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Cited by 5Pelvic floor disorders treatmentsSexual function and dysfunction studiesHernia repair and management

Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial

Open access
Brandt, Corlia, van Vuuren, E.C. Janse·2022·Physiotherapy Canada
DOI 10.3138/ptc-2020-0053PMC PMC10262738
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Abstract

Randomized trial comparing postoperative pelvic floor muscle training, abdominal training, and standard care after pelvic floor reconstructive surgery.

Integrity signals

Registry

Crossref · 10.3138/ptc-2020-0053

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

22 of 59 cited sources checked · 7 supported · 2 flagged · accuracy not yet measured

  • Premisecitation

    None of the reviewed studies included abdominal muscle training in their interventions.

    “None of these studies had included abdominal muscle training in their interventions.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [4] Haya N, 2018, Cochrane Database Syst Rev source

      The Results (page unavailable) describe core exercises as part of the Pauls 2013 intervention. Because core exercises can involve abdominal muscle training, this conflicts with the categorical claim that none of the reviewed studies included it, although the review does not specify which core muscles were trained. (LLM, conf=0.78)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [13] Jarvis SK, 2005, Aust NZ J Obstet Gynecol source
    • cites [14] Frawley HC, 2010, Neurourol Urodyn source
    • cites [15] Lakeman MME, 2013, Int Urogynecol J source
  • Study design and conductcitation

    The construct validity, sensitivity, specificity, test-retest reliability, and inter- and intrarater reliability of the pelvic floor and abdominal measurement procedures were reported by Brandt and Janse van Vuuren.

    “The construct validity, sensitivity, specificity, test-retest, and inter-and intrarater reliability of these procedures were reported in Brandt and Janse van Vuuren.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [27] Brandt C, 2019, S Afr J Physiother source

      The Methods sections on pelvic floor and abdominal muscle measurement report validity or reproducibility for some procedures and intra- and inter-rater reliability for others (page numbers unavailable). They do not report sensitivity, specificity, or specifically construct validity for those procedures. The test–retest coefficient found in the Methods applies to a pain-rating scale, not the pelvic floor or abdominal measurements. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Study design and conductown data

    An a priori sample-size estimate indicated at least 30 participants per group were needed to allow for a 20% dropout rate.

    “The estimate was that we needed at least 30 participants per group to account for a 20% dropout rate.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [13] Jarvis SK, 2005, Aust NZ J Obstet Gynecol source
    • cites [14] Frawley HC, 2010, Neurourol Urodyn source
    • cites [16] Faul F, 2007, Behav Res Methods source

      The A Priori Power Analyses section (page unavailable) explains how to calculate a sample size before a study. It does not report the citing study’s estimate of 30 participants per group or a 20% dropout allowance; its example of groups of 30 in Tests for Means concerns a different calculation. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    A recent systematic review found only a few low-quality studies investigating perioperative physiotherapy in populations with pelvic floor dysfunction.

    “A recent systematic review found only a few low-quality studies that had investigated perioperative physiotherapy in populations with pelvic floor dysfunction.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] Haya N, 2018, Cochrane Database Syst Rev source

      The Discussion reports only three trials of perioperative pelvic floor muscle training, supporting the claim that studies were few. However, the review was limited to women undergoing pelvic organ prolapse surgery, not pelvic floor dysfunction generally, and the Background rates some training evidence as moderate quality rather than low quality throughout. The copy provides no page numbers for these passages. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    A structured PFMT programme did not show a consistent benefit for outcomes after surgery.

    “A structured PFMT programme did not indicate a consistent benefit of the outcomes after surgery.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [4] Haya N, 2018, Cochrane Database Syst Rev source
    • cites [13] Jarvis SK, 2005, Aust NZ J Obstet Gynecol source
    • cites [14] Frawley HC, 2010, Neurourol Urodyn source
    • cites [15] Lakeman MME, 2013, Int Urogynecol J source
  • May combine two claims. 31
  • Classified as probably not a substantial claim. 22
  • The quote only partly states this claim. 3

  • May combine two claims.

    Interpretationcitation

    A lack of individualized progression and of reporting adherence may explain the limited benefit of pelvic floor muscle training on postoperative pelvic floor muscle function in those studies.

