Two‐year effects and cost‐effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care

Panman, CMCR; Wiegersma, M; Kollen, BJ; Berger, MY; Lisman‐Van Leeuwen, Y; Vermeulen, KM; Dekker, JH

doi:10.1111/1471-0528.13992

Cited by 57Pelvic floor disorders treatmentsSexual function and dysfunction studiesUrinary Bladder and Prostate Research

Two‐year effects and cost‐effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care

Panman, CMCR, Wiegersma, M, Kollen, BJ, Berger, MY, Lisman‐Van Leeuwen, Y, Vermeulen, KM, Dekker, JH·2017·BJOG: An International Journal of Obstetrics & Gynaecology

DOI 10.1111/1471-0528.13992

Open this paper in CoChat — free account

Abstract

Objective: To compare effects and cost‐effectiveness of pelvic floor muscle training (PFMT) and watchful waiting in women with pelvic organ prolapse. Design: Randomised controlled trial. Setting: Dutch general practice. Population: Women (≥55 years) with symptomatic mild prolapse, identified by screening. Methods: Linear multilevel analysis. Main outcome measures: Primary outcome was change of pelvic floor symptoms (Pelvic‐Floor‐Distress‐Inventory‐20 [PFDI‐20]) during 24 months. Secondary outcomes were condition‐specific and general quality of life, costs, sexual functioning, prolapse stage, pelvic floor muscle function and women's perceived improvement of symptoms. Results: PFMT (n = 145) resulted in a 12.2‐point (95% CI 7.2–17.2, P < 0.001) greater improvement in PFDI‐20 score during 24 months compared with watchful waiting (n = 142). Participants randomised to PFMT more often reported improved symptoms (43% versus 14% for watchful waiting). Direct medical costs per person were €330 for PFMT and €91 for watchful waiting but costs for absorbent pads were lower in the PFMT group (€40 versus €77). Other secondary outcomes did not differ between groups. Post‐hoc subgroup analysis demonstrated that PFMT was more effective in women experiencing higher pelvic floor symptom distress at baseline. Conclusion: PFMT resulted in greater pelvic floor symptom improvement compared with watchful waiting. The difference was statistically significant, but below the presumed level of clinical relevance (15 points). PFMT more often led to women's perceived improvement of symptoms, lower absorbent pads costs, and was more effective in women experiencing higher pelvic floor symptom distress. Therefore, PFMT could be advised in women with bothersome symptoms of mild prolapse. Tweetable abstract: Pelvic floor muscle training can be effective in women with bothersome symptoms of mild prolapse.

Integrity signals

Registry

Crossref · 10.1111/1471-0528.13992

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

The two RCTs offering supervised PFMT for a longer time showed improvement in bladder and anorectal symptoms in women with POP.
“The two RCTs offering supervised PFMT for a longer time showed improvement in bladder and anorectal symptoms in women with POP [25, 39, 74].”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [39]
Significant differences in some measures of POP symptoms were maintained at the 2-year longitudinal follow-up.
“Significant differences were maintained in some of the measures of symptoms at the 2-year longitudinal follow-up [39].”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [39]
In Wiegersma et al.-14, there was no difference in POP-Q, but significant improvement in PFDI-20 in PFMT vs control; 57% vs 13% reported overall improvement in symptoms.
“No difference in POP-Q. Significant improvement in PFDI-20 in PFMT vs control; 57% in PFMT vs 13% in control reported overall improvement in symptoms”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [39]
Long-term effect was found in the findings of Panman et al. 2017 and McClurg et al. 2019, but not of Barber et al. 2015, Jelovsek et al. 2018 and Due et al. 2016b.
“Long-term effect was found in the findings of Panman et al. 2017 [39] and McClurg et al. 2019 [52], but not of Barber et al. 2015 [62], Jelovsek et al. 2018 [67] and Due et al. 2016b [50].”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [39]
Eight studies found that PFMT improved bladder symptoms and five studies found improvement of anorectal symptoms in women with POP.
“Eight studies found that PFMT improved bladder symptoms [38, 39, 43, 44, 47, 60, 61, 74] and five studies found improvement of anorectal symptoms [39, 43, 44, 47, 61, 74].”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [39]

