The objective of this study was to describe adherence to behavioral and pelvic floor muscle training (BPMT) in women undergoing vaginal reconstructive surgery for organ prolapse (POP) and to examine whether adherence was associated with 24-month outcomes.
Participants were women ≥18 years of age with vaginal bulge and stress urinary incontinence symptoms planning to undergo vaginal reconstructive surgery for stage 2-4 vaginal or uterine prolapse. They were randomized to either sacrospinous ligament fixation or uterosacral ligament suspension and to perioperative BPMT 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.
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.
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.
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.
Physical therapy. 2023 Jun 15 [Epub ahead of print]
Diane Borello France, Diane K Newman, Alayne D Markland, Katie Propst, J Eric Jelovsek, Sara Cichowski, Marie G Gantz, Sunil Balgobin, Sharon Jakus-Waldman, Nicole Korbly, Donna Mazloomdoost, Kathryn L Burgio, NICHD Pelvic Floor Disorders Network
Department of OB/GYN, Magee-Womens Hospital and Department of Physical Therapy, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282., Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania., University of Alabama at Birmingham, Department of Medicine and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center at the Birmingham VA Health Care System, Birmingham, Alabama., Department of Obstetrics & Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio., Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina., Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon., Department of Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina., Department of Obstetrics & Gynecology, University of Texas Southwestern, Dallas, Texas., Department of Obstetrics, Gynecology and Urogynecology, Kaiser Permanente, Downey, California., Department of Obstetrics & Gynecology, Brown University, Providence, Rhode Island., Medical Officer and Project Scientist/Director of the NICHD Pelvic Floor Disorders Network, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.