Women’s Health – Pelvic Organ Prolapse (4) – Anna Wallin Women’s Health Physio

4. Result

4.1 Interventions

The included studies used PFMT as main intervention. Varying instructions for frequency, duration, number of repetitions and sets were given (see Table IV). The study by Bernades compared PFMT and hypopressive exercise against controls that received no exercise. Frawley looked at the effects of PFMT during the rehabilitation face after POP surgery. Kashyap studied effectiveness of PFMT given in 1-to-1 sessions with a physiotherapist compared to the effectiveness of PFMT instructed through self-instruction manuals (SIM). The two studies by Braekken compare daily individual PFMT, with supervised PT sessions several times per month, to controls. They were based on the same sample group and conducted during the same period. Therefore they used the same intervention. Hagen studied individualized PFMT training, given in 1-to-1 physiotherapy sessions and compared it to controls. For detailed information regarding number of repetitions, sets and duration see “PFMT program” under Table IV.

Table IV. Study, group division, interventions, instruction and PFMT program overview

First author, year Groups Intervention and instructions PFMT program Notes
Bernardes, 2010 Gt

 

PFMT, instructed to perform PFM contraction properly. 8-12 reps x3 sets daily close to maximal contraction (lying, sitting, standing), contraction held 6-8 sec. All participants received lifestyle advice.
Gt2 Contract PFM in conjunction with hypopressive exercise (using diaphragmatic breathing). 10 reps lying & standing, PFM contraction held 3-8 sec.
Gc “The knack”
Braekken, 2010.1 Gt Individual strength training once daily + supervised 4/month (1-3 months) then 2/month (3-6 months), exercise diary, booklet and DVD with PFMT. 8-12 reps x3 sets daily close to maximal contraction. All participants received lifestyle advice and were instructed “the knack”.
Gc
Braekken, 2010.2 As above As above As above As above
Frawley, 2010 Gt 8 PT sessions (1 pre-op, post-op 6, 7 8, 10, 12 weeks and 9m), PMFT. First three months: 8-12 reps (6-8 sec) x3 sets/day varying positions.

Three months until end of study:  8-12 reps (6-8 sec) 1-2 sets/day varying positions.

All participants received “usual care”, and were instructed “the knack”.
Gc
Hagen, 2014 Gt 5 1-on-1 appointments over 16 weeks with PT, follow up 6 & 12 m, individualized PFMT. Individualized. Aim: 10 reps 10 sec 3 times/day & 50 fast contractions 3 times/day. All participants received lifestyle advice and were instructed “the knack”.
Gc
Kashyap, 2013 Gt One-to-one instruction about PFMT, PFMT and self-instruction manual (SIM). 3 times/day, 10 contractions held for 10 sec with 10 sec rest between contractions.
Gsim SIM only.

DVD; Digital videodisc

Gc; Group controls

Gt; Group training

Gt1; Group training1

Gt2; Group training2

Gsim; Group self-instruction manual

“The knack”; for further definition of “the knack” see paragraph 1.4

PFM; Pelvic floor muscles

PFMT; Pelvic floor muscle training

Post-op; postoperative

Pre-op; preoperative

PT; Physiotherapist

SIM; Self-instructive manual

4.2 Demographic outcome

Factors such as age, BMI, number of vaginal births and menopausal status was included where available as these are important indicators for POP risk. Level of POP severity was also included where available. When compared not all studies were homogenous with regards to age, severity of POP and menopausal status etc. The studies by Braekken were based on the same sample group. The study by Frawley was the only one where there was a significant difference between the intervention group and controls. The training group had a lower average BMI, higher number of vaginal births and higher level of self-reported incontinence (16).

Table V. Study and group specific (training and controls) demographic details

First author, year, country Demographics Group training (Gt): mean at baseline Demographics Group control (Gc): mean at baseline
Bernardes, 2010, Brazil GT1 [n=21]

Age: 51,9

BMI: 29,9

#Pregnancies: 3,2

#Deliveries: 1,8

Menopausal status: 15 (71%)

GT2 [n=21]

Age: 56,7

BMI: 28,8

#Pregnancies: 3,8

#Deliveries: 2,4

Menopausal status: 16 (76%)

GC [n=16]

Age: 58,7

BMI: 29,7

#Pregnancies: 3,7

#Deliveries: 3

Menopausal status: 11 (68%)

Braekken 2010.1, Norway GT [n=59]

Age: 49,4

BMI: 25,8

Parity: 2,4

POP severity: POP I 8 (13,8) – POP II 36 (63,8) – POP III 14 (22,4)

GC [n=50]

Age: 48,3

BMI: 26,1

Parity: 2,4

POP severity: POP I 11 (22) – POP II 29 (58) – POP III 10 (20)

Braekken 2010.2, Norway As above

Postmenopausal n (%): 26 (44,1)

As above

Postmenopausal n (%): 18 (36)

Frawley, 2010, Australia GT [n=27]

Age: 57,4

BMI: 27,6

#Vaginal deliveries: 2,4

Postmenopausal n (%): 19 (70,4)

Exposure to PFMT: awareness of PFMT 25 (92,6) – past experience PFMT 16 (59,3)

GC [n=24]

Age: 55,8

BMI: 25

#Vaginal deliveries: 3,2

Postmenopausal n (%): 15 (62,5)

Exposure to PFMT: awareness of PFMT 23 (95,8) – past experience PFMT 14 (58,3)

Hagen, 2014, United Kingdom, New Zealand, Australia GT [n=225]

Age: 56,2

BMI: 27,15 [n=214]

Parity: 2 [n=223]

POP severity: POP I 23 (10) – POP II above hymen 48 (21) – POP II at/below hymen 116 (52) – POP III 38 (17)

GC [n=222]

Age: 57,5

BMI: 27,42 [n=210]

Parity: 2 [n=217]

POP severity: POP I 18 (8) – POP II above hymen 47 (21) – POP II at/below hymen 127 (57) – POP III 29 (13) POP IV 1 (<1)

Kashyap, 2013, India GT [n=70]

Age: 46

Parity: 3

Postmenopausal n (%): 33 (47,1)

POP-SS score 6,03

PFIQ-7 score 11,57

GTsim [n=70]

Age 47

Parity: 3

Postmenopausal n (%): 27 (38,5)

POP-SS score: 7,11

PFIQ-7 score: 12,91

BMI; Body mass index

Gc; Group controls

Gt; Group training

Gt1; Group training1

Gt2; Group training2

Gsim; Group self-instruction manual

n; Number of participants

PFIQ-7; Pelvic floor impact questionnaire

POP; Pelvic organ prolapse

POP-SS; Pelvic organ prolapse symptom score

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