Women’s Health – Pelvic Organ Prolapse (7) – Anna Wallin Women’s Health Physio

5.2 Methodology

This was a literature review. The study design was chosen because we saw the need for a new review of PFMT treatment and prevention of POP. A Cochrane review by Hagen and Stark on conservative prevention and management was published in 2011. It included research published between 2003 and 2010. It wanted to: “determine the effects of conservative treatment (physical and lifestyle interventions) for the prevention or treatment of POP in comparison with no treatment or other treatment options (such as mechanical or surgery)” (12). The Cochrane review also included six studies. However, only two out six studies were also included in this review. The result findings from the articles by Braekken were pooled in the Cochrane review, as they both describe different aspects of the same study (10) (19). In this review the articles by Braekken are presented separately. The study by Frawley was also included here, thus excluding four studies from the Cochrane review. One pilot study from 2009 by Hagen, Stark, Glazener, Sinclair and Ramsay was followed by a large-scale multi-center trial (22). The multi-center study is included here. A Tunisian study by Ghroubi, Kharrat, CHaari, Ayed, Guermazi and Elleuch was excluded because it did not follow the language criteria (23). One Thai article by Piya-Anant was excluded as it was older than 10 years (24). Finally, a study by Jarvis, Hallam, Lujic, Abbott and Vancaillie conducted in Australia only evaluated effects of PFMT on urine incontinence (UI) (25). Similarly to this review the Cochrane review by Hagen and Stark could not draw any conclusions regarding prevention. Since the Cochrane review more and higher quality studies with larger sample groups have been published, but to our knowledge have not yet been reviewed. This motivated the choice of study design. The study design allowed us to research published studies on PFMT treatment and prevention of POP, through which we could gain a good overview of the interest and demand for this field. The studies included here, still had relatively small sample groups (between 51 and 477 participants). Studies with lager sample sizes are still needed. To conduct a large-scale study like this was not realistic with the time and budget set for this project. Again, this is why this study design was chosen.

5.2.1 Quality assessment

There were difficulties finding studies that could be compared with regards to e.g. study methodology, intervention and objective. This could affect the quality of the review. However, measures were applied to make the study results as comparative as possible. Here lays one key strength and weakness of this study. The data was selected in order to make the studies comparable. In doing this the authors subjectively chose what data to include. This may create a data bias.

5.2.2 PEDro scale

The PEDro scale was used to assess quality of each individual study and allowed the studies to be compared. It was chosen because it is an evidence scale designed to specifically assess research within the field of physiotherapy, although not all categories within the scale were applicable. Blinding of all subjects (category 5) as well as blinding therapists who administer the therapy (category 6) was not possible when researching the effects of PFMT.

5.2.3 Search strategy

One of the strengths of the review was that several databases and search (MeSH) terms were used. This allowed a wide search. Nonetheless, the number of included studies remained low. This could be due to the search strategy. Had even more databases been included more studies might have been found. We believe however, that the low number of studies is a result of lacking research.

5.2.4 Inclusion criteria

The inclusion criteria were chosen in order to include cohesive studies with highest possible quality. One of the strengths of the review was that all the included studies were randomized controlled trials and used PFMT as main intervention. It could be speculated that the inclusion criteria and study objective were too narrow (however as we will explain below, we believe that this review has highlighted an important gap between research interest and public need for more and effective POP therapies).

This review found that there was a lack of POP/PFMT research, as the low number of included studies demonstrates. The lack of studies was the main weakness of the review. Had the inclusion criteria been different, more research might have been available for review. PFMT is an evaluated method for prevention and treatment of other pelvic floor dysfunctions, such as UI. Due to inclusion criteria, study design and objective limitations UI/PFMT research was not included in this review. Findings from UI/PFMT research could have supplied further indications regarding POP prevention and effects of PFMT programs.

It can only be speculated as to why POP/PFMT research is scarce. Women’s health has historically been stigmatized or shy of research attention (26). This may result in a lacking discussion (clinically and privately), resulting in lacking knowledge of the prevalence, complications and effects on QoL that it might have to patients.

5.3 Significance

The results concluded in this review are important to both the field of physiotherapy and patients. PFMT is an exercise method that many physiotherapists are familiar with, which can be used and instructed in order to help and improve QoL for many women.

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