Randomized Controlled Trial

. 2023 Sep 1;103(9):pzad059.

doi: 10.1093/ptj/pzad059.

Adherence to Perioperative Behavioral Therapy With Pelvic Floor Muscle Training in Women Receiving Vaginal Reconstructive Surgery for Pelvic Organ Prolapse

Collaborators, Affiliations

Collaborators

NICHD Pelvic Floor Disorders Network:
Nicole Korbly, Matthew D Barber, Anna Frick, Betsy O'Dougherty, Katie Propst, Ly Pung, Beri M Ridgeway, Cheryl Williams, J Eric Jelovsek, Cindy L Amundsen, Ingrid Harm-Ernandes, Mary Raynor, Nazema Y Siddiqui, Anthony G Visco, Alison C Weidner, Jennifer M Wu, Sharon Jakus-Waldman, Gouri Diwadkar, Keisha Y Dyer, Lynn M Hall, Linda M Mackinnon, Shawn A Menefee, John N Nguyen, Jasmine Tan-Kim, Gisselle Zazueta-Damian, Linda Brubaker, Elizabeth Mueller, Mary Tulke, Diane Borello-France, Sara Cichowski, Marie Gantz, Lauren Klein Warren, Daryl Matthews, Scott Grey, Amanda Shaffer, Tamara T Terry, Jutta Thornberry, Dennis Wallace, Ryan E Whitworth, Kevin A Wilson, Katherine Hartmann, Alicia Ballard, Julie Burge, Kathryn L Burgio, Kathy Carter, Patricia S Goode, Alayne D Markland, Lisa S Pair, Candace Parker-Autry, Holly E Richter, R Edward Varner, Tracey S Wilson, Michael E Albo, Cara Grimes, Emily S Lukacz, Charles W Nager, Yang Wang Casher, Yeh-Hsin Chen, Donna DiFranco, Bev Marchant, Cathie Spino, John T Wei, Diane Newman, Jan Baker, Yvonne Hsu, Maria Masters, Amy Orr, Shanna Atnip, Sunil Balgobin, Elva Kelly Moore, David Rahn, Joseph Schaffer, Clifford Wai, Susan F Meikle, Kathryn L Burgio, Alayne D Markland, Scott Grey

Affiliations

¹ Department of OB/GYN, Magee-Womens Hospital, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA.
² Division of Urology, Penn Center for Continence and Pelvic Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Department of Medicine, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center at the Birmingham VA Health Care System, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁴ Department of Obstetrics & Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
⁵ Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina, USA.
⁶ Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
⁷ Department of Biostatistics and Epidemiology, RTI International, Triangle Park, North Carolina, USA.
⁸ Department of Obstetrics & Gynecology, University of Texas Southwestern, Dallas, Texas, USA.
⁹ Department of Obstetrics, Gynecology and Urogynecology, Kaiser Permanente, Downey, California, USA.
¹⁰ Department of Obstetrics & Gynecology, Brown University, Providence, Rhode Island, USA.
¹¹ The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.

PMID: 37318279
PMCID: PMC10476875
DOI: 10.1093/ptj/pzad059

Randomized Controlled Trial

Adherence to Perioperative Behavioral Therapy With Pelvic Floor Muscle Training in Women Receiving Vaginal Reconstructive Surgery for Pelvic Organ Prolapse

Diane Borello-France et al. Phys Ther. 2023.

. 2023 Sep 1;103(9):pzad059.

doi: 10.1093/ptj/pzad059.

Collaborators

NICHD Pelvic Floor Disorders Network:
Nicole Korbly, Matthew D Barber, Anna Frick, Betsy O'Dougherty, Katie Propst, Ly Pung, Beri M Ridgeway, Cheryl Williams, J Eric Jelovsek, Cindy L Amundsen, Ingrid Harm-Ernandes, Mary Raynor, Nazema Y Siddiqui, Anthony G Visco, Alison C Weidner, Jennifer M Wu, Sharon Jakus-Waldman, Gouri Diwadkar, Keisha Y Dyer, Lynn M Hall, Linda M Mackinnon, Shawn A Menefee, John N Nguyen, Jasmine Tan-Kim, Gisselle Zazueta-Damian, Linda Brubaker, Elizabeth Mueller, Mary Tulke, Diane Borello-France, Sara Cichowski, Marie Gantz, Lauren Klein Warren, Daryl Matthews, Scott Grey, Amanda Shaffer, Tamara T Terry, Jutta Thornberry, Dennis Wallace, Ryan E Whitworth, Kevin A Wilson, Katherine Hartmann, Alicia Ballard, Julie Burge, Kathryn L Burgio, Kathy Carter, Patricia S Goode, Alayne D Markland, Lisa S Pair, Candace Parker-Autry, Holly E Richter, R Edward Varner, Tracey S Wilson, Michael E Albo, Cara Grimes, Emily S Lukacz, Charles W Nager, Yang Wang Casher, Yeh-Hsin Chen, Donna DiFranco, Bev Marchant, Cathie Spino, John T Wei, Diane Newman, Jan Baker, Yvonne Hsu, Maria Masters, Amy Orr, Shanna Atnip, Sunil Balgobin, Elva Kelly Moore, David Rahn, Joseph Schaffer, Clifford Wai, Susan F Meikle, Kathryn L Burgio, Alayne D Markland, Scott Grey

