Pessary self-management improves QoL and compliance among patients with pelvic organ prolapse
Although no randomized trials have evaluated pessary self-management, non-randomized studies have shown that self-management is associated with higher levels of convenience, access to help and support, lower adverse event rates, and a greater likelihood of continuing pessary use. However, the effectiveness of self-management has yet to be evaluated.
A study published in eClinicalMedicine found that self-managed women and clinic-based pessary care had a comparable quality of life, with fewer complications and less healthcare resource use and cost. These findings support offering self-management to women who can, which could decrease healthcare resource use and reduce pessary complications.
Prolapse affects 30-40% of women. Those using a pessary for prolapse usually receive outpatient care. This trial compared the effectiveness and cost-effectiveness of pessary self-management versus clinic-based care (SM vs CBC) about condition-specific quality of life (QoL).
Parallel-group, superiority RCT recruiting from 16 May 2018 to 7 February 2020, with follow-up to 17 September 2021. Eligible women: ≥18 years old, using pessary (except Shelf, Gellhorn, or Cube) retained ≥2 weeks. Exclusions included limited manual dexterity, cognitive deficit, pregnancy, and non-English teaching. SM group received 30-minute teaching, an info leaflet, a 2-week follow-up call, and telephone support. CBC group received routine appointments. The primary outcome was Pelvic floor-specific QoL (PFIQ-7) and incremental net monetary benefit for cost-effectiveness 18 months post-randomization. The allocation was done by a remote web-based app based on age, user type, and centre.
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