Proceedings of the 12th European Conference on Knowledge ...

4. What a bi<strong>of</strong>eedback is
Manel González-Piñero et al
Bi<strong>of</strong>eedback, is in simple terms, a means <strong>of</strong> attaching a device whe<strong>the</strong>r it have sound, lights or a
picture, to show <strong>the</strong> patient how <strong>the</strong>y are performing. It can be as simple as touching a muscle with
ones fingers to feel when it contracts. It has been defined as: '… <strong>the</strong> detection <strong>of</strong> a physiological
process (ei<strong>the</strong>r directly or indirectly) and <strong>the</strong> presentation <strong>of</strong> this information to a patient who is <strong>the</strong>n
able, with training, to use <strong>the</strong> information to gain control over <strong>the</strong> process.'
It is a technique developed over <strong>the</strong> last 3 decades, which is intended to teach subjects to bring
certain physiologic processes under voluntary control. Application <strong>of</strong> this technique to medical
conditions was popularized during <strong>the</strong> 1970s, along with a variety <strong>of</strong> o<strong>the</strong>r behavioural <strong>the</strong>rapies
(Subcommittee on Nonpharmacologic Therapy Report, 1986). These <strong>the</strong>rapies were primarily directed
toward disorders that were thought to include a component <strong>of</strong> stress, psychosomatic, or
psychophysiologic features.
5. Benefits <strong>of</strong> bi<strong>of</strong>eedback vs. medication
There are multiple behavioural techniques and protocols, but <strong>the</strong>ir comparative efficacy is unknown.
Because technical aspects cannot be detailed sufficiently in reports <strong>of</strong> clinical trials, behavioural
interventions also are difficult to replicate in practice. One behavioural technique, bi<strong>of</strong>eedback, has
been even less widely used for urge incontinence because it <strong>of</strong>ten has required repeated
instrumentation <strong>of</strong> <strong>the</strong> bladder and urinary sphincter (Resnick, 1998). Moreover, despite <strong>the</strong> expertise
and time entailed, behavioural techniques are poorly reimbursed. By contrast, pharmaco<strong>the</strong>rapy
works more quickly and also requires no behavioural expertise, less physician time, and less patient
participation. None<strong>the</strong>less, although drugs help most patients, non drug restores continence to <strong>the</strong>
majority. Fur<strong>the</strong>rmore, all <strong>of</strong> <strong>the</strong> agents currently used engender adverse effects, expense, and
inconvenience (Fantl et al., 1996), and most must be taken several times daily and indefinitely. Thus,
an equally or more effective one-time intervention would be welcome.
The study by Burgio (Burgio et al., 1998) demonstrates that a less-invasive bi<strong>of</strong>eedback approach can
achieve <strong>the</strong>se goals. The study also serves as a rich source <strong>of</strong> information and provides valuable
lessons for clinicians. The investigators’ decision to begin <strong>the</strong>rapy with oxybutynin at 2.5mg3 times
daily was wise. The effect <strong>of</strong> oxybutynin was equivalent to that achieved in trials using higher
dosages, but it caused far fewer adverse effects and a lower rate <strong>of</strong> subject attrition (Fantl et al.
1996). Equally important, efficacy continued to increase beyond 2 weeks, longer than previously
reported, but consistent with o<strong>the</strong>r recent data (Appell, 1997) (Abrams et al., 1998). Thus, clinicians
should avoid escalating dosages <strong>of</strong> oxybutynin too quickly or abandoning pharmaco<strong>the</strong>rapy too soon.
6. The open innovation process followed in <strong>the</strong> R&D process <strong>of</strong> a
Bi<strong>of</strong>eedback for urinary incontinence
Technology
Detection
Selection Evaluation Protection Exploitation
License
Transfer
Spin‐<strong>of</strong>f
Agreement
Figure 4: Technical University <strong>of</strong> Catalonia’s Value Chain
“Open innovation is a paradigm that assumes that firms can and should use external ideas as well as
internal ideas, and internal and external paths to market, as <strong>the</strong> firms look to advance <strong>the</strong>ir
technology” , as Chesbrough (2003: Introduction), defined in his work. The boundaries between a firm
and its environment have become more permeable; innovations can easily transfer inward and
outward. The central idea behind open innovation is that in a world <strong>of</strong> widely distributed knowledge,
companies cannot afford to rely entirely on <strong>the</strong>ir own research but should instead buy or license
processes or inventions (i.e. patents) from o<strong>the</strong>r companies.
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