Mobile App and Video Visits Equally Effective for Remote Behavioral UI Treatment in Women Veterans

A randomized clinical trial evaluating 2 remote delivery modalities for treating behavioral urinary incontinence (UI) among women veterans found that both a mobile health app and video visits were effective in improving symptoms. Although women using the mobile app experienced earlier symptom improvement, differences between the groups were not clinically meaningful. A booster video visit for nonresponders did not provide additional benefit.

The PRACTICAL trial enrolled 286 nonpregnant women veterans with UI across 3 VA health systems. Participants were randomized to receive either: 

• Daily UI self-management via the MyHealtheBladder mobile app over 8 weeks;
• A one-time video visit with a trained continence specialist;
• Nonresponders at 8 weeks were rerandomized to receive either a booster video visit or continued treatment.

The primary outcome was change in symptom severity at 12 weeks, measured by the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF). A minimal clinically important difference (MCID) was defined as a reduction of 2.52 points.

At 12 weeks, women in the app group saw a mean ICIQ-UI SF score reduction of −3.6 (95% CI, −4.4 to −2.8) versus −2.3 (95% CI, −3.1 to −1.5) in the video visit group (P = .02). However, the between-group difference of −1.3 points did not meet the MCID threshold for clinical significance.

The app group reached the MCID at 4 weeks, while the video visit group did not reach it until 24 weeks. At 24 weeks, improvements were sustained in both groups, but the between-group differences were no longer statistically significant.

Among 29 app nonresponders, no significant difference in symptom improvement was observed between those who received a booster visit and those who continued app use (−1.0 vs −1.2 points, P = .10). Similar results were seen in the video visit nonresponder group.

Remote behavioral UI treatment is effective using both app-based and video modalities, providing flexible, scalable options for care delivery. The mobile app may offer a slight advantage in symptom improvement speed but not magnitude.

“Although women had earlier improvements in UI severity scores with the UI app than the video visit, the between-group differences did not reach clinically important differences at 12 weeks,” the authors stated.

This study indicates that remote behavioral UI therapy is effective and accessible via mobile app or video. Booster visits offer no added benefit for nonresponders. These findings support broader implementation of remote UI care models across the VA system.

References 
Markland A D, Goldstein K M, Beasley T M, et al. Remote access to urinary incontinence treatments for women veterans: the PRACTICAL randomized clinical trial. JAMA Netw Open. 2025;8;(9):e2532111. doi:10.1001/jamanetworkopen.2025.32111