A 12-Item Short-Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity
WARE, J. E., KOSINSKI, M., & KELLER, S. D. (1996) · Medical Care · doi:10.1097/00005650-199603000-00003 · Cited by 17,392 · see citing works
Untitled work
(1997) · doi:10.1097/00005650-199711000-00002 · Cited by 4,544 · see citing works
The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction
Bump, R. C., Mattiasson, A., Bø, K., Brubaker, L. P., DeLancey, J. O. L., Klarskov, P., Shull, B. L., & Smith, A. R. B. (1996) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(96)70243-0 · Cited by 4,275 · see citing works
An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction
Haylen, B. T., Ridder, D. J. M. K. D., Freeman, R. M., Swift, S., Berghmans, B. C. M., Lee, J., Monga, A. K., Petri, E., Rizk, D. E. E., Sand, P. K., et al. (2009) · Neurourology and Urodynamics · doi:10.1002/nau.20798 · Cited by 3,090 · see citing works
Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7)
Barber, M. D., Walters, M. D., & Bump, R. C. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.12.025 · Cited by 1,357 · see citing works
Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide
Twisk, J. W. R. (2003) · Cited by 1,244 · see citing works
Pelvic organ prolapse
Jelovsek, J. E., Maher, C., & Barber, M. D. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60462-0 · Cited by 976 · see citing works
A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)
Rogers, R. G., Coates, K. W., KAMMERER-DOAK, D. N., Khalsa, S., & Qualls, C. (2003) · International Urogynecology Journal · doi:10.1007/s00192-003-1063-2 · Cited by 754 · see citing works
Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects
Swift, S., Woodman, P., O'Boyle, A., Kahn, M., Valley, M., Bland, D., Wang, W., & Schaffer, J. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.10.602 · Cited by 752 · see citing works
Applied Multilevel Analysis
Twisk, J. W. R. (2006) · Cambridge University Press eBooks · doi:10.1017/cbo9780511610806 · Cited by 692 · see citing works
Standardization of terminology of pelvic floor muscle function and dysfunction: Report from the pelvic floor clinical assessment group of the International Continence Society
Messelink, B., Benson, T., Berghmans, B. C. M., Bø, K., Corcos, J., Fowler, C. J., Laycock, J., Lim, P. H., van Lunsen, R. H. W., Nijeholt, G. A. B. L. À., et al. (2005) · Neurourology and Urodynamics · doi:10.1002/nau.20144 · Cited by 545 · see citing works
Progression and remission of pelvic organ prolapse: A longitudinal study of menopausal women
Handa, V. L., Garrett, E., Hendrix, S. L., Gold, E. B., & Robbins, J. A. (2004) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2003.07.017 · Cited by 353 · see citing works
The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population
Hove, M. C. P. S., Pool‐Goudzwaard, A., Eijkemans, M. J. C., Steegers‐Theunissen, R. P. M., Burger, C. W., & Vierhout, M. E. (2009) · International Urogynecology Journal · doi:10.1007/s00192-009-0902-1 · Cited by 266 · see citing works
Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): A multicentre randomised controlled trial
Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., Frawley, H., Galea, M. P., Logan, J., McDonald, A., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(13)61977-7 · Cited by 258 · see citing works
Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide
Braitman, L. E. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-8-200404200-00042 · Cited by 247 · see citing works
Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial
Brækken, I. H., Majida, M., Engh, M. E., & Bø, K. (2010) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.02.037 · Cited by 241 · see citing works
Symptomatic Pelvic Organ Prolapse at Midlife, Quality of Life, and Risk Factors
Fritel, X., Varnoux, N., Zins, M., Breart, G., & Ringa, V. (2009) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e3181985312 · Cited by 197 · see citing works
Natural history of pelvic organ prolapse in postmenopausal women
Bradley, C. S., Zimmerman, M. B., Qi, Y., & Nygaard, I. E. (2007) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000255977.91296.5d · Cited by 158 · see citing works
A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength
Culligan, P. J., Scherer, J., Dyer, K. Y., Priestley, J., Guingon-White, G., Delvecchio, D., & Vangeli, M. (2010) · International Urogynecology Journal · doi:10.1007/s00192-009-1046-z · Cited by 140 · see citing works
Symptomatic pelvic organ prolapse and possible risk factors in a general population
Hove, M. C. P. S., Pool‐Goudzwaard, A., Eijkemans, M. J. C., Steegers‐Theunissen, R. P. M., Burger, C. W., & Vierhout, M. E. (2008) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2008.08.070 · Cited by 139 · see citing works
Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care
Wiegersma, M., Panman, C. M. C. R., Kollen, B. J., Berger, M. Y., Lisman-Van Leeuwen, Y., & Dekker, J. H. (2014) · BMJ · doi:10.1136/bmj.g7378 · Cited by 122 · see citing works
Self-citation
A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse
Hagen, S., Stark, D., Glazener, C., Sinclair, L., & Ramsay, I. (2009) · International Urogynecology Journal · doi:10.1007/s00192-008-0726-4 · Cited by 116 · see citing works
Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: Validation of three global patient ratings
Burgio, K. L., Goode, P. S., Richter, H. E., Locher, J. L., & Roth, D. L. (2006) · Neurourology and Urodynamics · doi:10.1002/nau.20243 · Cited by 109 · see citing works
Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial
Stüpp, L., Resende, A. P. M., Oliveira, E., Castro, R. A., Girão, M. J. B. C., & Sartori, M. G. F. (2011) · International Urogynecology Journal · doi:10.1007/s00192-011-1428-x · Cited by 85 · see citing works
Can pelvic floor muscle training prevent and treat pelvic organ prolapse?
Bø, K. (2006) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1080/00016340500486800 · Cited by 78 · see citing works
The Effect of Pelvic Organ Prolapse on Sexual Function in a General Cohort of Women
Tok, E. C., Yaşa, O., Ertunç, D., Savaş, A., Durukan, H., & Kanık, A. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2010.01940.x · Cited by 69 · see citing works
Untitled work
(2003) · PubMed · Cited by 61 · see citing works
Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I–III pelvic organ prolapse
Kashyap, R., Jain, V., & Singh, A. (2013) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2012.11.012 · Cited by 53 · see citing works
Apport du traitement conservateur dans la prise en charge du prolapsus urogénital de bas grade. Le devenir après deux ans
Ghroubi, S., Kharrat, O., Chaari, M., Ben Ayed, B., Guermazi, M., & Elleuch, M. H. (2008) · Annales de Réadaptation et de Médecine Physique · doi:10.1016/j.annrmp.2007.11.002 · Cited by 46 · see citing works
Vaginal prolapse – perceptions and healthcare‐seeking behavior among women prior to gynecological surgery
Pakbaz, M., Rolfsman, E., Mogren, I., & Löfgren, M. (2011) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/j.1600-0412.2011.01225.x · Cited by 37 · see citing works
Pelvic floor muscle training versus watchful waiting or pessary treatment for pelvic organ prolapse (POPPS): Design and participant baseline characteristics of two parallel pragmatic randomized controlled trials in primary care
Wiegersma, M., Panman, C. M. C. R., Kollen, B. J., Vermeulen, K. M., Schram, A. J., Messelink, E. J., Berger, M. Y., van Leeuwen, Y., & Dekker, J. H. (2013) · Maturitas · doi:10.1016/j.maturitas.2013.10.014 · Cited by 33 · see citing works
Self-citation

