BACKGROUND: The enuresis alarm is the only antienuretic treatment with a clear curative potential, yet it is not often offered by healthcare professionals. We have previously shown that alarm treatment can be successfully managed by the families themselves, but that support by a nurse very much increases adherence. We wanted to see whether adherence could be improved by providing video messages for encouragement. METHODS: This is part of a large multinational study using an alarm device linked to an app downloaded on a smartphone used by a parent or the subject themselves. The app records baseline background data as well as alarm use and wet/dry nights during treatment. Instructions regarding alarm use, in accordance with the ICCS guidelines, are also given by the app. A subset of users were also, via the app, given animated video instructions and encouragement featuring a dedicated researcher and pediatrician. All users managed the treatment themselves without the support of healthcare professionals. Only users who had started alarm therapy at least three months before analysis were included and only therapy during the first three months was evaluated. RESULTS: In total, 1052 subjects were included. All were given adequate instructions from the app but only 617 were also provided with video support. Baseline data (age, sex distribution, baseline enuresis frequency, concomitant daytime incontinence, previous treatment attempts) did not differ between the groups. The average treatment duration was shorter for those receiving video support (35.5 ± 34.2 vs 44.1 ± 31.3 days; p < 0.001). Furthermore, adherence, measured as the number of nights per week when the alarm was actually used, was lower, week after week, for those receiving video support (p < 0.001 for all weeks). Regarding the end result of therapy, those receiving video support had a higher risk of ending therapy prematurely (69.5% vs 57.5%; p = 0.006), but among those adhering to therapy for the full duration (minimum 6 weeks) video support did not adversely affect the chance for a favorable outcome (46.9% vs 49.2%; p = 0.651) CONCLUSIONS: Although enuresis alarm therapy can be managed by the families independently from healthcare professionals, adherence remains a challenge and this is not alleviated by providing video support and encouragement in addition to mere instructions. We will analyze whether language barriers can be part of the problem.
