title: Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care.
abstract: OBJECTIVE
  To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Dutch primary care.
  
  
  METHODS
  Women aged 55 years or over with symptomatic mild prolapse (leading edge above the hymen) were identified by screening. Exclusion criteria were current prolapse treatment or treatment in the previous year, malignancy of pelvic organs, current treatment for another gynaecological disorder, severe/terminal illness, impaired mobility, cognitive impairment, and insufficient command of the Dutch language.
  
  
  METHODS
  Pelvic floor muscle training versus watchful waiting.
  
  
  METHODS
  The primary outcome was change in bladder, bowel, and pelvic floor symptoms measured with the Pelvic Floor Distress Inventory-20 (PFDI-20), three months after the start of treatment. Secondary outcomes were changes in condition specific and general quality of life, sexual function, degree of prolapse, pelvic floor muscle function, and patients' perceived change in symptoms.
  
  
  RESULTS
  Of the 287 women who were randomised to pelvic floor muscle training (n=145) or watchful waiting (n=142), 250 (87%) completed follow-up. Participants in the intervention group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) points more on the PFDI-20 than did participants in the watchful waiting group (P=0.005). Of women in the pelvic floor muscle training group, 57% (82/145) reported an improvement in overall symptoms from the start of the study compared with 13% (18/142) in the watchful waiting group (P<0.001). Other secondary outcomes showed no significant difference between the groups.
  
  
  CONCLUSIONS
  Although pelvic floor muscle training led to a significantly greater improvement in PFDI-20 score, the difference between the groups was below the presumed level of clinical relevance (15 points). Nevertheless, 57% of the participants in the intervention group reported an improvement of overall symptoms. More studies are needed to identify factors related to success of pelvic floor muscle training and to investigate long term effects.Trial registration Dutch Trial Register (www.trialregister.nl) identifier: NTR2047.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands.
authors.forename: Marian
authors.initials: M
authors.lastname: Wiegersma
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands.
authors.forename: Chantal M C R
authors.initials: CM
authors.lastname: Panman
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands.
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Kollen
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands.
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Lisman-Van Leeuwen
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, FA21, PO Box 196, 9700 AD Groningen, Netherlands j.h.dekker@umcg.nl.
authors.forename: Janny H
authors.initials: JH
authors.lastname: Dekker
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D017773:Pelvic Floor / Q000503:physiopathology*; D056887:Pelvic Organ Prolapse / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D057832:Watchful Waiting