title: Peri-operative physiotherapy to prevent recurrent symptoms and treatment following prolapse surgery: supported by evidence or not?
abstract: OBJECTIVE
  To provide a clinical opinion based on current literature reporting on the effects of peri-operative pelvic floor muscle training (PFMT) on postoperative pelvic floor symptoms, recurrent treatment after pelvic organ prolapse (POP) surgery and current clinical practice in the Netherlands.
  
  
  METHODS
  The PubMed database was searched, with dates from 1966 to May 2012, for all types of studies reporting on the effects of peri-operative PFMT on recurrent treatment and/or pelvic floor symptoms after POP surgery. Also, current clinical practice in the Netherlands was evaluated.
  
  
  RESULTS
  Two small randomised controlled trials (RCTs), with differences in the population included, were identified. The first RCT concluded that peri-operative PFMT reduced the risk of pelvic floor symptoms 12 weeks after surgery and improved the quality of life. The second trial concluded that there is no significant beneficial effect 12 months after surgery. However, when looking at the reported outcomes in this trial micturition symptoms and quality of life improved more in the treatment group too. Studies evaluating whether peri-operative PFMT reduced the rate of recurrent treatment for POP-related symptoms, were not identified. This lack of evidence reflects the current clinical practice, as most gynaecologists do not offer peri-operative PFMT to their patients.
  
  
  CONCLUSIONS
  Peri-operative PFMT may reduce the risk of pelvic floor symptoms and improve the quality of life after POP surgery, although evidence is insufficient to implement this in current clinical practice. Since the results of the two RCTs on this topic are promising, there is an urgent need for robust, well-designed trials to evaluate the efficacy and (cost-)effectiveness of peri-operative PFMT.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-205, PO Box 22700, 1105 DE Amsterdam, The Netherlands. m.m.lakeman@amc.uva.nl
authors.forename: Marielle M E
authors.initials: MM
authors.lastname: Lakeman
authors.forename: Steven E Schraffordt
authors.initials: SE
authors.lastname: Koops
authors.forename: Bary C
authors.initials: BC
authors.lastname: Berghmans
authors.forename: Jan Paul W R
authors.initials: JP
authors.lastname: Roovers
mesh_terms: D005260:Female; D006801:Humans; D009426:Netherlands; D056887:Pelvic Organ Prolapse / Q000517:prevention & control* / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D026741:Physical Therapy Modalities; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D016896:Treatment Outcome