Long waiting times for specialist urology outpatient clinics for children are frustrating for both parents and health practitioners. Delays may result in a deterioration in health and quality of life. Electronic Advice and Diagnosis Via the Internet following Computerized Evaluation (eADVICE) is a web-based ehealth programme which uses an embodied conversational agent (‘Dr Evie’) to engage with the child regarding their wetting. Caldwell et al. present the results of a randomised controlled trial (Dec 2018 – Dec 2020) comparing six-months of access to eADVICE with standard care at the time of referral to a group of tertiary continence clinics. eADVICE improved all clinical outcomes including doubling of the proportion of children who were dry at six-months, improved the quality of life of children using the programme, but did not reduce clinic appointment requests by parents. Two hundred and thirty-nine families consented to participate; 120 children were randomised to eADVICE (families could access the programme at a time convenient to them and could revisit every two weeks if needed for further assessment and advice regarding fluid intake, bowel management, timed voiding, enuresis alarm training, medications and reducing caffeine intake) and 119 to waitlist control. Data was collected at baseline, six months and 12 months. Participants mean age was 8.8 years. 4 The proportion of participants requesting a clinic appointment six months after referral was 78% for the intervention eADVICE and 84% for control. At six months, the proportion in each group who were dry both day and night over 14 consecutive days was 23% for eADVICE and 10% for control. Overall, at six-months, 42% vs. 24% of parents and 43 vs. 31% of children in the eADVICE and control groups respectively, were happy with the treatment they had received as part of the study. The main reason for not being happy was their child’s continence problem was not resolved rather than dissatisfaction with the programme. This is an interesting paper showing that web-based eHealth programmes can be useful in improving incontinence for children whilst being on a waiting list to be seen, however, it does not reduce specialist appointments in the long run. The authors conclude that factors other than a child’s health status influence parental decisions to seek specialist care (after more than six-months of waiting, parents may lack confidence in their child’s clinical improvement and continue to seek face-to-face reassurance from a specialist).
Evaluation of a web-based eHealth programme for children with urinary incontinence: eADVICE Trial
Reviewed by Neil Featherstone
A randomized controlled trial of a web-based management support system for children with urinary incontinence: the eADVICE trial.
CONTRIBUTOR
Neil Featherstone
Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).
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