Flagged first, then by citations

Sorted by citations

Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial
Hagen, S., Glazener, C., McClurg, D., Macarthur, C., Elders, A., Herbison, P., Wilson, D., Toozs-Hobson, P., Hemming, C., Hay-Smith, J., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(16)32109-2 · Cited by 90 · see citing works
International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training
Bø, K., Anglès-Acedo, S., Batra, A., Brækken, I. H., Chan, Y. L., Jorge, C. H., Kruger, J., Yadav, M., & Dumoulin, C. (2022) · International Urogynecology Journal · doi:10.1007/s00192-022-05324-0 · Cited by 64 · see citing works
“However, two studies focused on secondary prevention, as they included women who had not sought health care for assessment or treatment of the condition [37, 38] and a third published [39] 2-year follow-up of one of these [38] (Table 3).”
BackgroundInfluential
Effects of Pelvic-Floor Muscle Training in Patients with Pelvic Organ Prolapse Approached with Surgery vs. Conservative Treatment: A Systematic Review
Espiño-Albela, A., Castaño-García, C., Díaz-Mohedo, E., & Ibáñez-Vera, A. J. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12050806 · Cited by 28 · see citing works
“Five studies [14,18,19,21,24] with 451 patients in the control group and 466 in the PMSC group reported changes in sexual function using the PISQ-12 questionnaire [14,18,19,21], while Braekken, et al.”
BackgroundMethodInfluential
The effect of pelvic floor muscle training for women with pelvic organ prolapse: A meta-analysis
Wang, T., Wen, Z., & Li, M. (2022) · International Urogynecology Journal · doi:10.1007/s00192-022-05139-z · Cited by 24 · see citing works
Predictors of Success for Pelvic Floor Muscle Training in Pelvic Organ Prolapse
Wiegersma, M., Panman, C. M. C. R., Hesselink, L. C., Malmberg, A. G. A., Berger, M. Y., Kollen, B. J., & Dekker, J. H. (2019) · Physical Therapy · doi:10.1093/ptj/pzy114 · Cited by 17 · see citing works
Self-citation
Impact of pelvic floor muscle training in pelvic organ prolapse
Basnet, R. (2021) · International Urogynecology Journal · doi:10.1007/s00192-020-04613-w · Cited by 15 · see citing works
Entrenamiento muscular del suelo pélvico en el tratamiento del prolapso de órganos pélvicos: un metaanálisis de ensayos controlados aleatorizados
Ge, J., Wei, X. J., Zhang, H. Z., & Fang, G. Y. (2021) · Actas Urológicas Españolas · doi:10.1016/j.acuro.2020.01.012 · Cited by 16 · see citing works
A scoping review of the evidence for supervised pelvic floor muscle training for improving signs or symptoms of pelvic organ prolapse in post-menopausal women
Crowley, H., & Brennen, R. (2024) · Physical Therapy Reviews · doi:10.1080/10833196.2024.2433348 · Cited by 1 · see citing works

