Quality of Life Improvements From Prolapse Surgery Are Not Enhanced by Pelvic Floor Therapy

Perioperative behavioral therapy with pelvic floor muscle training at the time of prolapse repair surgery provides no additional improvement in health-related quality of life (HRQOL) or sexual function, according to findings published in July 2017 in Physical Therapy. The study reports the planned secondary analysis of the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, a 2x2 factorial, randomized, controlled, multicenter trial comparing 2 different vaginal vault suspension methods for prolapse repair and the effect of a vigorous perioperative pelvic floor program versus usual care.

As reported previously, no differences were found for the trial’s primary outcome measures. Prolapse and incontinence outcomes 2 years after surgery were similar for women undergoing uterosacral and sacrospinous ligament vaginal vault suspension procedures, and urinary outcomes at 6 months and prolapse outcomes at 2 years did not improve beyond usual care following perioperative behavioral therapy with pelvic muscle training.

However, the investigators were also interested in determining whether perioperative training could improve other factors, such as HRQOL and sexual function. The investigators therefore administered pelvic floor and sexual function questionnaires and assigned a Brink score to each participant in the OPTIMAL trial to assess these outcomes.

For this secondary analysis, participant-reported outcomes were assessed before surgery and again at 6, 12, and 24 months. Responses on HRQOL surveys, as well as measures of the Brink score, were compared between participants randomized to undergo BMPT and those assigned to usual perioperative care.

With comparable response rates between the 2 groups and no differences in demographic or baseline characteristics, no significant differences in body image, sexual function, or other QOL measures were observed at any time point. Brink scores also did not differ between the 2 groups, despite high self-reported adherence to exercise in the pelvic therapy group.

The primary and secondary analyses of the trial suggest that the addition of perioperative behavioral and pelvic physical therapy to the current perioperative care program would offer little added benefit for women undergoing uterosacral or sacrospinous ligament vaginal vault suspension procedures.

“These findings may reflect the significant improvement in quality of life women recognize after surgical treatment of prolapse, which may overwhelm any additional benefit from pelvic floor therapy during the same time frame,” remarks Alison Weidner, MD, the study’s first author, a urogynecologist at Duke. “But clinicians may still offer pelvic floor therapy to women with symptoms outside of the perioperative time frame.”