    “The lack of individualized progression and reporting of adherence might be a reason for the limited benefit of PFMT on the postoperative PFM function found in those studies.14,38,39”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [14] Frawley HC, 2010, Neurourol Urodyn source
    • cites [38] Pauls RN, 2013, Female Pelvic Med Reconstr Surg source
    • cites [39] Barber MD, 2014, JAMA source

      The Results (Behavioral Intervention Outcomes; page not specified) found no difference in pelvic floor muscle strength between groups, but the proposed explanation is contrary to this trial’s Methods. The Methods (Study Interventions; page not specified) state that exercises were individually progressed and adherence was assessed; the Results report adherence at 6 and 24 months. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Changes in integrated PFM and abdominal muscle function, along with comorbidities and complications, are unknown and may affect surgical outcome.

    “The changes in the integrated pelvic floor muscles (PFM) and abdominal muscle function, among other comorbidities and complications (including contextual factors), are unknown and may affect the surgical outcome.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [4] Haya N, 2018, Cochrane Database Syst Rev source

      The Results (page unavailable) say evidence was insufficient to determine whether pelvic floor muscle strength differed between the training and control groups. The Discussion (page unavailable) also reports limited data on perioperative interventions and their outcomes. The paper does not address integrated pelvic floor and abdominal muscle function or establish how changes in that function, comorbidities, or contextual factors may affect surgical outcome. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [5] Maher C, 2013, Cochrane Database Syst Rev source
    • cites [6] Bo K, 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    In a POP population, the P-QOL has good internal consistency, interrater reliability, and test-retest reliability.

    “As determined in a population with POP, the P-QOL has good internal consistency (Cronbach's α > 0.80), interrater reliability ( r > 0.5), and test-retest reliability ( r = 0.872).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [26] Brandt C, 2016, S Afr J Obstet Gynecol source

      The Results report very high internal consistency (mean Cronbach’s α = 0.94) and test–retest reliability above 50%. They do not report interrater reliability of r > 0.5 or test–retest reliability of r = 0.872; agreement between questionnaire items is instead reported using kappa values. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    McClurg and colleagues' findings came from a small sample of 57, so their results should be interpreted with caution.

    “Unfortunately the findings of McClurg and colleagues were based on a small sample ( N = 57), which might indicate caution when interpreting their results.41”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [41] McClurg D, 2014, Int Urogynecol J source
      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    McClurg and colleagues and Barber and colleagues, like the current trial, used individualized pelvic floor muscle exercises rather than a standard protocol.

    “Like Barber and colleagues 39 and the current study, they included individualized PFM exercises instead of a standard protocol.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [39] Barber MD, 2014, JAMA source

      The Methods (Study Interventions; page unavailable) describe individualized progressive pelvic floor muscle exercises. But the Discussion (page unavailable) says the individualized intervention used a standard protocol, contrary to the claim that it was used instead of one. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Recent literature recommends that pelvic floor muscle training studies use exercise protocols based on scientific exercise guidelines and the principles of specificity and overload because these affect outcomes.

    “Recent literature has emphasized that studies of PFMT should investigate exercise protocols based on scientific exercise guidelines and the principles of specificity and overload because they will have a substantial effect on the outcomes.37,41”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [37] Ferla L, 2016, Fisioter Mov source

      The Discussion (page unavailable) calls for studies of abdominal training in pelvic floor dysfunction, but does not address exercise protocols based on scientific exercise guidelines or the principles of specificity and overload. Searches for those principles and for protocol recommendations found no passage supporting the attributed claim. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [41] McClurg D, 2014, Int Urogynecol J source

      The Methods describe an individualized exercise programme that progressed with pelvic floor muscle function, and the Discussion recommends defining appropriate advice after prolapse surgery. Neither passage recommends protocols based on scientific exercise guidelines or the principles of specificity and overload, or says those principles substantially affect outcomes. Searches for those terms and for their asserted effect on outcomes found no supporting passage in our copy; page numbers were unavailable. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Findings among these studies were inconsistent, and data were still scarce.

    “The findings among these studies were inconsistent, and there was still a paucity of data.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] Haya N, 2018, Cochrane Database Syst Rev source

  • May combine two claims.

    Interpretationown data

    This trial's finding of improved strength but not EMG differs from Frawley, Barber, and Duarte, who found no improvement in pelvic floor muscle strength or EMG.

