Activity Restriction Recommendations and Outcomes After Reconstructive Pelvic Surgery: A Randomized Controlled Trial
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, double-blind 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 (n=45 liberal, n=50 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. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02138487.
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Two trials reported on objective failure at any site (Barber 2014; Mueller 2017).
“Two trials reported on objective failure at any site (Barber 2014; Mueller 2017).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
The effect of liberal activity on pelvic organ prolapse outcomes after surgery remains unclear.
“Given the trial design as a superiority study, and caution in the interpretation of nonsignificant secondary outcomes in such trials, the effect of liberal activity on POP outcomes after surgery remains unclear.7”
From Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery (2023) · cites this paper as [7]
The abdominal surgery literature regarding postoperative activity is limited; a recent systematic review identified only 2 randomized trials.
“The abdominal surgery literature regarding postoperative activity is limited. A recent systematic review of activity restrictions after abdominal surgery identified only 2 randomized trials.5,6,7”
From Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery (2023) · cites this paper as [7]
Another randomized trial of restrictive versus liberal activity recommendations following pelvic organ prolapse surgery found no differences in patient satisfaction at 3 months and 1 year postoperatively.
“Another randomized trial of restrictive vs liberal activity recommendations following POP surgery found no differences in patient satisfaction at 3 months and 1 year postoperatively.7,8”
From Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery (2023) · cites this paper as [7]
Our study population differs from the Mueller et al study in that only 45% underwent mesh sacrocolpopexy compared with 61% in the Mueller et al study.
“Separate from trial design, our study population differs, as only 45% underwent mesh sacrocolpopexy compared with 61% in the Mueller et al study.”
From Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery (2023) · cites this paper as [7]
Our findings are consistent with the randomized superiority trial by Mueller et al of restrictive vs liberal activity recommendations following prolapse surgery.
“Our findings are consistent with the aforementioned randomized superiority trial by Mueller et al7 of restrictive vs liberal activity recommendations following prolapse surgery.”
From Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery (2023) · cites this paper as [7]
Two trials with a total of 210 women evaluated POP surgery with restricted versus liberal postoperative activity instructions.
“POP surgery with restricted versus liberal postoperative activity instructions: two trials with a total of 210 women (Arunachalam 2019; Mueller 2017).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
Three trials reported on awareness of prolapse (Ballard 2014; Barber 2014; Mueller 2017).
“Three trials reported on awareness of prolapse (Ballard 2014; Barber 2014; Mueller 2017).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
Two trials reported on POPQ assessments (Barber 2014; Mueller 2017).
“Two trials reported on POPQ assessments (Barber 2014; Mueller 2017).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
There may be no clinically relevant difference in women's awareness of prolapse with restricted versus liberal postoperative activity instructions.
“Based on evidence from a single trial (Mueller 2017), there may be no clinically relevant difference in women's awareness of prolapse with restricted versus liberal postoperative activity instructions (OR 0.94, 95% CI 0.20 to 4.53; 1 study, 95 women; low‐certainty evidence; Analysis 10.1).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
There may be no clinically relevant difference in objective failure at any site with restricted versus liberal postoperative activity instructions.
“Based on evidence from a single trial (Mueller 2017), there may be no clinically relevant difference in objective failure at any site with restricted versus liberal postoperative activity instructions (OR 0.65, 95% CI 0.26 to 1.62; 1 study, 95 women; low‐certainty evidence; Analysis 10.2).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
There may be no evidence of a clinically relevant difference in PGI-I scores amongst women given restricted versus liberal postoperative activity instructions.
“Based on evidence from a single trial (Mueller 2017), there may be no evidence of a clinically relevant difference in PGI‐I scores amongst women given restricted versus liberal postoperative activity instructions (OR 0.31, 95% CI 0.06 to 1.68; 1 study, 83 women; low‐certainty evidence; Analysis 10.5).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
There may be no clinically relevant difference in POPQ assessment for Point Ba amongst women given restricted versus liberal postoperative activity instructions.
“Based on evidence from a single trial (Mueller 2017), there may be no clinically relevant difference in POPQ assessment for Point Ba amongst women given restricted versus liberal postoperative activity instructions (MD 0.10, 95% CI ‐0.50 to 0.70; 1 study, 77 women; low‐certainty evidence; Analysis 10.3).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
There may be no clinically relevant difference in POPQ assessment for Point C amongst women given restricted versus liberal postoperative activity instructions.
“Based on evidence from a single trial (Mueller 2017), there may be no clinically relevant difference in POPQ assessment for Point C amongst women given restricted versus liberal postoperative activity instructions (MD 0.16, 95% CI ‐0.37 to 0.69; 1 study, 95 women; low‐certainty evidence; Analysis 10.3).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
There may be no clinically relevant difference in POPQ assessment for Point Bp amongst women given restricted versus liberal postoperative activity instructions.
“Based on evidence from a single trial (Mueller 2017), there may be no clinically relevant difference in POPQ assessment for Point Bp amongst women given restricted versus liberal postoperative activity instructions (MD 0.18, 95% CI ‐0.43 to 0.79; 1 study, 77 women; low‐certainty evidence; Analysis 10.3).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
In the same trial, there was no clinically relevant difference in POPQ assessment at three months' follow-up between restricted and liberal postoperative activity instructions.
“Similarly, the same trial reported no clinically relevant difference in POPQ assessment at three months' follow‐up with restricted versus liberal postoperative activity instructions (Mueller 2017).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Mueller 2017
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- Authors
- Mueller, M. G., Lewicky-Gaupp, C., Collins, S. A., Abernethy, M. G., Alverdy, A., & Kenton, K.
- Affiliations
- Northwestern University (US)
- Venue
- Obstetrics & Gynecology
- Published
- 2017-04
- Volume
- 129
- Issue
- 4
- Pages
- 608-614
- ISSN
- 0029-7844 (ISSN-L)
- 1873-233X
- OpenAlex
- W2592219654
- Cited by
- 46
- References
- 16
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 9 · 2019: 1 · 2018: 3 · 2017: 2
- FWCI
- 3.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Keywords
- postoperative activity restrictions, pelvic organ prolapse surgery, sacrocolpopexy, patient satisfaction, pelvic floor symptoms, urinary symptoms, anatomical outcomes, heavy lifting
- MeSH terms
- Activities of Daily Living, Aged, Double-Blind Method, Female, Humans, Middle Aged, Postoperative Period, Weight-Bearing, Treatment Outcome, Patient Satisfaction, Pelvic Floor, Plastic Surgery Procedures, Directive Counseling, Pelvic Organ Prolapse
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