clin Trials"},{"issue":"4","key":"zoi250904r20","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1001\/jama.2022.24324","article-title":"Sequential, multiple assignment, randomized trial designs.","volume":"329","author":"Kidwell","year":"2023","journal-title":"JAMA"},{"issue":"22","key":"zoi250904r21","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1001\/jama.2025.4347","article-title":"CONSORT 2025 statement: updated guideline for reporting randomized trials.","volume":"333","author":"Hopewell","year":"2025","journal-title":"JAMA"},{"issue":"10","key":"zoi250904r22","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1001\/jamainternmed.2018.3766","article-title":"Effect of group-administered behavioral treatment on urinary incontinence in older women: a randomized clinical trial.","volume":"178","author":"Diokno","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"5","key":"zoi250904r23","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1056\/NEJMoa0806375","article-title":"Weight loss to treat urinary incontinence in overweight and obese women.","volume":"360","author":"Subak","year":"2009","journal-title":"N Engl J Med"},{"issue":"2","key":"zoi250904r24","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research.","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"issue":"2","key":"zoi250904r25","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/ijcp.12085","article-title":"Comorbidities associated with bladder dysfunction.","volume":"67","author":"Tannenbaum","year":"2013","journal-title":"Int J Clin Pract"},{"issue":"3","key":"zoi250904r26","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1093\/aje\/kwr193","article-title":"The PhenX Toolkit: get the most from your measures.","volume":"174","author":"Hamilton","year":"2011","journal-title":"Am J Epidemiol"},{"issue":"3","key":"zoi250904r27","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1016\/S0022-5347(05)00348-4","article-title":"The International Consultation on Incontinence Modular Questionnaire: www.iciq.net.","volume":"175","author":"Abrams","year":"2006","journal-title":"J Urol"},{"issue":"8","key":"zoi250904r28","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1002\/nau.22657","article-title":"ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence.","volume":"34","author":"Nystr\u00f6m","year":"2015","journal-title":"Neurourol Urodyn"},{"issue":"1","key":"zoi250904r29","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1186\/s12905-024-02947-x","article-title":"Minimum important difference of the ICIQ-UI SF score after self-management of urinary incontinence.","volume":"24","author":"Nystr\u00f6m","year":"2024","journal-title":"BMC Womens Health"},{"issue":"10","key":"zoi250904r30","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.2522\/ptj.20080387","article-title":"Adherence to behavioral interventions for urge incontinence when combined with drug therapy: adherence rates, barriers, and predictors.","volume":"90","author":"Borello-France","year":"2010","journal-title":"Phys Ther"},{"issue":"5","key":"zoi250904r31","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1002\/nau.20243","article-title":"Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: validation of three global patient ratings.","volume":"25","author":"Burgio","year":"2006","journal-title":"Neurourol Urodyn"},{"issue":"4","key":"zoi250904r32","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1177\/1740774514536795","article-title":"Optimization of behavioral dynamic treatment regimens based on the sequential, multiple assignment, randomized trial (SMART).","volume":"11","author":"Collins","year":"2014","journal-title":"Clin Trials"},{"issue":"5","key":"zoi250904r33","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1002\/nau.23116","article-title":"Mobile app for treatment of stress urinary incontinence: a randomized controlled trial.","volume":"36","author":"Asklund","year":"2017","journal-title":"Neurourol Urodyn"},{"issue":"5","key":"zoi250904r34","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1007\/s00404-024-07380-x","article-title":"Pelvic floor muscle training in telerehabilitation: a systematic review and meta-analysis.","volume":"309","author":"Hao","year":"2024","journal-title":"Arch Gynecol Obstet"},{"issue":"2","key":"zoi250904r35","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1370\/afm.2585","article-title":"App-based treatment in primary care for urinary incontinence: a pragmatic, randomized controlled trial.","volume":"19","author":"Loohuis","year":"2021","journal-title":"Ann Fam Med"},{"key":"zoi250904r11","volume-title":"Telehealth Services Designed for Women: An Evidence Map","author":"Goldstein","year":"2017"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2839007\/markland_2025_oi_250904_1757431903.53839.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T15:00:37Z","timestamp":1758034837000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2839007"}},"subtitle":["The PRACTICAL Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,9,16]]},"references-count":35,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.32111","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,16]]}}}