Resuming physical activities following Prolapse Surgery Safe and effective: JAMA

There is a lack of evidence-based data regarding Restrictions on postoperative activity after pelvic organ prolapse (POP) surgery. Following surgery, many pelvic surgeons place lifting and activity restrictions on patients.

Considering this, researchers in the present study evaluated whether expedited activity results in noninferior anatomic and symptomatic outcomes compared with standard activity restrictions after POP surgery.

The key points in this research study are:

• There were 107 women of mean age 62.8 years in the study with stage ≥ 2 pelvic organ prolapse undergoing apical reconstructive surgery.
• The study was conducted in a single academic tertiary referral centre in Durham, NC.
• One hundred seven participants were randomized and analyzed as 54 in the standard postoperative activity instructions and 53 in the expedited postoperative activity instructions. Standard postoperative activity instructions were no lifting ≥ 10 lbs for six weeks, return to work at two weeks for sedentary work, and six weeks for manual work.
• Expedited postoperative activity instructions included no activity or weight lifting restrictions, resume activities and work as soon as able.
• The primary outcomes included anatomic and symptom outcomes.
• SLmax was the most distal point of pelvic organ support loss; noninferiority margin (NIM) 1.0 cm.
• POPDI or Pelvic Organ Prolapse Distress Inventory score range 0.300; a high score means more stress; NIM 34.3 points.
• At three months, the mean SLmax in the expedited and standard groups was −1.7 cm and −1.5 cm.
• The mean maximum support loss was 0.18 cm higher within the vaginal canal in the expedited group after adjusting for baseline SLmax.
• The coprimary outcome of the POPDI score in the expedited and standard group was mean (SD) 23.7 vs 25.7 points.
• After adjustments, the mean POPDI scores were 5.79 points lower in the expedited group.

The study's strength was related to the use of a randomized controlled noninferiority design, relevant primary anatomic and symptomatic measures, accelerometer data and occupation-related data.

Concluding further, they said, "Based on the findings of our study, patients receiving liberal activity instructions experienced noninferior anatomic and symptomatic outcomes at three months following vaginal or laparoscopic apical prolapse surgery without major complications."

Further reading:

O'Shea M, Siddiqui NY, Truong T, Erkanli A, Barber MD. Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery: A Randomized Clinical Trial. JAMA Surg. Published online May 31, 2023. doi:10.1001/jamasurg.2023.1649