Affiliations

¹ Department of OB/GYN, Magee-Womens Hospital, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA.
² Division of Urology, Penn Center for Continence and Pelvic Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Department of Medicine, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center at the Birmingham VA Health Care System, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁴ Department of Obstetrics & Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
⁵ Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina, USA.
⁶ Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
⁷ Department of Biostatistics and Epidemiology, RTI International, Triangle Park, North Carolina, USA.
⁸ Department of Obstetrics & Gynecology, University of Texas Southwestern, Dallas, Texas, USA.
⁹ Department of Obstetrics, Gynecology and Urogynecology, Kaiser Permanente, Downey, California, USA.
¹⁰ Department of Obstetrics & Gynecology, Brown University, Providence, Rhode Island, USA.
¹¹ The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.

PMID: 37318279
PMCID: PMC10476875
DOI: 10.1093/ptj/pzad059

Abstract

Objective: The objective of this study was to describe adherence to behavioral and pelvic floor muscle training in women undergoing vaginal reconstructive surgery for organ prolapse and to examine whether adherence was associated with 24-month outcomes.

Methods: Participants were women ≥18 years of age, with vaginal bulge and stress urinary incontinence symptoms, planning to undergo vaginal reconstructive surgery for stages 2 to 4 vaginal or uterine prolapse. They were randomized to either sacrospinous ligament fixation or uterosacral ligament suspension and to perioperative behavioral and pelvic floor muscle training or usual care. Measurements included anatomic failure, pelvic floor muscle strength, participant-reported symptoms, and perceived improvement. Analyses compared women with lower versus higher adherence.

Results: Forty-eight percent of women performed pelvic floor muscle exercises (PFMEs) daily at the 4- to 6-week visit. Only 33% performed the prescribed number of muscle contractions. At 8 weeks, 37% performed PFMEs daily, and 28% performed the prescribed number of contractions. No significant relationships were found between adherence and 24-month outcomes.

Conclusion: Adherence to a behavioral intervention was low following vaginal reconstructive surgery for pelvic organ prolapse. The degree of adherence to perioperative training did not appear to influence 24-month outcomes in women undergoing vaginal prolapse surgery.

Impact: This study contributes to the understanding of participant adherence to PFMEs and the impact that participant adherence has on outcomes at 2, 4 to 6, 8, and 12 weeks and 24 months postoperatively. It is important to educate women to follow up with their therapist or physician to report new or unresolved pelvic symptoms.

Trial registration: ClinicalTrials.gov NCT00597935.

Keywords: Behavior Therapy; Pelvic Floor Disorders; Women’s Health.

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References

1. Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123:141–148. - PMC - PubMed
1. Dumoulin C, Alewijnse D, Bo K, et al. Pelvic floor muscle training adherence: tools, measurements, and strategies – 2011 ICS state of the science seminar research paper II of IV. Neurourol Urodynam. 2015;34:615–621. - PubMed
1. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:CD005654. 10.1002/14651858.CD005654.pub4. - DOI - PMC - PubMed
1. Wu YM, Welk B. Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review. Res Rep Urol. 2019;11:179–188. - PMC - PubMed
1. Hagen S, Glazener C, McClurg D, et al. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. Lancet. 2017;389:393–402 Epub 2016 Dec 21. PMID: 28010994. - PubMed

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Adherence to Perioperative Behavioral Therapy With Pelvic Floor Muscle Training in Women Receiving Vaginal Reconstructive Surgery for Pelvic Organ Prolapse

Collaborators

Affiliations

Adherence to Perioperative Behavioral Therapy With Pelvic Floor Muscle Training in Women Receiving Vaginal Reconstructive Surgery for Pelvic Organ Prolapse

Authors

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Abstract

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