Women’s Health – Pelvic Organ Prolapse (3) – Anna Wallin Women’s Health Physio

2. Objective

The objective of this review was to determine the effectiveness of PFMT on POP with regards to prevention and treatment from existing research and studies. We wanted to examine common recommendations and training programs and what effects they had.

3. Method

3.1 Research design

This was a literature review. The method was used to enable gathering, validations and comparisons of research results in order to investigate and evaluate the effects of PFMT.

3.2 Inclusion criteria

Studies that were included were:

  • Studying patient groups with POP as main condition
  • Studying individuals with POP mainly related to pregnancy
  • Studies that used PFMT as main intervention
  • Quantitative studies
  • Randomized controlled trials
  • Written in English or Swedish
  • Available free online

3.3 Exclusion criteria

Studies that were excluded were:

  • Studying individuals with POP mainly related to genetic disorders or obesity
  • Trials mainly studying the effects of PFMT on pelvic floor dysfunctions other than POP (e.g. UI)
  • Articles older than 10 years

3.4 Search method

Included databases were PubMed, Cinahl, Cochrane and PEDro. A primary search was conducted in March 2014. Additional searches were conducted during June and July 2014. Keywords were used in addition to search filters, in order to narrow down the search (see Table II).


 

Table II. Database, MeSH term, search limitations, search hits and selected studies overview

Database MeSH terms Limits Hits Selected studies (first author, year)
Cinahl Pelvic organ prolapse

Exercise

Prevention

Published between 1999 and 2014 9 Braekken, 2010.2

 

 

Total: 1

Pelvic organ prolapse quantitative 12

 

Total: 0

Pelvic organ prolapse exercise 19 Braekken, 2010.1

Total: 1

Pelvic floor

Exercise

Pregnancy

40

 

Total: 0

Cochrane Pelvic organ prolapse

Exercise

Prevention

1

 

 

Total: 0

PEDro Pelvic floor training

Prolapse

Published between 1999 and 2014

Clinical trial

15

 

Kashyap, 2013

 

Total: 1

PubMed Pelvic organ prolapse

Exercise

Prevention

Free full text online

Published between 1999 and 2014

2

 

 

Total: 0

Pelvic organ prolapse

Physical therapy

19 Bernardes, 2012

 

Total: 1

Pelvic floor

Exercise

Pregnancy

20

 

Total: 0

Pelvic floor muscle training prolapse 120 Hagen, 2014

Total: 1

Pelvic floor training

Prolapse

110 Frawley, 2009

Total: 1

Total: 367 Total: 6

MeSH; Medical subject heading

3.5 Search result

During the literature search 367 records were screened. There were ten studies included in the final stage of selection. There was one pilot study that was followed by a large-scale multi- center study and was therefore excluded. One article was excluded because it did not follow the criteria for language. One article was excluded as it did not look at POP related outcome factors primarily. Finally, one was excluded because of lacking accessibility. Ultimately six randomized controlled trials were selected after being checked for relevance and availability. Five out of six studies were assessor blinded. All included studies were published between 2008 and 2013. The search however included articles published 1 January 1999 and more recent.

3.6 Quality assessment

All articles were assessed with Physiotherapy evidence database (PEDro) scale, with a minimum level of 4 out of 10 (see table III).

Table III Quality assessment according to PEDro

First author, year (1) 2 3 4 5 6 7 8 9 10 11 PEDro score
Bernardes, 2012 (x) x x x x 4/10
Braekken, 2010.1 (x) x x x x x x x x 8/10
Braekken, 2010.2 (x) x x x x x x x x 8/10
Frawley, 2012 (x) x x x x x x 6/10
Hagen, 2014 (x) x x x x x x x 7/10
Kashyap, 2013 (x) x x x x x x x 7/10

PEDro; Physiotherapy evidence database

**See appendix 2 for detailed overview of the PEDro scoring system

3.7 Ethical considerations

Written and informed consent was given and discussed in the following articles, Bernades, Braekken (2010.1 and 2010.2), Hagen and Kashyap. The only article that did not mention if informed consent was given was the article by Frawley. However, all studies were approved by ethical committees.

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