Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial

Suzanne Hagen, Diane Stark, Catherine Glazener, Sylvia Dickson, Sarah Barry, Andrew Elders, Helena Frawley, Mary P Galea, Janet Logan, Alison McDonald, Gladys McPherson, Kate H Moore, John Norrie, Andrew Walker, Don Wilson

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Background: Pelvic organ prolapse is common and is strongly associated with childbirth and increasing age. Women with prolapse are often advised to do pelvic floor muscle exercises, but evidence supporting the benefits of such exercises is scarce. We aimed to establish the effectiveness of one-to-one individualised pelvic floor muscle training for reducing prolapse symptoms. Methods: We did a parallel-group, multicentre, randomised controlled trial at 23 centres in the UK, one in New Zealand, and one in Australia, between June 22, 2007, and April 9, 2010. Female outpatients with newly-diagnosed, symptomatic stage I, II, or III prolapse were randomly assigned (1:1), by remote computer allocation with minimsation, to receive an individualised programme of pelvic floor muscle training or a prolapse lifestyle advice leaflet and no muscle training (control group). Outcome assessors, and investigators who were gynaecologists at trial sites, were masked to group allocation; the statistician was masked until after data analysis. Our primary endpoint was participants' self-report of prolapse symptoms at 12 months. Analysis was by intention-to-treat analysis. This trial is registered, number ISRCTN35911035. Findings: 447 eligible patients were randomised to the intervention group (n=225) or the control group (n=222). 377 (84%) participants completed follow-up for questionnaires at 6 months and 295 (66%) for questionnaires at 12 months. Women in the intervention group reported fewer prolapse symptoms (ie, a significantly greater reduction in the pelvic organ prolapse symptom score [POP-SS]) at 12 months than those in the control group (mean reduction in POP-SS from baseline 3·77 [SD 5·62] vs 2·09 [5·39]; adjusted difference 1·52, 95% CI 0·46–2·59; p=0·0053). Findings were robust to missing data. Eight adverse events (six vaginal symptoms, one case of back pain, and one case of abdominal pain) and one unexpected serious adverse event, all in women from the intervention group, were regarded as unrelated to the intervention or to participation in the study. Interpretation: One-to-one pelvic floor muscle training for prolapse is effective for improvement of prolapse symptoms. Long-term benefits should be investigated, as should the effects in specific subgroups.

LanguageEnglish
Pages796-806
Number of pages11
JournalLancet
Volume383
Issue number9919
Early online date28 Nov 2013
DOIs
Publication statusPublished - 1 Mar 2014

Fingerprint

Pelvic Organ Prolapse
Pelvic Floor
Prolapse
Randomized Controlled Trials
Muscles
Control Groups
Exercise
Intention to Treat Analysis
Back Pain
New Zealand
Self Report
Abdominal Pain
Life Style
Outpatients
Research Personnel
Parturition

Keywords

  • pelvic organs
  • prolapse
  • pelvic floor muscle training

Cite this

Hagen, Suzanne ; Stark, Diane ; Glazener, Catherine ; Dickson, Sylvia ; Barry, Sarah ; Elders, Andrew ; Frawley, Helena ; Galea, Mary P ; Logan, Janet ; McDonald, Alison ; McPherson, Gladys ; Moore, Kate H ; Norrie, John ; Walker, Andrew ; Wilson, Don. / Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY) : a multicentre randomised controlled trial. In: Lancet. 2014 ; Vol. 383, No. 9919. pp. 796-806.
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Hagen, S, Stark, D, Glazener, C, Dickson, S, Barry, S, Elders, A, Frawley, H, Galea, MP, Logan, J, McDonald, A, McPherson, G, Moore, KH, Norrie, J, Walker, A & Wilson, D 2014, 'Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial' Lancet, vol. 383, no. 9919, pp. 796-806. https://doi.org/10.1016/S0140-6736(13)61977-7

Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY) : a multicentre randomised controlled trial. / Hagen, Suzanne; Stark, Diane; Glazener, Catherine; Dickson, Sylvia; Barry, Sarah; Elders, Andrew; Frawley, Helena; Galea, Mary P; Logan, Janet; McDonald, Alison; McPherson, Gladys; Moore, Kate H; Norrie, John; Walker, Andrew; Wilson, Don.

