Physiotherapy as an adjunct to prolapse surgery: an assessor-blinded randomized controlled trial.
BACKGROUND
This assessor-blinded randomized controlled trial investigated the effect of a pre- and post-operative physiotherapy-supervised pelvic floor muscle (PFM) training program in women undergoing surgery for prolapse or hysterectomy.


METHODS
Participants were assessed pre-operatively, and at 3, 6, and 12 months post-operatively by a blinded physiotherapy assessor. Following randomization, participants were allocated to a control group (CG) which included "usual care" (as provided by the surgeon and the hospital staff), or a treatment group (TG) which included one pre-operative and seven post-operative treatment sessions over 12 months. Primary outcomes were bladder and prolapse symptoms, measured by the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ).


RESULTS
Fifty-one participants were randomized. The 12-month post-operative findings showed there was no difference in the prevalence of the primary outcomes (ORs 1.2, 1.3). There were no significant differences between groups on the change scores of the UDI (mean: 44.1 [5.1]; 54.0 [5.4], P = 0.20) nor the IIQ (median: 0.0 [9,14]; 10.0 [5,19], P = 0.09). The repeated measures analyses also demonstrated no significant changes.


CONCLUSIONS
The program tested did not improve bladder or prolapse symptoms in this trial. Reasons may include the effectiveness of surgery alone, wide variance in data, small sample size, insufficient training by the TG, and PFM training by the usual care group.
Frawley
Helena C
HC
Melbourne Physiotherapy School, University of Melbourne, Parkville, Victoria, Australia.
Phillips
Bev A
BA
Bø
Kari
K
Galea
Mary P
MP
D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor; D056887:Pelvic Organ Prolapse / Q000534:rehabilitation* / Q000601:surgery*; D026741:Physical Therapy Modalities; D016037:Single-Blind Method