Perioperative Behavioral Therapy and Pelvic Muscle Strengthening Do Not Enhance Quality of Life After Pelvic Surgery: Secondary Report of a Randomized Controlled Trial
Year: 2017
Type: article
Abstract: BACKGROUND: There is significant need for trials evaluating the long-term effectiveness of a rigorous program of perioperative behavioral therapy with pelvic floor muscle training (BPMT) in women undergoing transvaginal reconstructive surgery for prolapse. OBJECTIVE: The purpose of this study was to evaluate the effect of perioperative BPMT on health-related quality of life (HRQOL) and sexual function following vaginal surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). DESIGN: This study is a secondary report of a 2 × 2 factorial randomized controlled trial. SETTING: This study was a multicenter trial. PARTICIPANTS: Participants were adult women with stage 2-4 POP and SUI. INTERVENTION: Perioperative BPMT versus usual care and sacrospinous ligament fixation (SSLF) versus uterosacral ligament suspension (ULS) were provided. MEASUREMENTS: Participants undergoing transvaginal surgery (SSLF or ULS for POP and a midurethral sling for SUI) received usual care or five perioperative BPMT visits. The primary outcome was change in body image and in Pelvic Floor Impact Questionnaire (PFIQ) short-form subscale, 36-item Short-Form Health Survey (SF-36), Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire short form (PISQ-12), Patient Global Impression of Improvement (PGII), and Brink scores. RESULTS: The 374 participants were randomized to BPMT (n = 186) and usual care (n = 188). Outcomes were available for 137 (74%) of BPMT participants and 146 (78%) of the usual care participants at 24 months. There were no statistically significant differences between groups in PFIQ, SF-36, PGII, PISQ-12, or body image scale measures. LIMITATIONS: The clinicians providing BPMT had variable expertise. Findings might not apply to vaginal prolapse procedures without slings or abdominal apical prolapse procedures. CONCLUSIONS: Perioperative BPMT performed as an adjunct to vaginal surgery for POP and SUI provided no additional improvement in QOL or sexual function compared with usual care.
Source: Physical Therapy
DOI: 10.1093/ptj/pzx077
Institutions: Duke University, Duke Medical Center, Cleveland Clinic, University of Alabama at Birmingham, The University of Texas Southwestern Medical Center, University of Utah, University of Utah Health Care, Loyola University Medical Center, Loyola University Chicago, Kaiser Permanente, Kaiser Permanente San Diego Medical Center, RTI International, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: American Urogynecologic Society, International Urogynecological Association, Pelvalon, National Institutes of Health, National Institute of Child Health and Human Development, Office of Research on Women's Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1322164543, G1823400309, G308805389, G3106779825, Perioperative Pelvic Floor Rehab: A Rrandomized Trial, Pelvic Floor Disorders Network Clinical Sites, G3951286095, G4470154012, Pelvic Floor Disorders Network, G4909160110, Pelvic floor Disorders Network-Data Coordinating Center, Cleveland Clinic Clinical Site, Pelvic Floor Disorders Network Data Coordinating Center (U01), Pelvic Floor Disorders Network - Duke University Clinical Site, NICHD Pelvic Floor Disorders Network Clinical Sites (U10), G7658321000, Clinical and Translational Resaerch in the Pelvic Floor Disorders Network, G8606977717, Pelvic Floor Disorders Network 2021, Pelvic Floor Disorders Network Data Coordinating Center, Duke University Medical Center (DUMC) Pelvic Floor Disorders Network (PFDN) Clinical Site
OpenAlex ID: W2782511226