Adherence to Perioperative Behavioral Therapy With Pelvic Floor Muscle Training in Women Receiving Vaginal Reconstructive Surgery for Pelvic Organ Prolapse
Authors: Borello-France Diane , Newman Diane K , Markland Alayne D , Propst Katie , Jelovsek J Eric , Cichowski Sara , Gantz Marie G , Balgobin Sunil , Jakus-Waldman Sharon , Korbly Nicole , Mazloomdoost Donna , Burgio Kathryn L ,   for The NICHD Pelvic Floor Disorders Network, Korbly Nicole , Barber Matthew D , Frick Anna , O’Dougherty Betsy , Propst Katie , Pung Ly , Ridgeway Beri M , Williams Cheryl , Eric Jelovsek J , Amundsen Cindy L , Harm-Ernandes Ingrid , Raynor Mary , Siddiqui Nazema Y , Visco Anthony G , Weidner Alison C , Wu Jennifer M , Jakus-Waldman Sharon , Diwadkar Gouri , Dyer Keisha Y , Hall Lynn M , Mackinnon Linda M , Menefee Shawn A , Nguyen John N , Tan-Kim Jasmine , Zazueta-Damian Gisselle , Brubaker Linda , Mueller Elizabeth , Tulke Mary , Borello-France Diane , Cichowski Sara , Gantz Marie , Warren Lauren Klein , Matthews Daryl , Grey Scott , Shaffer Amanda , Terry Tamara T , Thornberry Jutta , Wallace Dennis , Whitworth Ryan E , Wilson Kevin A , Hartmann Katherine , Ballard Alicia , Burge Julie , Burgio Kathryn L , Carter Kathy , Goode Patricia S , Markland Alayne D , Pair Lisa S , Parker-Autry Candace , Richter Holly E , Edward Varner R , Wilson Tracey S , Albo Michael E , Grimes Cara , Lukacz Emily S , Nager Charles W , Casher Yang Wang , Chen Yeh-Hsin , DiFranco Donna , Marchant Bev , Spino Cathie , Wei John T , Newman Diane , Baker Jan , Hsu Yvonne , Masters Maria , Orr Amy , Atnip Shanna , Balgobin Sunil , Moore Elva Kelly , Rahn David , Schaffer Joseph , Wai Clifford , Meikle Susan F , Burgio Kathryn L , Markland Alayne D , Grey Scott 
Published: June 2023

Abstract

Objective
The objective of this study was to describe adherence to behavioral and pelvic floor muscle training in women undergoing vaginal reconstructive surgery for organ prolapse and to examine whether adherence was associated with 24-month outcomes.

Methods
Participants were women ≥18 years of age, with vaginal bulge and stress urinary incontinence symptoms, planning to undergo vaginal reconstructive surgery for stages 2 to 4 vaginal or uterine prolapse. They were randomized to either sacrospinous ligament fixation or uterosacral ligament suspension and to perioperative behavioral and pelvic floor muscle training or usual care. Measurements included anatomic failure, pelvic floor muscle strength, participant-reported symptoms, and perceived improvement. Analyses compared women with lower versus higher adherence.

Results
Forty-eight percent of women performed pelvic floor muscle exercises (PFMEs) daily at the 4- to 6-week visit. Only 33% performed the prescribed number of muscle contractions. At 8 weeks, 37% performed PFMEs daily, and 28% performed the prescribed number of contractions. No significant relationships were found between adherence and 24-month outcomes.

Conclusion
Adherence to a behavioral intervention was low following vaginal reconstructive surgery for pelvic organ prolapse. The degree of adherence to perioperative training did not appear to influence 24-month outcomes in women undergoing vaginal prolapse surgery.

Impact
This study contributes to the understanding of participant adherence to PFMEs and the impact that participant adherence has on outcomes at 2, 4 to 6, 8, and 12 weeks and 24 months postoperatively. It is important to educate women to follow up with their therapist or physician to report new or unresolved pelvic symptoms.