title: An overactive bladder online self-management program with embedded avatars: a randomized controlled trial of efficacy.
abstract: OBJECTIVE
  To determine whether an avatar-based, online, self-management program is an effective therapeutic approach for women with overactive bladder (OAB). OAB is a highly prevalent symptom complex that significantly impacts health-related quality of life (HRQOL). Behavioral interventions can produce substantial improvement in symptoms and HRQOL. Online education programs offer patients with OAB an alternative to face-to-face self-management instruction. Evidence suggests that avatars (digital humans) embedded into online programs may help persuade and motivate patients to adopt healthy behaviors.
  
  
  METHODS
  In a 12-week, randomized, controlled trial, women (aged >55 years) with symptoms of OAB for at least 3 months were randomized to 2 versions of a 3-part, online, self-management program. After collecting the baseline metrics, the intervention group viewed a generic avatar coach with a self-avatar peer mentor designed to resemble the participant, and the control group viewed the identical online program with voice only. Participants viewed part 1 at week 1 and parts 2 and 3 at week 6. Participants completed daily bladder diaries throughout the 12-week period and OAB-related outcome measures at weeks 1, 6, and 12.
  
  
  RESULTS
  Forty-one women completed the study (mean age = 61 years, standard deviation = 6). The analysis of covariance of week-12 outcome measures with the baseline as covariates demonstrated significant improvements in the intervention group in OAB questionnaire HRQOL (P = .02; large effect), 24-hour frequency (P <.001; large effect), night-time urination (P <.001; large effect), urgency (P <.001; large effect), and urge incontinence (P <.001; large effect).
  
  
  CONCLUSIONS
  An avatar-based intervention embedded into an online self-management program improved OAB HRQOL and symptoms in women.
authors.affiliation: Laboratory of E-Learning and Multimedia Research, Bruce W. Carter Miami Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Miami, FL; Division of Geriatrics and Palliative Medicine, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL. Electronic address: allen.andrade@va.gov.
authors.forename: Allen D
authors.initials: AD
authors.lastname: Andrade
authors.affiliation: Division of Geriatrics and Palliative Medicine, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Ramanakumar
authors.initials: R
authors.lastname: Anam
authors.affiliation: Division of Geriatrics and Palliative Medicine, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Chandana
authors.initials: C
authors.lastname: Karanam
authors.affiliation: Division of Geriatrics and Palliative Medicine, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Pamela
authors.initials: P
authors.lastname: Downey
authors.affiliation: Laboratory of E-Learning and Multimedia Research, Bruce W. Carter Miami Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Miami, FL; Division of Geriatrics and Palliative Medicine, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Jorge G
authors.initials: JG
authors.lastname: Ruiz
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012648:Self Care / Q000379:methods*; D013813:Therapy, Computer-Assisted; D053201:Urinary Bladder, Overactive / Q000628:therapy*