Women’s Health – Pelvic Organ Prolapse (5) – Anna Wallin Women’s Health Physio

4.3 Outcome

Outcome measurements included severity of POP symptoms and bother, morphological changes (i.e. muscle length and thickness) and severity of POP measured by POP-Q. All but one article reported that PFMT had reduced POP symptoms, bother and/or severity, and improved morphological factors.

Table VI. Study, objective, length, number of participants, outcome variables and result overview

First author, year, country Objective Study length n Outcome variable Result Notes
Bernardes, 2012, Brazil Evaluate efficacy of PFMT and hypopressive exercise for increasing cross-sectional area (CSA) of levator ani in women with POP 3 months 58 Gt1: CSA (mm) 1.6 (0.4) ./. 2.1 (0.3) Before ./. after
Gt2: CSA (mm) 1.4 (0.3) ./. 1.8 (0.5)
Gc: CSA (mm) 1.5 (0.3) ./. 1.4 (0.3)
Braekken, 2010.1, Norway Investigate morphological and functional changes after PFMT in women with POP 6 months 109 Gt: Muscle thickness, rest (mm)

Levator hiatus area, rest (cm2)

Muscle tightness, rest (mm)

Levator hiatus area, Valsalva (cm2)

Muscle length, Valsavla (mm)

9.0 ./. 10.5

23.7 ./. 22.2

121.2 ./. 117.2

29.5 ./. 28.9

142.3 ./. 140.0

Before ./. after
Gc: Muscle thickness, rest (mm)

Levator hiatus area, rest (cm2)

Muscle length, rest (mm)

Levator hiatus area, Valsalva (cm2)

Muscle length, Valsalva (mm)

9.4 ./. 9.0

22.6 ./. 22.6

113.9 ./. 115.6

30.3 ./. 30.6

137.9 ./. 141.1

Braekken, 2010.2, Norway Investigate efficacy of PFMT in reversing POP and alleviating symptoms 6 months 109 POP stage

Symptoms (frequency)

Symptoms (bother)

Position bladder/rectum

See Table VII

32 (78%) ./. 8 (31%)

29 (67%) ./. 11 (42%)

See results above

Gt ./. Gc

 

 

Frawley, 2012, Australia Investigate the effect of a pre- and post-operative PT supervised PFMT program in women undergoing POP surgery or hysterectomy 12 months 51 UDI total score 54.0 ./. 44.1 Gt ./. Gc final
Hagen, 2014, United Kingdom, New Zealand, Australia Establish the effectiveness of 1-to-1 individually PFMT for reducing POP symptoms 12 months 477 POP-SS

Improvement prolapse symptoms

-3.77 ./. -2.09

57% ./. 45%

Gt ./. Gc final
Kashyap, 2013, India Compare effect of 2 packages of PFMT programs among women attending outpatient departments 6 months 140 POP-SS  -2.99 ./. -1.25 Gt ./. Gsim final

CSA; cross-sectional area

Gc; Group controls

Gt; Group training

Gt1; Group training1

Gt2; Group training2

Gsim; Group self-instruction manual

PFIQ-7; Pelvic floor impact questionnaire

POP; Pelvic organ prolapse

POP-SS; Pelvic organ prolapse symptom score

PFMT pelvic floor muscle training

PT; Physiotherapist

UDI; Urinary distress index

*See appendix 1 for a detailed article overview

 

 

Table VII. Study, outcome variables, p-value compared within and between intervention groups and POP-Q improvement outcome overview

First author, year Outcome P Intra P Pan POP-Q improvement
Bernardes, 2012 Gt1: CSA (cm2) <.001 n/a Used but no data available
Gt2: CSA (cm2) .001
Gc: CSA (cm2) .816
Braekken, 2010.1 Gt: Muscle thickness, rest (mm)

Levator hiatus area, rest (cm2)

Muscle length, rest (mm)

Levator hiatus area, Valsalva (cm2)

Muscle length, Valsalva (mm)

<.001

.002

.001

.004

.001

<.001

.001

.007

.21

.001

n/a
Gc: Muscle thickness, rest (mm)

Levator hiatus area, rest (cm2)

Muscle length, rest (mm)

Levator hiatus area, Valsalva (cm2)

Muscle length, Valsalva (mm)

.065

.870

.441

.512

.106

Braekken, 2010.2 POP stage

Improvement symptoms (bulging or heaviness) frequency and bother

n/a

.000*

Gt: 19%

Gc: 8%*

Frawley, 2010 Gt: UDI total score .46 /.46 n/a
Hagen, 2014 Reduction POP-SS score

Improvement prolapse symptoms

n/a .0053

.0125

Gt: 27%

Gc: 20%

Kashyap, 2013 POP-SS score (Gt (-2.99) and Gsim (-1.25)) n/a .0002 n/a

CSA; Cross-sectional area

Gc; Group controls

Gt; Group training

Gt1; Group training1

Gt2; Group training2

Gsim; Group self-instruction manual

POP; Pelvic organ prolapse

P intra; comparison development within one group

P pan; comparison development between all groups

POP-SS; Pelvic organ prolapse symptom scale

UDI; Urinary distress index

*No improvements in POP stage I (controls and training)

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