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Activity Restriction Recommendations and Outcomes After Reconstructive Pelvic Surgery: A Randomized Controlled Trial

Mueller, Margaret G. MD; Lewicky-Gaupp, Christina MD; Collins, Sarah A. MD; Abernethy, Melinda G. MPH, MD; Alverdy, Alex MS; Kenton, Kimberly MD, MS

doi: 10.1097/AOG.0000000000001924
Contents: Original Research
Journal Club

OBJECTIVE: To assess the relationship between prescribed postoperative activity recommendations (liberal compared with restricted) after reconstructive prolapse surgery and patient satisfaction and pelvic floor symptoms.

METHODS: In our multicenter, randomized, double-blind clinical trial, women undergoing reconstructive prolapse surgery were randomized to liberal compared with restricted postoperative activity recommendations. Liberal recommendations instructed women to resume postoperative activity at the woman's own pace with no restrictions on lifting or high-impact activities. Conversely, restricted recommendations instructed women to avoid heavy lifting or strenuous exercise for 3 months. The primary outcome, patient satisfaction, was assessed on a 5-point Likert scale at 3 months postoperatively with the question, “How satisfied are you with the result of your prolapse surgery?” Secondary outcomes included anatomic outcomes and pelvic floor symptoms.

RESULTS: From September 2014 to December 2015, 130 women were screened and 108 were randomized. Ultimately, 95 were allocated to study intervention (n=45 liberal, n=50 restricted) and completed the primary outcome. Baseline characteristics (including pelvic organ prolapse quantification stage and demographics) and surgical intervention did not differ between groups. Most women underwent a minimally invasive sacrocolpopexy (58) followed by vaginal suspension (27) or vaginal closure procedures (nine). Rates of satisfaction were similarly high in the liberal and restricted recommendations groups (98% compared with 94%, odds ratio 0.36 [0.036–3.55], P=.619). Anatomic outcomes did not differ between groups; however, fewer pelvic floor symptoms were reported in the liberal group.

CONCLUSION: Satisfaction was equally high 3 months after prolapse surgery in women who were instructed to liberally resume activities compared with those instructed to restrict postoperative activities. Women who liberally resumed their activities reported fewer prolapse and urinary symptoms and had similar short-term anatomic outcomes suggesting that allowing women to resume their normal activities postoperatively may result in improved pelvic floor outcomes.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02138487.

Recommending liberal resumption of normal activities, rather than restricting activity after reconstructive pelvic surgery, results in similar levels of satisfaction.

Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics & Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, John Hopkins University School of Medicine, Baltimore, Maryland.

Corresponding author: Margaret G. Mueller, MD, 250 E Superior Street, Suite 5-2370, Chicago, IL 60611; email: mgmueller@nm.org.

Funded by a grant from the Friends of Prentice charitable organization. The authors thank Drs. Bhumy Dave, Alix Leader-Cramer, Kate Bocheska as well as Maureen Sheetz for their contributions to recruitment for this study.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.