Activity restriction recommendations and outcomes after reconstructive pelvic surgery: A randomized controlled trial

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

Research output: Contribution to journalArticle

Abstract

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, doubleblind 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 (n545 liberal, n550 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.

LanguageEnglish (US)
Pages608-614
Number of pages7
JournalObstetrics and Gynecology
Volume129
Issue number4
DOIs
StatePublished - 2017

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Reconstructive Surgical Procedures
Randomized Controlled Trials
Prolapse
Pelvic Floor
Patient Satisfaction
Pelvic Organ Prolapse
Suspensions
Odds Ratio

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Mueller, M. G., Lewicky-Gaupp, C., Collins, S. A., Abernethy, M. G., Alverdy, A., & Kenton, K. (2017). Activity restriction recommendations and outcomes after reconstructive pelvic surgery: A randomized controlled trial. Obstetrics and Gynecology, 129(4), 608-614. DOI: 10.1097/AOG.0000000000001924

Activity restriction recommendations and outcomes after reconstructive pelvic surgery : A randomized controlled trial. / Mueller, Margaret G.; Lewicky-Gaupp, Christina; Collins, Sarah A.; Abernethy, Melinda G.; Alverdy, Alex; Kenton, Kimberly.

In: Obstetrics and Gynecology, Vol. 129, No. 4, 2017, p. 608-614.

Research output: Contribution to journalArticle

Mueller, MG, Lewicky-Gaupp, C, Collins, SA, Abernethy, MG, Alverdy, A & Kenton, K 2017, 'Activity restriction recommendations and outcomes after reconstructive pelvic surgery: A randomized controlled trial' Obstetrics and Gynecology, vol. 129, no. 4, pp. 608-614. DOI: 10.1097/AOG.0000000000001924
Mueller MG, Lewicky-Gaupp C, Collins SA, Abernethy MG, Alverdy A, Kenton K. Activity restriction recommendations and outcomes after reconstructive pelvic surgery: A randomized controlled trial. Obstetrics and Gynecology. 2017;129(4):608-614. Available from, DOI: 10.1097/AOG.0000000000001924
Mueller, Margaret G. ; Lewicky-Gaupp, Christina ; Collins, Sarah A. ; Abernethy, Melinda G. ; Alverdy, Alex ; Kenton, Kimberly. / Activity restriction recommendations and outcomes after reconstructive pelvic surgery : A randomized controlled trial. In: Obstetrics and Gynecology. 2017 ; Vol. 129, No. 4. pp. 608-614
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N2 - 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, doubleblind 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 (n545 liberal, n550 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.

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