Restoring pelvic floor function in men: review of RCTs
Dorey, G. (2005) · British Journal of Nursing · doi:10.12968/bjon.2005.14.19.19944 · Cited by 28 · see citing works
The effect of pelvic floor muscle training on pelvic floor function and sexuality postpartum. A randomized study including 300 primiparous
Schütze, S., Heinloth, M., Uhde, M., Schütze, J., Hüner, B., Janni, W., & Deniz, M. (2022) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-022-06542-z · Cited by 35 · see citing works
Pelvic Pain of Myofascial Origin in Women: Correlation with Lower Urinary Tract Symptoms
Einig, S., Ruess, E., Schoetzau, A., Bartet, K. A., Heinzelmann-Schwarz, V. A., Vigo, F., & Kavvadias, T. (2024) · Advances in Urology · doi:10.1155/2024/5568010 · Cited by 4 · see citing works
Evidence-based physiotherapy for the pelvic floor : bridging science and clinical practice
Bø, K. (2007) · Churchill Livingstone eBooks · Cited by 4 · see citing works
Efficacy analysis of pelvic floor exercise on postpartum pelvic floor dysfunction
Gui-zhe, Q. (2015) · China Modern Medicine

Authors: Panman, C., Wiegersma, M., Kollen, B., Berger, M., Lisman‐Van Leeuwen, Y., Vermeulen, K., & Dekker, J.
Affiliations: University Medical Center Groningen (NL)
Department of General Practice University Medical Centre Groningen University of Groningen Groningen the Netherlands
Venue: BJOG: An International Journal of Obstetrics & Gynaecology
Publisher: Wiley
Published: 2016-03-21
Volume: 124
Issue: 3
Pages: 511-520
ISSN: 0306-5456 (ISSN-L)
1470-0328
1471-0528
DOI: 10.1111/1471-0528.13992
OpenAlex: W2300062853
Cited by: 57
References: 31
Citations by year: 2026: 1 · 2025: 2 · 2024: 8 · 2023: 4 · 2022: 12 · 2021: 5 · 2020: 9 · 2019: 3 · 2018: 7 · 2017: 4 · 2016: 2
FWCI: 5.68
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
PubMed (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders: ZonMw (4201.1001)
Topics: Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
Keywords: pelvic floor muscle training, pelvic organ prolapse, expectant management, cost-effectiveness, pelvic floor symptoms, PFDI-20, quality of life, absorbent pads, women's health, primary care, postmenopausal women
MeSH terms: Aged, Cost-Benefit Analysis, Exercise Therapy, Female, Follow-Up Studies, Humans, Middle Aged, Netherlands, Primary Health Care, Quality of Life, Surveys and Questionnaires, Treatment Outcome, Pelvic Floor, Pelvic Organ Prolapse, Watchful Waiting, General Practice

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Two‐year effects and cost‐effectiveness of pelvic floor muscle training in mild pelvic organ prolapse: a randomised controlled trial in primary care

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks