Göran Umefjord

Internet-delivered therapist-guided physical activity for mild to moderate depression: a randomized controlled trial

Objective. The main hypothesis, and the objective of the study, was to test if the participants allocated to the treatment group would show a larger reduction in depressive symptoms than those in the control group. Methods. This study was a randomized nine week trial of an Internet-administered treatment based on guided physical exercise for Major Depressive Disorder (MDD). A total of 48 participants with mild to moderate depression, diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders, were randomized either to a treatment intervention or to a waiting-list control group. The main outcome measure for depression was the Beck Depression Inventory-II (BDI-II), and physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). The treatment program consisted of nine text modules, and included therapist guidance on a weekly basis. Results. The results showed significant reductions of depressive symptoms in the treatment group compared to the control group, with a moderate between-group effect size (Cohen’s d = 0.67; 95% confidence interval: 0.09–1.25). No difference was found between the groups with regards to increase of physical activity level. For the treatment group, the reduction in depressive symptoms persisted at six months follow-up. Conclusions. Physical activity as a treatment for depression can be delivered in the form of guided Internet-based self-help. Trial Registration. The trial was registered at ClinicalTrials.gov (NCT01573130).

Internet-based treatment of stress urinary incontinence: a randomised controlled study with focus on pelvic floor muscle training

Stress urinary incontinence (SUI) affects 10‒35% of women, and it is sometimes very distressful. Pelvic floor exercises are the first line of treatment, but access barriers or embarrassment may prevent women from seeking help. There is a need for new, simple, and effective ways to deliver treatment. Management of SUI without face‐to‐face contact is possible, and Internet‐based treatment is a new, promising treatment alternative.

Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training

To evaluate the long‐term effects of two non‐face‐to‐face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT).

Stress urinary incontinence and quality of life: a reliability study of a condition-specific instrument in paper and web-based versions.

Quality of life is an important outcome measure in studies of urinary incontinence. Electronic collection of data has several advantages. We examined the reliability of the Swedish version of the highly recommended condition‐specific quality of life questionnaire International Consultation on Incontinence Modular Questionnaire‐Lower Urinary Tract Symptoms Quality of Life (ICIQ‐LUTSqol), in paper and web‐based formats in women with stress urinary incontinence.

Women’s Experiences of Internet-Based or Postal Treatment for Stress Urinary Incontinence:

Stress urinary incontinence is common and sometimes embarrassing. New, simple, and easily accessible treatments are needed. We telephone interviewed 21 women who participated in a randomized controlled study comparing two treatment programs based on instructions for pelvic floor muscle training. One program was Internet-based and included email support by a urotherapist; the other was sent by post. There was no face-to-face contact in either program. Our main aim was to explore the women’s experiences of the Internet-based treatment. Grounded theory analysis revealed three categories: hidden but present, at a distance but close, and by myself but not alone. These were incorporated in a core category: acknowledged but not exposed. The leakage was often a well-hidden secret, but the study treatments lowered the barrier for seeking care. In the Internet group, a supportive patient–provider relationship developed despite the lack of face-to-face contact. Internet-based treatment programs can increase access to care and empower women.

Cost-effectiveness of an Internet-based treatment program for stress urinary incontinence

To perform a deterministic cost‐utility analysis, from a 1‐year societal perspective, of two treatment programs for stress urinary incontinence (SUI) without face‐to‐face contact: one Internet‐based and one sent by post. The treatments were compared with each other and with no treatment.

Mobile app for treatment of stress urinary incontinence : a randomized controlled trial

To evaluate the effect of a mobile app treatment for stress urinary incontinence (SUI) in women.

Evolving techniques in text-based medical consultation – physicians’ long-term experiences at an Ask the doctor service

INTRODUCTION Both the demands and the options for patients to communicate with health care providers utilizing eHealth solutions are increasing. Some patients, or relatives to patients, want to consult another health care provider than the regular one, merely in text. OBJECTIVE To improve text-based medical consultation by learning from long-term experiences. MATERIALS AND METHODS Physicians with comprehensive experience of answering free-text medical inquiries at an official health portal in Sweden were interviewed. The interviews were analyzed using a grounded theory approach. RESULTS Over time, the interviewed physicians developed strategies on how to formulate the answer to a medical inquiry from a previously unknown inquirer. The answering physicians experienced their primary role as providers of medical information and as mediators between an inquirer and the regular health care provider. Many of the answering physicians experienced a personal development with improved communication skills, also in face-to-face meetings with patients. CONCLUSION Text-based medical consultation is part of an expanding area in eHealth. The development of strategies, guidelines, ethical considerations as well as educational efforts are needed to optimize the skills of asynchronous text-based health consultation.