• Alison C Weidner, Matthew D Barber, Alayne Markland, David D Rahn, Yvonne Hsu, Elizabeth R Mueller, Sharon Jakus-Waldman, Keisha Y Dyer, Lauren Klein Warren, Marie G Gantz, and Susie Meikle.
• Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Dr, Suite 310, Durham, NC 27707 (USA).
• Phys Ther. 2017 Nov 1; 97 (11): 1075-1083.

BackgroundThere is significant need for trials evaluating the long-term effectiveness of a rigorous program of perioperative behavioral therapy with pelvic floor muscle training (BPMT) in women undergoing transvaginal reconstructive surgery for prolapse.ObjectiveThe purpose of this study was to evaluate the effect of perioperative BPMT on health-related quality of life (HRQOL) and sexual function following vaginal surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI).DesignThis study is a secondary report of a 2 × 2 factorial randomized controlled trial.SettingThis study was a multicenter trial.ParticipantsParticipants were adult women with stage 2-4 POP and SUI.InterventionPerioperative BPMT versus usual care and sacrospinous ligament fixation (SSLF) versus uterosacral ligament suspension (ULS) were provided.MeasurementsParticipants undergoing transvaginal surgery (SSLF or ULS for POP and a midurethral sling for SUI) received usual care or five perioperative BPMT visits. The primary outcome was change in body image and in Pelvic Floor Impact Questionnaire (PFIQ) short-form subscale, 36-item Short-Form Health Survey (SF-36), Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire short form (PISQ-12), Patient Global Impression of Improvement (PGII), and Brink scores.ResultsThe 374 participants were randomized to BPMT (n = 186) and usual care (n = 188). Outcomes were available for 137 (74%) of BPMT participants and 146 (78%) of the usual care participants at 24 months. There were no statistically significant differences between groups in PFIQ, SF-36, PGII, PISQ-12, or body image scale measures.LimitationsThe clinicians providing BPMT had variable expertise. Findings might not apply to vaginal prolapse procedures without slings or abdominal apical prolapse procedures.ConclusionsPerioperative BPMT performed as an adjunct to vaginal surgery for POP and SUI provided no additional improvement in QOL or sexual function compared with usual care.© 2017 American Physical Therapy Association

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