    “This differs from the findings of Frawley and colleagues, Barber and colleagues, and Duarte and colleagues, 14,39,40 who did not find improvement in PFM strength or EMG measures.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [14] Frawley HC, 2010, Neurourol Urodyn source
    • cites [39] Barber MD, 2014, JAMA source

      The Results (Behavioral Intervention Outcomes; page not provided) report no between-group difference in change in pelvic floor muscle strength at 6 or 24 months. The Methods (Outcomes; page not provided) identify strength as a Brink-scale measure, but the paper does not report EMG measures, so it cannot support that part of the attributed finding. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [40] Duarte TB, 2020, Int J Physiother source

      The Pelvic floor muscle strength section reports no important between-group improvement in peak strength, mean strength, or endurance with added training. The Secondary outcomes section says strength was measured by manometry; our copy does not report EMG measures, so the EMG part of the attribution is unsupported. Page numbers were not available in the indexed passages. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationown data

    This trial's finding of improved strength with few sessions contradicts studies with many postoperative follow-up sessions that found limited benefit of pelvic floor muscle training on strength.

    “This contradicts the results of studies with a high number of postoperative follow-up sessions, 39,40 which have demonstrated a limited benefit of PFMT on strength measures.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [39] Barber MD, 2014, JAMA source
    • cites [40] Duarte TB, 2020, Int J Physiother source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Both intervention groups had a median of four follow-up sessions over 6 months.

    “B oth intervention groups had a median of four followup sessions over 6 months.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Compared with the control group, the abdominal muscle training plus PFMT group had increased pelvic pain.

    “The abdominal muscle training + PFMT group, however, showed increased symptoms in all three categories compared with the control group (see T able 4 ).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Exercise compliance rates were more than 60% at 3 months and more than 55% at 6 months.

    “Exercise compliance rates at 3 months were more than 60%; at 6 months, they were more than 55% (online Table S2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data

    Compared with the control group, the abdominal muscle training plus PFMT group had increased urinary frequency.

    “The abdominal muscle training + PFMT group, however, showed increased symptoms in all three categories compared with the control group (see T able 4 ).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The PFMT and abdominal muscle training plus PFMT groups had increased urinary frequency, and only the abdominal muscle training plus PFMT group had increased bulging and discomfort.

    “The PFMT and abdominal muscle training + PFMT groups demonstrated increased symptoms of urinary frequency, and only the abdominal muscle training + PFMT group showed increased symptoms of bulging and discomfort.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The abdominal training plus PFMT group had significantly better Sahrmann scale scores at 6 months than both the control and PFMT groups.

    “| Sahrmann scale, 6 mo | | | | | | | | Groups 1 and 2 | 19.50 | 32.50 | - | 168.000 | -3.246 | 0.00 | | Groups 2 and 3 | - | 38.43 | 19.90 | 142.000 | -4.507 | 0.00 | | Groups 1 and 3 | 32.27 | - | 22.64 | 221.000 | -2.380 | 0.02 |”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In this trial, pelvic floor muscle training improved pelvic floor muscle strength but did not improve EMG measures.

    “The PFMT group in our study demonstrated a beneficial effect on strength, but not on EMG measures.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The trial was registered with the Pan-African Clinical Trials Registry under PACTR201811741131369.

    “the trial was registered with the Pan-African Clinical Trials Registry (PACTR201811741131369).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    At baseline, the groups did not differ significantly in age, BMI, or number of pregnancies or deliveries.

    “The one-way ANO VA did not indicate any significant differences among the groups for age, BMI, or number of pregnancies or deliveries ( p > 0.05) at baseline.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Patients were unaware of differences in treatment protocols among the groups.

    “The patients were unaware of the differences in treatment protocols among the groups.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    An intention-to-treat analysis was performed.

    “An intention-to-tr eat analysis was done using SAS (Version 9.4; SAS Institute Inc., Cary, NC) and IBM SPSS Statistics (Version 26.0;IBM Corp., Armonk, NY).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Eligible participants were stratified and randomly allocated to three groups using a computerized list generated by a biostatistician and kept by an independent research assistant who enrolled them.

