Pelvic floor rehabilitation in women undergoing pelvic floor reconstructive surgery
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Date
2016-07
Authors
Brandt, Corlia
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
INTRODUCTION: Pelvic organ prolapse (POP) has a mean prevalence of 455 to
681 per 1000 women (aged 50 to 60 years). Approximately 11% may need surgery,
of which 30% may need follow-up surgery. The effect that comprehensive muscle
training can have on prevention and treatment of POP in conjunction with surgery, is
still under-investigated and controversial.
AIMS: To describe the symptoms, signs, quality of life (QOL) and muscle function in
women scheduled for pelvic floor reconstructive surgery; and to determine/compare
the outcomes of a pelvic floor muscle training (PFMT) programme, and a core
training programme in this population.
METHODOLOGY: Eighty one women scheduled for PF reconstructive surgery were
randomly assigned to three groups in this randomised, controlled, double blind trial.
Group 1 received a PFMT programme, group 2 a core stability programme, while
group 3 was the control group. Participants received intervention for six months from
pre- to post-operative. The P-QOL, SF-36, two-dimensional ultrasound, POP-Q
staging, the PERFECT scale, EMG, Sahrmann scale and PBU was used to measure
QOL, POP, PFM and abdominal muscle function respectively. Additional outcome
measures included exercise compliance and the Visual Faces Scale for pain
assessment. Descriptive statistics and 95% CI`s were used to determine statistical
significance. Spearman, Pearson CC`s, and effect sizes were used to correlate
muscle variables at baseline.
RESULTS: Women (mean age 59 years) with predominantly stage III POP (n=100)
showed affected prolapse impact (66.7%), social (median 33.3%), emotional
(median 44.4%0) and severity measures (median 25%) according to the P-QOL at
baseline. Women were physically inactive (80-85%) and showed a tendency towards hypertension (47%), depression (12%), and hypothyroidism (18%). Only
15% had previously been introduced to PFM exercises, and 7% to core training. All
outcomes for the PFM and abdominal muscle function were not within normal
reported ranges pre-operatively. Statistical significant correlations were found
between different components of PFM function, and between PFM and abdominal
muscle function (p<0.05) at baseline. PFMT yielded the most significant changes
regarding PFM function during the first three months (endurance, thickness of
perineal body, length of levator hiatus), while only group 2 showed significant
changes in abdominal muscle function (Sahrmann and PBU levels, 95% CIs [1;3]
and [1;9]) in addition to the latter up to six months. Both intervention groups had
some statistically significant muscle changes when compared to the control group.
Only group 2 yielded a statistical significant improvement in the total P-QOL score
(95% CI [1.5;28.4]).
DISCUSSION/CONCLUSION: It seems that both PFMT and core muscle training
are important to address different, but specific biomechanics and muscle function for
the prevention and treatment of POP. Co-morbidities, symptoms and signs, and the
effect they may have on motor control and QOL, motivates for a comprehensive,
lifestyle orientated, and biopsychosocial rehabilitation model for patients scheduled
for pelvic floor reconstructive surgery.
Description
Keywords
Thesis (Ph.D. (Health Professions Education))--University of the Free State, 2016, Generative organs, Female, Uterus -- Prolapse, Pelvic floor -- Diseases -- Physical therapy, Pelvis -- Surgery