Dr. Miguel Ángel Mañanas and Dr. Juan José Ramos.
Almost a third of women suffer urinary incontinence at some point in their lives. It may appear at any age with varying degrees of severity, and it has several causes. Many women are not aware that they suffer from a disorder; they normalize it or they do not know that it can be cured. If it is not treated, it ends up affecting daily activities and quality of life in many ways.
In the WOMEN-UP project, led by the UPC, we are developing technology that improves the treatment of this very common disorder. The first recommendation in most cases of stress and mixed incontinence is to train the pelvic floor muscles. By following a plan of specific exercises, sometimes combined with some changes in habits, incontinence can improve notably and even be cured. The success rate is 70%, but only if the exercises are done properly. This is the cheapest treatment and can be done at home. However, it requires perseverance by the patient and a personalized exercise plan. To be effective, it is important for the professional to adapt the plan to each patient and evaluate their progress. To ensure that the exercises are done correctly, biofeedback devices and software can be used. Through a vaginal probe these devices gather data on the contractions of the muscles that are involved.
On the market, there are some devices that can be used to follow an exercise plan at home that are designed to make the exercises more attractive. Most are comprised of a vaginal probe connected to a device that guides the user during the training session and evaluates performance. Some incorporate simple games to make the exercises more fun. They are designed for women to self-manage their incontinence without having to visit a therapist constantly; but there are no guarantees without supervision.
Device designed in the WOMEN-UP project.
The solution that we are working on through the WOMEN-UP project incorporates all of the innovations made to date, as well as biofeedback: remote supervision and motivation to increase effectiveness and reduce to a great extent the waiting lists and cost of long-term care. The system is comprised of three elements: a games application for mobile phones; wireless devices that detect muscle contractions and send the data to the mobile phone; and a web platform that gathers data and the progression of treatment. It includes a belt with sensors to detect abdominal activity as well as a vaginal probe to detect pelvic floor activity, in order to determine whether the patient is contracting the right muscles to do the exercises properly.
Probably, the most attractive feature for patients is that the exercises are done while you play “serious games”, that is, games designed for a reason other than pure enjoyment. The application with games guides the patient during each session, provides results in real time and enables them to contact their therapist if they need to through a connection to the web platform that stores and presents the data. On the platform, the therapist consults the information online to monitor progress and programme personalized activities.
From the end of 2016 to February 2017, we carried out a technical trial involving eleven patients at the Pelvic Floor Unit of Hospital Clínic, in coordination with another ten at the Kuopio University Hospital (Finland), using the first prototype of the system. Patients stated that they felt much more motivated about the training than before, which means that there were more opportunity for the treatment to be successful.
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The clinical trial will start in September with a group of 300 volunteers with urinary incontinence, using a second prototype that is improved and wireless. Participating organisations include Hospital Clínic, the Academic Medical Center of Amsterdam and the Kuopio University Hospital. The call for volunteers who wish to participate has already started through the webpage www.stopui.com. We are looking for 110 volunteers in Barcelona, 110 in Amsterdam and 80 in Finland; a broad and varied simple that enables us to consider the evaluations of patients, doctors and nurses.
WOMEN-UP is the first Project of this magnitude focused on conservative treatment of this disorder. It is funded by the European Commission as part of the Horizon 2020 programme. It has been underway since February 2015 and will end in July 2018, when the device will be marketed by a company in the consortium. The total cost is 3.5 million euros, of which the European Union will provide over 3.2 m.
Eight organisations in seven countries of the EU are also working on this project: the Spanish partners are the UPC and the Fundación Privada Clínic para la Investigación Biomédica; the company Mega Electronics Ltd. and Kuopio University Hospital in Finland; the Academic Medical Center of Amsterdam; the European Urogynaecological Association; the Rumanian Babes-Bolyai University ; and the Swiss company YouRehab Ltd.
Dr Miguel Ángel Mañanas, coordinator of WOMEN-UP, and Dr Juan José Ramos, scientific coordinator of WOMEN-UP, researchers of the Biomedical Engineering Research Center (CREB UPC)