    “The eligible participants were stratified and randomly allocated to three groups -PFMT, abdominal muscle training + PFMT, and controlusing a computerized list generated by a biostatistician and kept by an independent research assistant who enrolled the participants.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    QOL increased in all three groups over 6 months, which might indicate that the improvement was due to surgical repair rather than the interventions.

    “QOL increased in all three groups over 6 months, which might indicate that the improved QOL was due to the surgical repair rather than the interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The study was a double-blind, three-arm randomized controlled clinical trial.

    “This was a double-blind, three-arm, randomized controlled clinical trial.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Participants were stratified by age, Modified Oxford Scale muscle strength, previous surgery, and physiotherapy received.

    “The participants were stratified according to age (≤ 65 y or > 65 y), muscle str ength (score of ≤ 2 vs. > 2 on the Modified Oxford Scale), previous surgery, and physiotherapy received”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    At baseline, the groups did not differ significantly in menopause status, stage of prolapse, or type of work.

    “The Kruskal-Wallis test also indicated no significant differences among the groups for menopause status, stage of prolapse, or type of work ( p > 0.5).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Three women's health physiotherapists were trained to deliver the intervention per protocol, were blinded to group allocation and unaware of other protocols, and each was allocated to one group to maintain blinding.

    “Thr ee women's health physiotherapists with 5 years' experience and postgraduate training in this field were independently trained to deliver the intervention according to a predetermined protocol.They were blinded to the group allocation and unaware of the content of the other protocols; each was allocated to one group to ensure blinding.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The two intervention groups each lost two participants to follow-up, and the control group lost three.

    “The two intervention groups each lost two participants to follow-up, and the control group lost three (two each in the intervention groups due to diagnosis of cancer and the three in the control group due to problems with transport; see Figure 1 ).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Box's Test for Equivalence of Covariance Matrices had a p-value greater than 0.05.

    “B ox's Test for Equivalence of Covariance Matrices indicated a p -value of > 0.05.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Based on conservative treatment outcomes, PFMT programmes can improve PFM function and reduce POP symptoms and signs.

    “On the basis of conservative treatment outcomes, pelvic floor muscle training (PFMT) programmes can lead to improved function of the PFM and a decrease in the symptoms and signs of POP.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [6] Bo K, 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [9] Doaee M, 2014, Int Urogynecol J source
    • cites [10] Shafik A, 2003, World J Surg source
    • cites [11] Thompson JA, 2006, Neurourol Urodyn source
    • cites [12] Bo K, 2003, Neurourol Urodyn source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No changes were made to the trial outcome measures after the trial began.

    “N o changes were made to the trial outcome measures after the trial commenced.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    At baseline, the groups did not differ significantly in participation in sports, smoking, previous surgery, type of prolapse, or type of surgery received.

    “No differences were indicated by the χ 2 test in compar ing the groups with regard to participation in sports, smoking, previous surgery received, type of prolapse present, or type of surgery received during the study (Pearson χ 2 test, p > 0.5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    The pain scale had construct validity and test-retest reliability coefficients of 0.82 and 0.70, respectively, based on a previous study in patients with POP.

    “The construct validity and testretest reliability coefficients were 0.82 and 0.70, respectively, based on the findings from a previous study investi gating pain in patients with POP.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Heit M, 2002, Obstet Gynecol source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A pilot study with six eligible participants used the same procedures as the main study, made no methodological or outcome-measure changes, and its results were included in the final analysis.

    “We conducted a pilot study with six participants who fulfilled the eligibility criteria.The same procedures were followed as for the main study, and no changes were made in methodology or outcome measures.The results of the pilot study were included in the final analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Perioperative pelvic floor muscle training appears to have similarly limited benefits across high- and low-resource settings, with or without urinary incontinence, ages 18-81, varying follow-up visits, different training programmes, and different outcome measures.

    “There seem to be similar limited benefits in populations in high-and low-resource settings, with the presence of POP with or without urinary incontinence, in groups aged 18-81 years, with different numbers of follow-up visits, and with different PFMT programmes in terms of duration, intensity, and progression and when measured with a variety of outcome measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Good adherence together with the individualized programme may have been responsible for the positive outcome.

    “Together with the individualized programme, this might have been responsible for the positive outcome, which can be of significant clinical value in a resource-restricted setting, although the study setting may limit the generalisability of the results to resource-restricted health systems.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The positive outcome may be clinically valuable in resource-restricted settings.

