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The Evaluation of Baseline Physical Function and Cognition in Women Undergoing Pelvic Floor Surgery

Nieto, Maria L. MD*; Kisby, Cassandra MD; Matthews, Catherine A. MD*; Wu, Jennifer M. MD, MPH*‡

Female Pelvic Medicine & Reconstructive Surgery: January/February 2016 - Volume 22 - Issue 1 - p 51–54
doi: 10.1097/SPV.0000000000000223
Original Articles

Objectives Physical and cognitive function impairments are associated with increased perioperative morbidity; however, limited data exist regarding these parameters in women planning pelvic floor surgery. Thus, our goal was to assess baseline physical function and cognition in patients scheduled for pelvic reconstructive surgery and to evaluate factors associated with preoperative upper and lower body function.

Methods In a prospective study, we evaluated sociodemographics, body mass index, the Functional Comorbidity Index (FCI), Katz Activities of Daily Living (ADL), and Instrumental ADL (IADL). Physical function was evaluated with Timed Up and Go (TUG) test and dynamometers to assess handgrip and pinch strength. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive impairment.

Results Among 142 women in our study population, mean age was 58.4 ± 13.9 years, comorbidities were low (mean FCI, 3.7 ± 2.7) and independence level was high (mean ADL, 5.7 ± 0.5; mean IADL, 7.8 ± 0.8). Mean TUG test was 11.6 ± 4.5 seconds, reflecting mildly impaired mobility. Maximum handgrip and pinch strength were 51.7 ± 16.6 lb and 12.7 ± 3.6 lb, respectively, which represent normal/above average scores. Age (P = 0.007), body mass index (P = 0.003), IADL (P = 0.003), and MMSE (P = 0.003) were significantly associated with TUG test scores in a multivariate linear regression analysis that adjusted for FCI. The mean MMSE mean score was 29.2 ± 0.9; only 3.5% had mild cognitive impairment and 0.7% had moderate-severe impairment.

Conclusions Women undergoing elective pelvic reconstructive surgery had good physical and cognitive function. The simple TUG test was the most likely tool to identify patients with poorer physical function.

Evaluation of baseline physical function using the Timed Up and Go Test in patients undergoing pelvic floor surgery easily identifies patients with poor mobility.

From the *Division of Urogynecology, Department of Obstetrics/Gynecology, University of North Carolina at Chapel Hill, Chapel Hill; †Department of Obstetrics and Gynecology, Duke University, Duke-Durham; and ‡Center for Women's Health Research and Center of Health and Aging, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Reprints: Maria L. Nieto, MD, University of North Carolina at Chapel Hill, CB no. 7570, 3032 Old Clinics Bldg, Chapel Hill, NC 27599-7570. E-mail:

J.M. Wu is a Proctor and Gamble consultant. C.A. Matthews is a Pelvalon and Boston Scientific consultant. The other authors have declared that there are no conflicts of interest.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.