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

DOI

10.1093/ptj/pzad059

Diane Borello-France, Department of OB/GYN, Magee-Womens Hospital, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA.
Diane K. Newman, Division of Urology, Penn Center for Continence and Pelvic Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Alayne D. Markland, 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.
Katie Propst, Department of Obstetrics & Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Eric Jelovsek, Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina, USA.
Sara Cichowski, Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
Marie G. Gantz, Department of Biostatistics and Epidemiology, RTI International, Triangle Park, North Carolina, USA.
Sunil Balgobin, Department of Obstetrics & Gynecology, University of Texas Southwestern, Dallas, Texas, USA.
Sharon Jakus-Waldman, Department of Obstetrics, Gynecology and Urogynecology, Kaiser Permanente, Downey, California, USA.
Nicole Korbly, Department of Obstetrics & Gynecology, Brown University, Providence, Rhode Island, USA.
Donna Mazloomdoost, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.
Kathryn L. Burgio, 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.

Document Type

Journal Article

Publication Date

9-1-2023

Publication Title

Physical therapy

Volume

103

Issue

9

Keywords

Behavior Therapy, Pelvic Floor Disorders, Women’s Health

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.

Open Access

37318279 (pubmed); PMC10476875 (pmc); 10.1093/ptj/pzad059 (doi); 7198478 (pii)

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