    “Together with the individualized programme, this might have been responsible for the positive outcome, which can be of significant clinical value in a resource-restricted setting, although the study setting may limit the generalisability of the results to resource-restricted health systems.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Compliance and adherence were monitored weekly using a training diary, Likert scale, and telephone reminders by the principal investigator.

    “Their compliance and adherence were monitored weekly using a training diary, Likert scale, and telephone reminders by the PI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The study setting may limit how far the results can be generalised to resource-restricted health systems.

    “Together with the individualized programme, this might have been responsible for the positive outcome, which can be of significant clinical value in a resource-restricted setting, although the study setting may limit the generalisability of the results to resource-restricted health systems.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The variables on which the PFMT group improved-power, number of fast contractions, and endurance-were not similar to the measures used in prior studies and were therefore not comparable.

    “However, the variables we usednamely, power, increased number of fast contractions, and endurance -on which the PFMT group showed improvement were not similar to the measures investigated in those studies and are therefore not comparable.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Postoperative physiotherapy in conjunction with POP surgery remains under-investigated and controversial.

    “P ostoperative physiotherapy in conjunction with pelvic organ prolapse (POP) surgery is still under-investigated and controversial.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [6] Bo K, 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [9] Doaee M, 2014, Int Urogynecol J source
    • cites [10] Shafik A, 2003, World J Surg source
    • cites [11] Thompson JA, 2006, Neurourol Urodyn source
    • cites [12] Bo K, 2003, Neurourol Urodyn source

  • May combine two claims.

    Interpretationown data

    Postoperative pelvic floor muscle training can beneficially affect pelvic floor muscle function and therefore pelvic organ support, especially in resource-poor settings where patients rely on home exercise programmes.

    “This study indicates that postoper ative pelvic floor muscle training can have a beneficial effect on pelvic floor muscle function and therefore pelvic organ support, specifically in resource-poor settings in which patients need to depend on home exercise programmes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Evidence for the effects of postoperative PFMT is limited and of low quality, and the effects of adding light abdominal muscle training with PFMT remain controversial.

    “The evidence for the effects of postoperative PFMT is, however, still limited and of low quality, and the effects of including light abdominal muscle training with PFMT are still controversial.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [6] Bo K, 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [9] Doaee M, 2014, Int Urogynecol J source
    • cites [10] Shafik A, 2003, World J Surg source
    • cites [11] Thompson JA, 2006, Neurourol Urodyn source
    • cites [12] Bo K, 2003, Neurourol Urodyn source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All surgery was performed by the same surgeon, who had more than 10 years' experience and international qualifications in urogynecology.

    “All the surgery was performed by the same surgeon, who has more than 10 years' experience and international qualifications in urogynecology.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The aim of surgical management is to correct prolapse and address associated symptoms and dysfunction that decrease QOL.

    “The aim of surgical management is to correct the prolapse and address the associated symptoms and dysfunction leading to decreased quality of life (QOL).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Bo K, 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

44 of 44

  • The authors state this as an assumption.

    If an integrated function exists between the pelvic floor and abdominal muscles, both muscle groups might be affected in this population.

    “This hypothesis was based on the assumption that if an integrated function existed, both these muscle groups might be affected in this population.”

  • The paper relies on this without support.

    The effects of postoperative physiotherapy and inclusion of abdominal muscle training are unclear, and there is a paucity of studies on this topic.

    “however, the effects of postoperative physiotherapy and inclusion of abdominal muscle training still remain unclear, and there is a paucity of studies on this topic in the literature.”

  • The paper relies on this without support.

    Physiotherapy is beneficial for conservative management of pelvic organ prolapse.

    “P hysiotherapy has proved to be beneficial for the conservative management of pelvic organ prolapse;”

  • The paper relies on this without support.

    The limited number of postoperative sessions was mostly because participants lacked transport to the clinic.

    “mostly because of lack of transport to the clinics.”
4 of 4

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?

  • Training interventions improve coordination, endurance, and vascularization of the pelvic floor, thereby promoting optimal muscle recruitment and enhancing pelvic support.

