Biofeedback and serious game system for pelvic floor muscle training in women with urinary incontinence

Abstract

Background: Pelvic floor muscle training (PFMT) is the recommended approach to address mild to moderate urinary incontincence (UI), although the adherence is variable. This makes elements of training delivery important in treatment effectiveness. Hence, the conversion of biofeedback approach into serious games played on a mobile phone is innovative and may prove effective in motivating women to adhere to their PFMT schedules. Methods: A mixed approach was implemented to develop serious game scenarios and test the biofeedback and games in a pilot trial. The game functionalities were amended and further tested together with biofeedback system in a trial with 21 women with UI, recruited in 2 hospitals. We collected quantitative (number of sessions performed, rating of different game functionalities etc) and qualitative data (interviews focused on satisfaction with using the system and barriers to adherence; think aloud protocols focused on the momentum experience of women with using the system). Results: Women performed on average 33 sessions, range [4; 70] with the game and biofeedback system. The evaluation of the games was overall favourable and motivated women to carry their scheduled sessions. The feedback received at the end of the training was perceived by women as being the most important game feature in improving future PFMT performance. Discussion: The results show that biofeedback incorporated in a serious game system is a promising approach to motivate women to adhere to PFMT. This study illustrates an innovative, evidence based and iterative approach to develop a system of game-based biofeedback.