In: Lancet, Vol. 383, No. 9919, 01.03.2014, p. 796-806.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY)

T2 - Lancet

AU - Hagen, Suzanne

AU - Stark, Diane

AU - Glazener, Catherine

AU - Dickson, Sylvia

AU - Barry, Sarah

AU - Elders, Andrew

AU - Frawley, Helena

AU - Galea, Mary P

AU - Logan, Janet

AU - McDonald, Alison

AU - McPherson, Gladys

AU - Moore, Kate H

AU - Norrie, John

AU - Walker, Andrew

AU - Wilson, Don

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Background: Pelvic organ prolapse is common and is strongly associated with childbirth and increasing age. Women with prolapse are often advised to do pelvic floor muscle exercises, but evidence supporting the benefits of such exercises is scarce. We aimed to establish the effectiveness of one-to-one individualised pelvic floor muscle training for reducing prolapse symptoms. Methods: We did a parallel-group, multicentre, randomised controlled trial at 23 centres in the UK, one in New Zealand, and one in Australia, between June 22, 2007, and April 9, 2010. Female outpatients with newly-diagnosed, symptomatic stage I, II, or III prolapse were randomly assigned (1:1), by remote computer allocation with minimsation, to receive an individualised programme of pelvic floor muscle training or a prolapse lifestyle advice leaflet and no muscle training (control group). Outcome assessors, and investigators who were gynaecologists at trial sites, were masked to group allocation; the statistician was masked until after data analysis. Our primary endpoint was participants' self-report of prolapse symptoms at 12 months. Analysis was by intention-to-treat analysis. This trial is registered, number ISRCTN35911035. Findings: 447 eligible patients were randomised to the intervention group (n=225) or the control group (n=222). 377 (84%) participants completed follow-up for questionnaires at 6 months and 295 (66%) for questionnaires at 12 months. Women in the intervention group reported fewer prolapse symptoms (ie, a significantly greater reduction in the pelvic organ prolapse symptom score [POP-SS]) at 12 months than those in the control group (mean reduction in POP-SS from baseline 3·77 [SD 5·62] vs 2·09 [5·39]; adjusted difference 1·52, 95% CI 0·46–2·59; p=0·0053). Findings were robust to missing data. Eight adverse events (six vaginal symptoms, one case of back pain, and one case of abdominal pain) and one unexpected serious adverse event, all in women from the intervention group, were regarded as unrelated to the intervention or to participation in the study. Interpretation: One-to-one pelvic floor muscle training for prolapse is effective for improvement of prolapse symptoms. Long-term benefits should be investigated, as should the effects in specific subgroups.

AB - Background: Pelvic organ prolapse is common and is strongly associated with childbirth and increasing age. Women with prolapse are often advised to do pelvic floor muscle exercises, but evidence supporting the benefits of such exercises is scarce. We aimed to establish the effectiveness of one-to-one individualised pelvic floor muscle training for reducing prolapse symptoms. Methods: We did a parallel-group, multicentre, randomised controlled trial at 23 centres in the UK, one in New Zealand, and one in Australia, between June 22, 2007, and April 9, 2010. Female outpatients with newly-diagnosed, symptomatic stage I, II, or III prolapse were randomly assigned (1:1), by remote computer allocation with minimsation, to receive an individualised programme of pelvic floor muscle training or a prolapse lifestyle advice leaflet and no muscle training (control group). Outcome assessors, and investigators who were gynaecologists at trial sites, were masked to group allocation; the statistician was masked until after data analysis. Our primary endpoint was participants' self-report of prolapse symptoms at 12 months. Analysis was by intention-to-treat analysis. This trial is registered, number ISRCTN35911035. Findings: 447 eligible patients were randomised to the intervention group (n=225) or the control group (n=222). 377 (84%) participants completed follow-up for questionnaires at 6 months and 295 (66%) for questionnaires at 12 months. Women in the intervention group reported fewer prolapse symptoms (ie, a significantly greater reduction in the pelvic organ prolapse symptom score [POP-SS]) at 12 months than those in the control group (mean reduction in POP-SS from baseline 3·77 [SD 5·62] vs 2·09 [5·39]; adjusted difference 1·52, 95% CI 0·46–2·59; p=0·0053). Findings were robust to missing data. Eight adverse events (six vaginal symptoms, one case of back pain, and one case of abdominal pain) and one unexpected serious adverse event, all in women from the intervention group, were regarded as unrelated to the intervention or to participation in the study. Interpretation: One-to-one pelvic floor muscle training for prolapse is effective for improvement of prolapse symptoms. Long-term benefits should be investigated, as should the effects in specific subgroups.

KW - pelvic organs

KW - prolapse

KW - pelvic floor muscle training

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