    “Training interventions improve coordination, endurance, and vascularization of the pelvic floor, thereby promoting optimal muscle recruitment and enhancing pelvic support [35,38,43].”

    From Pelvic Floor Muscle Training Following Surgery for Pelvic Organ Prolapse: Recommendation from Scientific Literature (2026) · cites this paper as [35]

    The Discussion (page unavailable in our copy) reports improved pelvic floor muscle endurance after training and suggests this may contribute to pelvic organ support. The training protocol teaches correct contractions, but the paper does not show improved coordination, vascularization, or optimal muscle recruitment; its support finding is also tentative and specific to women after reconstructive surgery. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Eleven full publications or meeting abstracts published from 2005 until 2021 were included in the review of PFMT in connection with POP surgery.

    “Eleven full publications or meeting abstracts which were published from 2005 until 2021 [62–72] were included.”

    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 [63]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Control-group thickness change is called significant despite a nonsignificant table result

    Minor

    The text says right puborectalis thickness increased significantly from baseline to three months in all three groups. Table 6 reports p = 0.12 for that comparison in the control group.

  • Contraction-repetition estimate does not match its confidence interval

    Minor

    The stated confidence interval is centered on 1.581, rather than the reported mean difference of 0.857.

    Reported 0.857 · recomputed 1.581

  • First puborectalis thickness estimate does not match its confidence interval

    Minor

    The reported mean difference of 1.487 is above the upper confidence limit of 1.439. The midpoint of the stated interval is 0.8575, suggesting that the two thickness estimates in this sentence may have been exchanged.

    Reported 1.487 · recomputed 0.8575

  • Second puborectalis thickness estimate falls outside its confidence interval

    Minor

    The reported mean difference of 0.857 is below the lower confidence limit of 0.882. The interval's midpoint is 1.4875, approximately the mean reported for the preceding comparison.

    Reported 0.857 · recomputed 1.4875

  • Puborectalis movement estimate does not match its confidence interval

    Minor

    The stated confidence interval is centered on 4.142, not the reported mean difference of 1.581.

    Reported 1.581 · recomputed 4.142

5 of 5

Cites

Flagged first, then by citations

Research works printed but not linked: 10

  1. Henn EW, 2009, SAMJ, 99, 229
  2. Haya N, 2018, Cochrane Database Syst Rev, 8, CD013105
  3. Maher C, 2013, Cochrane Database Syst Rev, 4, CD004014
  4. Bo K, 2015, Physical therapy for the pelvic floor: bridging science and clinical practice
  5. Hagen S, 2009, Cochrane Database Syst Rev, 4, CD003882
  6. Laycock J, 2001, Clinical guidelines for the physiotherapy management of females aged 16–65 with stress urinary incontinence
  7. MacKenzie JF, 2014, Work, 47, 453
  8. Brandt C, 2019, S Afr J Physiother, 75, a472
  9. Heit M, 2002, Obstet Gynecol, 99, 23
  10. Du Prel J-B, 2009, Dtsch Arztebl Int, 106, 335

Cited by

Sorted by citations

Related

Authors
Brandt, C., & van Vuuren, E. C. J.
Affiliations
  • University of the Witwatersrand (ZA)
  • School of Allied Health Professions, University of the Free State, Bloemfontein, Free State, South Africa.
Corresponding author
Brandt, Corlia
ORCID
Brandt, Corlia
Venue
Physiotherapy Canada
Publisher
University of Toronto Press Inc. (UTPress)
Published
2022-05-01
Volume
74
Issue
2
Pages
126-138
ISSN
  • 0300-0508 (ISSN-L)
  • 1708-8313
DOI
10.3138/ptc-2020-0053
PMC
PMC10262738
OpenAlex
W3167632719
Cited by
4
References
40
Citations by year
2026: 1 · 2024: 1 · 2023: 1 · 2022: 1
FWCI
0.56
Type
journal article
Language
en
Open access
Locations
  • Physiotherapy Canada (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
  • Health Sciences › Medicine › Surgery › Hernia repair and management
Keywords
postoperative physiotherapy, pelvic organ prolapse, pelvic floor reconstruction, pelvic floor muscle training, abdominal muscle strengthening, pelvic floor muscle function, abdominal muscle function, quality of life, urinary frequency, pressure biofeedback, electromyography

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.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

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 ›

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