Institutional members access full text with Ovid®

Impact of Physical Therapy on Quality of Life and Function After Vaginal Reconstructive Surgery

Pauls, Rachel N. MD*; Crisp, Catrina C. MD*; Novicki, Kathleen PT; Fellner, Angela N. PhD; Kleeman, Steven D. MD*

Female Pelvic Medicine & Reconstructive Surgery: September/October 2013 - Volume 19 - Issue 5 - p 271–277
doi: 10.1097/SPV.0b013e31829c64ea
Original Articles
Journal Club Q and A
Journal Club

Objectives: Although pelvic floor physical therapy (PFPT) can be beneficial for complaints after vaginal reconstructive surgery, it is not routinely offered to all patients. We sought to evaluate the role of perioperative PFPT in improving quality of life and function after prolapse repairs.

Methods: This randomized controlled trial compared PFPT to standard care after vaginal reconstructive surgery. The intervention group received PFPT 2 weeks preoperatively and 2, 4, 6, 8, and 12 weeks postoperatively, as well as a physician assessment. Control subjects underwent a physician’s assessment alone at the same time points postoperatively. Both groups completed pelvic organ prolapse quantification examinations, intravaginal electromyography (EMG), voiding diaries, and validated questionnaires at baseline and 12 weeks. The primary outcome was change in the World Health Organization Quality of Life-BREF scale after surgery.

Results: Forty-nine women completed the study: 24 women in the PFPT group and 25 women in the control group. At 12 weeks, condition-specific questionnaires improved for the entire sample, confirming effectiveness of surgery. Nevertheless, no significant differences were noted between the groups despite therapy with PFPT. However, intravaginal EMG measures were notably affected by the intervention. The PFPT group showed significantly lower averages across all measurements of rest, indicating positive impact on muscle function. Pearson correlations revealed associations with better scores on the World Health Organization Quality of Life-BREF physical domain and greater EMG relaxation, supporting effects from PFPT on quality of life.

Conclusions: Pelvic symptoms improved in all subjects after vaginal reconstructive surgery. Whereas PFPT did not result in detectable subjective differences in this short-term study, superior muscular function suggested benefit from the intervention.

Pelvic floor physical therapy following vaginal reconstructive surgery resulted in superior muscular function at 3 months postoperatively, and could lead to improvements in overall quality of life.

From the *Division of Urogynecology and Reconstructive Pelvic Surgery,Department of Obstetrics and Gynecology, TriHealth Good Samaritan Hospital; †Center for Core and Pelvic Floor Physical Therapy, Sports Therapy Inc; and ‡Hatton Institute for Research and Education, TriHealth Inc, Cincinnati, OH.

Reprints: Rachel N. Pauls, MD, Program Director, Fellowship in Female Pelvic Medicine and Reconstructive Pelvic Surgery, Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, 3219 Clifton Ave, #100, Cincinnati, OH, 45220. E-mail: Rachel_Pauls@trihealth.com.

Reprints will not be available.

The study received funding from the Medical Education Research Fund, TriHealth Good Samaritan Hospital, Cincinnati, Ohio.

The authors have declared they have no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins