Cargando…
Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care
Objective To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse. Design Randomised controlled trial. Setting Dutch primary care. Participants Women...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group Ltd.
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273538/ https://www.ncbi.nlm.nih.gov/pubmed/25533442 http://dx.doi.org/10.1136/bmj.g7378 |
_version_ | 1782349852377612288 |
---|---|
author | Wiegersma, Marian Panman, Chantal M C R Kollen, Boudewijn J Berger, Marjolein Y Lisman-Van Leeuwen, Yvonne Dekker, Janny H |
author_facet | Wiegersma, Marian Panman, Chantal M C R Kollen, Boudewijn J Berger, Marjolein Y Lisman-Van Leeuwen, Yvonne Dekker, Janny H |
author_sort | Wiegersma, Marian |
collection | PubMed |
description | Objective To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse. Design Randomised controlled trial. Setting Dutch primary care. Participants Women aged 55 years or over with symptomatic mild prolapse (leading edge above the hymen) were identified by screening. Exclusion criteria were current prolapse treatment or treatment in the previous year, malignancy of pelvic organs, current treatment for another gynaecological disorder, severe/terminal illness, impaired mobility, cognitive impairment, and insufficient command of the Dutch language. Interventions Pelvic floor muscle training versus watchful waiting. Main outcome measures The primary outcome was change in bladder, bowel, and pelvic floor symptoms measured with the Pelvic Floor Distress Inventory-20 (PFDI-20), three months after the start of treatment. Secondary outcomes were changes in condition specific and general quality of life, sexual function, degree of prolapse, pelvic floor muscle function, and patients’ perceived change in symptoms. Results Of the 287 women who were randomised to pelvic floor muscle training (n=145) or watchful waiting (n=142), 250 (87%) completed follow-up. Participants in the intervention group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) points more on the PFDI-20 than did participants in the watchful waiting group (P=0.005). Of women in the pelvic floor muscle training group, 57% (82/145) reported an improvement in overall symptoms from the start of the study compared with 13% (18/142) in the watchful waiting group (P<0.001). Other secondary outcomes showed no significant difference between the groups. Conclusions Although pelvic floor muscle training led to a significantly greater improvement in PFDI-20 score, the difference between the groups was below the presumed level of clinical relevance (15 points). Nevertheless, 57% of the participants in the intervention group reported an improvement of overall symptoms. More studies are needed to identify factors related to success of pelvic floor muscle training and to investigate long term effects. Trial registration Dutch Trial Register (www.trialregister.nl) identifier: NTR2047. |
format | Online Article Text |
id | pubmed-4273538 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BMJ Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-42735382015-01-06 Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care Wiegersma, Marian Panman, Chantal M C R Kollen, Boudewijn J Berger, Marjolein Y Lisman-Van Leeuwen, Yvonne Dekker, Janny H BMJ Research Objective To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse. Design Randomised controlled trial. Setting Dutch primary care. Participants Women aged 55 years or over with symptomatic mild prolapse (leading edge above the hymen) were identified by screening. Exclusion criteria were current prolapse treatment or treatment in the previous year, malignancy of pelvic organs, current treatment for another gynaecological disorder, severe/terminal illness, impaired mobility, cognitive impairment, and insufficient command of the Dutch language. Interventions Pelvic floor muscle training versus watchful waiting. Main outcome measures The primary outcome was change in bladder, bowel, and pelvic floor symptoms measured with the Pelvic Floor Distress Inventory-20 (PFDI-20), three months after the start of treatment. Secondary outcomes were changes in condition specific and general quality of life, sexual function, degree of prolapse, pelvic floor muscle function, and patients’ perceived change in symptoms. Results Of the 287 women who were randomised to pelvic floor muscle training (n=145) or watchful waiting (n=142), 250 (87%) completed follow-up. Participants in the intervention group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) points more on the PFDI-20 than did participants in the watchful waiting group (P=0.005). Of women in the pelvic floor muscle training group, 57% (82/145) reported an improvement in overall symptoms from the start of the study compared with 13% (18/142) in the watchful waiting group (P<0.001). Other secondary outcomes showed no significant difference between the groups. Conclusions Although pelvic floor muscle training led to a significantly greater improvement in PFDI-20 score, the difference between the groups was below the presumed level of clinical relevance (15 points). Nevertheless, 57% of the participants in the intervention group reported an improvement of overall symptoms. More studies are needed to identify factors related to success of pelvic floor muscle training and to investigate long term effects. Trial registration Dutch Trial Register (www.trialregister.nl) identifier: NTR2047. BMJ Publishing Group Ltd. 2014-12-22 /pmc/articles/PMC4273538/ /pubmed/25533442 http://dx.doi.org/10.1136/bmj.g7378 Text en © Wiegersma et al 2014 http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Research Wiegersma, Marian Panman, Chantal M C R Kollen, Boudewijn J Berger, Marjolein Y Lisman-Van Leeuwen, Yvonne Dekker, Janny H Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care |
title | Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care |
title_full | Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care |
title_fullStr | Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care |
title_full_unstemmed | Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care |
title_short | Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care |
title_sort | effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273538/ https://www.ncbi.nlm.nih.gov/pubmed/25533442 http://dx.doi.org/10.1136/bmj.g7378 |
work_keys_str_mv | AT wiegersmamarian effectofpelvicfloormuscletrainingcomparedwithwatchfulwaitinginolderwomenwithsymptomaticmildpelvicorganprolapserandomisedcontrolledtrialinprimarycare AT panmanchantalmcr effectofpelvicfloormuscletrainingcomparedwithwatchfulwaitinginolderwomenwithsymptomaticmildpelvicorganprolapserandomisedcontrolledtrialinprimarycare AT kollenboudewijnj effectofpelvicfloormuscletrainingcomparedwithwatchfulwaitinginolderwomenwithsymptomaticmildpelvicorganprolapserandomisedcontrolledtrialinprimarycare AT bergermarjoleiny effectofpelvicfloormuscletrainingcomparedwithwatchfulwaitinginolderwomenwithsymptomaticmildpelvicorganprolapserandomisedcontrolledtrialinprimarycare AT lismanvanleeuwenyvonne effectofpelvicfloormuscletrainingcomparedwithwatchfulwaitinginolderwomenwithsymptomaticmildpelvicorganprolapserandomisedcontrolledtrialinprimarycare AT dekkerjannyh effectofpelvicfloormuscletrainingcomparedwithwatchfulwaitinginolderwomenwithsymptomaticmildpelvicorganprolapserandomisedcontrolledtrialinprimarycare |